COVID-19 is one of the fastest-moving and hardest-hitting pandemics in human history. Even before COVID-19 was a factor, there weren’t nearly enough intensive care beds or ventilators or health care workers trained to manage intensive care needs.
Now that the pandemic is hitting the region, we expect hospitals in sub-Saharan Africa to reach their capacity at a terrifying speed, especially in comparison with developed countries. Inadequate access to personal protective equipment or weak infection prevention and control measures raise the risk of health worker infection.
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Over 8 000 – 10 000 health workers in the 40 countries which have reported on such infections have been infected with COVID-19 so far between July 14- July 23 (see chart above), a sign of the challenges medical staff on the front lines of the outbreak face, according report by the World Health Organization.
This comes as COVID-19 cases in Africa appear to be gathering pace. There are now more than 750 000 cases of COVID-19, with over 15 000 deaths. Some countries are approaching a critical number of infections that can place stress on health systems.
So far, about 10% of all cases globally are among health workers, though there is a wide range between individual countries. In Africa, information on health worker infections is still limited, but preliminary data finds that they make up more than 5% of cases in 14 countries in sub-Saharan Africa alone, and in four of these, health workers make up more than 10% of all infections.
In many African countries infection prevention and control measures aimed at preventing infections in health facilities are still not fully implemented. When WHO assessed clinics and hospitals across the continent for these measures, only 16% of the nearly 30 000 facilities surveyed had assessment scores above 75%. Many health centres were found to lack the infrastructure necessary to implement key infection prevention measures, or to prevent overcrowding. Only 7.8% (2213) had isolation capacities and just a third had the capacity to triage patients.
Doctors, nurses and other health professionals are endangered by COVID-19
Health workers can also be exposed to patients who do not show signs of the disease and are in the health facilities for a range of other services. Risks may also arise when health personnel are repurposed for COVID-19 response without adequate briefing, or because of heavy workloads which result in fatigue, burnout and possibly not fully applying the standard operating procedures.
- June 3: 800 health workers infected with COVID-19 in Nigeria
- June 5: 1 713 health workers infected with COVID-19 in South Africa
- June 29: 90 health workers infected with COVID-19 in Mozambique
- July 15: 429 health workers infected with COVID-19 in Kenya
- July 17: 2 000 health workers infected with COVID-19 in Ghana
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The chart & timeline above shows health workers infected with COVID-19 in Nigeria, Ghana, Kenya and Mozambique between June – July 2020.
In June 2020, doctors and nurses working in public hospitals in Zimbabwe, went on strike over lack of PPEs, such as such, as protective suits, goggles and sanitizer, to use while treating patients. South Africa is now among the worst-hit countries in the world, healthcare workers in the country are increasingly becoming infected with Covid-19. It’s a similar situation in West Africa’s Togo, where several doctors and nurses contracted the virus after coming into contact with COVID-19 patients.
In Uganda, the time interval between the coronavirus nasopharyngeal swab at any of the satellite health facilities to the reporting of the test results (and limited self-isolation measures) will have exposed an average 5 – 7 or more persons to the virus and probably infected half (2 – 3) the number!
In such circumstances, health care workers in contact with the unconfirmed sick with COVID-19 carry the greatest risk of exposure to the infection. The likelihood of a health care worker becoming infected with Coronavirus is more than three times as high as the general population. And when they go back to their families, they become primary vectors of transmission.
Two months ago over 16% of COVID-19 infections in Sierra Leone were among health workers WHO report noted. The figure has now dropped to 9%. Cote d’Ivoire has reduced the proportion of infections among health workers from 6.1% to 1.4%. Scaling up infection prevention and control measures can further reduce infections among health workers.
Supplies of personal protective equipment are limited in Africa
Inadequate access to personal protective equipment or weak infection prevention and control measures raise the risk of health worker infection. Surging global demand for protective equipment as well as global restrictions on travel have triggered supply shortages.
Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics. Without adequate protection, COVID-19 mortality may be high among healthcare workers and their family in Africa given limited critical care beds and difficulties in transporting ill healthcare workers from rural to urban care centres.
In Africa, deaths from COVID-19 might far exceed what the world is witnessing right now unless major steps are taken. But we have little hope for substantial financial support when countries like the US cannot afford to properly supply its healthcare workers with personal protective equipment (PPE).
Saving more lives on the continent
Much can be done to protect healthcare workers, however. The continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key resources, and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Rapid DNA testing is more widespread in sub-Saharan Africa since the responses to AIDS and tuberculosis there, both in terms of expanded expertise and laboratory infrastructure.
Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around.
Telemedicine holds promise as it rationalises human resources and reduces patient contact and thus infection risks. Importantly, healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for COVID-19 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale.
Africa must brace itself for the storm ahead. In managing outbreaks, data on cases and outcomes are crucial to forecast the demand that will be made on the health system. If African countries think ahead of the data that will be needed in their health facilities for monitoring COVID-19 and think how best this can be collected, this will go some way to helping health services cope with the pandemic. There is no time to be lost.
Clearly there are multiple ways that international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s potentially devastating heath, socioeconomic and security impacts on the continent.
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