African health systems brace for wave of COVID-19 cases

As of March 19th, over 30 countries across Africa are presenting confirmed COVID-19 cases. In countries like Rwanda, Kenya and South Africa, travel restrictions and social distancing measures have been put in place.

Even so, the continent is ill prepared to deal with a pandemic of this magnitude. A Lancet modeling study of the preparedness and vulnerability of African countries against importations of COVID-19 cites 74% of African countries having an influenza pandemic preparedness plan with most of them being outdated (prior to the 2009 influenza A H1N1 pandemic) and considered inadequate to deal with a global pandemic.

In 2010, following the outbreak of influenza A H1N1, Downar and colleagues published an article in the Journal of Pain and Symptom Management, calling for countries to develop a Palliative Pandemic Plan, to ensure that health systems around the world are prepared for the surge in demand for palliative care that would occur in concert with a triage system for intensive care. However, to date the vast majority of countries have no such plan.

“The greatest fear is that as the pandemic evolves, there would be a complete collapse of the systems in some countries if we do not review the approaches at national level,” said Dr Emmanuel Luyirika, Executive Director of the African Palliative Care Association.

Here, Dr Luyirika shares the significant realities that Africa’s health systems may confront in the wake of a projected surge in COVID-19 cases:

Most African tertiary hospitals lack sufficient ICUs and therefore ventilators in both public and private health units. There were already waiting in the queue for ICU beds and difficulty in deciding who goes on a ventilator even before COVID-19. There are no ICUs in rural hospitals in most countries in Africa. Even if hospitals are to be given ICUs today, there are no trained personnel to man them.
The palliative care providers are not adequately trained to handle such infectious diseases as most of the training has been focused on non-infectious situations. So hospices are not adequately equipped to handle COVID-19 or Ebola or other highly infectious viral diseases.
The lack of resources means that access to protective garments and other requirements will dent the budgets of many hospices, some which are on the verge of collapse.
The ministries of health and health workers are up against a tide of fake news which is almost impossible to stand against.
All prevention and care messages to families about COVID-19 and national guidelines for families need to be translated from English or French into the several local languages and this is not happening as it should. An example is Uganda which has over 50 dialects and messages are mainly in four or five major ones.
The major providers of care are largely family members even where we have palliative care providers as most of the care happens at home. These family carers are least prepared to care for COVID-19 patients.
This disease has exposed the inadequacies of our investments in health systems as well as the lack of preparedness for us palliative care providers to deal with such a situation. As palliative care providers we are challenged to look beyond our circles as an ongoing process so that next time round when we get an infectious epidemic, we are better equipped and prepared.