THE AFRICAN HEALTHCARE PORTAL
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
April 2020
THE AFRICAN HEALTHCARE PORTAL
COVID-19 Newsletter
FEATURING
Telehealth in Nigeria - 2
COVID-19 in Egypt - 4
Fear: Global response to Pandemics - 5
Digital response to COVID-19 epidemic -7
Diagnosis & management of COVID-19 -8
UPDATE FROM OUR FOUNDER
Dr Yushavia Govender
The world as we know it has changed - the outbreak of the Corona virus has forced
us to change the way we work, spurring the need for tele-medicine, tele-psychology
and tele-radiology to mention a few.
It highlights the fragility of global healthcare systems and our poor preparedness for
a large scale viral outbreak almost a century since the Spanish influenza.
The articles featured in this newsletter provide a brief update on how COVID-19 is
being managed, lessons learned and the role of technology going forward.
One thing is for sure, our approach to healthcare must change if we are to overcome
existing and future pandemics.
TELEHEALTH & COVID-19 IN NIGERIA
Osita Aniemeka (PhD)
Ambassor for Telemedicine Today
Nigeria
African telemedicine market has experienced substantial
Telehealth
growth in recent years. From $18bn 2015, it’s expected to grow
into a $41bn next year. Telemedicine is a great promise for has proven to be a
Africa, especially for individuals living in geographically
challenged areas. With the support of SeekMed, the platform
blessing to
for affordable telemedicine, that helps connect patients with healthcare delivery
quality international healthcare professionals via a user-
friendly mobile application, Africa’s healthcare terrain has in the age of a
changed tremendously.
pandemic in
When telemedicine arrived in Nigeria in January, 2010 via a Nigeria.
pilot project at the Lagos University Teaching Hospital
(LUTH), the interactive electronic mode of teaching, research
and provision of medical services was embraced by lecturers,
students and patients because of its efficiency and cost-savings
potentials. Other colleges and universities in the country
where encouraged to consider partnerships with IT companies Like other African countries, it’s the poor state of
that provide telemedicine infrastructure. In Nigeria, preparedness for the pandemic in Nigeria that is creating the
telemedicine employs modern technology to improve fear and anxiety as well as the doubts in the minds of many.
medical education and services and is also a veritable The nation’s inadequate healthcare infrastructure is not just
tool for communication between medical experts in Nigeria outmoded but also out-of-use. Nigeria’s healthcare system,
and abroad. copied and never corrected was designed to bring patients
together in a place – the hospital. The sick and the infected
It took the new coronavirus to bring the real potentials of can only access healthcare by visiting hospitals.
telehealth to the fore in Nigeria. In an unmatched approach,
governments and health professionals became willing to What Nigeria seeks now is a healthcare apparatus where
deploy a technology that should have happened years ago, to healthcare personnel can provide care remotely – and
not only save lives but bring quality healthcare to the arguably, more competently and commendably – than in a
underrepresented mass of the population. The most packed, health center. With COVID 19, Nigeria is
populated nation in Africa now seeks ways and means of experimenting with the notion that some local health issues
deploying new telehealth strategies as Covid-19, the new can be resolved without the revered out-patient and in-patient
deadly masquerade is forcing a new dance beat, creating a approaches and in some cases with even the revered medic’s
dance step. physical touch.
Genesis of a success story...
Multimedia messaging was added to its list of features allowing
A few years ago in Nigeria, owning and subscribers to send pictures, audio clips, and even short video
operating a cell phone was an exclusive preserve of the clips to each other. EDGE also increased the speed of mobile
high and mighty in government and in the private internet browsing to Dial-up speeds. All these added up to
sector. Apart from the prohibitive cost of accelerate the basis for telehealth in Nigeria. With the incursions
between $500 and $1000, availability was an obstacle to of COVID 19 in Nigeria, the four cardinal points for telehealth
surmount. It was a matter of pride and prestige to hold success include:
the handset and flaunt it to the envy of the masses plus
connectivity was non-existent. 1. Stemming The Spread
With telehealth, COVID 19 spread has been stemmed faster and
After almost 20 years (August 2021) since the Global diagnoses made sooner. There are a handful tele-COVID
System for Mobile Communication (GSM) genre of services running at the moment and it is reported that the
communication was introduced into the Nigerian isolation centers who entered these services, are able to identify
market, it has made its mark in Africa. GSM in the critical cases in very short time for further isolation and
itself is not a new technology. It debuted in 1982 as a Pan- attention. Testing is faster and emergency care is better directed.
