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In mid-August President Adama Barrow finally succumbed to Civil Society Organisations call to address the nation. During his speech, he highlighted that “in April of this year, our health experts projected that by July-August 2020, cases of Coronavirus related infections and mortality will rise in the country. In the past weeks, we have witnessed this sad development, with a dramatic rise in the number of COVID -19 cases and deaths in our dear country.”
Statistically, we take a closer look at the data and speak to medical professionals to comprehend how July and August compared to other months. Daily Situation Reports on COVID-19 published by the Ministry of Health, provides months of data which were the reference for this article analysis. Several charts showing monthly and weekly trends emphasise that July and August have been difficult months with record deaths and positive COVID-19 cases.
As predicted July-August registered the highest mortality rates of 83 deaths with the second-highest death rate of 12 registered in July. Combined, August and July account for 95% of registered Coronavirus deaths. A low count of 5 deaths was registered in March (17th to 31st), April, May, June and September (1st to 9th) bringing the total COVID-19 fatalities toll to a century.
Did Gambia Government Use Early Warning Efficiently?
Given the President’s reminder statement, which highlighted that the Government had three months’ notice to prepare for the predicted spike in July-August we thought it best to gain further insight on the matter by interviewing frontline COVID-19 health care personnel based in The Gambia and the diaspora.
Surgical Resident Doctor, Pa Amadou Sohna, at Edward Francis Small Teaching Hospital explained that “as a frontliner, I haven’t seen any plans that were made by our government in terms of response to the Covid or even if there was a plan, nothing seemed to have worked. My assessment is that we had failed as a country in terms of response and sadly after we had so much time to plan and prepare for that as a country.”
United States-based Gambian Epidemiologist, Sally Manneh, currently working on COVID-19 in America believes that the problem is deeply rooted. “Pre pandemic, The Gambia was crippled with fragile health systems, burdened by a multitude of diseases, and resource-poor; The aforementioned is a recipe for disaster. As such, despite some of the good measures put in place, The Gambia lacks the essential tools necessary to combat an epidemic not to mention a pandemic.”
In her view “the government is limited in its capability to strengthen preparedness efforts against COVID-19 due to an inherited weak foundation and limited professional expertise needed to successfully execute prevention strategies.”
“The Setup Was Virtually Broken Down” says Parliamentarian
While the first chart shows that the monthly death was highest in July-August, this second chart also highlights that record-high testing was conducted in July-August with almost 7,000 tests conducted in August compared to the second-highest number of tests (over 3,500) conducted in July.
To date, the Gambia has registered a total of 3,362 COVID-19 cases. Out of this amount over 3,000 COVID-19 cases were confirmed in July and August, accounting for a whopping 89% of all COVID-19 cases registered from March 17th to September 9th. This means that the five remaining months of March, April, May, June and September registered a lower count of 344 Covid 19 cases.
Frontliner Dr Sohna emphasised the importance of intensifying efforts when he said that “there should have been adequate planning, ranging from proper testing centre (expansion and decentralisation of labs), have good and equipped treatment centres and all the resources (such as medications, oxygen supplies, PPEs and the like) needed by the workers to be able to do their work effectively.”
In an interview with Journalist Binta Jallow, National Assembly Chairperson for the Health Committee, Hon. Ousman Sillah he underlines the level of risk of front-line workers. While paying tribute to their heroic efforts he revealed that “they are the ones who are at the labs, the treatment centres, the ones who do sample collection. They are at risk; they risk their lives. I am a witness to this; I’ve seen what they are doing. And then the capacity there, they are few in numbers.”
“In-fact there was a time when it was a problem calling 1025 [COVID-19 toll-free number], you know the reason why? Most of them fell ill. Some of them had been infected with Covid, they tested positive. Others, because they were close contacts, they were quarantined. So, the setup was virtually broken down.”
“That’s why people were complaining. For me, I got more than 50 calls. People calling me, telling me that 1025 is not working. I also called [to check], initially they said it was technical issues but later they said there was no one around. The hard fact of the reality was that most of them fell ill” said the Parliamentarian for Banjul North.
Link to interview is shown below, watch from 43 min mark for statements quoted above.
What Could Government Have Done Differently to Prepare?
One of the key actions of the Government was not to rest on their laurels when they were warned of the July-August spike. Instead “this new government should have intensified early measures of prevention, such as closing international travel, mass sensitization programs, expanding health capacity, constructing temporary healthcare facilities in stadiums, providing free masks to the public…” said Ms Manneh
According to her the Government should have formed a Corona Virus task force much earlier consisting “of professional doctors, researchers, epidemiologists, health officials, etc. in The Gambia and beyond.” From her knowledge of Gambian medical personnel, she “can name four highly qualified doctor’s living in the Gambia who could have successfully spearheaded this taskforce”.
Weekly Trends of COVID-19 Death, Tests Conducted and Cases
To illustrate the weekly trends of COVID-19 deaths, positive cases and tests conducted, I created three charts shown below. To keep weeks isolated within each month, every month has been divided into five weeks as follows; week one (1st to 7th), week two (8th to 14th), week three (9th to 21st), week four (22nd to 28th) and week five (29th to 31st).
Chart number three below clearly shows that the deadliest week was from August 8th to August 14th which saw 40 people killed by the COVID-19 Pandemic. This was closely followed by the following week (15th to 21st August) which ranks as the second deadliest week with 24 deaths.
The fourth and fifth chart demonstrates that testing has reduced drastically over the past few weeks. While over 1,000 tests were conducted in almost every week in August, the first week of September has only seen 751 tests conducted.
“Still Within The Eye of The Storm”
In late August the Government announced that it would commence the 2020/21 tourist season in October 2020. With schools also expected to start before the end of the year, many are concerned and curious to know if the Gambia has gone over the curve and that the worst is over.
Epidemiologist, Ms Manneh, explained that “given, the multitude of factors and inconsistent data it is very difficult to state with all certainly if the Gambia has peaked or even gone over the curve. However, from my professional experience, I predict that cases will worsen over time. The fact is cases appear to be low because testing capacity has declined. We are still within the eye of the storm.”
“Predictive models utilize data to forecast outcomes. However, accuracy is measured by metrics and margins of error. At this juncture, published data from the Gambia fluctuates with significant data outliers, making predictive forecasting difficult” she said.
Dr Sohna also admitted that it would be difficult to “say if the worst is over because we [Gambia] don’t have the statistics to back this due to the low testing that was done, and also unaccountability of the cases (both illnesses and mortalities that happened at homes) and as well we need to remember this was a time people got sick and scared of the hospitals, afraid of catching the virus when they visit.”
In his view “we just need to be more vigilant as a country and be able to do testing on time and as well continue educating people to be watchful of their health during these times”.