Though the fight has not yet been won, it is worth noting that Botswana has, so far, done well in its fight against COVID-19.
According to Government of Botswana’s website, as at 14th May 2020, 11495 tests had been performed and resulted from which 11471 tested negative; 24 were confirmed cases; there was 1 death; there was no new confirmed case and there were 17 recoveries.
This, in my view, is an epic achievement if regard is had to several factors which we discuss herein. But before that, we give a brief timeline of COVID-19 to put the matter in its proper perspective.
On 31st December 2019, Wuhan Municipal Health Commission, reported a cluster of cases of Pneumonia in Wuhan, Hubei Province, in China. On 4th January 2020, WHO reported, through social media, that there was a cluster of Pneumonia cases – with no deaths – in Wuhan, Hubei province.
On 12th January 2020, China publicly shared the genetic sequence of COVID-19. The following day, on 13th January 2020, a case of COVID-19 was confirmed in Thailand, the first recorded case outside of China.
On 30th January 2020, WHO declared the novel coronavirus outbreak (2019-nCoV) a Public Health Emergency of International Concern (PHEIC). On 11th March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic.
On 13th March 2020, the COVID-19 Solidarity Response Fund was launched to receive donations from private individuals, corporations and institutions.
Africa’s first COVID-19 case was recorded in Egypt on 14th February 2020. On 21st March 2020, the Government of Botswana declared COVID-19 a public health emergency and introduced a number of precautionary measures in response to the pandemic.
On 30th March 2020, the Minister of Health and Wellness, Dr. Lemogang Kwape, announced Botswana’s first three cases of COVID-19. According to Dr. Kwape, the three had travelled to Britain and Thailand.
The following day, on 31st March 2020, His Excellency the President, Dr. Mokgweetsi Eric Keabetswe Masisi, declared a State of Public Emergency (SoPE) to deal with (COVID-19) in terms of section 17 of the Constitution of Botswana.
On 2nd April 2020 at midnight, Botswana entered into a lockdown, which is still on, and will, hopefully, end on 20th May 2020. Firstly, Dr. Masisi has to be commended for timeously declaring COVID-19 a public health emergency, something which resulted in the introduction of precautionary measures in response to the pandemic as recommended by WHO.
Of course, one may question why he only made such declaration on 21st March 2020 when WHO had declared it as such as far back as 30th January 2020. In my view, the fact that Africa only recorded its first case, in Egypt, on 14th February 2020, as well as the fact that there was no confirmed case locally warranted the wait and see approach.
In my view, had the declaration been made too early, the lockdown would have been longer something which would have been detrimental because anecdotal evidence suggests that countries which enter into a lockdown to early run the risk of having to lift it at a time that can put the lives of its citizens at risk.
Dr. Masisi must also be commended for not using the SoPE to contravene the Rule of Law and violate human rights as some had feared. For instance, the Legislature and the Judiciary remained functional during the SoPE. Martial law was never applied; those who were charged of offences were taken to the courts, which continued operational.
There have been few reported cases of brutality by members of the armed forces who enforced the lockdown, and when such allegations arose the President spoke strongly against them.
Parliament too remained functional. In fact, all the Emergency Powers Regulations which the President issued were passed by Parliament after intense debates which were televised for all to see. Secondly, Botswana must be commended for containing the virus and saving lives. You will be aware that since the first three cases were confirmed in Botswana on 30th March 2020, we have since had an addition of only 21 cases.
This, in my view, is an epic achievement considering the fact that we share a border with South Africa which is a COVID-19 epicentre in Africa. Not only that, we also share a porous border with Zimbabwe, a country with a multifunctional health system.
Further, since the first confirmed cases, we have had only 1 death and 17 recoveries. Of course, loss of life, even for one person, is regrettable, but the fact that out of 24 confirmed cases, only 1 person has died is quite commendable. This can only be because our screening, testing, quarantining and management system was effective.
Also commendable is the fact that, with the meagre resources at our disposal, we have been able to test 11495 people. Thirdly, government’s messaging with respect to social distancing and hygiene protocols was clear and well-articulated from the beginning.
Commendably, the messages were communicated in various indigenous languages through Botswana Television and Radio Botswana. Not only that. Sign language interpretation was also used to cater for those with hearing disabilities. Hopefully, in future a Braille will be considered for those with both hearing and visual impairments.
Fourth, government established a COVID-19 Relief Fund and put up an investment of Two Billion Pula as seed capital, something which saw foreign governments, banks, companies, parastatals and individuals making donations and contributions to help alleviate the effects of COVID-19 on our people.
To allay the fears that the money in the Fund may be misappropriated, government has made an undertaking that it shall ensure that at the end of the COVID-19 pandemic the Fund will be audited by Independent Auditors.
Fifth, food relief. Government assessed Batswana to identify those who are in distress after which those in need would be given food hampers. It ought to be stated that there have been several complaints that in some instances it took too long to conduct assessments and to distribute the food hampers.
There have also been complaints that even when the hampers were delivered, they were short and had some rotten items. There is no doubt that some of these problems were occasioned by the fact that we do not have enough Social Welfare Officers. Shortage of transport also contributed. That notwithstanding, anecdotal evidence suggests that majority of our people received and continue to receive food hampers.