European communication technology and had since
spread beyond the frontiers of Europe to 2. Continuous Monitoring
other regions, including Africa the good news is that There are some infected persons that need to be kept under
despite the late entry into the GSM market, Nigeria has observation round the clock and this is where the telehealth
outpaced many countries across the globe in comes handy in Nigeria. Telehealth is currently being used in a
terms of market size and telephone penetration. The first lot of COVID 19 intensive care units because there, the patients
GSM service rolled out in August 2001 followed a need to be monitored continuously. With the technology, the
successful Digital Mobile License, DML, auction experts get a permanent eye that helps them know about
conducted in January of the same year by the nation’s certain distractions, sudden changes and other important
telecom regulator, the Nigerian Communications signal(s).
Commission (NCC). That auction, the first in Africa,
was adjudged transparent and world-class by both the 3. Bolstering Second Opinion Syndrome
World Bank and the International Telecommunications Second opinion in medicine is a decision-support tool for
Union (ITU). The NCC had placed the asking price for ratification or modification of a suggested treatment, by another
each license at a conservative $100 million. But at the physician. During the COVID 19 pandemic, second opinion has a
end of the critical influence on the testing, treatment and prognosis. A
auction, each licensee paid as high as $285 million. simple phone call, a video from tele-COVID centers, etc., can
provide that now.
GSM technology has been the most prominent mobile
phone technology in the world. Although there are other 4. Rehab at Home
technologies that are competing with GSM, it’s still the When the infected recovers from the pandemic or is still being
best. GSM offers a lot of possibilities to telephony in treated in the remotest parts of the country, telemedicine is
Nigeria like text messaging and even low speed internet pretty useful for them. Healthcare professionals and
access. Further improvements were made with the specialists have kept a check on these persons even when they are
introduction of General Packet Radio Service (GPRS) and at home, which means that if and when a patient starts acting
Enhanced Data Rates for GSM Evolution (EDGE) that weird, the healthcare personnel will immediately know about it
extended the capabilities of GSM networks. will take help and rescue steps.
Telehealth has proven to be a blessing to healthcare delivery in
the age of a pandemic in Nigeria.
COVID-19 IN EGYPT ‘’Egypt is making substantial efforts to control
COVID-19 outbreak. Significant work is being done‘’,
Hager Ahmed & Fatma Sobh says Dr. Yvan Hutin, Director for Communicable
Diseases in WHO’s Regional Office and mission team
Medecins San Frontieres (MSF)
lead. The Egyptian MOHP has made remarkable
Egypt decisions since March, 2020, by intensifying its already
effective infectious diseases surveillance system to
On the 11th of March 2020, WHO announced COVID-19 define and detect suspected cases. Moreover, MOHP is
a pandemic. COVID-19 has caused more than 1,000,000 establishing dedicated hospitals for COVID-19 patients,
confirmed cases and above 60,000 deaths worldwide, suppling the central laboratories across Egypt with
since its outbreak in Wuhan, China in December 2019. COVID-19 diagnostic tests, and providing health workers
The concerns of the COVID-19 situation in Egypt were with training courses to deal with the new disease.
amplifying, due to the elevated number of tourists who
have visited Egypt prior to their diagnosis with COVID- Additional efforts were made to raise public awareness
19 after their return to their countries. of COVID-19 risk digitally using social media as well as
on the ground through health campaigns supported by
Egypt announced its first COVID-19 case several partners and volunteers.
in mid-February, since then, the number of confirmed
cases has exceeded 1000 cases, with more than 70 deaths The government has also taken crucial steps to limit the
and it keeps rising according to the last Egyptian outbreak, through partial lockdown of the country, with
ministry of health and population (MOHP) update on international flight restriction, closure of schools, work
April 4th, 2020. Although, it is difficult to estimate and religious places, with the exception of vital
accurately the real number of COVID-19 cases in Egypt services providers as hospitals/food supermarkets,
owing to many reasons. prohibition of any public gatherings, strict curfew after
7pm and disinfecting major streets and public
Firstly, the large youth population with a tendency to places. On the other hand, there is still much to be done,
not show symptoms or show mild symptoms. Secondly, such as improving the referral system of cases,
testing criteria was limited to travel history and contact increasing access to diagnostic tests, improving
with a confirmed case. In addition, the lack of abundant, preventive measures on all levels in different sectors and
rapid and cheap screening/diagnostic methods. full public integration. Each of these must to be
upgraded to effectively contain the COVID-19 outbreak.
