- Autores: Jan HDubbink, Tiago Martins Branco, Kelfala BB Kamara, James S Bangura, Erik Wehrens, Abdul MFalama, Abraham Goorhuis, Peter BJørgensen, Stephen S.Sevalie, Thomas Hanscheid, Martin Peter Grobusch
- Ano de Publicação: 2020
- Journal: Travel Medicine and Infectious Disease
- Link: https://www.sciencedirect.com/science/article/pii/S1477893920303744?via%3Dihub
Community transmission of COVID-19 is ongoing in the majority of countries in sub-Saharan Africa (SSA), threatening, as elsewhere, the capacity of national healthcare systems (HCS) in low- and middle-income countries (LMIC) [1, 2]. While the epidemic started slowly and late in SSA, currently – subject to often rapid changes – around 20,000 cases per day are reported [3], despite limited testing [1]. Shortages of personal protective equipment (PPE), as well as sophisticated and expensive molecular diagnostic tests are of concern. However, the biggest worry is the lack of health care workers (HCW) and health care infrastructure as a few figures compellingly illustrate. SSA has only 0.2 physicians per 1000 inhabitants (Europe 3.7, North America 2.6), while 10,000 HCW across the continent were infected by the 23rd of July [4]. In April, the WHO reported less than 2000 ventilators in 43, and only 5000 intensive care unit (ICU) beds in 41 African countries, respectively [1]. Worst though, their distribution is highly skewed. While many countries in SSA having just a few, if any [5]; in countries which govern such resources, like South Africa, they are mainly located in the private sector, creating corresponding access problems [1]. Non-profit organizations help with the procurement of materials at lower prices, like the African Medical Supply Platform; yet, a single N95 mask still costs 2 USD a piece on this platform [1].
COVID-19 combines all the aspects of a pandemic threat, which even pushed the HCS of some of the wealthiest countries to their limits, such as Italy’s Lombardy region or New York City. Although molecular methods are used for diagnosis, false negative result rates make repeated re-testing necessary [6], further limiting the overall availability of tests. Severe and critical cases need constant intensive monitoring, oxygen treatment, if not extremely resource-intensive and costly mechanical ventilation [6]. Not only direct COVID-19-related morbidity and mortality, but the indirect impact on non-COVID-19 related healthcare in overwhelmed HCS were of great concern already at the beginning of the epidemic [7]. If the richest countries struggle, what can be done if LMIC, such as Sierra Leone, which serves as an example in the following, are hit hard by the current exponential increase in cases?
