The United States Embassy in Somalia issued a statement that it has arranged a chartered flight from Mogadishu in collaboration with Ethiopian Airlines to help evacuate its citizens from Somalia. There are currently no international flights from Mogadishu.
“The Embassy strongly urges all U.S. citizens considering a departure from Somalia to book seats on this flight immediately. A decision to pass on this flight is, for all intents and purposes, a decision to shelter in place for the duration of the COVID-19 pandemic. There is no guarantee that future flights will be available. Tickets are sold on a first-come, first-serve basis.” the statement says.
Although official COVID-19 numbers from Somalia are from the capital only, the number of infections have risen drastically in recent days.
The statement did not include details how how others in other parts of Somalia could get to Mogadishu for this chartered flight. Ethiopian Airlines has not flown into Somalia
After all, we know smoking is bad for our health. It’s a leading risk factor for heart disease, lung disease and many cancers. Smoking also reduces our immunity, and makes us more susceptible to respiratory infections including pneumonia.
And smokers touch their mouth and face more, a risk for COVID-19 infection.
But a recent paper which examined smoking rates among COVID-19 patients in a French hospital hypothesised smoking might make people less susceptible to COVID-19 infection.
So what can we make of this?
What the study did
This study was a cross-sectional survey where the researchers assessed the exposure (smoking) and the outcome (COVID-19) at the same time. This type of research design can’t prove the exposure causes the outcome – only that there may be an association.
There were two groups included in the study – 343 inpatients treated for COVID-19 from February 28 to March 30, and 139 outpatients treated from March 23 to April 9. Among other data collected, participants were asked whether they were current smokers.
The researchers compared smoking rates in both groups with smoking rates in the general French population.
The results
The study found 4.4% of inpatients and 5.3% of outpatients with COVID-19 were smokers, after adjusting for differences in age and sex.
This was only a fraction of the prevalence seen in the general French population. Some 25.4% reportedly smoked daily in 2018.
The authors asserted:
current smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population.
The finding of lower rates of smokers among COVID-19 cases has been more recently described elsewhere, in a rapid review of 28 studies on smoking in COVID-19 patients from various countries.
The authors of the French study suggest the mechanism behind the protective effects of smoking could be found in nicotine.
SARS-CoV-2, the virus that causes COVID-19, gains entry into human cells by latching onto protein receptors called ACE2, which are found on certain cells’ surfaces.
The researchers have proposed nicotine attaches to the ACE2 receptors, thereby preventing the virus from attaching and potentially reducing the amount of virus that can get into a person’s lung cells.
The researchers are now planning to test their hypothesis in a randomised trial involving nicotine patches; though the trial is still awaiting approval from French health authorities.
So how should we interpret the results?
These counterintuitive results may be due to several biases, so let’s explore some alternative explanations.
First is what we call “selection bias”. The hospital patients may be less likely to be daily smokers than the general population. For example, health-care workers and those with existing chronic conditions were disproportionately represented in the inpatient sample – both of these groups usually show lower prevalence of current smoking.
Further, around 60% of the hospitalised patients in the study were ex-smokers (similar to the national prevalence). Some may have given up smoking very recently in response to the WHO declaring smoking as a risk factor for COVID-19. But they were classified as non-daily smokers in the study.
We can identify several biases in the study. Shutterstock
Second is what we call “social desirability bias”. COVID-19 patients may be more likely to deny smoking when asked about their smoking status in hospital, wanting to be seen by medical professionals as doing the right thing.
And data collection may have been incomplete for behavioural questions in busy hospitals overwhelmed by COVID-19 cases.
Finally, it’s important to note this paper has not yet been peer-reviewed.
Taken together, although there appears to be an association between smoking and COVID-19 in these hospital-based samples, there’s no evidence of a causal relationship – that is, that smoking prevents COVID-19.
Lots of research at pandemic speed
We must acknowledge this research has been conducted at “pandemic speed”, much faster than usual research time frames.
Normally it would be months between submission and publication – but in this case the researchers completed their observations and had the research published online within the same month.
