Fighting the COVID-19 Outbreak in Cameroon: Risk mitigation challenges

The new coronavirus, COVID-19, was first encountered in November 2019 It has gone on to affect over 1,000,000 people in over 209 countries, areas or territories around the world, causing more than 62,000 deaths as of 6 April 2020, reported WHO. On the same date, Cameroon’s active cases had shot up to 650, causing nine deaths within two weeks following detection of the first case, according to Covidvisualizer.com. The pandemic is growing exponentially and more lives are lost daily. Understanding the nature of this deadly and fast-spreading disease, and working in unity to fight it, are essential if we are to cap the number of infected persons and flatten the spread curve.

The most important things we must do to fight the virus are these:

Practice social distancing, stay home, practice strict personal hygiene, disinfect surfaces, and use face masks. These risk-mitigating measures significantly slow the spread of the virus. These measures save lives and free up medical resources for those who need them most. Unfortunately, in a resource-constrained country like Cameroon, even though the number of confirmed cases is soaring daily, citizen compliance with government rules and guidelines can prove problematic—especially if we are confused about the government’s actual COVID-19 policies and the related citizen responsibilities.

Social media chatrooms and discussion within community circles are awash with lies, false narratives, and half-truths about COVID-19 infection and treatment. My aim in this article is to enhance public understanding of this virus and offer researched information for effectively confronting the COVID-19 pandemic.

Alarming Misinformation

In Cameroon, as in many Sub-Saharan African countries, misinformed people claim that dark skin presents a natural defence to the COVID-19. Also, some echo that Chloroquine intake rids the body of the virus. Further, some people suggest that the consumption of water mixed with lemon and bicarbonate cures infected persons. On top of that, there exists a false narrative that the virus cannot survive in hot and humid regions. All these statements are starkly false, and even deadly. They breed complacency among citizens, undermine the government’s measures, and enhance the spread of the virus.

The public needs credible information from Government and trusted national institutions and support organizations in order to make informed decisions and comply with Government-mandated measures. Authoritative information from reliable sources will influence public behavior in ways that inhibit the spread of the disease. False information, on the other hand, may cause citizens to act in ways that spread the virus more rapidly and widely, exposing themselves and their communities to more risk.

As an example, Globe and Mail reported that “[a]t least two Nigerians are in hospital after being poisoned by an unproven drug that U.S. President Donald Trump is touting as a possible cure for the new coronavirus.” In the U.S. itself, as reported in The New York Times on 3/24/20, a man died and his wife was hospitalized after swallowing this drug to prevent infection by COVID-19. Nigeria’s Centre for Disease Control has warned the public via tweet that the World Health Organization has not approved use of the drugs chloroquine, or its less-toxic cousin hydroxychloroquine, against the virus. Clearly, false medical information spread to the public can result in terrible decisions and actions. And such actions could lead to more medical challenges among the population and infected persons may spread the virus unchecked.

What we know

Although we need more data in order more fully to understand the behaviour of COVID-19, we already know it is a severe respiratory disease that must be tackled with urgency, seriousness, and science-backed measures by all Governments and by all citizens. If the situation is handled right, most people will not die. We do know that COVID-19 is spread via human touch, and by virus being left on surfaces (handrails, doorknobs, table tops, etc.) by infected people—the surfaces later being touched by other people, who then touch their own faces, allowing the virus to come in through the mouth, nose, and eyes. We know that the virus also spreads through respiratory droplets ejected into the air (by coughing, sneezing, or even just talking and breathing) from infected persons. The challenge of containing the virus is made all the more difficult by the fact that most persons are infected for a long time (a week or more) before they show symptoms—and some never manifest any symptoms at all! Thus, infected persons may spread the virus before they show any signs, or without every showing signs of infection. Anyone—no matter the race, gender, color, nationality, or age—can be infected with COVID-19. For instance, a newborn baby was diagnosed with the COVID-19 in the U.K. on 30 March 2020, Reported The Telegraph

As of 31 March 2020, there was no treatment, cure or vaccine against COVID-19. Therefore, citizens have to follow the guidelines provided by WHO and the Government of Cameroon: social distancing, frequent washing of hands, avoiding facial contact with hands, and self-quarantine. Importantly, getting tested is crucial to know hot spots and ramp up additional targeted measures to curb the pandemic.

What we can do

The public needs simple, clear, and regular information from the Government and other competent organizations. Fighting COVID-19 is a collective battle. While citizens are expected to play their part, the Government’s role is to create an enabling environment. Actions such as contact tracing, patient surveillance, free testing, free treatment, quarantine follow-ups, and economic support to those most affected by the pandemic can create a conducive environment for fighting the virus. The Ministry of Public Health has issued several communiques to educate the public about COVID-19 and to offer advice on mitigating risk.

However, it’s not enough to issue a press statement or a written communiqué listing the measures the public should take in stopping the spread of the disease. Traditionally, the decisions and actions of many Cameroonians, especially those in rural communities, rely on information from friends and family members. To that end, the Government of Cameroon and other organizations have to make use of all channels and forms of communication to improve information flow to citizens. On one front, Government guidelines have to be communicated to citizens in the language they best understand. The language could be French, English, Pidgin, or a specific local dialect accommodating community practice.

