W.Yilma 4/27/20
As we know the newly emerged viral disease called Coronavirus (COVID-19) is widespread as a pandemic and become the number one public health problem worldwide. Ethiopia is one of the countries that has affected by this virus. As a result of this, Ethiopia is under an extended state of emergency declared by the Abiy government. No one is opposing this but what is behind the emergency declaration, and why 5 months is a subject of discussion for many Ethiopians and foreigners who follows Ethiopian politics closely. In particular what makes people suspicious is that during an emergency period, all power was given to the executive body, a green light to abuse power, with ultimate goal to establish the worst form of dictatorial government in Ethiopia. As a result of this Ethiopia is facing a challenge from two sides. One is the COVID-19 threat, and the second is from Abiy government attempt to establish one-man dictatorial regime in the country.The purpose of this article is not to talk about Abiy regime, but to share my opinion on the ongoing efforts to combat COVID-19 by the Ministry of Health-Ethiopia, and other regional states, in particular Tigray. Knowing the nature of COVID-19 infectivity and the socio-economic situation of Ethiopia, it will not fair for me to criticize the ongoing efforts by the government to contain this virus from spreading.Therefore, my intention here will be to share my opinion and express my concerns in some issues. I have appreciation to those health care and other supportingstaffs who are at front, working hard under difficult circumstances to combat this disease and safe human life. I truly believe that if the spread of this virus exceeds beyond its expectation, a country like Ethiopia fighting COVID-19 pandemic will not be an easy task, and may consumed the limited resources what the country has. What make difficult to control this virus is not only due to limited resources, absence of treatment or prophylactic, but also there are still undisclosed mystery,scientists do not know fully about the nature of COVID-19. This together with political uncertainties, economic difficulties, under development of the public health system and infrastructure, socio-cultural and religion practices, and other related factors make it difficult to fully control COVID-19 once the virus managed to established in the community and start spreading silently (community transmission) in highly susceptible population. Therefore, for Ethiopia, focusing on preventionmeasuresis the best form of action than administering supportive care for COVID-19 patients. As stated above no country is immune from this virus. Although different countries have different potential to fight this disease, the methods many countries are implemented is almost the same. Ethiopia government and some regional states are imposing non-pharmaceutical methods of controlling to curb the spread of thisvirus.To effectively control, how the COVID-19 is transmitting from person to person, and its immunogenicity should be known by scientists. Until now there are two methods of transmissions.The first route of transmission is person to person, and the second is fomite transmission (from virus contaminated surface, including hands). Understanding these routes of transmission, at this time the best ways to control COVID-19 areimplementingnon-pharmaceutical methods of control, such as quarantine, isolation, social distancing, movement control, selective travel banning or restrictions etc. Other supporting measures such as stay at home should be considered as self-quarantine, whereas isolation is separation of those who found positive for the virus and provide proper follow-up, including hospitalization when needed. What is important to note here is that, together with proper personal hygiene, social distancing (2 meters apart from each other), disinfecting working place areas (work place table surfaces areas, frequently touching areas, such as door opening handles, computer key bord, etc.)and frequent hand washing are considered one of the bestway of interventions measures that is critical to prevent the spread of this virus. Other measures such as wearing face mask, avoiding crowds, or limit exposure when going to groceries, market places, hair salons, avoid from using congested public transport etc. also are critical to curb the spread of COVID-19. However, the above-mentioned controlling methods are very difficult to implement in the country like Ethiopia where government is unable to subsidize or provide to the needy necessary finance and daily fooditems, water, and other basic necessary materials. Hence, for the majority of Ethiopians “stay at home” could be a choice between life and death. Taking this into consideration the battle with COVID-19 needs wide ranges of cooperation between the local government, international communities and the public at large. The above methods of control methods will bring the intended results, if only they supported with continuous active surveillances (mainly on case finding, and intensive testing,to know those who are true positive, and true negative). This must be followed bycontact tracing whenever someone was identifiedas positive case.Without these the emergency declaration “stay at home” or social distancing by themselves will not bring the intended results. What need to be mentioned here at this time is that each house hold members should be considered as one cluster and closely follow up their health