Disclose all isolation centres – NDC team writes to government

The NDC technical team on Covid-19 has asked government to make public all COVID-19 isolation centres in the country.

According to the team, transparency in the management of patients helps to reduce misconceptions about the virus.

“Transparency in patient management is also key in reducing misconceptions about COVID19 and the stigmatization of its sufferers and survivors. We recommend to government the full disclosure of the locations of all isolation and treatment centers around the country, as well as their respective capacities. Greater public knowledge of these locations may boost care-seeking behaviour as prospective patients will be reassured of treatment near their homes and loved ones or, at least, in their region or district of residence,” the team wrote in their latest proposal to government on the pandemic.

They also reiterated their call for government to put in place measures for testing across the entire 16 regions of the country.

Below are details of the team’s proposal to government

1. Testing & Contact Tracing We take note of efforts made by government to scale up testing and contact tracing efforts as part of measures to identify and isolate persons who have contracted COVID-19. Concerns about the comprehensiveness of the strategy remain, and we list below related recommendations and those for the broader aims of COVID-19 testing.

1.1. There remains a lack of clarity on the definition of the tertiary contacts category employed in the enhanced contact tracing program. The current understanding is that these individuals are identified not because of their known interactions with secondary contacts, but rather by virtue of their coresidence in localities where index cases reside. It also remains unclear if this extends to primary and secondary contacts. This clarification would allow epidemiologists and statisticians around the nation to evaluate the practical utility of the definition for the efficient identification of cases and use of testing resources, and to assess its marginal benefits in ensuring comprehensivity of contact tracing.

1.2. While the volume of testing has increased, we continue to recommend the adoption of additional testing strategies to expand the scope of Ghana’s testing program. The enhanced contact tracing model that has been used over the duration of the lockdown is still fundamentally rooted in a clinical approach to testing, as it is premised on index cases identified in facilities. A complementary program of community testing structured around the epidemiology of risk factors – as is presently in use in South Africa – would cast a meaningfully wider net and allow for the identification of cases resulting from missing links in the index cases’ transmission chains.

1.3. We encourage government communicators to desist from over interpretation and extrapolation of the COVID-19 prevalence among the persons tested so far. Taking for granted the internal validity of the statistic, the narrow scope of the testing pool would appear to limit the generalization of the prevalence. This is because the use of an overtly clinical approach as the basis for the tracing and testing may have resulted in the construction of a convenience sample rather than a representative one . Under those circumstances, it would be an error of external validity to conflate the sample-specific prevalence as an estimate of the true population-wide prevalence of COVID-19.

1.4. We urge government to take immediate steps to establish testing and processing facilities in each of the 16 regions in order to increase daily national throughput and to decentralize the testing process as much as possible in the interest of speed and efficiency. As part of these efforts, we recommend the establishment of a dedicated testing program for frontline health workers that allows for rapid assessment in a channel that is not constrained by the bottlenecks and backlog of the existing testing sites and processing laboratories.

1.5. It is important that government begin to roll out a strategy for consistent mass testing and aggressive contact tracing as part of its planning for the easement of the restrictions on movement in the designated hotspots. This must be done concurrently with the development of a plan to: ? Procure and undertake antibody testing in clinical staff and the general population as part of efforts to understand the true scale of the outbreak in Ghana and the local dynamics of immunity to the virus after infection. ? Procure reliable rapid testing kits and operationalize their use as a complement to the RTPCR approach in order to increase access to COVID-19 testing and to boost the daily throughput as well. ? Engage ISO certified private laboratories in a strategic public-private program to increase national throughput as a means of scaling up testing by focusing on processing of voluntary tests or samples collected in the course of the contact tracing.

1. Community Impact Mitigation The scenes reported at food distribution points in Accra and Kumasi over the course of the lockdown have been alarming, and threaten to defeat the underlying point of the social distancing protocols that have occasioned their necessity. The congested cues for cooked food, and its distribution in limited and overcrowded spaces, makes them a potential hub for COVID-19 transmission. Residents of the communities in question are low income, live in very close quarters, and have low rates of healthcare utilization; a combination of factors that would make local transmission within them as efficient as it would be hard to detect with a clinical testing model. We recommend urgent action to prevent this risk from manifesting itself as reality.

2.1. There is a pressing need for a consolidated strategic plan for food distribution to vulnerable groups including logistics, verification and evaluation protocols to ensure adequate coverage of the target population and accountability. 2.2. We recommend the immediate cessation of the distribution of cooked food, as the modality of its distribution presents a high contact situation that is ideal for COVID-19 transmission.

The distribution of unprepared and nonperishable items is a preferable alternative because: ? It reduces the number of times persons must congregate to collect food, and reduces the number of members of a household that must be involved in the collection itself. This, in turn, reduces overall contacts during the lockdown period and opportunities for transmission. ? It allows households greater agency to manage their consumption and reduces wastage as a consequence of the inability to properly store excess cooked food. This has been a regular complaint by the target households, which we do not believe should be dismissed as “ingratitude”. ? Cooked food also presents a relatively higher risk of food poisoning or contamination if the food distribution chain is not properly managed and overseen.

2.3. Children in the most vulnerable and food insecure households (poorest of the poor) should also be targeted with nutrition supplements in order to stave off the risks of malnutrition and stunting.

2.4. The plight of head porters and other such economic migrants who are currently trapped in the lockdown areas without income or a guarantee of sustenance is a humanitarian crisis and a moral afront. We recommend the immediate development of an evacuation protocol for such persons. Such a protocol should involve double testing of candidates for evacuation, a mandatory pre-departure quarantine using empty facilities (e.g. at second cycle institutions, trade fair dome), and focused health education. These individuals may be leveraged as messengers to their communities on the risks and realities of COVID-19. The transportation logistics of this evacuation can take advantage of resources of the State Transport Corporation, the Ghana Armed Forces, and other state institutions. Organisations with capacity to aid this program should be actively encouraged to do so.