Use + Remix

Managing COVID in 2022: first do no harm

Health systems will require additional support as the world leaves lockdowns behind. : JC Gellidon, Unsplash Health systems will require additional support as the world leaves lockdowns behind. : JC Gellidon, Unsplash

After two years of living through a pandemic, the consensus is we must learn to live with coronavirus. It’s time to evaluate our mitigation strategies.

By Francisca Mutapi, University of Edinburgh

As the world reaches its second year of living with the global pandemic, a grim picture is emerging.

More than 119 million people were pushed back into poverty in 2020, an equivalent of 255 million full-time jobs were lost, and the number of people suffering from hunger — which was already climbing before the pandemic — is estimated to increase by 83-132 million.

And this is before contemplating the illness, death and stresses on healthcare systems that COVID-19 has wrought. Nor the wider impacts of the restrictions of movement and social distancing.

The introduction and widespread uptake in vaccinations in some countries is reducing symptomatic illness and hospitalisations, but even those countries with high vaccination rates still face acute challenges with new virus strains; people are still getting infected, and  immune protection is waning.The consensus is settled: we are going to have to learn to live with the virus.

What does living with the virus imply? It means evaluating our mitigation strategies to ensure they are effective, proportionate, appropriate and sustainable. That they don’t escalate the damage already inflicted by the pandemic.

The past year has shown that lockdowns do not satisfy these four requirements. The impact of the pandemic has been different across continents. Contrary to predictions by prominent global health experts, Africa has experienced the lowest burden of COVID-19 and death.

Even allowing for lower reporting rates and low vaccine access, the mortality rate in Africa remains well below Western Europe or North America. Our studies and those of others indicate that several factors, including a younger and more rural population, have reduced Africa’s vulnerability to infection and disease.

When considering the wider indirect impacts of the pandemic on world economies, lower and middle-income countries have so far been the worst affected as they have weaker defences against economic shocks and tend to depend more on a few sectors, such as commodities and tourism. Lockdowns have been disproportionately damaging to Africa because they did not play to the continent’s strengths and circumstances.

Lockdowns stopped childhood vaccination programs that protect African children from diseases much more deadly to them than COVID-19, such as measles, pneumonia and meningitis. Schools, which are centres of so many child health and welfare programs were closed, even where most teaching is conducted outdoors.

Of those who will die due to the indirect effects of COVID-19 by the year 2030 in Africa, 80 percent will be children under 5.Analysis of the pandemic in the World Health Organisation (WHO) African region did not find benefits to stringent restrictions, such as social distancing and movement restrictions. Restrictions applied for a long time — or reintroduced late in the pandemic (for example, during an outbreak)— delivered, at best, a weaker, attenuated effect on the spread of the virus and the number of deaths.

The recent Wellcome Trust Global Monitor Report called for the COVID-19 tests, treatments and vaccines to be made available everywhere they are needed, highlighting that this will cost only a fraction of the economic loss the pandemic causes weekly.

Where do we go from here?

The first thing is to make optimal use of the tools we already have for making interactions safe. Regular testing before mixing with others, especially in large social settings, is recognised as an important tool to reduce transmission when those testing positive self-isolate and do not expose others to the infection. Lateral flow tests are now a credible alternative to PCR testing. Making them widely available at point of care will improve public uptake and compliance.

Vaccination is a highly effective tool that can make contacts safe but there is a need to increase vaccine availability to allow for better uptake. To do so requires wider distribution of the currently available vaccines and  removing barriers such as restrictive Intellectual Property ownership preventing countries being allowed to produce their own vaccines.

Further, if the IP and supply chain blocks are lifted, that would allow Africa to produce COVID-19 vaccines for locally circulating variants.  We know Africa can produce vaccines — such as the Johnson & Johnson’s COVID-19 vaccine — so any barriers to this need to be lifted.

Aside from IP issues, several vaccine candidates are stuck on African laboratory shelves for lack of funding, mechanisms and supplies to progress them to the vaccines needed.

Efforts need to be scaled up to address vaccine hesitancy, an important aspect in achieving individual and community protection through herd immunity. Reasons for hesitancy or low vaccine uptake are variable so there is need for locally relevant strategies to address them.

Some countries are making COVID-19 vaccination mandatory, but the impact this has on vaccination rates may be modest and the controversy surrounding this approach is unlikely to fade quickly.

There needs to be other ways to encourage buy-in. One approach is community engagement to build trust between health workers and the community. For example, engaging local and religious leadership to get their endorsement for vaccination, as has happened with the Pope, sends a powerful message to communities.

Finally, health systems must be strengthened to serve those who require care for COVID-19 as well as the other health needs of the community.

The lifesaver for critically ill COVID-19 patients is medical oxygenwe highlighted its acute shortage in Africa as early as March 2020, a scenario that has been repeated in other continents.

Health systems must serve all patients optimally, and not just a proportion of the people in the world. The uncovered racial bias in oximeters, devices that indicate when natural blood oxygen levels are critically low, is a reminder of the work ahead.

Oximeters overestimate the amount of oxygen in dark-skinned patients and this is believed to have cost lives of ethnic minority patients during the COVID-19 pandemic in the UK. The knowledge of that bias in oximeters is not new, several scientific papers have been published on the topic and discussed in the media.

Taken together, these interventions will help us mitigate the impact of COVID-19 in a more sustainable way that also minimises the negative impact on progress towards the Sustainable Development Goals.

Originally published under Creative Commons by 360info™. 

Francisca Mutapi is Professor of Global Health Infection and Immunity at the University of Edinburgh where she is also the deputy Director of the NIHR Global Health Unit TIBA (Tackling Infections to Benefit Africa). She is a Fellow of the African Academy of Sciences, Royal Society of Edinburgh and a 2021 TED and Aspen New Voices Fellow.

The underlying research supporting this publication was commissioned, in part, by the National Institute for Health Research (NIHR) Global Health Research Program (16/136/33) using UK AID from the UK Government. 

The views expressed in this publication are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Authors
Francisca Mutapi, University of Edinburgh
Editor
Reece Hooker, 360info
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