An unintended consequence of the early release of research is that it may provoke undue community hope or belief in unproven treatments.
We saw a similar phenomenon recently with the drug hydroxychloroquine, where supplies ran out for those who needed them after politicians proclaimed it as a cure for COVID-19.
So right now we need to put in extra effort to make sure early evidence is not misinterpreted or overstated.
As for the role of smoking in COVID-19 – this link requires substantially more research and critical appraisal. Because overall, smoking still kills. – Adrian Bauman, Melody Ding and Leah Shepherd
Blind peer review
On the whole, this Research Check represents a fair and balanced account of the study. The alternative explanations for the observation of low smoking status prevalence among the French hospital sample provided are possible.
One plausible explanation is error in recording smoking status. There is evidence of under-reporting and inaccurate reporting of smoking status within hospital samples, in general.
It’s unclear from the study what method was used to collect smoking status data. The authors simply state patients were “asked” and “data were collected in the context of care”. It’s important to know who asked the smoking status questions, what questions were asked, when they were asked, and what record keeping system was used.
Given clinical smoking status record keeping may not capture all smokers accurately, a better comparison would be to compare the 2020 data with pre-COVID-19 hospital patient data, rather than general population data which may have asked different questions. – Billie Bonevski
Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.
President of the Republic of Somaliland His Excellency Muse Bihi Abdi was sworn in on November 2017 after winning the election and although his predecessor’s government, also from the same party, was arguably the most corrupt in Somaliland’s history he has successfully convinced a clear majority of voters that he will do things differently and will be particularly harsh on corruption.
Fresh from victory and seemingly energized, President Bihi has made superficial changes to the government structure by creating some almost useless portfolios such as the Ministry of Investment and abolishing problematic powerhouses such as that of the Presidency and tacked the word “development” to every other ministry’s name, but besides that, President Bihi has kept many officials from his predecessor’s administration.
During the campaign, President Bihi has made many election promises and unsurprisingly has spectacularly failed to keep most of them, most notably to put an end to systemic corruption that has smothered Somaliland’s development which although not as visible as President Silanyo’s administration but there clear signs of government officials being emboldened to line their own pockets and reports of officials building or purchasing mansions in Turkey.
Former President of Somaliland HE Ahmed Mohamoud Siilaanyo
You see, if you expected something different from President Bihi, you should be disappointed but in reality there is nothing wrong with President Bihi’s government, it just happens to be the same as his predecessor, President Ahmed Mohamoud Siilaanyo. It may be a touch more sensitive to criticism.
There are exceptions, where President Bihi appointed new faces, not on merit of expertise on many cases but out of obligation for their loyalty to him during his time as a Kulmiye priah and possibly how loudly they campaigned for him or switched parties at the last minute.
And the rest? an incredibly inexperienced cast of idiots who seem to aimlessly wonder from one seminar and project to another with no guidance, supervision and zero metric to evaluate them.
Perhaps this is why President decided to keep people like SOLTELCO, the Mayor of Hargeisa untouched and thriving.
If you are wondering what happened to rest of President Siilaanyo’s cabinet? some of the most recognizable faces are serving as President Bihi’s personal aids and advisers.
President Bihi’s two years in office is littered with missed opportunities, opportunities to implement a bold agenda and chart a new course and perhaps make a real and a lasting impact but instead he opted to play it safe, perhaps safer than any other President before him by religiously sticking to the 4.5 and only picking those that would offer him the least amount of challenge.
Case in point, the Foreign Affairs, under President Bihi things are looking a lot less rosy and no new paths have been charted and in fact even old ones seem to be withering and closing up. What ever happen to Somaliland passport and the United Arab Emirates? What about the 19% share of Berbera Port given to Ethiopia? so many things swept under the rug.
What would happen if the President tapped Mr. Ahmed Ismail Samatar to lead our Foreign Affairs? We don’t know but we are certain he would be much more assertive than the NGO creatures that currently saturate this space.
