Monrovia – When Dr. Dougbeh Christopher Nyan came up with a ground-breaking invention in the form of a single test that rapidly detects and distinguishes a host of different infections, simultaneously, Rwanda was more than happy to seize on his invention.
Dr. Nyan’s test distinguishes multiple infections which bear the same symptoms, for example yellow fever, malaria, typhoid or Ebola. The test detects and identifies HIV/AIDS, Hepatitis viruses, Dengue, West Nile Virus and Chikungunya. Most testing methods take about 3 hours to 7 days or more, but this device gives test results within an hour, is simple to perform, and cost-effective for struggling economies. This new invention could prove to be revolutionary in the African and global market and provide a significant step in the detection and management of infectious diseases everywhere.
Like Dr. Nyan, the expertise of Mr. Tolbert Nyenswah, who was at the forefront of Liberia’s fight against the deadly Ebola virus epidemic in 2014 is now being used at the Johns Hopkins Bloomberg School of Public Health where he works as a Senior Research Associate in the department of International Health.
So, when Dr. Nyan had completed a lecture organized by the Rwanda
Military Hospital at the 2018 African Innovation Summit held in Kigali, his presentation of an infections diagnostic test was exhibited as one of Top 50 Innovations in Africa and selected from over 600 submissions.
Healthcare Workers Lives at Risk
Like Dr. Nyan, the expertise of Mr. Tolbert Nyenswah, who was at the forefront of Liberia’s fight against the deadly Ebola virus epidemic in 2014 is now being used at the Johns Hopkins Bloomberg School of Public Health where he works as a Senior Research Associate in the department of International Health.
In recent weeks, Nyenswah’s views have been sought from a wide-range of influential media and publications, including the BBC, the Washington Post and a host of others.
His experience in Liberia during Ebola has given Nyenswah a platform and a window to relate to the Covid-19 challenge facing many leaders.
Today, Nyenswah’s Incident Management System model is now amongst some of the many being sought in countries exploring ways to deal with the COVID-19 pandemic.
There appears to be no shortage of brains for Liberia when it comes to dealing with pandemics such as the deadly Coronavirus. In fact, some are suggesting that authorities should begin tapping their expertise and utilize them in dealing with COVID-19 on a larger scale – since in fact, they are providing expertise globally.
In 2014, former Sierra Leonean President Ernest Bai Koroma tapped some of the best brains from the Diaspora and more recently, Ghanaian President Nana Akufo-Addo tapped Dr. Anarfi Asamoa Baah, the former World Health Organization (WHO)Assistant Director to lead the country’s COVID-19 Response.
In addition to Dr. Nyan and Mr. Nyenswah, a number of Liberians are proudly flying the flag and making immense contributions around the world.
Dr. Harven DeShield, who has a doctorate in biochemistry and a patent and Food and Drug Law with a background in regulatory law, involving pharmaceutical drugs/therapeutics and medical devices, runs a small clinical stage biotech company with two phase 2a Ready USFDA cleared products to treat hypotension (low blood pressure) in septic shock patients (including COVID-19 induced septic shock) and shock due to severe blood loss (hemorrhagic shock and exsanguination).
DeShield says Septic shock along with pneumonia and acute respiratory distress syndrome (ARDS) are the three main manifestations of COVID-19. “We’re for the most part, a virtual company with relationships with independent contract labs and consultants as a means to keep all of our costs down. We’re a Delaware C-Corp registered company. We affiliate with an incubator in Chicago that provides some support to us as a company founded by a US military vet (Dr. Cuthbert Simpkins). Our business activities are primarily covered by State of Louisiana, Illinois and Delaware.”
The Liberian-born Dr. Lisa Cooper, a Professor of Medicine at Johns Hopkins University, is a general internist, social epidemiologist, and health services researcher. She was one of the first scientists to document disparities in the quality of relationships between physicians and patients from socially at-risk groups. She then designed innovative interventions targeting physicians’ communication skills, patients’ self-management skills, and healthcare organizations’ ability to address needs of populations experiencing health disparities.
The author of more than 180 publications and the principal investigator of more than 15 federal and private foundation grants, Dr. Cooper directs the Johns Hopkins Center for Health Equity, where she and her transdisciplinary team work with stakeholders from healthcare and the community to implement rigorous clinical trials, identifying interventions that alleviate racial and income disparities in social determinants and health outcomes. The Center also provides training to a new generation of health equity scholars and advocates for social change with policymakers.