Furthermore, greater attention and support for research
Limiting contact has is required - A possible collaboration with the WHO to
open the first Biosafety level 3 laboratory in Egypt has
been key to curb the been tabled.
spread, and we have
To conclude, as this is a fight against a new disease,
followed similar learning is ongoing and measures are adapted as new
measures as other information filters through. For that, the Egyptian
experience and efforts against COVID-19 outbreak are
countries
impressive, particularly the health sector performance,
and the rapid progress they achieve determinedly.
FEAR: GLOBAL RESPONSE TO PANDEMICS
Elvis Ogweno (MPH, MSc, CCP) & Tanya Gravier (MPH)
Samaritan's Purse Independent Consultant
Kenya USA
Epidemics are hardly a novelty. They have been COVID-19
shaping, mapping, and fundamentally altering human
history across the world for millennia. Infectious Infectious diseases of the lower respiratory tract,
diseases have consistently threatened humans, their tuberculosis, HIV/AIDS, malaria, and diarrheal
governments, and social security. African countries are diseases still represent the top causes for morbidity
highly vulnerable to outbreaks which are perpetuated and mortality in African countries.
by poverty, poor healthcare infrastructure, and The threat of COVID-19 is an undeniable source of
unstable governance at national, state, and local levels. political and social anxiety for African countries
particularly due to the severity of the disease in
Unpredictable pandemics constitute black swan events individuals with underlying health conditions. Several
with immense potential to severely erode market African countries have healthcare systems
confidence and countries’ economic capacities, thus that are already overwhelmed by the double burden
triggering crises of political faith from which it is often of both communicable and non-communicable
difficult to recover. It is therefore not surprising to diseases and obstructed by gradual privatization.
witness the surge of alarmism and panic in the wake of These systems would be strongly challenged by the
the novel corona virus outbreak that causes the disease quarantine of even hundreds or more suspected
COVID-19 which has now been elevated to pandemic COVID-19 cases.
level status and has infected about 680,000
individuals worldwide, officially exceeding the Currently there are no approved vaccines or
threshold of 32,000 deaths. treatments. Although several drugs are being
investigated for their efficacy in treating COVID-19
Just when the World Health organization was looking infection including, an investigational drug that was
forward to announcing the world is Ebola free on the originally intended to treat Ebola called remdemisvir,
12th of April, 2020, this milestone was eclipsed by the several protease inhibitors that are normally used to
novel corona virus outbreak that began mid-December treat HIV, the anti-malarial drugs
in Hubei Province, Wuhan, China. hydroxychloroquine and chloroquine, and the
macrolide antibiotic azithromycin, and
results have been encouraging, more studies and
Previous epidemic experiences randomized clinical trials will be needed in order to
characterized by strong
determine which treatment or treatments are most
multilateral coordination have
effective.
also helped Africa develop
greater responsiveness to
impeding threats
Hanta virus
In addition to COVID-19, the recent report of the Access to health services is often determined by other socio-
death of a man from hanta virus while riding on a economic or political factors, with poverty and insecurity
crowded bus in China ignited more fear that yet being some of the greatest obstacles. These challenges will
another outbreak was lurking around the corner for need to be addressed in order to keep this upward life
expectancy trend.
humanity. However, it is important to note that the
hanta virus is not a novel disease and is transmitted to
Because of these strong inequalities between countries, poor
humans by mice through their saliva, urine, and faeces.
healthcare infra-structure, and unstable political climates,
People usually come in contact with the virus through
Africa is poised to be the weakest link in global containment
inhalation of contaminated dirt and dust particles
efforts. Yet, the narrative about Africa’s vulnerability and
while cleaning.
weakness once again fails to grasp that the continent is exactly
that, a continent with different political, economic, and
Although an African hanta virus, also known as
healthcare systems, each endowed with different levels of
Sangassou virus and was identified in the rodent
resilience. Africa’s fragile states are torn by conflict, political
species Hylomyscus simus in Guinea of 2006, there
instability, or grave poverty that are less resilient and more
have been no known outbreaks in Africa to date. It is vulnerable to shocks. Other African countries have undergone
not known how widespread the presence of hantavirus dramatic improvements in the development of a more robust
is in Africa, and researchers screening for the presence disease surveillance and monitoring apparatus mainly because
of hantavirus in South Africa also found no evidence of of the mobilization of resources and capacities during the
infection out of over 2000 rodent samples tested. Ebola outbreak. Several governments already possess
Infection with hanta virus is greatly feared as it may enhanced screenings and trained health workers at airports
lead to the development of two serious types of which definitely contributes to strong COVID-19 response
diseases in humans: Hemorrhagic fever with renal capabilities. More importantly, previous epidemic
syndrome (HFRS) and cardiopulmonary syndrome. experiences characterized by strong multilateral coordination
Fortunately, hantavirus cannot be transmitted from have also helped Africa develop greater responsiveness to
human-to-human, therefore the risk of such an impeding threats which offers hope in the face of this
outbreak in Africa is very low. pandemic.