On the health portfolio, the President is well aware of the state of health care of the country and the proliferation of private hospitals, and at a time the country is bracing for a deadly pandemic which is undoubtedly claiming more lives than the Ministry of Health knows or admits, the President is sticking to his choice for Health Minister, an academic with zero knowledge of public health and has never managed a kiosk let alone a colossal and dysfunctional system that needs a fresh bold ideas. Once again, we do know know what would happen if the President were to pick Dr. Gaboose as a health minister, instead of bickering with him on television.
What about the Ministry of Finance and Dr. Shire who is a little more than a glorified cashier and has yet to institute any meaningful reform of public finance to curb widespread corruption? Imagine if the President were to seek out Mr. Mohamed Hashi Elmi once more for this job?
Instead of seeking out not just talent but people that can challenge him, the President has a history of taking the easy way out and finding the most demure of public servants who would offer the least amount of resistance and ideas.
The slightest whiff of impropriety from those around you or choose to serve the nation should bother you. Those who police social media and arrest citizens for expressing their opinion should bother you even more. A hungry child who goes to public school should bother you. A person dying few meters away from the Presidency for lack of oxygen in the Hospital should bother you. A family loosing a son in El-Afweyn should bother you. This is the job you wanted when you ran for President.
You have two and half years left in office and with your current lackluster performance a re-election is far from guaranteed. What is ticking is not just time but your lifetime opportunity to make a lasting impact in Somaliland and leave it better than you found it.
Put your fist down for a sec, your legacy as a freedom fighter is no more stellar than your predecessor’s, yet you know well how tattered his image was when he left office. Do not put those who ruined President Siilaanyo’s legacy in charge of your own and the fate of the nation.
Mr. President, it is time to stop celebrating mediocrity and try a different approach with less yes-men and un-clinch your fist and reach out to your toughest critics and listen to them. Be bold, be what those who elected you thought you were.
Somaliland Chronicle is responsible for the content of this editorial.
President Bihi answered questions today after his visit to the Ministry of Health Development. The questions were mostly focused on COVID-19 prevention and build up of the nations capabilities to help those that it may afflict.
The President was asked if his government has reached out to Turkey and Qatar which are two countries that have provided most COVID-19 aid to the world. The President replied that they are talking to everyone although what Turkey has given Somaliland was no adequate but they are expecting Qatar to bring a shipment tomorrow.
According to a post by the Manager of Berbera Port, Mr. Said Hassan Abdillahi, Somaliland is shipping more than 3000 camels to Egypt, its largest shipment of ever of camels.
Mr. Abdillahi explained that the port has all the facilities that make it possible to handle such large quantities of camels which he described to be the most difficult of all livestock.
An unidentified captain with Mr. Abdillahi stated that despite the expected slowdown of global shipping, Berbera Port has never been busier. Currently docked ships include the Panamanian flagged Yosor due to depart for Egypt and the MSC Jasmine container ship waiting to dock.
Name of Vessel
Arrival Date/Time
MSC JASMINE
4/30/2020 16:24
SEA KING
4/29/2020 2:10
YOSOR
4/28/2020 6:43
LARSHOLMEN
4/28/2020 1:34
M.V.KOTA KAYA
4/27/2020 8:31
PAMBA 1
4/25/2020 6:16
RULAS
4/25/2020 4:36
BARAKAALE
4/22/2020 8:51
OKEE AUGUST
4/21/2020 3:46
Publicly available shipping information shows a total of 10 ships docking at Berbera Port compared to 8 ships serviced at Somalia’s largest port in Mogadishu.
Berbera Port currently under DP World management is undergoing an expansion of 450 meters due to be completed soon.
According to sources from Somaliland Ministry of Health Development, a person who exhibited the symptoms of COVID-19 in Borama whose test has been sent overseas has passed away.
A high ranking official from the Ministry of Health confirmed to Somaliland Chronicle that deceased person exhibited all the symptoms of coronavirus and that the results were expected tomorrow.
Photos at the burial site showed the body being handled with a degree of caution and almost empty of by people in protective gear.
