Partial Curfew or Lockdown? The Indecisiveness of Government- A Recipe for CoronaVirus’ Victory Over Liberia
The experiences of many people passing through Red Light, Waterside and Duala to get to their homes summed up to one conclusion: “the messages about the CoronaVirus Disease- how it is contagious and deadly and have evaded the health systems and economies of bigger countries that are technologically advanced than Liberia are being played, but Liberians are hearing only with their ears and not their minds”.
By T. Benjamin Myers, Contributing Writer
When people hear with their ears only, they listen to the sound being made aloud. But when they listen with both ears and minds, they hear the sound being made and also understand the message being transmitted through the making of sound and apply themselves to the principles contained therein. This speaks to paying attention to details! Unfortunately, it seems Liberians have not learned from their experiences with the Ebola Virus Disease that claimed over four thousand lives of men, women and children.
In the wake of a so-called lockdown measure instituted by the government of Liberia which takes effect at 3pm, Liberians are allowed to have interactions on a very, very massive scale as though the virus is ineffective between 6:00am to 2:59pm and by 3pm, it becomes active and contractable. It was assumed that the lockdown was intended to minimize the level of interactions between citizens with an overall goal to curb the possible spread of the virus and enhance effective contact tracing. To the contrast, this is not the case; thus, leaving one to wonder what the essence of the so-called lockdown in the first place was.
To date, the marketplaces like Red Light, Duala and Waterside are still crowded with petty traders and buyers and interestingly, this is done without any form of regulation whatsoever. People stay for as long as they can in those places without observing any of the health protocols as laid down by health authorities. Additionally, commercial banks and other monetary institutions like Money Gram and Western Union where people go daily for transactions, have no strong regulation as customers stand in congested queues to enter those places. To say the least, Liberia is the only country where either its citizens are in defiance to the lockdown regulations, or the government has refused to exert seriousness in the enforcement of the lockdown.
As a consequence of GoL’s lack of capacity and will to actually enforce the lockdown, citizens loiter the streets in absolute disregard to social distancing, which is the most notable thing to consider at the moment. The government takes no issue with the movement of people that potentially poses higher threats to their lives and the economy in general, even after 3pm. This careless approach of government will be the weak lane through which CoronaVirus may creep deeply into Liberia’s already vulnerable health system and claim thousands of lives. Government must decide now!
The onus is now on the government, particularly the Legislature, to effectively use its oversight function on the Executive to ensure that the lockdown is altogether enforced, and in a way that guarantees the safety of lives. Other than this, what is being instituted is not a lockdown intended to curb the widespread of the virus, but a partial curfew that is politically mindful of what electorates would do in the aftermath of the virus on elections’ day.
Such indecisiveness as being exhibited by government in the wake of the death to patient ratio being astronomical in comparison to countries within the sub-region, will constitute the natural stage upon which CoronaVirus shall stand to evade the Liberian economy and annihilate its people. Thorough CARE has to be taken!
Few things upon full implementation, may help in strengthening the fight against the CoronaVirus:
1. The Government of Liberia needs to consider a total lockdown to enable effective contact tracing and minimize to a very great extent, the ongoing massive interactions that form the bases of the rapid increase in the number of cases in recent days.
2. GoL MUST consider in its national CoronaVirus plan, the very large procurement of Personal Protective Equipment (PPE) for health workers. As at now, health workers account for 28 percent of the overall infection in the country (Source: NPHIL). This means that they are the most vulnerable people who are most likely to meet their untimely demise. GoL’s plan will never make any sense if those with the expertise of fighting the virus have no security whilst on the battlefield. They might just go AWOL and the invisible enemy may have a walkthrough.
3. Since the virus is one that enters the lung and causes respiratory problem, thus making it difficult for patients to freely give out and take in air, such fight is never possible without the availability of ventilators to aid patients in breathing. GoL MUST also ensure that ventilators are brought into the country and placed at designated isolation centers where patients are struggling for their lives.