Mr. Nyenswah, who led the Ebola outbreak fight, says: “When you’re in a dire situation where people are in the streets, [you have] no best practice testing capacity … and you are setting up an incident management system at the same time … Before you really understand what the process is about, especially when information is weak …”
“Infections in health care settings will most likely force health care workers to abandon their post for safety. The most aggressive and remedial actions to remedying something like this is to quickly invest in infections prevention and control program which include distribution of personal protective equipment to about 700 public health facilities and 1000 plus private health facilities in Liberia. This strategy will increase workers confidence to “keep safe and Incentivizing the workers, especially those in harm’s way with some hazards pay will have a tremendous impact putting that in the stimulus package.”
Mr. Tolbert Nyenswah, Senior Research Associate in the department of International Health, Johns Hopkins Bloomberg School of Public Health
As an expert on killer diseases, Nyenswah knows the potential for danger, especially when more and more healthcare workers are putting their lives in harms’ way on a daily basis.
A recent SOS message from Dr. Sia Camanor, Chief Medical Officer at the John F. Kennedy Medical Center now making the rounds on WhatsApp and social media highlighted the plight of those on the frontlines of the COVID-19 pandemic.
Dr. Camanor alarmed: “I need all the help I can get to motivate my staff. We are in bad times and I am worried about the other health workers staying home because of fear of getting the virus. Too many COVID related deaths are now happening.”
Nyenswah: Infections Likely to Drive Away Healthcare Workers
For Nyenswah, such dilemma is a serious business in health care settings. “Nosocomial infections (infections of disease in healthcare facilities and workers) in an outbreak can be serious. A total of 192 health workers died from Ebola, including 300 others that got infected in Liberia. In the West African region, the indirect impact of Ebola in health care was grave: 1,091 estimated deaths due to HIV, 2, 714 estimated deaths due to tuberculosis, 6,818 estimated deaths due to malaria.”
Nyenswah says the reduction in access to healthcare services because of Ebola caused an estimated 10,600 additional deaths due to untreated conditions in Guinea, Liberia and Sierra Leone. “It can create panic among the workers. The adverse impact is on other people who are non-COVID-19 patients, those who seek routine services for other infectious diseases that are endemic in Africa including Liberia. Such as malaria, TB, HIV/AIDS, non-communicable diseases like hypertension, diabetes, stroke, heart diseases.”
With the rains coming, Nyenswah says diarrhea diseases like cholera will be on the increase too. “Infections in health care settings will most likely force health care workers to abandon their post for safety. The most aggressive and remedial actions to remedying something like this is to quickly invest in infections Prevention and control program which include distribution of personal protective equipment to about 700 public health facilities and 1000 plus private health facilities in Liberia. This strategy will increase workers confidence to “keep safe and Incentivizing the workers, especially those in harm’s way with some hazards pay will have a tremendous impact putting that in the stimulus package. The goal is to keep the routine health services functional while at the same time seamlessly fight COVID-19.”
Liberia’s Worst-Case Scenario
With the number of confirmed cases of COVID-19 just about the 100-case mark, the 40-beds 14 military hospital is reportedly running out of beds and ill-equipped to offer serious haven filled with ventilators and oxygen, compounded by the lack of stable electricity.
As more and more communities become overwhelmed and shelling the virus, experts warn that the worst-case scenario for Liberia would be hundreds of cases with very little room to cater to the infected.
Recently, Dr. Mosoko Fallah, head of the National Public Health Institute (NPHIL)cautioned that some 300 people are carrying the virus in the communities untested, putting Liberia on the time bomb waiting to explode.
Meanwhile, the brains of two of the country’s castaway products are being sidestepped – and their ideas and suggestions taken out of context and politicized.
Both Nyenswah and Dr. Nyan have faced attacks in recent days for offering their views on Liberia’s handling of the pandemic.
There are many repurposed approved for other indications drugs that are “experimentally available” to treat CV-19 infected patients with varying degrees of safety and efficacy – including Actemra, Remdesivir, Falciviprir, Azithromycin (z-pak), Interferon Alpha 2b, Hydrochloquine, Chloroquine Phosphate. Experimental usage in the world encompasses the fact that in most countries including in the US, a medical doctor/clinician can use any drug to treat a patient for an indication like a CV-19 infection, even if that drug is not approved by a regulatory body for that specific indication.”
Dr. Harven DeShield, Biochemist
Nyenswah has in recent times insisted that politicians stay out of the COVID-19 fight in Liberia, a call that has drawn some criticisms from some Monrovia City Mayor Jefferson Koijee. “Let the political people go to do their work; keep the technical people”, says Mr. Nyenswah, who currently works at the Johns Hopkins University in the United States as a Researcher. He also served as the first Director General of the NPHIL prior to leaving Liberia. Nyenswah has also been a strong advocate for resurrecting some 3,000 trained Contact Tracers are across the country from the Ebola outbreak to join the current COVID-19 fight instead recruiting new ones.