No other detail about the deceased, including sex, age and if there were in the vulnerable group with preexisting conditions and a course of treatment if any were immediately not available and officials have promised more information when the test results are received.
Although there is no widespread testing in Somaliland, the government has been taking steps to educate the public, ban large public gathering and ban import and sale of khat to prevent the spread of COVID-19.
— Ministry Of Health Development Somaliland (MoHD) (@SomalilandMoHD) April 25, 2020
So far the official mortality rate from COVID-19 in Somaliland is zero.
Update
On May 1st 2020, The Minister of Health Development Hon. Omar Abdillahi Ali has confirmed yesterday’s case to be the first COVID-19 fatality in Somaliland. The Minister stated that the deceased was a local business man with no history of travel.
The Minister also announced three more confirmed cases of COVID-19 in Somaliland bringing the total to 9 cases.
Senator Sam Brownback with then-Senator Barack Obama and actor George Clooney at 2006 press conference to raise awareness of Darfur crisis and genocide. Photo: AP
“Now, to date, we have seen some released already, and I’d just like to go down through a few of these countries that we’ve seen prisoner releases from, including in several of these cases religious prisoners released. We’ve seen countries including Afghanistan, Azerbaijan, Bahrain, Ethiopia, Ghana, Indonesia, Iran, Israel, Italy, Jordan, Saudi Arabia, Somaliland, Syria, and Tunisia all have some prisoner release programs taking place, and in a number of these cases having some religious prisoners that are being released amongst the entire group that’s being released. And we hope to see more of these taking place as well as we move forward”. Said Ambassador Brownback.
In a Presidential Directive, The President of Somaliland Republic His Excellency Muse Bihi Abdi on April 1st 2020 has pardoned 574 prisoners.
There was no detail in the President Bihi’s pardon directive to indicate the actual composition of prisoners released and if they included anyone under arrest for religious reasons, the directive which released 574 prisoners was for people who committed and were sentenced for minor offences.
Officials from Somaliland government decline to comment on Ambassador’s comment and praise for Somaliland but one official with a foreign mission who did not want to be identified stated “We are knocking a lot of doors and we have friends who are sympathetic to our cause and know how well Somaliland has done among its neighbors in terms of civil liberties and freedom’s, we are happy Ambassador Brownback has acknowledged this fact”.
It is unclear how Somalia’s Federal Government will react to Ambassador Brownbacks comments about Somaliland or if it has already lodged a complaint with the US government. President Farmajo’s government has lodged multiple complaints to international bodies about dealing with Somaliland and has cut all diplomatic ties to Guinea–Conakry when President Bihi visited the West African Nation mid last year.
Ambassador Brownback has has served as a US Senator with direct involvement in US foreign policy and the State Department.
The curve of the coronavirus pandemic started to bend upwards in Africa only recently – just as the curve in the 10 most-affected countries around the world was flattening.
Policymakers in Africa must now absorb lessons from the experiences of other countries and avoid policy mistakes. Most importantly they need to implement a COVID-19 policy manifesto that is capable of inoculating African economies from the crisis and reignitng economic activities after the pandemic.
Such a manifesto would have to assemble all available levers of policy. This would require public health, fiscal, monetary, financial, labour market, environmental, industrial, regional integration, and social welfare policies.
Public health policy is the first place to start. The Global Health Security Index shows that only 21 out of 54 African countries are somewhat prepared from a clinical perspective to deal with epidemic threats. The other 33 are completely ill-equipped.
Public spending
“The pandemic is no time for fiscal distancing,” the president of the African Development Bank, Akinwumi Adesina, recently noted. In other words, this is not the time to hold back government expenditure.
Fiscal policy needs to respond from both the expenditure and revenue sides. It can be used to cushion the impact of the shock and minimise economic dislocation – a dual objective of saving lives and livelihoods.
The pandemic offers policymakers an opportunity to build resilient health systems capable of withstanding the pressure from the pandemic and broaden access to health care. This can be achieved by:
boosting surveillance and assessment through upgrading laboratory capacity required for testing and detection;
efficient clinical management so that first responders do not become patients themselves, and
maintaining essential services such as food and agriculture, energy, law enforcement and public works to speed up recovery.
