As at 23 March 2020, the number of countries in Africa reporting confirmed cases of COVID19  has increased to 44 from the fist report in Egypt on 23 February. The spread of the virus on the continent has during this period been on a steady rise. During one of his press briefing the WHO Chief, Dr Tedros addressing Africa said ‘big gatherings should be banned …. Africa must wake up, my continent must wake up’.

On 22 March the Deputy Head of the Africa Centre for Disease Control of the African Union rang the alarm bell warning African states that Africa is in the ‘morning of the #COVID19 outbreak’ & went on to state that ‘When the rate is compared to #Europe, the message is ACT FAST to #FlattenTheCurve’

Africa shifted in a mater of two weeks from being a continent watching the spread of the virus in other parts of the world to becoming a continent facing the gathering storm of #COVID19. As the spread of the virus marches across the continent while COVID19 ravages countries with well endowed economic and health systems, African countries started, rather slowly and hesitantly in some instances, to announce various preventive and containinment measures (hand washing, ban of physical contact, social distancing, ban of gatherings in large numbers, closure of schools etc).

Both the spread of the virus on the continent and the beginning of the announcement of prevention and containment measures by affected states, major debates ensued across the continent. The debates centered around how best countries like Ethiopia should respond, what are the combination of measures that have the prospect of flattening the curve and how best these measures can be designed to fit local context and how best they are crafted and executed effectively.

1. From the experience of countries affected by the virus and those that make progress in flattening the curve of the spread of the virus, the very first and most important step is recognition of the seriousness of the threat the spread of the COVID19 poses to the health, life and social-economic wellbeing of individuals, families, communities and the society as a whole. The novel coronavirus is a new virus that spreads rapidly and leads to serious respiratory illness with major fatality rate particularly on old people and people with underlying health conditions. It’s spread not only overwhelms health systems & risks the lives of people in large number but also capable of severe disruptions to the lives of individuals, families and communities & the functioning of the national economy.

The first test of whether a state in Africa such as Ethiopia has risen to the occasion in responding to the COVID19 pandemic is the level of recognition of the gravity of the threat the pandemic poses.

2. It has also emerged from the experience of the countries that made progress in containing the virus that countries with clear plan for the prevention and containment of COVID19 that is designed taylored to the particular context of the country and scale of the spread can stand the chance of limiting community transmission. Such plan not only manifests the recognition by decision-makers of the gravity but also serves as the basis for introducing the relevant prevention behavioral steps and public health measures.

The second test for assessing the response of a government to COVID19 is the existence of well crafted and clear plan. The plan should have clear articulation of the nature of the threat,  pandemic that presents a serious threat to public health, the range of measures required to prevent and contain the threat, the implementation mechanisms including mobilization of emergency responders and (the logistical, technical and financial) resources, the timely introduction of the range of measures as situation evolves, communication strategy, mitigation measures to ease the determental impacts of the serious measures particularly on the most vulnerable sections of society, clear execution strategy and follow through and monitoring and follow up mechanisms (including judicial supervision)

3) For effective and legally grounded response, it is imperative that measures are adopted on the basis of duly enacted law of general application. In the absence of such a law on which response measures are introduced, there will be serious problem of legal certainty, risk of arbitrariness and abuse of state power and unpredictability and incoherence on the range of measures that could be adopted. The law can be one adopted for purposes of mobilizing the response to the specific public health problem (Senegal is introducing a law declaring a state of emergency) or based on an existing law deigned to deal with major social and health crises such as the (National Desaster Act of South Africa).

Whether response is grounded on a duly enacted law of general application is the third test by reference to which the performance of states in Africa is to be assessed.

4) In terms of the specific prevention and containment measures, from the WHO advisory and experience of countries affected by the virus, it has become clear that countries need to introduce a combination of preventive individual and socio-economic behavioral measures and the accompanying public health measures. These include avoiding touching common surfaces, thorough and regular hand washing with soap for at least 40 seconds, using sanitizers where watching is not possible, avoid touching face, avoid physical contacts with others and social distancing and ban of public gatherings of all kinds beyond a certain threshold (ranging from 2 in Germany to 100 in South Africa), closure of schools, limiting or banning of movements and suspension of works reaching to a point of total lockdown.

As WHO chief Dr Tedros aptly put it in a tweet on 23 March, ‘Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time – but they are defensive measures. You can’t win a football game only by defending. You have to attack as well.’ Accordingly, these ‘defensive’ measures have to be accompanied by the public health measures of vast screening, testing, contact tracing, isolation, quarantine & treatment and care.

