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Dr Tatenda Simango

This has been a week of great interest in the health sector of Zimbabwe. Tough decisions had to be made by President Mnangagwa to avoid a total collapse of the health system.

The new Minister of Health and Child Care, Vice President Constantino Chiwenga has a mammoth task ahead of him. The fact that the SARS-CoV-2 virus is completely novel means that governments, scientists, and medical officials were caught off guard and are still scrambling to understand this complex disease means urgent recourse is needed to avert an exponential increase of Covid-19 morbidity and fatality.

People under investigation (PUI) are still escaping from quarantine centres. Patients in quarantine are getting frustrated by waiting for results that may take up to a week to come after they have completed the 10-14-day quarantine period. Some now have to get private laboratories to test them for them to get released.

There is still confusion as to the criteria of who gets admitted to Bulawayo’s Covid-19 hospital United Bulawayo Hospitals (UBH). There was a patient that was turned away from UBH because she had a positive rapid test instead of the standard PCR result. She used public transport to commute from UBH to Mpilo Central Hospital, then home to begin her self-isolation on the advice of a nurse at Mpilo casualty. These policy irregularities are recipe for disaster.

When one gets diagnosed with Covid-19 the questions that come to mind include:

Will I survive?

Will I get worse

How will my family be affected?

Will my family survive?

Will the community accept me during and after infection?

Will my employer take me back unconditionally?

Will my business be affected; will I not lose my clients (stigma)?

Covid-19 positive patients need more than guidelines and support to get through these conditions. The rapid response team is overwhelmed to function effectively; provision of technical psychological and material support of affected people.

We need survivors who volunteer to come on radio, television and newspapers to tell their stories of how they may have been infected and how the journey on being in isolation was. Such informercials will help the common person on how important it is to follow the national guidelines. Moreover that this is not a death sentence.

Such a support network has become a necessity. The response team is too overwhelmed and fatigued to support all the emotional needs of the Covid-19 patients.

When one receives a positive result, they accept it like a death sentence and it takes a while to digest the result. There is urgent need for support groups for recently diagnosed patients as well as those in isolation and quarantine. Having a virtual friend on the other line keeps one sane whilst in isolation by hearing how other people are handling their journeys. The groups can be social media groups that can be administered by health workers who have also been diagnosed and survived the condition. They will also assist in addressing any medically inaccurate theories/myths.

The support network will augment the indoor activities that have been used to make the lockdown bearable. Many have mastered a lot of indoor workouts like yoga, skipping and aerobics that they can enjoy alone or together with the family. Online preaching, prayer and intercession has helped people cope with the spiritual aspect of their health. Down time to do quite a bit of cleaning, maintenance work around the house and changing things around are activities that a lot of people have been putting off for a long time since they would be busy with work and other daily activities that would take them out of the house. Others have taken this time out to try new recipes for the family as well as doing a bit of baking.

However, the question still remains, what happens if the local transmission cases keep rising? If many people become sick with Covid-19 at once, the health care system could quickly become overwhelmed. This amount of infection could also lead to serious complications and thousands of deaths, especially among older people and those who have chronic conditions.

The matter of herd immunity may come into play. Herd immunity occurs when a large portion of the community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune. If herd immunity has been established and maintained in a population for a sufficient time, the disease is inevitably eliminated — no more endemic transmissions occur.

However, there are some major problems with relying on community infection to create herd immunity to the virus that causes Covid-19. It isn’t yet clear if infection with the Covid-19 virus makes a person immune to future infection.

A vaccine would be the fastest way of getting herd immunity, unfortunately we are still a long wait till trials have approved one.

The black market has seen the inflow of controlled prescription medicine being sold for a profit because of the panic that has gripped the market. People are stocking up and self-medicating on dexamethasone, hydroxychloroquine, zinc and vitamin C and aspirin. It is very important to see your doctor for advice on the need to take these drugs. The side effects of some of these drugs can be fatal; hydroxychloroquine (antimalarial medication) — blurring of vision, ringing of the ears (tinnitus), convulsions to name a few. Dexamethasone, a potent steroid, side effects include high blood pressure, weight gain, decreased immunity, increased blood sugar levels. Aspirin side effects include ulcers, abdominal cramps, stroke from blood thinning.

The fatality rate is still under one percent in Zimbabwe. We should bear in mind that most cases are asymptomatic (a good number will not even know they had the infection) whilst 80 percent have mild to moderate symptoms at worst. This is hopeful news, most of those who get infected will have flue like symptoms and improve without a need for treatment. Prevention still stands as the best cure, we can only win together.

Till next week.

Dr Tatenda Simango can be contacted on [email protected] or follow him on Facebook@ 9th Avenue Surgery.