4. Instead of getting involved with unnecessary large spending in the face of a projected 50 percent fall in revenue as indicated in the President’s letter sent to the Legislature, GoL MUST begin immediately revamping and also creating new isolation centers for the purpose of quarantining those making entry into the country, and as well those confirmed to have the virus. Paying expensive hotel bills to quarantine people will take away a large chunk of the already limited capital Liberia has to its control; and will also limit its power to fight for a longer period until the virus is eradicated.
5. As mentioned in the President’s letter also, the CoronaVirus outbreak is having negative impact on economies around the globe and to a very great extent, Liberia is included. Interestingly, media institutions are businesses who themselves are subject to bankruptcy as a result of the accompanying economic conundrums of the virus. For the safety messages sole designed by health authorities to go far and wide, the media MUST play an integral role in the process of disseminating the information. Thus, as has been done with the $25m stimulus package and the payment of petty traders’ loans, so must the Government of Liberia consider same for the media to sustain its operations during the course of the fight.
This is actually beyond politics as the virus knows no party. It kills whoever it has the opportunity to reach irrespective of the person’s position in the Liberian society. As the history goes, it was brought into the country not by an ordinary peasant, but a senior government official who had gone to the Netherlands to attend a major government function. Today, health workers are being lost to the virus, thus accounting for 28 percent of the confirmed cases recorded so far. It is possible that it might just spring beyond these chains to gain roots in communities where people live. One can only hope that it does not gravitate to the point of repeating the venomous history of Ebola.
At this crossroad of national emergency, the fight against the virus must NOT be personalized by anyone; not even Pres George Weah. All hands have to be placed on deck to ensure a concerted effort that stands invincible against any foe! Both the government and citizens have a crucial role to play in this process. Whilst it is GoL’s responsibility to determine the shape and condition of the lockdown as well as device a systematic approach to the containment measures, it is also the responsibility of the citizens to unconditionally adhere to the laid down regulations! Let posterity judge either side that defaults on its national responsibility!Racing to respond to the COVID-19 pandemic in over 70 countries
Doctors Without Borders/Médecins Sans Frontières (MSF) teams are racing to respond to the coronavirus pandemic in the more than 70 countries where we run existing programs, while opening projects in new countries as they become outbreak hotspots.
MSF’s response to COVID-19, the disease caused by the new coronavirus, focuses on three main priorities: Supporting health authorities to provide care for patients with COVID-19, protecting people who are vulnerable and at-risk, and keeping essential medical services running.
Across our projects, MSF teams are improving infection prevention and control (IPC) measures to protect patients and staff and slow the spread of the coronavirus. Strengthening IPC measures is absolutely crucial to protect health workers and patients, both in COVID-19 care centers and in all other facilities providing vital health services, in order to avoid amplifying the pandemic or being forced to shut down.
Health systems worldwide are in urgent need of personal protective equipment (PPE) so that essential medical services can stay open. The global shortage of PPE is the reality for health workers in most countries where we work, who routinely face shortages of crucial items such as masks, aprons, and testing equipment. Reliable access to protective equipment, to COVID-19 tests, to oxygen, and to drugs for supportive care will only become more urgent as COVID-19 spreads in countries with little access to medical tools.
Caring for patients with COVID-19
In the US and Europe, which are currently the epicenters of the pandemic, MSF’s response focuses on improving care for the most vulnerable and at-risk communities, such as elderly people in nursing homes, homeless people, and migrants living in precarious circumstances. Among these groups, mortality rates have sometimes reached extraordinary and shocking levels.
“In our visits to nursing homes, we always note a lack of basic protective equipment and a lack of screening for frontline workers and potentially infected residents,” says Caroline De Cramer, MSF medical adviser for our programs in Belgium. “It is important to test nursing home residents as quickly as possible. They are extremely vulnerable because they are doubly at risk, due to their age and their communal living conditions.”