states without contacting with the nearby another cluster is important. This needs the community active participation with these programs. In this way, through local health care representatives, it will be easy to know whether or not the COVID-19 is circulating within the community. In additions to the above-mentioned measures, strengthening sentinel reporting system from hospitals, high- and low-level clinics, and organize quick response teams (to visit all suspected cases) equipped with sample collecting materials is more important to understand the epidemiological situation of the virus. Depending on the situation, the contact tracing team could be part of this team. The two-testing available at this time are taking swabs sample, preferably from nose, and blood draw. The former is to isolate the genetic material of COVID-19 (using RT-PCR), and the latteris to detect the antibody against COVID-19 (IgM and IgG).Isolation of the virus is more accurate than looking for the antibodies. One of the problems in dealing with COVID-19 is that the scientists do not have a clear picture about the nature of the virus and its immunogenicity. Because of this, the current antibody testing and their efficacy (accuracy) to identify those with disease or without disease are still under discussions. This indicates some results have shown discrepancies (high possibility to get false positive or false negative, which some estimated to be around 30%). During an infection disease surveillance program having 30% of inaccuracy testing result have a huge impact on the ongoing disease control program. In particular in Ethiopia where quality control is not in place, and the government is receiving reagents and testing materials in the form of donation from different sources, it is likely that the ongoing testing program could miss those who actually have the virus (false negative) or could falsely diagnosed positive those who do not have the disease in question. Therefore, knowing the quality (standardize test) of the reagents and materials donated from different countries is important before using them in mass screen testing. The other issue which need to be raised her is that does Ethiopia has aneffective governmental structurethat enable to effectively disseminate information to the public from top to bottom? Except in Tigray there are no organized and effective governmental structures that connect the regional states offices with the lower (Kebele) level to exchange and disseminate necessary information with regard to COVID-19 cases. In time like this, information exchange is very important to implement effective disease control measures. In developed nations this problem is not existed and any information regarding this virus reached fast to the higher office, and help them to take necessary measures as fast as possible at a national level. As we know the regional state of Tigray, has send 23,000 personnel(the majority of the participants are volunteers) to all parts of the region to collect necessary information regarding COVID-19. During this blanket surveillance, other than community awareness, the team members has looking for people who show flue like syndrome (although there is a possibility to miss those individuals who are at incubation period or asymptomatic, with no high temperature).The experience from Tigray should be a lesson for other regional states to follow. Without volunteer’s participation, fighting COVID is impossible in countries like Ethiopia. On the other hand, what we should understand is that, COVID-19 have an incubation period from 4 to 14 days. Therefore, after blanket snap-shot like surveillance, it would be better to strengthen the surveillance activitiesby identifying priority areas through purposive selection methods (in refugee congregated areas, porous bordering areas, military camps, known entry posts, industries areas, large towns etc.). If those 23,000 volunteers, send at the end of stay at home order,I hope accurate and valuable data was collected which could help the regional state to take appropriate measures with regard COVID-19. What is important to note here is that Providing personal protective equipment (PPE) to volunteers should be part of this mission to avoid disease transmission from volunteers to the visiting house hold members or the vice versa. Few words about measuring temperature and wearing gloves. I do not see the importance of checking temperature, and its contribution to identify those who have and have not COVID-19. I do not see anywhere data how many people were detected that their temperature was found above normal. There is evidence that in some people there is subclinical (inapparent) form of COVID-19, and also during incubation period body temperature may not be rise above normal or may show a slight increase which does not necessary mean it is due to COVID-19 infection (I do not know in this case what is the threshold to say the temperature is high. Similarly, wearing gloves by government officials and other ordinary people in public places is sending a wrong message to the public. Wearing gloves helps only for those people who are working in hospitals, service giving areas, markets etc. Even for those workers, there are designated areas where they should remove their gloves right before they leave their working areas. By any means, people should not allow to wear gloves in public common areas, as long as washing hands before touching their face is a good protective measure for COVID-19.
