Last-mile Covid response

Apart from random mass testing as is the case in Iceland, there is a need to Isolate positive cases to tackle Covid-19 in Malawi.

Self-isolation has not worked, so isolation should be compulsory. How you communicate and implement this is important because, without isolating positive cases, the battle is lost.

Isolation centres for patients who are positive but asymptomatic, need to be appropriate for non-incarcerated people so that they can enjoy quality life during the time until they are cleared to be Covid-free.

Some countries are using universities, hotels, hostels to house those who tested positive, but do not ned to be hospitalised.

A related issue is de-stigmatising Covid since stigma can be an even greater virus than a corona when suspects do not come forward for testing, driving the disease underground and further into communities.

We learnt about the destructive power of stigma in the fight against HIV.

We must preserve anonymity, but also allow high-profile people who test positive to share their experiences.

We also need to protect our health workers.

The lessons from Europe and the US, where many health workers have been infected and sadly died, shows the disease is so virulent that even in the most sophisticated healthcare systems with adequate sanitation, health workers succumb to the illness. 

The rest of the world is expecting our system to collapse.  It does not have to.

We must invest in personal protective equipment for our frontline staff and have adequate disinfection measures in the facilities.

Most importantly, let us intensify prevention so that the epidemic in Malawi does not reach the predicted thousands of cases in our hospitals.

Equally important is contact tracing

Since Covid-19 is mostly transmitted through personal contact—given an average household in Malawi holds at about five people—a person who tests positive might have already infected all members of the household by the time they are discovered.

If there is no full isolation, a single case can infect dozens in crowded urban areas and markets.

We can achieve significant contact tracing by using lay civil servants who are staying at home because of current work restrictions.

With five-10 tracers per case, we would get significant information about the contacts of positive cases to prevent further contagion.

Testing all arriving at our borders is vital. All people arriving at the border must obtain results within minutes.

Closing borders would not work. Border movement is inevitable since the landlocked country relies on its neighbours to transport its essential supplies.

Since some traffic is necessary and our borders are porous anyway, those coming into Malawi must accept to be tested or quarantined for 14 days.

Social science tells us that people cannot sustain lockdowns for months on end.

Stopping people from attending religious meetings or funerals of loved ones may be the correct approach, but it is not socially nor culturally desirable and does not appear to be working anyway.

Furthermore, politicians are among the first to disobey these rules by holding campaign rallies drawing big crowds ahead of the fresh presidential election. 

If we cannot stop such gatherings and social distancing, all people attending such functions should wear face masks. If not, we should expect to see an exponential rise in Covid-19 cases and disastrous consequences for our health and economy after the election.