Assistance should also be targeted at the most vulnerable groups.
Vulnerable groups
Women and young people are among the most vulnerable groups to suffer the impact of the crisis. Policymakers should therefore extend direct financial payments to informal sector and insecure women and young workers with families.
In addition, small and medium-sized enterprises should be helped to stay afloat. In Africa, more than 80% of economic activity is in the informal sector. Small and medium-sized enterprises are much more vulnerable to both demand and supply-side shocks from lockdowns. Hence governments need to use specific policies that target formal and informal sector enterprises.
Since a significant number of small enterprises in the informal sector avoid or do not pay taxes, more general policies beyond tax relief, such as deferrals on rent and utility payments, can be used to target this group. This was done in Côte d’Ivoire. Lump-sum subsidies in the form of monthly one-off allowances can also be used to support small enterprises and keep them afloat.
These additional expenditures will likely exceed revenues during the crisis. Governments must therefore have a fiscal recovery plan that would seek a careful balance between fiscal stimulus and fiscal consolidation: that is, tightly cutting back spending after the crisis.
Managing debt
Debt sustainability should continue to be the priority. Without a post-crisis fiscal consolidation plan, sovereign debt defaults – a situation where governments are not able to pay back their debt – might be the next pandemic.
COVID-19 will add to the debt burden of African economies and heightens the likelihood of a widespread and far-reaching sovereign debt crisis, if not properly managed.
On top of increased expenditure and collapsing tax, non-tax, and foreign exchange earnings, countries are also experiencing disorderly capital flight because of extreme risk aversion by investors. In turn this is fuelling volatile market movements and widening spreads on African sovereign bond yields, making African debt instruments riskier and pricier to investors.
This leaves governments unable to refinance maturing debt.
Although they have already sought debt repayment moratoriums from the World Bank and International Monetary Fund, African policymakers need to actively seek debt repayment moratoriums from private, bilateral and multilateral creditors.
The crisis forcefully supports the case for including state-contingent clauses that stipulate actions to be taken when a catastrophic event occurs in sovereign debt contracts. Crisis-contingent clauses in the debt contracts would have meant automatic debt relief for affected countries without the need to actively seek debt rescheduling by creditors. This model is already working well for Haiti whenever an earthquake occurs.
Financial lifelines
Institutions such as the IMF, World Bank and African Development Bank have announced financial packages tailored to the COVID-19 pandemic. These facilities provide a lifeline to implement the COVID-19 policy manifesto and inoculate African economies from the devastating effects of the pandemic.
Policymakers should act quickly to save African lives and livelihoods.
Chuku Chuku, OIC-Manager for Macroeconomic Policy, Debt Sustainability and Forecasting at the African Development Bank and Lecturer (on leave of public service) at the Department of Economics, The University of Uyo
This article is republished from The Conversation under a Creative Commons license.
Covid-19 and Sub-Saharan disease response and readiness?
Malnutrition and disease means COVID-19 could be more deadly in Africa than elsewhere in the world.
Health systems in Africa have limited capacity to absorb the pandemic.
The strategic approach should focus on containment and aggressive preventive measures.
Continents case detection, case management disease surveillance systems is too low and most areas none existing.
Growth in Sub-Saharan Africa has been significantly impacted by the ongoing corona virus outbreak and is forecast to fall sharply from 2.4% in 2019 to -2.1 to -5.1% in 2020, the first recession in the region over the past 25 years, according to the latest Africa’s Pulse, the World Bank’s twice-yearly economic update for the region.
Uniqueness of Africa in general- The continent’s population and health systems make it different from other regions that have experienced COVID-19 to date. Three factors are important at the population level.
Clean running water and soap are in such short supply that only 15 percent of sub-Saharan Africans had access to basic hand-washing facilities in 2015, according to the United Nations. In Liberia, it is even worse — 97 percent of homes did not have clean water and soap in 2017, the U.N. says
Experiences in Asia and Europe showed that people over 60, and those with significant health problems are most vulnerable to severe cases of COVID-19. Although Africa’s youth may be considered a significant protective factor in the pandemic, how the virus will evolve and manifest itself on the continent remains unknown.