In summary, this draws attention to the prime importance of
Situational analysis in Africa developing the overall resilience of African health systems.
Multilateral efforts need to be sustained year-long for their
Despite the high prevalence of both infectious and sheer intrinsic value, and not just in the face of rogue
non-infectious diseases throughout Africa and the epidemics that are unlikely to cause as much morbidity and
mortality as other more prevalent diseases in the region. And
recent Ebola outbreaks in West Africa and the DRC,
although there is still much to be learned about the virus that
the overall average healthy life expectancy in Africa is
causes COVID-19, experts evaluate it is less likely to survive in
on an upward trend, increasing from 50 to 53 years
the hostile warm environments of Africa than in colder
between 2012 and 2015. However, there are strong
regions because heat is more likely to environmentally
inequalities that exist between and within countries in
inactivate the virus making it less likely to spread as quickly as
the African region.
it has in colder climates where the virus can survive outside
the body longer.ROLE OF DIGITAL DURING COVID-19
Developers
Mohini Bhavsar
Digital Health Expert at Dimagi should be aware
Senegal of how their
COVID-19 is catapulting health systems But the question remains of whom these digital solutions may be
health solutions are meant to serve. In the
around Africa to further strengthen
surveillance and response efforts with the development of these tools, many vulnerable excluding key
populations, including women and those in
help of digital solutions. Many countries
are turning to local software developers, rural communities, are often overlooked. groups
social enterprise technology companies, Developers should be aware of how their
and even big tech partners and mobile solutions may be excluding these key groups
network operators. With this influx of from accessing care due to obstacles such as
actors, there are two key principles to reduced access to smartphones. Consider
keep in mind when designing and alternatives to be inclusive to feature-phone
developing the solutions. users, such as SMS-based platforms and the
generous use of audio-visual prompts for lower
After the 2014-2016 Ebola epidemic in literacy audiences.
West Africa, many new technology
Dimagi and many other technology providers
solutions were rapidly tested and
endorse the Principles for Digital Development ,
deployed for rapid response. In Sierra
which seek to address these challenges and
Leone, Guinea, and Liberia, Dimagi
facilitate collaboration. These principles
supported solutions for contact tracing,
include designing for the user and revising and
health worker training, facility readiness,
improving upon existing solutions but also
stock management, and diagnostic and
extend to designing for scale and building for
test result tracking. Other groups like
sustainability.
eHealth Africa stood up call center
coordination centers in Sierra Leone and Next month, the World Health Organization is
mass messaging campaigns led by Viamo slated to release its global resolution on Digital
in the DRC. Health , which will offer guidance to health
officials around the world on the selection and
development of their own digital solutions.
As we’re responding to the COVID-19
This guidance will echo these principles of
pandemic, we have the benefit of working equity of care and sustainability while offering
with proven solutions from this existing a long-term roadmap for the emerging digital
library of tools. Expanding on existing ecosystem.
infrastructure and proven solutions will
The Africa CDC has just reported 5,287 new
help us save considerable time and lives.
cases on the continent. To respond effectively
to this rapidly moving pandemic, we have to
move quickly. Building on existing and proven
solutions will help us do this. But in this effort,
we cannot lose sight of our core principle to
serve all people, including those who are
hardest to reach.DIAGNOSIS & MANAGEMENT OF
COVID-19
Dr Rajen Morar (MBChB, FCP (SA), MMed FCCP
Head of Pulmonology at Charlotte Maxeke Academic Hospital
South Africa
SARS-CoV-2 is a novel coronavirus identified in late The chest x-ray may be normal or may demonstrate
2019 as the cause of COVID-19 (coronavirus disease bilateral, peripheral, patchy opacities and chest. CT
2019). On March 11, 2020, the World Health chest scan (not routine) shows bilateral ground glass
Organization (WHO) declared the world-wide outbreak opacities, crazy paving, and consolidation.
of COVID-19 a pandemic. It has turned our world Pleural effusions are rare (5-10%).
upside down.