Koijee recently drew ire when he announced plans to train about 6,000 contact tracers in three days, predominantly ruling party (CDC) youth and loyalists, who have been deployed across the capital to conduct public sensitization.
The mayor has accused Nyenswah, the former head of NPHIL, the scientist, Dr. Nyan of trying to disrupt constructive efforts in the fight against coronavirus in Liberia.
Dr. Nyan: Leave Politics Out
Dr. Nyan has been a critic of mechanisms being used by the Liberian health authorities to curb the spread of the coronavirus in Liberia.
But Mayor says Dr. Nyan needs to come clear. “You can’t pretend here.”
The mayor says Dr. Nyan should have contacted the office of the Mayor before coming up with these criticisms about the active case finders. “If he had those qualms, if he is so a genuine person and he is not politically driven and not politically motivated the first thing he would have done was to try to reach out to us and see whether he can be able to pitch out his medical professional advice,” Koijee said.
President George Manneh Weah recently appointed Madam Mary Broh, Director-General of the General Services Agency to serve as National Response Coordinator for the Executive Committee on Coronavirus in Liberia.
The committee filled with a lot of political appointees has been criticized for not tapping into the knowledge of renowned Liberians with expertise in curbing and controlling diseases – for the very least for input and advice.
It is a question still baffling many including both Dr. Nyan and Mr. Nyenswah.
“Chloroquine? I would not advise that only because Chloroquine has other side effects, complications. If somebody has malaria, I think they should take Chloroquine. But not to take Chloroquine just to prevent yourself from getting COVID-19 because we don’t have any evidence that it is something that will help – and it could cause other problems. Some people ended up taking too much of it in America and ended up getting sick and even one person died from it. So, it’s not a good idea to take that unless a doctor recommends it.”
Dr. Lisa Cooper, Professor of Medicine, Johns Hopkins University
“The government of Liberia has not approached me to help fight the COVID-19 pandemic. Instead, I have consistently offered my expertise and diagnostic technology free of charge since January this year to the government but was ignored. Hence, I too have been wondering why our country, Liberia, with one of the weakest health systems in the world will consciously chose to ignore its expertise that are willing to provide services to help fight the COVID-19 Pandemic. I am worried that the Pandemic is getting out of hand and that this is spilling out danger for our people.”
Asked about their impressions of Liberia’s ongoing fight against the pandemic, both men have not hidden their dissent over the way authorities are handling the fight.
Says Dr. Nyan: “From every indication, the fight against the COVID-19 pandemic in Liberia is showing to be ineffective, confusing and militaristic. It is being managed with unprofessional and unscientific approaches, while also ignoring free expert advice. This is hurting the COVID-19 fight in Liberia and will further help to spread the virus in the population. I hope that our government will rethink its approach and put the proper expertise and resources in place that will professionally lead the charge against the COVID-19 Pandemic.”
Hopeful Signs for Drugs, Vaccines
For Dr. DeShield all is not lost as there are many repurposed approved for other indications drugs that are “experimentally available” to treat a CV-19 infected patients with varying degrees of safety and efficacy – including Actemra, Remdesivir, Falciviprir, Azithromycin (z-pak), Interferon Alpha 2b, Hydrochloquine, Chloroquine Phosphate. Experimental usage in the world encompasses the fact that in most countries including in the US, a medical doctor/clinician can use any drug to treat a patient for an indication like a CV-19 infection, even if that drug is not approved by a regulatory body for that specific indication.
“The government of Liberia has not approached me to help fight the COVID-19 pandemic. Instead, I have consistently offered my expertise and diagnostic technology free of charge since January this year to the government but was ignored. Hence, I too have been wondering why our country, Liberia, with one of the weakest health systems in the world will consciously chose to ignore its expertise that are willing to provide services to help fight the COVID-19 Pandemic. I am worried that the Pandemic is getting out of hand and that this spelling out danger for our people.”
Dr. Dougbeh Chris Nyan, Scientist
Secondly, DeShield explains that experimental use can fall under emergency approval by a regulatory body to treat a specific indication. “Lastly, compassionate use subject to state and/or federal approvals in the US also covers experimental use of many of these drugs by COVID-19 patients. For example (not yet publicly disclosed), tomorrow we will be doing a Press Release that one of two phase 2 ready products, VBI-S, recently received USFDA authorization to be used to treat COVID-19 induced Septic Shock.”