The second factor within the population is the high prevalence of malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis. Liberia, for example, has one of the highest rates of stunting in the world: one in three children under five years old are stunted. In recent weeks, we have witnessed an increase in the incidence of malnutrition. Moreover, the rainy season has come early this year, which means that malaria cases will rise rapidly and peak malaria cases in 2020 may coincide with the ongoing COVID-19 pandemic.
We should therefore anticipate that in Africa a higher incidence of severe forms of COVID-19 will occur in younger patients because of the demographics and associated endemic conditions that affect the immune system. Malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis are likely to increase the severity of COVID-19. Africa may not see the same narrative of “most people who get it will be fine” play out.
Third, social cohesion and social gatherings are of great importance in Africa. For example, weekly attendance of a religious service is highest in Africa with rates as high as 82% in Uganda and Ethiopia. As a result, measures to impose social and physical distancing may prove to be more challenging, as demonstrated by the protests that broke out on 20 March 2020 in Senegal after public gatherings, including gatherings at mosques were banned as cases of COVID-19 rose. Earlier this week, Tanzania came under scrutiny when it was announced that the country will not close places of worship
Health systems Factors.
Double disease Burden and lacking the capacity for treating the critically ill care.
There are two major health system factors that will make the COVID-19 response in Africa more challenging.
First, the continent is experiencing the double burden of diseases: in addition to dealing with these endemic infectious diseases, health systems in Africa are facing non-communicable diseases, including injury, and cancer. As a result, the health systems are stretched thin to begin with, and there is very little room to absorb the COVID-19 pandemic.
Less than 1,000 a thousand Ventilator machines in 1.3 billion African population.
Report by the International Rescue Committee (IRC) finds that fragile and conflict-affected countries face a double emergency: the arrival and impact of COVID-19, and the secondary humanitarian, economic and political havoc this outbreak will wreak While there is so many African countries are dealing with civil wars at the moment.
10 African Countries Have No Ventilators
Report shows South Sudan only has four ventilators for the entire country; Northeast Syria has 11; Sierra Leone has 13; in Venezuela, 90% of hospitals lack critical supplies.
In South Sudan, where less than half the country’s health facilities are functioning, there are 24 ICU beds and four ventilators. With life-saving humanitarian programs globally facing unprecedented disruption and suspension, countries like South Sudan which are already gripped by high levels of malnutrition may face famine.
Second, the capacity to provide critical care is the lowest in the world. Severe forms of COVID-19 lead to respiratory failure requiring ventilation support. The ability to treat severe forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen. A recent analysis of countries with the highest numbers of intensive care beds per capita does not include any country from Africa. In Liberia for example, there are no intensive care units (ICU) with ventilators. Uganda has 0.1 ICU bed/100,000 population. In contrast, the United States has 34.7 beds/100,000 populations.
The analysis shows that COVID-19 will cost the region between $37 billion and $79 billion in output losses for 2020 due to a combination of effects. They include trade and value chain disruption, which impacts commodity exporters and countries with strong value chain participation; reduced foreign financing flows from remittances, tourism, foreign direct investment, foreign aid, combined with capital flight; and through direct impacts on health systems, and disruptions caused by containment measures and the public response.
While most countries in the region have been affected to different degrees by the pandemic, real gross domestic product growth is projected to fall sharply particularly in the region’s three largest economies – Nigeria, Angola, and South Africa— as a result of persistently weak growth and investment. In general, oil exporting-countries will also be hard-hit; while growth is also expected to weaken substantially in the two fastest growing areas—the West African Economic and Monetary Union and the East African Community—due to weak external demand, disruptions to supply chains and domestic production. The region’s tourism sector is expected to contract sharply due to severe disruption to travel.