The diagnosis is confirmed by nasopharyngeal swab for
SARS-CoV-2 is a single-stranded RNA virus, binds to SARS-CoV-2 reverse-transcriptase polymerase chain
the (angiotensin converting enzyme 2) ACE2 reaction testing. It is important to differentiate SARS-
receptor on type II pneumocytes, and spreads from CoV-2 from other circulating respiratory viruses
person to person via respiratory droplets and contact. particularly influenza, where the clinical picture may be
Other similar coronaviruses caused epidemics in 2002 similar. This may be significant as we approach winter
[Severe Acute Respiratory Syndrome Coronavirus and influenza season in South Africa. Co-infection has
(SARS-CoV)] and in 2012 [Middle East Respiratory also been reported.
Syndrome coronavirus (MERSCoV)]. The reported
incubation time is 3-12 days with a median duration of Infection control and isolation recommendations are
viral shedding of 20 days. The attack rate is about 30- evolving and should be performed according to
40%, the reproduction number (R0) is 2.68 with a case best known practices. Empiric antibiotics are
fatality rate (CFR) of between 1.5-12%. recommended for secondary bacterial infection.
Corticosteroids are not recommended unless for other
Patients may be asymptomatic, have mild cough to indications [e.g., asthma, COPD exacerbation, acute
fulminant respiratory failure. The commonest respiratory distress syndrome (ARDS)]. Oxygen
symptoms include, cough, fever, fatigue, dyspnoea, administration if patient is hypoxemic, early
anosmia, sore throat and gastrointestinal (nausea, intubation and avoid aerosolization of secretions. Use
vomiting, diarrhoea) symptoms. lung-protective ventilation strategies, prone and
paralyze as needed. Monitor for and treat myocarditis,
Laboratory abnormalities include leukopenia, cardiomyopathy and cardiogenic shock.
lymphopenia and thrombocytopenia, elevated urea and
creatinine, elevated transaminases, and total bilirubin.
Procalcitonin is normal or low with an elevated C-
reactive protein and ferritin, and elevated lactate
dehydrogenase.No specific coronavirus drugs or vaccines have proven
to be effective. ACE inhibitors and angiotensin receptor
blockers (ARBs) as treatments or risk factors for severity No specific
of disease is speculative.
coronavirus drugs
Clinical trials are investigating the efficacy of drugs such or vaccines have
as chloroquine or hydroxychloroquine, zinc,
azithromycin, remdesivir, lopinavir/ritonavir, ribavirin, proven to be
oseltamivir, tocilizumab, immunoglobulin, convalescent
effective.
plasma, and traditional Chinese medicine. Of interest is
the Bacillus Calmette-Guérin (BCG) vaccine, which may
confer some protective effect against coronaviruses.
Eighty percent of patients have mild symptoms, 15%
moderate, and 5% severe.
Most patients deteriorate gradually with a median of 8-9
days from symptom onset to ARDS. Pregnant women
and children have a better prognosis. Older age, co-
morbidities including diabetes, cardiovascular disease
including hypertension, and chronic lung disease,
higher admission sequential organ failure assessment
(SOFA) score and laboratory abnormalities such as
elevated D-dimer, ferritin and troponin have
been associated with worse outcomes.
Hand-washing, travel restrictions, contact tracing, social
and physical distancing, quarantine of suspected cases
and exposed individuals are recommended to slow the
rate of spread and to ‘flatten the curve’. The
COVID-19 pandemic, which is a major worldwide
public health emergency, poses a great threat to health,
social welfare and global economy. It is heartening to
see that COVID 19 has taught us respect for our
common humanity with health being the basis of wealth
as many nations go into ‘lockdown’.UPDATES FROM THE AFRICAN HEALTHCARE PORTAL
Case Study Discussion Room eLearning
We strive to ensure high levels of data Our dedicated eLearning platform
security in an age where cyber attacks are provides Healthcare professionals the
on the rise. opportunity to share content with other
professionals either for free or for a fee.
We encourage professionals to make use of
our free Case study discussion room which Your content is securely stored, and
features a private chat, document share, cannot be reproduced or used
white board and video conference tool. inappropriately.
Our Case study library provides a space to Call for proposals
share your experiences and learnings with
other professionals on the continent. We encourage professionals to contact us
Contributions from all topics within to host webinars, online courses, vlogs
Healthcare are welcome. and podcasts - thousands may learn from
you.
Upcoming edu initiatives:
1. Management of Ebola Virus Disease
Contact
2. Sterilizing N95 Masks: Do's & Dont's
3. Strengthening Maternal and Child care: Email:
Lessons from COVID-19
Sales@africanhealthcareportal.com
Facebook: @AHP4ESD
Twitter: @AHP4ESD
Web-app:
www.africanhealthcareportal.comYou can also read
