The Ministry of Health Development announced an additional 6 COVID-19 cases and one death. The number of confirmed COVID-19 cases has risen for the 3rd day in a raw to a total of 40 total confirmed cases and 5 deaths.
Rise in case could be attributed to testing equipment recently donated by WHO and has recently came online to conduct tests locally here in Somaliland.
The brief statement from the Ministry of Health Development stated that 4 of the cases are in Hargeisa while 1 is from Berbera and the other from Burao.
Although the ministry did not say how many tests it conducted, previous statistics put out by the ministry showed 380, meaning the 6 new positive cases are out of 16 tests conducted by the ministry. There is no statement from the National Preparedness Committee for COVID-19 on the rising cases of COVID-19 in Somaliland.
In countries across Africa, the public health restrictions imposed to deal with the COVID-19 pandemic have thrown many people out of work. Cities face the risk of widespread hunger, with the collapse of urban incomes and disruptions in food supply chains. And where there are government-run relief programs, many have only reached a fraction of the people who have lost their incomes.
Most African countries are experiencing rapid urbanisation. But this trend can temporarily slow or even reverse during civil war or economic crisis. This is due to the fact that in crisis, as food prices rise and incomes fall, many people turn to farming to support themselves. Migration to rural areas to access agricultural land thus provides an important type of informal safety net.
Yet one of the unique challenges of this crisis is that restrictions on movement in and out of cities are being used to curb transmissions. For example, countries such as Ghana, Kenya and Nigeria have prohibited people from leaving major cities, effectively cutting off many from the informal social safety net during this time of crisis.
Most African governments are struggling to provide adequate relief to jobless people. Not only COVID-19 but also hunger are real risks to public health. Therefore, it is imperative to develop containment strategies that further ensure people do not go hungry.
Many African governments lack the financial and administrative capacity to launch new large-scale formal safety net programs. But they may still be able to run smaller programs which help people safely migrate back to more food-secure rural areas, simultaneously reducing the risk of transmission.
What might a safe rural migration program look like?
The basic idea is straightforward: help urban residents cover the costs of returning to stay with their extended families in the countryside, provide sanitary supplies to reduce the risk of infection in transit, and scale up health system surveillance to catch and contain potential rural outbreaks early.
It is important to note that this solution will not work for all urban residents, nor indeed for all African countries. However, in some places and if done properly, it could at least take some of the pressure off surviving in urban areas, and make it more likely that the people who remain can receive other targeted support.
What a safe programme would entail
There are a number of important considerations for the design of a safe rural migration program.
First, the safe rural migration approach is only appropriate for countries which already have adequate food stocks in rural areas. It will be difficult for governments to intervene to scale up food production for returnees if it is not already sufficient. And encouraging people to migrate to areas which are likely to be affected by drought, floods, or locusts, will only make it more difficult to provide assistance to them later if their harvest fails.
Second, people should also only be encouraged to consider migrating if they have an extended family support network already available in a rural area. This way, the extended family can help to provide housing and access to farmland for new returnees. If people travel to a rural area without a place to stay or access to land, this could create a new rural poverty crisis.
It isn’t feasible for governments to independently verify whether people will have a place to stay in a rural area if they’d like to migrate. But one way to handle this issue is to have the government provide only small subsidies to cover the cost of a one-way bus ticket. This will encourage people to travel only if they believe they can find a place to stay at the other end.
This subsidised-ticket approach has recently been studied in Bangladesh, albeit to encourage urban migration rather than rural, and before the pandemic began.
Reducing public health risks in rural areas
A safe migration program must also consider the potential trade-off between reducing food insecurity in cities, and increasing the risk of the virus in rural areas. This is a difficult decision.
There is currently no easy way to compare the known risk of hunger in cities like Nairobi, where over 60% of residents in poor neighbourhoods report that they are already going hungry, to the potentially high risk of COVID-19 outbreaks in rural areas.
There are major factors to consider if an infected but asymptomatic person does travel back to a rural area. In particular, access to sanitation and healthcare tends to be worse in rural areas, which could result in more rapid transmissions. It’s important for governments to take steps to minimise the risk of transmission. The surest approach would be requiring everyone who wished to travel to pass a COVID-19 test before departure.
However, given that African countries have struggled to scale up testing even for frontline health workers, it is unlikely that a mass testing program for rural returnees could be organised quickly enough.
A second-best strategy would be to organise safe travel for the returnees. At an individual level, this would involve providing them with masks and hand sanitiser.
From a public transport perspective, it would ensure regular disinfection of selected transport modes and collection points, as well as arranging transport on buses, rather than lower capacity vehicles, that would allow adequate ventilation and two meters of distance between each passenger. Governments could also offer to temporarily cover some of the costs of bus companies running at half capacity.
People wishing to return to rural areas should also be provided with information about the risks of transmission and the importance of handwashing and phyisical distancing.
Scaling up rural health surveillance
The recent Ebola epidemics in West Africa and the Democratic Republic of Congo have offered many lessons about containing outbreaks in rural areas. Building on local knowledge, for example, they have helped develop realistic strategies for patient isolation. This needs to be a key component in a policy on safe migration, as all returnees should strongly be encouraged to self-isolate for 14 days after their trip.
Furthermore, ensuring that new outbreaks of COVID-19 are identified and contained quickly will be a further important part of any safe rural migration plan. To do this, healthcare workers must build trust with local communities so that they can carry out proper surveillance on the spread of the disease. These types of surveillance and support can build on community health worker systems which already exist in many rural areas.
Safe rural migration programmes will not be an adequate substitute for formal social protection, or for support to both urban and rural food systems. Furthermore, given the potential health risks, any migration plan should be piloted on a small scale first. Governments should make sure to collect regular data on food security and public health in the participating rural areas, in order to make sure that the program is working effectively.
But there are no simple solutions for the COVID-19 pandemic. Time is of the essence – to contain new infections, and to prevent people from going hungry. This is just one idea that could buy some African governments time, in the absence of an effective vaccine, to begin developing more formalised support programmes, while importantly also keeping people from going hungry.
The Somaliland Ministry of Health Development, today has confirmed the third death of COVID-19 and additional 11 cases of the disease in Somaliland.
The Minister of Health Development Hon. Omar Ali Abdillahi and the Director General Dr. Mohamed Abdi Hergeye in their daily briefing announced the new results.
The Ministry has previously stated that the testing equipment donated by WHO has been setup and all tests are being conducted locally. Tests were sent to South Africa in the past.
Although the ministry did not say how many tests it conducted, previous statistics put out by the ministry showed 320, meaning the 11 new positive cases are out of 60 tests conducted by the ministry.
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.
