Almost every country has confirmed Covid-19 cases. Yet, every country is different and must adopt strategies that work in its context while learning from one another.
Based on the evidence of its Covid-19 epidemiology, each country must create appropriate strategies to suit its economic, political and cultural environment.
To long-distance athletes, the last mile is often the hardest. The end is in sight, but you are tired and you must push harder to reach the finish line.
As a public health researcher, I have followed the different approaches countries have adopted to fight the Covid-19 pandemic.
I am most intrigued by Iceland, which has tested nearly 15 percent of its population of 364 134. It has recorded 1 801 cases, 98 percent of whom have recovered and only 10 people have died. Currently, Iceland is having zero new cases per day.
Early in February, Iceland, adopted mass testing to isolate infected people even when they had no symptoms.
Random testing that shaped the policy found no symptoms in nearly half of positive cases, yet they spread of the disease.
The UK, however, was late in mass testing and 32 769 people—14.6 percent of the 227 741 confirmed cases—have sadly died.
New York City randomly tested 3 000 people and found that one in five had the virus without being aware.
In France, re-testing of old samples from pneumonia patients revealed that the virus was already in Europe in December, a month before the first case was detected there.
Closer to home, lockdown policies, movement restrictions and border closures remain in force. Malawi has confirmed 63 confirmed cases over a month since its first case. This number appears lower than the neighbours, but there is no room for complacency since there could be more cases that we do not know about.
The country must use the “last-mile approach” and the resolve not to see new Covid-19 cases. It must invest in mass testing, contact tracing and isolating cases.
This will ultimately be cheaper—in terms of lives lost and the effect on the economy—than waiting for the apocalypse to happen and then attempting to deal with that.
Malawi’s “last-mile” approach to Covid-19 entails fast-forwarding the mitigation approach as if we have already experienced the thousands of cases and deaths—and we are now down to manageable numbers of new infections with the end in sight.
We must work hard to prevent the 63 known cases from infecting others by emphasising respiratory hygiene and isolation of positive cases; we must test all who enter our country; we should emphasize social distancing, and we need to understand our Covid-19 epidemiology better through random testing.
There is no vaccine for Covid-19. Scientists say it may take at least two years before a vaccine is found.
Thus, we must find other ways of getting out of this situation that recognises that this is not a short term challenge.
Malawi does not need to follow to the letter the early steps that Europe or the US took, including widespread lockdowns to “flatten the curve”.
Malawi needs to fast-forward and implement future measures that worst-hit countries will need to implement to lift their lockdowns.
We must significantly invest in mass and random testing to identify cases as this is a cheaper strategy in the long run than dealing with many sick people.
Random testing reveals population-based parameters which you cannot get through facility-based testing. The Malawi Population-based HIV Impact Assessment is an example of efforts to get population-based data for the fight against HIV.
Universities are ready and willing to support testing, but a handful of testing centres is not sufficient for a population of 18 million.
Malawi should also learn from South Africa and introduce mobile testing units. We can use community health workers wearing appropriate personal protective equipment.