Sixth, employee protection. When the SoPE and lockdown were announced, there were fears that many employees would lose their jobs through unlawful retrenchments and dismissals.
Government must be commended because it avoided, or at least deferred, this by promulgating Regulations that prohibited the retrenchment and dismissal of employees during the SoPE. It, however, ought to be stated that some employees were retrenched and/or dismissed because it took some time before the Regulations were amended to that effect.
To cater for the companies that could not be able to continue operating because of the financial constraints occasioned by the lockdown, the Regulations permit company closure during the SoPE.
In my view, the Regulations should have also addressed such issues as forced paid leave; forced unpaid leave; reduction of salaries, etc. because they remain a source of conflict between employers and employees and will, no doubt, burden the courts in due course.
Seventh, assistance for businesses. Realising that businesses’ cashflow will be affected by the lockdown, government introduced a wage subsidy to subsidise eligible business in the payment of wages. Also, in an effort to give businesses some cash-flow relief, Government guaranteed loans by commercial banks to businesses affected by COVID-19.
Government also gave eligible businesses affected by COVID-19 access to credit to support ongoing operations in conditions where credit became more difficult to obtain. Government also gave tax concessions to businesses in eligible sectors.
Government also made an undertaking that institutions will pay Government Purchase Orders (GPOs) within five (5) days and parastatals will pay within 24 hours. Government also made an undertaking that it will pay all outstanding arrears for invoices within two (2) weeks and extended the validity period for GPOs. It also undertook to expedite VAT refunds to businesses to assist with cash flow.
The private sector also came to the party. In the financial services industry, Banks agreed to offer restructuring of loan facilities, including owner-occupied residential property mortgages and motor vehicle loans. Commercial banks offered a payment holiday for three (3) months with the option to extend to six (6) months to the affected sectors.
Banks also restructured and rescheduled regular payment obligations including life insurance premium payment, retirement fund contributions and loan instalments for at least three months. Most importantly, Batswana have to be commended for respecting the lockdown and adhering to the social distancing and hygiene protocols for if they had not done so we would have had more infections and deaths.
Our Nurses, Doctors, Social Welfare Officers, the Police and soldiers who were at the forefront of the battle deserve special commendation. Of course, we could have done better in such areas as assessments and delivery of food hampers; expeditious allocation of travel permits and establishment of a rent subsidy, but, on the whole, we did well, especially considering the size of our economy and the fact that we have never faced such a devastating pandemic.
But, the war is not over. As we move towards the lifting of the lockdown on 21st May 2020 as planned, two issues remain of concern to me. The first is the issuance of green permits which will be required for travel across zones from the 21st May 2020.
In my view, the Regulations must be amended to include, among essential travel, travel for medical reasons, travel to be with family and any other travel which the Issuing Officer may, in his or her own discretion, deem fit.
The second is the development of a COVID-19 Economic Stimulus Programme (ESP). My prayer is that when the COVID-19 ESP is developed, priority should be given to sustainable programmes as opposed to short term projects designed to gain quick political expediency as was the case in 2016.
*Ndulamo Anthony Morima, LLM(NWU); LLB(UNISA); DSE(UB); CoP (BAC); CoP (IISA) is the proprietor of Morima Attorneys. He can be contacted at 71410352 or email@example.com
The announcement on June 5 that Botswana finally had a national lottery was received with a fair amount of fanfare. There was no frenzied fist pumping or some such joyous acclamation or ululation but the mood of anticipatory excitement was palpable, more so on social media.
The euphoria, albeit a muted one, is understandable: we have at long last come to the party too, when many of our fellow African countries have had state lotteries for decades now. Zambia’s, for example, has been in existence since the early 70s. As the all-too-familiar but counter-productive adage goes, there’s no hurry in Botswana, with some people adding the rather hollow and vainglorious boast, “We are very rich”, which certainly is a side-splitting stretch of the truth.
Exactly how did Joseph (Yuya to the Egyptians) look like, General Atiku? The answer is not a difficult one as his well-preserved mummy, along with that of his wife Tuya, was found in a tomb of the Valley of the Kings in Egypt in 1905.
He does not remotely look like the Egyptians of the day, General, who were Negroid, but comes across as a white Jew. One description characterises him thus: “He was a person of commanding presence, whose powerful character showed itself in his face.
There is a school of thought which holds the view that mass community testing is a necessity if we are to win the war against the COVID-19 pandemic. Another holds the view that targeted testing is sufficient. I subscribe to the latter view for reasons I shall discuss herein.
First is the issue of the cost of the tests as opposed to their value. Unfortunately, I am not aware of the cost per test in Botswana. I shall use the case of South Africa for two reasons.
Firstly, at the beginning of the pandemic, our samples were taken there for testing. Secondly, though the Botswana Pula is stronger than the South African Rand, the cost of the COVID-19 test is unlikely to vary much because of the proximity of the two countries.