In São Paulo, Brazil, MSF teams provide medical consultations and help identify cases of COVID-19 among homeless people, migrants, refugees, drug users, and the elderly, referring patients in more serious condition to hospitals.
In Spain, Italy, Belgium, and France—all currently pandemic hotspots—we also support several hospitals that have been overwhelmed by the number of COVID-19 patients. Depending on the specific needs, our support ranges from advice and training on infection prevention and control methods to setting up wards for patients recovering from COVID-19 and for patients with moderate symptoms of the disease.
MSF also cares for patients in dedicated COVID-19 facilities in Burkina Faso, Democratic Republic of Congo (DRC), Cameroon, Ivory Coast, Mali, and Pakistan. We are preparing dedicated COVID-19 facilities in Kenya, Lebanon, Niger, Philippines, Senegal, Syria, and Yemen, among other places. These facilities will treat patients with moderate to severe forms of COVID-19, including those who suffer from acute respiratory problems.
We’re also sending an oxygen production unit to Burkina Faso, which will be able to produce oxygen in large quantities for several dozen patients at the same time. Patients with severe COVID-19 symptoms often suffer from hypoxia (low oxygen levels in body tissue) and need extra oxygen. Providing patients with sufficient oxygen without the use of invasive techniques in places where there is little intensive care capacity is a key challenge.
In most countries where we already run programs, such as Colombia, Iraq, and Nigeria, we are opening dedicated wards inside health facilities to help keep COVID-19 patients separate from uninfected patients and to extend hospitals’ capacity to provide care.
“The initial goal of our response is to help hospitals handle suspected or confirmed COVID-19 patients, to make sure they are welcomed and treated as well as possible under the circumstances, and to prevent their further spreading the virus to patients or staff,” says Shaukat Muttaqi, MSF head of mission in Iraq, where we are supporting hospitals in Mosul, Baghdad, and Erbil.
Similar activities are being carried out around the world. In the Haitian capital, Port-au-Prince, MSF has reconfigured an existing emergency care center to isolate and refer patients suspected of having COVID-19. In Tanzania’s Nduta refugee camp, where MSF is the main health care provider for 73,000 Burundian refugees, we are building triage and isolation areas in health clinics and in the main MSF hospital where patients with suspected COVID-19 will be referred. In Bangladesh, where nearly a million Rohingya refugees live in sprawling camps across Cox’s Bazaar district, we have built dedicated COVID-19 wards and isolation rooms in our field hospitals. This ongoing work will add 300-bed capacity.
Empowering people to protect themselves and reduce transmission
Worldwide, the response to COVID-19 has relied heavily on large-scale lockdowns of populations and physical distancing measures, with the aim of reducing transmission and preventing health systems from becoming overwhelmed. But for people dependent on daily activities for their survival, such as day laborers and those living in precarious or overcrowded settings, self-isolation and lockdowns are not realistic. In some places, hundreds of thousands—sometimes even millions—of people live in difficult and dangerous conditions, without any social safety net. It is crucial to provide people with the means to protect themselves and others.
“Most recommendations for protecting people against the virus and slowing down its spread simply cannot be implemented in Idlib [province],” says Cristian Reynders, field coordinator for MSF operations in northwestern Syria. “How can you ask [homeless] people to stay at home to avoid infection? We are talking about almost one million displaced people—at least one-third of Idlib’s total population—most of whom live in tents in camps. They no longer have homes.”
To help people protect themselves, MSF teams run health promotion activities in practically all of our projects, so that people understand the steps they can take to reduce their chances of contracting COVID-19 and to stop the further spread of the coronavirus. Where possible, we are distributing soap and setting up water points so people can regularly wash their hands. These measures, and additional assistance such as the provision of reusable cloth masks, are even more crucial for people at risk of developing serious complications, including elderly people and those living with other diseases, such as diabetes, hypertension, cancer, HIV, or tuberculosis (TB).
