US impressed by Zimbabwe coronavirus fight

US Centre for Disease Control and Prevention (CDC-Zimbabwe) acting country director Kelsey Mirkovic
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THE coronavirus (Covid-19) pandemic has wreaked havoc world-wide with countries such as the United States (US) being one of the most affected. Zimbabwe has so far recorded over 50 confirmed cases, 18 recoveries and four deaths.

There are fears the cases could increase as the government continues testing more people in the country.

Daily News on Sunday reporter Nokuthaba Nkomo interviewed the US Centre for Disease Control and Prevention (CDC-Zimbabwe) acting country director Kelsey Mirkovic on how the US government has been helping fight the pandemic in the country and on how it can improve its response in the fight against the pandemic learning from the US experience. Below are the excerpts.

Q: What specific role is CDC-Zimbabwe playing in combating the pandemic in the country?
A: So far the US government has provided over US$6 million to support the Covid-19 response in Zimbabwe. CDC-Zimbabwe has provided roughly half of that amount.

In April we announced that we will provide US$3 million to strengthen surveillance, laboratory, and infection prevention and control activities in Zimbabwe, as well as support the planning for vaccine introduction if or when a vaccine is identified.

The funds will go to the organisations that CDC already partners with in the fight against HIV/Aids.

Q: Given the impact of the epidemic in the United States, are you as an organisation in a position to continue assistance to countries like Zimbabwe?
A: Since the outbreak of Covid-19, the US government, including CDC, has committed more than US$900 million in assistance globally specifically aimed at fighting the pandemic. CDC continues to provide substantial support in the United States and globally, including here in Zimbabwe.

CDC Zimbabwe is committed to supporting our long-lasting relationship with the Health ministry and will continue to do so.

Transparency and accountability in the use of donor assistance is also paramount to continuing this relationship.
CDC has continued to support the Health ministry to respond to the Covid-19 pandemic in Zimbabwe by providing technical experts.

These experts work in teams focusing on laboratory, epidemiology and surveillance, case management, infection prevention and control, risk communication and community engagement, and coordination.

CDC’s long-standing support of laboratory sciences in Zimbabwe has continued through direct technical assistance related to Covid-19 sample collection, processing, and transport.

In addition, CDC’s HIV surveillance implementing partner, International Centre for Aids Care and Treatment Programmes (ICAP), has offered 16 vehicles with drivers to support contact tracing and rapid response teams, leveraged the electronic health record system to track recent returnees to Zimbabwe, and donated
US$18 000 for personal protective equipment (PPE).

CDC Zimbabwe’s clinical partners, I-TECH and Zimbabwe Association of Church-Related Hospitals (ZACH), have redirected US$75 000 to buy soap and water to set up hand washing stations and have provided communication materials on Covid-19 prevention to more than 300 health facilities supported by the President’s Emergency Plan for Aids Relief (PEPFAR).

Q: So far Zimbabwe has 51 confirmed cases. In your assessment, is Zimbabwe doing enough to slow down the acceleration of the pandemic?

A: Zimbabwe made a very good decision to initiate a nationwide lockdown early after imported cases were identified. This has likely limited the spread of the virus and has allowed the government more time to prepare for a scenario in which case counts increase.

Continuing to practice social distancing, practicing good hygiene, including frequent hand washing with soap, and wearing cloth face masks while in public spaces where social distancing is difficult to practice (such as in public transportation and grocery stores) will continue to limit the spread of Covid-19 and protect our family and community members.

The government has worked hard to strengthen contact tracing of confirmed Covid-19 patients. This means identifying the people who came in close contact with a Covid-19 positive patients, who can then be instructed to quarantine in their homes for the 14-day period during which symptoms would appear.

If contacts develop symptoms, they can be tested. Keeping the contacts of cases quarantined prevents the virus from spreading.

Tracing contacts involves a lot of human resources. So far, the government has done a good job of tracing the contacts of cases that have been identified. Unfortunately, this strategy only works if all the cases are identified, which requires testing people who have symptoms consistent with Covid-19, such as pneumonia or persistent fever and cough. Earlier on, like most countries, Zimbabwe was only testing people who had symptoms and who travelled from a country with active transmission of Covid-19, which means some cases may have been missed.

Q: What lessons can the government learn from the experience of the US?

A: The United States likely had many imported cases of Covid-19 that went undetected. Early in the pandemic, we did not know that many people who contract Covid-19 have no symptoms, or very mild symptoms, but were still able to spread the virus to other people.

The ability for the virus to spread from one person to another before the infected person feels sick makes it very easy to spread Covid-19.

As scientists learn more about how the virus spreads, we will continue to update guidance meant to keep us all safe. The United States has begun developing guidance to reopen some businesses.

As Zimbabwe is several weeks behind the United States in the progression of the outbreak, we will have an opportunity to learn best practices for easing the lockdown and reopening the economy.

Even as the government makes steps toward these measures, we need to remember to practice social distancing, wash our hands, and wear cloth face masks when in public places where social distancing is difficult to practice.