According to Dr. Nathi Mdladla, Associate Professor and Head of Intensive Care Unit (ICU) at Sefako Makgatho University, the cost of a COVID-19 test in South Africa per capita is ZAR 1 200.00. This is equivalent to BWP 811.63.
To put the issue of cost into perspective, we need to consider Botswana’s COVID-19 statistics. As at 23rd June 2020, Botswana had 33919 tests performed and resulted; 33830 negative cases; 89 confirmed cases; 10 new confirmed cases; 1 death and 25 recoveries.
If we use the amount of BWP 811.63 per test, it means we spent BWP 27, 529,677.97 on tests out of which there were only 89 confirmed cases and the rest were negative. From these 89 confirmed cases, only 1 died.
If we had been conducting mass community testing as some people suggest, we could have tested, say, 120,000 people by now at a staggering cost of BWP 97, 395,600.00.
According to Dr. Mdladla, when embarking on a medical test of any sort regard must be had to, inter alia, the indication of the test, that is is there any value derived from testing? Here, the question is: are you testing for a particular value or you are testing for the sake of testing?
It is common cause that COVID-19 neither has a vaccine nor a cure. If you take HIV/AIDS for instance, though it has no cure, it has treatment in the form of Anti-Retroviral (ARVs) drugs.
So, if there were to be mass community testing for HIV/AIDS, for instance, one of the values of such tests would be to enrol those who test positive on ARV treatment.
The fact is, due to resource constraints, the hundreds or thousands who may test positive for COVID-19 from mass community testing cannot even all be put in quarantine or isolation even if they are symptomatic. No country can have such capacity.
In my view, the only benefit that can be derived from mass community testing is awareness of the prevalence of the pandemic, and perhaps the most affected areas. The question is: what further value can be derived from that?
Proponents of mass community testing argue that this information is useful for the country to decide on its allocation of resources for procurement of ventilators, PPE equipment and hospital beds.
In my view, a country does not need to spend millions in mass community testing for such a purpose. The same result can be achieved through scenario planning and modelling, something which all countries have done or ought to have done.
In my view, instead of spending millions in mass community testing, the country should assume the worst-case scenario and use such money to procure ventilators, PPE equipment and hospital beds. In any case, even if the worst case scenario does not materialise, such resources can be used for future medical eventualities.
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is accuracy of a test . That is, the test must have a high specificity and high sensitivity. It must have very low false negatives and low false positives.
In early April, the President, Vice President, some cabinet ministers, Members of Parliament and some journalists were put in quarantine following a case involving a nurse who had contact with them, which some argue may have been a false positive.
About one week ago, the Greater Gaborone COVID-19 zone was put on lock down because of false positive results at a private hospital.
In my view, given the possible false COVID-19 results, it would not be prudent to conduct mass community testing. Imagine if the tests return thousands of false positives!
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is that the test must be meaningful for wide-spread use, for instance, if a cure exists and where knowing the status has impact on disease/population management then the test is useful.
We have already argued that since COVID-19 has no cure, mass community testing would be of little value, if any. Dr. Mdladla argues that knowing that one’s status is positive does not change anything for the majority of patients who are not sick as the disease is self-limiting, but it is useful in those presenting with moderate to severe symptoms.
He also argues that even if one tests negative there is a possibility that this could be wrong and one need not drop their guard. In his view, therefore, it is better to assume that everyone is positive and to test only those who are symptomatic for focused management. I agree.
He posits the question: if 80% of the population has mild disease that does not require admission, what is the value of knowing that people are positive when they can’t be treated, especially in the face of high false negatives?
In his view, it would be cost effective to assume that everyone is positive and continue practices aimed at limiting the spread of the virus. I agree. This is where our resources should go to, not to mass community testing.
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is that they must be cheap and easy to perform and interpret.
In my view, if a single COVID-19 test can cost about BWP 811.63, it is not cheap. Some people earn that much as a monthly salary which takes care of an entire household. The fact that the test is so costly suggests that it is not easy to perform and interpret.
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is that they should require minimal expertise in the remote population settings.
Clearly, considering the cost of a COVID-19 test, and the fact that the tests can only be conducted by experts using specialised equipment, it can be safely concluded that the test requires high expertise, making it difficult to conduct in remote population settings.
It is common cause that Botswana’s population is mainly based in rural and remote arears, posing a challenge for mass community testing if it were ever to be government policy.
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is that they should be less invasive, giving an example of a pregnancy test which one can conduct on their own. It appears to me that the COVID-19 test fails this test since it must be conducted by an expert.
The other consideration which Dr. Mdladla says should be taken into account when conducting medical tests is that they should entail short processing time to allow an appropriate intervention in the shortest time.
It appears to me that the COVID-19 test passes this test since the results can be available within 48 hours though a second test must be made about two days apart to confirm the initial result.
In view of the aforegoing, I conclude that government of Botswana’s decision to conduct targeted COVID-19 testing as opposed to mass community testing is well advised.
*Ndulamo Anthony Morima, LLM(NWU); LLB(UNISA); DSE(UB); CoP (BAC); CoP (IISA) is the proprietor of Morima Attorneys. He can be contacted at 71410352 or firstname.lastname@example.org