Dr. Cooper agrees that a lot of different tests are being carried out for medication right now. “I think it is possible that we could get medication that could be effective sometime within this year, six months to a year. I think before we would get a vaccine. So, I think there’s a possibility. Right now, there’s only been a small study that has shown a promise for a drug called Remdesivir. Early on, they had thought that they had found some positive responses in Chloroquine, but it’s not clear. So, right now, we’re still waiting. There’s some large studies going on in Europe and some in the United States, so hopefully we will have some answers in a few months.”
Nevertheless, she says the rush for another drug being pushed by US President Donald Trump may be a bit premature. “Chloroquine? I would not advise that only because Chloroquine has other side effects, complications. If somebody has malaria, I think they should take Chloroquine. But not to take Chloroquine just to prevent yourself from getting COVID-19 because we don’t have any evidence that it is something that will help – and it could cause other problems. Some people ended up taking too much of it in America and ended up getting sick and even one person died from it. So, it’s not a good idea to take that unless a doctor recommends it.”
Dr. DeShield, when ask how can a small country like Liberia and most countries in Africa gain access to experimental drugs currently being tested for public use, explains that many or most of the “experimental use” drugs are concurrently undergoing clinical trials in many parts of the world to assess their safety and efficacy in a definitive manner. “I think most of these clinical trials will likely be done in possibly 9-12 months but again these drugs are available for use right now. Unlike the experimental use availability of drug therapeutics right now, if we are lucky, a vaccine will likely take 12 to 18 months to be made available to the public. All of these drugs are available to Liberia by directly purchasing from the drug companies and/or third-party distributors. More than likely, Liberia will not have to pay the full price for these drugs.”
In Liberia, authorities have been coy when pressed as to what drugs are being used to treat those who have come down with the virus, creating a state of uncertainty and a wall of secrecy surrounding the methodology of treatment being administered.
No Ventilators in Liberia?
For now, Dr. Cooper says the key for Liberians is to pick up on the lessons of the Ebola outbreak of 2014. “I’m sure they’re on top of it because they know about it from Ebola but the number one thing is people knowing how to wash their hands, carefully and not touch their faces, and maintain a distance from people they are not living with – six to eight feet. The other thing that everyone could do is tie a cloth or scarf over their nose and mouth. It doesn’t have to be a professionally-made mask, it could just be a cloth that would cover their nose and mouth – whenever they are in public place or whenever they are going to be around other people – and if everybody does that then the spread of the virus would be reduce – it still means that people still need to maintain their distance from each other. People who are older, who have medical conditions, especially are the ones that need to stay out of public places, crowds and things like that.”
Additionally, Dr. Cooper says for a country like Liberia that does not have a lot of ventilators, it cannot afford to have so many people getting sick at one time.
DeShield, whose consulting work colleagues have access to all of the PPEs, test kits and other essentials, attention to the basics could go a long way. “Just imagine a ventilator at least according to them can be bought for 15K. And in Liberia, we barely have them. Apparently and when we do, we don’t’ have trained respiratory therapists and others to maintain them.
In an Op-Ed for Time Magazine last week, Dr. Jerry Brown who was instrumental in helping to lead Liberia’s response to the Ebola outbreak of 2014 and is now involved in the current COVID-19 response, said, to the best of his knowledge, Liberia doesn’t have any ventilators at all. “Without the right kind of care for the worst cases, he says, “the five percent of the patients that go to the severe state of the disease will die.” For a patient in severe respiratory distress, “I wouldn’t be able to do anything beyond providing supportive care, and slowly you would die in my presence.”
For Nyenswah, in order for Liberia to win the battle against COVID-19, authorities will first need to get the coordination right with one command and control system, ramp up testing about 200 test a day, 700 to 1000 test a week and provide personal protective equipment to 700 public health facilities and 1000 private health facilities in all 15 counties.
The former NPHIL boss is also encouraging health authorities to begin expanding isolation units, refurbish existing triages and isolation unit in all 15 counties and target more than 1000 treatment beds for COVID-19, because cases are in the communities.
“There is also a strong need to have contact tracers recruited and provided refresher training in all 15 counties. 100% contacts should be traced to get ahead of the epi-curve, for us to flatting the curve, and bend the curve. Incentivize health care workers, give them hazard pay.”
Additionally, Nyenswah asserts, there is a strong need to create a special facility to give care to health workers who will get infected. “It will give them confidence that when they get infected they have a place to be treated. We created the Monrovia treatment center near the RIA purposefully for health workers during Ebola.”
For Dr. Cooper, it all comes back to the basics and finding a familiar formula that works. “Liberia did an outstanding job of contact tracing during Ebola outbreak and that’s why we were able to contain it. So, we have experience in dealing with things like this – public health prevention – so we should go back and remember all those things that worked for Ebola – and do it – again.”