Connect with us
Advertisement

Covid-19 Response: Why Should a Financially Robust Debswana Cry Wolf?

Randlord Nicky

The great Roman Stoic philosopher, statesman, dramatist, and satirist Seneca once said, “Whatever we give to the wretched, we lend to our own fortune”. Are individuals or institutions of substance of our day heedful of this altruistic moral? Are their acts of benefaction no more than a PR stunt?

This content is locked

Login To Unlock The Content!

Continue Reading

Columns

Government Should Restrict State Lottery Participation To Citizens

30th June 2020

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.

This content is locked

Login To Unlock The Content!

Continue Reading

Columns

Moses was Joseph’s Grandson

30th June 2020

… and he was not encountered on a water course

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.

This content is locked

Login To Unlock The Content!

Continue Reading

Columns

The case against COVID-19 mass community testing

30th June 2020

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 anmorima@gmail.com

Continue Reading