On another front, local examples have to be used so that the local audience can relate readily.

Implementing WHO and national guidelines can be challenging in Cameroon. The average number of persons in a household in Douala and Yaounde is about four to seven—and in some cases, they live within a very confined space. Many areas lack drinking water, let alone readily available water for washing hands. Many families living in poverty have faced daunting challenges to buy water and antibacterial soap to wash hands. Other families survive on daily street sales to feed and support themselves. For these reasons, the Government must identify local situations and take steps to build public trust and facilitate public compliance to the WHO guidelines and national measures.

On 29 March 2020, Human Rights Watch published a seminal article about ensuring medical care and reducing detainee population at overcrowded detention facilities and shelters for displaced people. The article, titled “Libya: Detainees at Risk of Coronavirus Spread,” encouraged governments around the world to take concrete steps in these directions. Many Governments have taken appropriate actions, and they are worth emulating in Cameroon. On 27 March 2020, Ethiopia’s president released over 4,000 prisoners to prevent overcrowding in prisons and to help contain the spread of the coronavirus, reported Democracy Now. Earlier in March, BBC reported the Iranian Government temporarily freed 54,000 prisoners to combat spread.

On 1 April 2020, President Abdelmadjid Tebboune of Algeria pardoned close to 5,000 detainees who have 18 months or less to serve their sentences, noted BBC. Similarly, the Government of Cameroon needs to take aggressive and urgent action to depopulate prison facilities as one way to minimize the spread of COVID-19 and save lives. A first step would be to establish criteria for such releases including individuals awaiting trial, older persons, persons with underlying health conditions, and persons with minor offenses. Unless the Government takes this kind of action, thousands more lives will be at risk.

Government preparedness

So far, Cameroon’s response to the pandemic is weak. The country needs to strengthen its city-level health system preparedness and build resilience capacity to fend off biosecurity threats such as COVID-19. Recent events in Cameroon emphasize this need. On 20 March 2020, patients and staff fled the Yaounde Central Hospital, the country’s lone COVID-19 diagnostic center, when the first confirmed case was announced. To manage the situation, the Hospital Director, Professor Pierre Fouda, assured patients that the infected patients were kept in isolation. Despite his assurance, most staff and patients never returned to the hospital. Following the announcement, thousands of people flooded hospitals and pharmacies to buy protective face masks and gloves. Most likely, as the number of COVID-19 patients spike in Cameroon, there will be an acute shortage of essential health-disposable inventories that could increase public vulnerability and speed up the spread of COVID-19.

The increasing number of COVID-19 patients will rapidly overwhelm Cameroon’s health system and resources. Unfortunately, Cameroon has a sub-standard number of medical doctors, nurses, and support staff. WHO recommends that countries maintain at least one doctor per 10,000 inhabitants; they estimate Cameroon has one doctor per 40,000 inhabitants. For a population of 24 million, Cameroon faces an immediate shortage of at least 1800 medical doctors. A surge in COVID-19 patients would overwhelm the country’s health system within weeks and and trigger a snowball spread effect, resulting in an exponential increase of infections in Cameroon. The death toll would be horrible.

Follow Science, not Fiction

Misleading information about COVID-19 spreads the virus or causes health complications, if not death. False hope from evangelical prophesying pastors may lead to complacency, infection, and further unwitting spread of the virus. Beyond lockdown and following WHO guidelines, the Government of Cameroon must set up multiple testing centers across every council, recruit and deploy competent laboratory technicians, and conduct free tests for COVID-19. Testing is vital for several reasons. First, testing allows the Government to gather data that is useful for large-scale decision-making and planning. For instance, through testing, the Government gets to know which communities have infections, how many people are infected, and the growth rate of the virus. It is essential to know how far the virus has spread. For one thing, it is important to determine when various restrictions on transport and other areas can be lifted. Government and public reaction for 1 million confirmed cases require more resources, urgency, and care than for 100 confirmed cases.

Second, testing also ingrains in citizens the belief that Government action in fighting COVID-19 is essential and requires more attention and compliance. Testing helps citizens know whether they are a danger to their family members and the general public. A citizen who has tested positive will take more seriously the doctor’s advice to stay home, to isolate, and to wear a face mask. Indeed, for about 90% of all COVID-19-positive cases, the main treatment needed is isolation and maybe some throat lozenges. Although enduring a bout of infection by this virus is very unpleasant for most people, only about 10% of all infected have severe, life-threatening symptoms. On the other hand, if a test is negative, it clears the person to return to an un-isolated and “approaching normal” life.

There remain many unanswered questions about COVID-19. Available data is based on recent trends, personal experiences, and research from similar viruses like Severe Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). More research is needed to address many unresolved issues about COVID-19, such as survival of the virus on surfaces, exposure to higher and lower temperatures, and COVID-19 reinfection. But we already know this: COVID-19 is highly contagious and has already killed tens of thousands of people around the world. Cameroon must take decisive steps to confront this fast-spreading disease.