Africa has the highest global mortality rate among critically ill COVID-19 patients despite having the world’s lowest COVID-19 infections and deaths overall, a recent study published by the Lancet found. Shortage of critical care resources and their underuse are some of the contributing factors. Dr Christian Owoo, a Senior Lecturer in the Department of Anaesthesia, University of Ghana Medical School and a Consultant Anaesthetist/Intensivist and Head of Intensive Care Unit at Korle Bu Teaching Hospital in Accra, discusses ways to prevent severe COVID-19 illness and avert a surge in deaths.
What are the dangers should hospitals be overrun by COVID-19 patients?
If hospitals in Africa are overrun by COVID-19 patients, most probably, there will be an exponential rise is rate of infection (patients, health workers and community), severe/critical COVID-19 cases and deaths. Hospitals will be overwhelmed as a result adversely affecting the management of non-COVID-19 patients especially, those with chronic medical conditions, scheduled surgeries, medical and surgical emergencies and critical diseases resulting in collateral excess non-COVID-19 related morbidities and mortalities.
What are the lessons from previous COVID-19 surges and handling severe illness?
We have learnt lessons about the gaps in our health systems, the interventions that have been shown to significantly minimized severe/critical diseases and mortality, as well as interventions that do not work or are even harmful.
We have also learnt that the best outcomes from treating severe/critical cases comes from early identification of patients at risk, preventions of progression to severe disease and early aggressive treatment of severe cases before the onset of complications and organ dysfunction. These interventions include early emergency resuscitation and stabilization; appropriate and early administration of oxygen therapy and anticoagulation; appropriate use of corticosteroids and antimicrobials; management of comorbidities; nutritional, physical and psychological therapies. This requires a lot of coordination and commitment of resources, most of which are now significantly depleted, fatigued or non-existent after the previous surges. There is also the need for multi-sectorial and interdisciplinary approach to health care.
The impact of the pandemic has not been restricted to only COVID-19 related diseases but has resulted in significant disruption of care and excess morbidity and mortality among patients requiring emergency and critical care for non-COVID-19 related diseases as well as increased risk of complicating the course of hospitalization and management of other diseases Essential critical human resources, infrastructure, equipment, medications, logistics and funding has been repurposed to respond to COVID-19 at the expense of other diseases and health programmes, eroding most of the gains already made in these other critical health issues.
How can countries better cope with a huge rise in severe COVID-19 cases?
The best way for countries to better handle a huge rise in severe COVID-19 cases is by aggressively preventing COVID-19 infections by continuing to strictly enforce the protocols aimed to minimizing importation and community spread of the virus (hand hygiene, mask wearing, social/physical distancing, improved detection of infection, isolation and treatment), while rapidly scaling up vaccination rollouts.
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Other direct interventions at better handling potential severe COVID-19 surges should include monitoring and evaluation of interventions in previous surges, especially in coordination and management of severe/critical diseases to uncover gaps at different levels and pillars of the health system.
Early mobilization of resources as well as efficient stock management to cover both the potential COVID-19-related surge in severe diseases and the resultant surge in non-COVID-19 related critical diseases is also crucial. A rapid expansion of critical care capacity by increased recruitment and repurposing of health care workers and training in at least basic essential critical care management is also needed.
Equally important is the expansion of medical oxygen supply and the oxygen therapy capacity of health workers, including the availability of oxygen delivery devices and resuscitation equipment at all levels of the health system. Strengthening coordination and collaboration between health-related agencies and other relevant sectors and between countries and international agencies is also pivotal.
I believe that the COVID-19 pandemic has presented us with enough justification and opportunity to now invest sustainably in building the capacity for acute and critical care service in African countries. This is crucial to the delivery of quality health care to our populations both for communicable and noncommunicable diseases.
Should African countries continue to implement these preventive and management protocols and are efficient in our vaccination programmes, we stand a very good chance of not only averting a further surge in severe COVID-19 but also sooner than later breaking the recurrent circuit of this pandemic and getting back our liberty and our way of life.
SOURCE: World Health Organization (WHO), Ghana