If we want to beat coronavirus, then every extreme measures we have is now

Imagine the resultant outcome of a farmer going to farm without any farm implement or a clinician going to work without a stethoscope? Sadly, that was the situation of Ghana which banked all its hopes on hope and prayers the only means of combating the COVID-19 (Agyeman-Manu, 2020; Bayuo, 2020). We just hoped the disease never reached us, sadly we were wrong as usual as the disease started trickling in sporadically. The country could have stepped up efforts at its boarders, closing all illegal entries, effective screening at the legal points of entry, quarantining and strict enforcement of self-isolation. The cases of COVID-19 started with two on a faithful Thursday and has exponentially risen to 19 in just about a week. We were still comfortable and hid behind the fact that almost all the cases are imported or exotic.

It is important to note that the virulence, the infectivity, and the pathogenicity of the virus is unmatched, in country where chronic diseases (Non-communicable disease) rate is around 80% among adults of 30years and above, and accounts for about 43% of crude death, we can't take kindly to this disease knowing the pathogenicity and fatality rate is exacerbated by the presence of any chronic disease (co-morbidities). This data would make it scarier with higher fatality if the pandemic is not controlled. We must take a cue from Iran, where it is reported at a point in time that every 10munites, COVID-19 kills one person in Iran.

As we were swimming in the pool of reassurance, there came several cases raising the cases to 19 including the dreaded community transfers as three out the 19 have not travelled to any country at all in the past 14 days. For the sake of emphasis and analysis I would rely on the five cases reported on 20th March, 2020 on the official portal ghanahealthservice.org/covid19/. Now to get the picture very well, the first and third persons reported in that five cases neither traveled nor were known to have had contact with any confirmed case so the possibility is that they got the infection from someone who possibly has the infection but has not been identified or they might have had contact with someone who have had contact with a confirmed case and has also been infected who has not been identified by officialdom. I dont want to believe that they are index cases on their own or they had it from non-human source (that would be the scariest). Now in the case of common source transmission, they might have come into contact with an infected surface (being it door handle, money or anything) and got exposed to the infection which technically means others who might have had contact with same surface (s) are also exposed and can also get the infection.

As alarming and scary as this may sound, the actual number of people with the COVID-19 could be much higher than confirmed cases in Ghana as has been stated by experts (WHO, 2020; Bayuo, 2020). A new report based on data from China finds that for every known case of infection, there could be up to 10 people with the virus that remain unidentified in a community. In china where the virus started, it is widely believed that the explosion in the number of cases came from, those with mild, or no symptoms (healthy carriers) exposed large number of people as far as two third of all who got infected with the disease unaware. In short, the undiagnosed and the healthy carriers are responsible for almost all news cases. In another study by University of Texas, they shockingly found out that the period between cases in the chain of transmission is less than a week (7days) and that more than 10% of patients are infected by a healthy carriers.

In the case of the 34 year old woman who was known to have contact with an infected person in the five reported cases on the 20th March, 2020, it makes the primary contact tracing easy. We can easily quarantine her co-workers and their families but what about the people who also came into contact with their families and the ones that came into contact with the people who have had contact with their families? The chain goes on and on and on. Possibly we might be having more cases unknowingly than we have confirmed.

The two basic strategies in the control of an outbreak are containment and mitigation. The essence of containment is to trace, test, treat, and isolate infected individuals to stop disease from being spread to the rest of the population as well as quarantining of suspected or potentially exposed persons. When containment is no longer possible then we mitigate to slow it down in order not to be overwhelmed. We lost the first step of boarder control, proper screening, quarantining and enforcement of self-isolation and now we have also lost the second step of avoiding local transmission.

Even countries with advance health care systems, facilities and resources are overwhelmed (Agyemang-Manu, 2020). We currently have only two facilities Noguchi in Accra and Kumasi Center for Collaborative Research (KCCR) in Kumasi capable of carrying out the test for COVID-19 with results taking hours or days to get depending on which location samples were sent from. South Korea test as high as 15,000 people on daily basis for COVID-19 and if your guess is right as mine we don't have that kind of capacity as announced by the Minister of Health. The already designated facilities for the management of COVID-19 and the 50 bed capacity infectious disease facility being built in Korle-Bu in the next one month will not save us if drastic measures are not taken by our health authorities. Our system prior to this COVID-19 was already overburden with its own problems already: no bed syndrome is not a news and we have lost precious lives as a result and it wont be a different case now this is likely to deteriorate or worsen with Personal Protective Equipment (PPE) running out quickly worldwide because every country is preparing for the worse.

This deadly pandemic should be viewed as an enemy to humanity which is wreaking havoc in seconds and minutes. Economic losses will always be secondary to human life and that is the rule of nature. Sands are running out fast in the hour glass and every extreme measure we have to put in place to combat COVID -19 is now and not later. If it calls for lockdown or the shutdown of the country now to avoid further escalation, we should do so, of what use would it be to take drastic measures after we have lost precious lives. Public Health experts, clinicians, Civil Society Organizations among others should come together with their expertise and guide and direct government on this natural disaster to forestall any calamity.

God bless our homeland Ghana and make our nation great and strong.

Isaac Ackah

isaacstone24@gmail.com