The COVID-19 crisis also has the potential to spark a food security crisis in Africa, with agricultural production potentially contracting between 2.6% in an optimistic scenario and up to 7% if there are trade blockages. Food imports would decline substantially (as much as 25% or as little as 13%) due to a combination of higher transaction costs and reduced domestic demand.
Several African countries have reacted quickly and decisively to curb the potential influx and spread of the corona virus, very much in line with international guidelines. However, the report points out several factors that pose challenges to the containment and mitigation measures, in particular the large and densely populated urban informal settlements, poor access to safe water and sanitation facilities, and fragile health systems. Ultimately, the magnitude of the impact will depend on the public’s reaction within respective countries, the spread of the disease, and the policy response. And these factors together could lead to reduced labor market participation, capital under utilization, lower human capital accumulation, and long-term productivity effects.
Recent study from Yale University-Should Low-Income Countries Impose the Same Social Distancing Guidelines as Europe and North America to Halt the Spread of COVID-19? by Zachary Barnett-Howell, Ahmed Mushfiq Mobarak
The much lower estimated benefits of social distancing and social suppression in low-income countries are driven by three critical factors:
(a) Developing countries have smaller proportions of elderly people to save via social distancing compared to low-fertility rich nations.
(b) Social distancing saves lives in rich countries by flattening the curve of infections, to reduce pressure on health systems. Delaying infections is not as useful in countries where the limited number of hospital beds and ventilators are already overwhelmed and not accessible to most.
(c) Social distancing lowers disease risk by limiting people’s economic opportunities. Poorer people are naturally less willing to make those economic sacrifices. They place relatively greater value on their livelihood concerns compared to concerns about contracting coronavirus.
Not only are the epidemiological and economic benefits of social distancing much smaller in poorer countries, such policies may also exact a heavy toll on the poorest and most vulnerable
In Africa, social distancing is a privilege few can afford?
The myth of self-isolation
Knowing the realities on the ground, it is curious that the WHO and ministries of health in different African countries are recommending that people self-quarantine if they could have been exposed to the coronavirus. In Rwanda, for example, a man travelling from the US has potentially infected his wife and brother, accounting for three of the seven cases. Which raises the question: how are people in shared accommodation expected to self isolate?
Ugandan police hit vendors who refused to clear the streets
Slums and informal settlements are also part of the physical infrastructures of many African cities. All of them were overcrowded and lacked services even before the threat of a global health crisis emerged.
Think of Alexandra in Johannesburg, where over 700,000 people are estimated to live in less than 5 square kilometres (1.9 square miles), Mbare in Harare with some 800,000 people, Kibera in Nairobi with at least 250,000, and Makoko in Lagos with over 300,000 whose homes are built on stilts in a lagoon.
No choice to ‘work from home’
It is more practical for people who work in offices to “work from home” but if your only means of livelihood is selling tomatoes or second-hand clothes at an informal market in a big city, how do you begin to do this “online”?
The choice before you is often to stay home and fail to provide the evening meal for your family, or to brave it out into the city and try and fend for your family. If I was that person selling at a market, I know what choice I would make. It is not social distancing.
For those concerned about the risk of exposure to the virus, the WHO recommends self-quarantining. This has so far included advice for people not to share bathrooms, living space and even bedrooms, if they can. But what if you live in a house where the bedroom doubles as a kitchen and living space – all shared with your (sometimes extended) family?
Struggling health systems
A lot has been said about the health systems of many African countries and how they would struggle to cope with a fast-spreading virus like the coronavirus. Indeed, after many years of conflict, in countries like South Sudan and Somalia, the health system has almost collapsed.
In some countries around the Sahel – Niger, Burkina Faso and Mali – people continue to be displaced by conflict and live in squalid conditions in displaced peoples’ camps. Even in countries not in conflict, like Uganda and Zimbabwe, structural adjustment programmes proffered by the International Monetary Fund (IMF) and the World Bank have seen a continuous decrease in funding available for healthcare. The Abuja declaration of 2001, requiring each country to set aside at least 15 percent of its national budget for healthcare, is still gathering dust in health authorities’ offices. None of the parties to the declaration has managed to achieve its goals.