In this context, the test for assessing the effectiveness of the measures introduced based on whether the measures involve the right combination, whether they are introduced early enough to have the impact, and whether they are formulated in clear and precise terms leaving no gap for ambiguity or uncertainty in terms of knowing what is required and what is banned. Timing is a major factor, the earlier a country introduces the ‘defensive’ measures, the better chance it has to flatten the curve.

5. Implementation and compliance with respect to the ‘defensive measures’ are critical. It has been said that the slowing down of the spread depends on individual and social behavior – each individual being on the frontline of the fight against COVID19.

The fifth test is whether the measures are compulsory or only advised and whether they are communicated and formulated in clear and unambiguous terms. Clarity is another major factor. The clearer and more precise the formulation and communication of the ‘defensive’ measures with limited and highly regulated exceptions, the more chance you have for a higher level of compliance with the measures.

There is also the important question of communication – how are leaders behaving when they address and when they hold meetings and when the inform the public on why heeding the ‘defensive’ measures is important. If people feel that the virus affects mostly old people or others with other illness, and/or if they feel that the virus is like any serious flu like disease, and/or if people feel that you can get the virus only from symptomatic people, there is very little chance of achieving wider compliance. So question is – are people told that this virus is deadly, that heeding these measures is an imperative to avoid severe sickness and death to self or other people, and that each individual should behave as if she is infected with the virus and as if every other person that they run into in public places also carry the virus irrespective of symptoms?

There is also the issue of general application of the measures. In this regard the question is whether the ban on public gatherings applies to only to social meetings or whether it applies to all gatherings of a certain magnitude whether such gatherings are political, religious or social. If inconsistent whereby a state closes schools but allows pretty much all other kinds of gatherings including political and religious meetings, the resultant inconsistency and hence the confusing messaging means that the state fails the test totally.

From the various states that introduced yhes measures, those that have set the benchmark for best practice include South Africa and Rwanda.

6) Contextual tailoring of ‘defensive Measures’ is another profoundly important aspect of the equation for effectiveness of the measures in the African context. In a context in which large portion of the population live in highly congested areas, slums and informal settlements, with no access to water and soap for washing hands, use public transport where social distancing is impossible, the introduction of the ‘defensive measures’ should involve the provision of the means for following with such measures – daily desinfection and deep cleaning of congested neighborhoods, distribution of sanitizers, the establishment of portable washing stations with soap along with advocacy interventions to facilitate some level of compliance. Similarly, given the fact that the vast majority of people depend on daily engagement in economic activities in the informal sector, such measures as social distancing, hand washing, avoiding gathering is unlikely to be observed. This can be enforced with the introduction of complete loackdown as in Rwanda or South Africa only if mitigating measures involving the provision of food items, consumables, and direct cash grants are also provided for the social-economically vulnerable people.

In this respect, the test is whether the defensive measures have taken due account of this reality in the country and tailor its implementation to the needs and conditions of the masses of the poor to protect them from the virus. The adoption therefore of what are called community bailout measures are key in this respect to ensure that the economically vulnerable are not pushed into not having food to eat, water to drink and medical support.

7) Then there is the issue of the strategy for dealing with people infecsted with the virus. In this respect, having clarity on how much the health system can provide treatment and care and for who and on what grounds requires clarity, the sourcing of the supplies, logistics and technical capacity for such treatment and care and the mechanism for dealing with others for who treatment and care could not be provided by the health system.

The test in this context is the existence of a strategy for treatment and care. But this may not be the area where many African states can find themselves to be in a position to do that well given the poor state of our health system, although this does not preclude the need for strategy.

8) Equally important is to introduce monetary and other supports measures for cushioning the adverse economic and social impacts of the measures particularly when the measures lead to closure of businesses, factories and other institutions.

This concerns with the measures for economic bailout of workers and businesses. In this respect, while African states don’t have the resources and capacity, they should put in place such measures as postponing certain payments, provision of tax breaks, special dispensation for most affected workers and small and medium businesses etc for easing the economic impact.

9) Finally, clear framework for monitoring and evaluation is critical which requires the establishment of an emergency committee or command post subject to judicial supervision for reviewing the measures and their implementation of measures based on the data from the monitoring and evaluation.

The test in this regard may include the whether the state has put place in place a framework and structure for monitoring, evaluation and review as well as regular communication on the same.

I am not a public health expert. I am a human rights practitioner. The foregoing is informed by a review using the human rights lense and a rough review of the emerging lessons from the responses to COVID19 in the continent and outside.

It is an attempt at providing some preliminary criteria to answer the question of how good or badly our states are responding to the threat that the COVID19 pandemic poses to the health and life of the public. Felt that better to pen my thoughts down in my blog than tweeting them, hence this blog is written instead of my tweeting on this question.

How well or badly is your country doing and how would this affect the health and life of the public?

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