Q: American ambassador to Zimbabwe Brian Nichols recently said the US is capitalising on investments already made for HIV prevention in terms of laboratory support. What additional investments have been made to ensure HIV testing equipment meets the standards to be used to test for coronavirus presence?

A: As Ambassador Nichols indicated, PEPFAR resources and support to laboratories have been substantial. These resources have resulted in seven laboratories receiving International Organisation for Standardisation accreditation and hundreds of laboratory technicians being trained in sample processing techniques.

Our funding also supports systems for quality assurance. Zimbabwe’s Covid-19 response has directly benefited from these investments.

In addition to CDC, other American entities such as the Gates Foundation and Abbott Laboratories have invested in health systems in Zimbabwe, and are now working on Covid-19 response efforts.

Currently, the equipment and chemical testing supplies used for Covid-19 diagnosis are different from those used for HIV viral load testing or diagnosis. That could change if future Covid-19 testing includes chemical testing supplies that can be used in machines where HIV viral load testing is done.

A large part of the US$3 million from CDC to support the Covid-19 response in Zimbabwe will go to assist laboratory activities.

These activities will include capacity building and mentoring of laboratory technicians conducting the Covid-19 testing, strengthening quality assurance systems, and procuring commodities related to sample testing and preservation.

PPEs for laboratories and additional laboratory commodities remain a scarce resource and stock levels need to be closely monitored and used wisely to ensure this does not become a limiting factor in testing.

Q: What are your thoughts on the Health and Child Care ministry’s quarantine procedures, testing, contact tracing and treatment in Zimbabwe?

A: Zimbabwe’s Health ministry has completed a number of critical activities as part of the Covid-19 response. For example, there are now five public health laboratories able to test for Covid-19 in Harare and Bulawayo.
Several Covid-19 treatment and isolation centres were identified throughout the country and are in various stages of readiness.

The ministry has capitalised on other systems, including the Electronic Health Record system, to document and follow travellers returning to Zimbabwe from Covid-affected countries. The Ministry has also recognised the importance of maintaining other health services and worked to ensure HIV-infected patients have at least three months of medication, that immunisation services remain open, and that pregnant women receive antenatal care and deliver babies in hospitals.

Q: What gaps have you identified and how can they be addressed?

A: Unfortunately, the global shortage of PPEs and test kits continues to plague Zimbabwe as well as many other countries. The ministry is working with international donors, including CDC, to look for solutions to these challenges.

Misinformation circulating on Whatsapp also remains a barrier to a strong response. For example, I have seen reports that Covid-19 cannot be transmitted in hot or humid areas, or that eating hot peppers or lemons can prevent or cure Covid-19. These rumours are simply not true.

Q: The government recently failed to meet its target to test 33 000 people by the end of April with doctors also complaining that the Rapid Diagnostic Tests (RDT) that are mostly used are not reliable as they only detect antibodies and not the virus. What do you think can be done to speed up the testing process and at the same time get accurate results?

A: Laboratory PCR tests detect the presence of Covid-19 virus and can detect the virus up to two days before a person starts feeling ill. If the PCR test is positive, it means the virus is present in the nasal tissue and the person is infectious and able to transmit the virus to other people.

RDT tests can be used to determine if a person has been exposed to Covid-19 through detection of antibodies that are produced by the person who has been infected rather than detecting the virus itself.
Unfortunately, it takes one to three weeks for a person’s immune system to build up enough antibodies against Covid-19 to obtain a positive test result, which means that people in the early stages of Covid-19 will have a negative RDT.

This means a sick person could test negative on an RDT even though they have Covid-19 and might be spreading the virus in their communities. Since a PCR test can detect the virus very early for people who are infectious, it is a much better test.

Only PCR tests should be used at this stage in the pandemic where we must identify cases that need to be monitored for severe illness, isolated, and have their contacts traced.

Setting a testing target is important to help ensure enough commodities like swabs for collecting samples, reagents for running the tests and PPEs. However, it is more important to test the right people for Covid-19. This includes testing people who display Covid-like illnesses, such as pneumonia, testing people who recently died who had Covid-like symptoms and testing the contacts of identified cases who become sick. Testing healthy people with no known exposure drains the limited resources needed for active case finding.

Q: Madagascar has been using a herbal tea and traditional healers. Do you think this is proper…?

A: No, this is a bad idea. Besides not working to fight Covid-19, some herbal teas can interfere with prescription medication and make it less effective.
Someone who is taking any medication, such as for HIV or heart disease, should talk to their health care providers before taking any herbal or traditional supplements.

As of now, there are many drugs that are being tested for treatment of Covid-19 through rigorous controlled trials.
There are currently over 20 companies working on potential vaccines or treatments. At least 15 of those companies are in the United States and some have begun trials, which means testing on humans.

As of now, there are no treatment options which have received the Food and Drug Administration (FDA) approval, but several treatments are already showing promising signs of effectiveness, including Remdesivir (an antiviral drug) which has received an emergency use authorisation by the FDA.

All prevention and treatment options, including herbal teas or traditional medicines, should go through the same rigorous process to ensure they work and are safe before people use them.

Source – dailynews