It clearly does not require a pandemic to expose the gaps in the health system. If developed systems like in northern Italy can buckle under pressure from COVID-19, one can only imagine the impact this will have on front-line health staff who are without adequate training, protective equipment and even basic drugs.
No one knows how the pandemic will spread across Africa. But we know it is a matter of time. One can not help but wonder if it is not time for African governments, with support from the WHO, to develop recommendations that take all these environmental conditions into account.
Social distancing could probably work in China and in Europe – but in many African countries, it is a privilege only a minority can afford.
The WHO has done well since the onset of the outbreak to provide leadership and access to information about a virus that virtually nothing was known about just several weeks ago. But now, more must be done to reimagine our governance systems, especially because healthcare is intrinsically linked to everything else.
And in Africa – likely the next battlefield for the virus – tackling COVID-19 will need more imagination and alternative solutions from all of us.
Poorer countries such as sub Saharan Africa. also have limited capacity to enforce distancing guidelines, and lock-downs may have counterproductive effects if it forces informal sector workers and migrants to reverse-migrate from densely-populated urban areas and spread the disease to remote rural areas of poor countries. It is imperative that the source code for influential epidemiological models (on which the widely-adopted social distancing guidelines are based) are made publicly accessible, so that social scientists can explore the sensitivity of benefit estimates to changes in assumptions about compliance with distancing guidelines or the baseline prevalence of co-morbidities, chronic illnesses or malnutrition that make COVID-19 infections more deadly.
Recommendations.
1. Masks and home-made face coverings are comparatively cheap. A universal mask wearing requirement when workers leave their homes is likely feasible for almost all countries to implement.
2. Targeted social isolation of the elderly and other at-risk groups, while permitting productive individuals with lower risk profiles to continue working. Given the prevalence of multi-generational households, this would likely require us to rely on families to make decisions to protect vulnerable members within each household.
3. Improving access to clean water, hand-washing and sanitation, and other policies to decrease the viral load.
4. Widespread social influence and information campaigns to encourage behaviors that slow the spread of disease, but do not undermine economic livelihoods. This could include restrictions on the size of religious and social congregations, or programs to encourage community and religious leaders to endorse safer behaviors and communicate them clearly.
The Questions for the public
Does Covid-19 drives sub-Saharan Africa to 30 years recession?
Is there other methods to flatten the curve beyond lock-down and social distancing forgot about the vaccination?
About the Author Dr Essa Abdi Jama was one of the first medical students ever to graduate as a doctor in Somaliland. He as served in a number of senior civil service roles, including serving as the Somaliland Internship Programme Coordinator, and the Director of Human Resources at the Somaliland Ministry of Health. He is currently based out of Port Moresby, Papua New Guine.
Disclaimer: The viewpoints expressed by the authors do not necessarily reflect the opinions, viewpoints of Somaliland Chronicle and it’s staff.
In a report issued by the Ministry of Finance Development titled Fiscal and Economic Implication of COVID-19, Somaliland government is predicting a 30% drop in revenue in 2nd quarter and has put the total resources required to deal with the cost of COVID-19 at a whopping $110,805,000.00.
According to the report, Somaliland’s economy will shrink by 5% due to COVID-19 pandemic impact instead of the previously expected 2% growth.
The report by the Ministry of Finance Development includes a COVID-19 budget deficit support of 36 million dollars. And although, itt does not show if the government has so far solicited funds from any donors, sources say there are early stage talks with a major donor to help Somaliland with COVID-19 budget deficit support.
Additionally, there is a 54 million dollars for Humanitarian assistance to families affected. According to the report, this amount is needed to help 60,000 families with basic necessities for the rest of the year.
It is not entirely clear who the audience of this report are but the conclusion seems to indicate that it may be intended for the donar community.
Somaliland government has taken a number of economic steps due to COVID-19 pandemic including tax reduction on basic food commodities, an austerity measure that froze much of the development related expenditure prior to issuing this dire report.
The existence of this report was first reported by Geeska. Read the full report here.