For example, in Uzbekistan, our health promotion activities include specially tailored messaging on TB and COVID-19 for TB patients and their families. In South Africa, MSF has reassigned existing staff from all four of our projects to our COVID-19 response. They are now working to limit the spread of the infection through contact tracing (both in-person and over the telephone) and the development and dissemination of health promotion materials. Teams are also assisting vulnerable asylum seekers and elderly homeless people to mitigate the impact of the national 21-day lockdown.
In Liberia, MSF teams are distributing soap. In the Malian capital of Bamako, where there have already been confirmed cases, and in camps from Syria to Mexico and Nigeria to Greece, we are setting up water points for hand-washing and clean drinking water.
In Burkina Faso, Ivory Coast, Mali, Niger, and South Africa, MSF has started producing cloth masks for use in the community. These locally made cloth masks, while not the same as those required by medical staff, can help prevent transmission of the virus if used appropriately and as long as handwashing and physical distancing are observed as much as possible.
Keeping essential services running
Suddenly faced with huge numbers of new patients, many countries’ already fragile health systems can quickly collapse under pressure from this pandemic, with disastrous consequences. If medical care were to falter, then common childhood killers like measles, malaria, and diarrhea, would go untreated. Other essential services MSF provides, such as sexual and reproductive health care, emergency room services, maternity and surgical wards, and treatment of patients living with HIV or TB, would go unmet. This would have a terrible impact on the people we serve and would surely increase the number of deaths.
In the hundreds of health facilities MSF works in around the world, our teams are rolling out infection prevention and control measures and reorganizing services to prevent transmission. For example, consultations have been reformatted to maintain safe distances between patients. Hospitalization wards have been redesigned to allow enough space between each bed. Health facilities now have separate patient pathways to divert those with suspected COVID-19 away from others. In Niger, rather than having large numbers of people visiting health centers to be checked for possible malaria, MSF community health workers go into communities to help provide this service. And in Kenya, MSF has adapted the way we care for people with HIV by providing patients with three-month prescriptions for antiretroviral drugs so they can come to health centers less frequently. In South Africa, our teams are ensuring patients suffering from HIV/TB co-infection get medication refills delivered straight to their homes.
Across the world, from Cameroon and DRC to El Salvador, Nigeria, Sudan, and Yemen, MSF teams are training and supporting local health authorities on infection prevention and control methods, and on the detection and triage of patients with COVID-19 to prevent health facilities from becoming amplifiers of the pandemic.
“Continuing our medical activities in areas already facing massive health needs is an absolute priority for MSF,” explains Albert Viñas, MSF emergency coordinator for Cameroon. The COVID-19 outbreak in Cameroon poses an additional challenge for a country marked by violence that has displaced hundreds of thousands of people. “COVID-19 activities require extra resources, staff, and materials in a situation where the global movements of people and goods has become very, very difficult. Our teams are working around the clock to maintain our regular lifesaving activities while responding to this new outbreak.”
Unfortunately, some projects have been suspended as a result of new restrictions linked to COVID-19, such as MSF’s pediatric surgical program in Liberia, which received some of the country’s most critical surgery cases. The project was suspended as a result of travel restrictions imposed to limit the spread of the COVID-19, making it impossible to replace our international pediatric surgeon who left at the end of March.
We have also been forced to suspend some non-vital activities, such as elective surgery, and reorganized others to reduce the risks for patients and staff. For example, in Pakistan, we have put our cutaneous leishmaniasis treatment services on hold as a temporary measure to avoid the spread of COVID-19. In Jordan, MSF’s reconstructive surgery hospital for war-wounded people from across the Middle East continues to care for 170 patients, but has stopped new admissions for surgery for the time being.
Despite these constraints, MSF teams in all countries where we work are striving to find ways to keep doing as much of our lifesaving work as possible while adapting to the multiple and serious challenges of the coronavirus pandemic.