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The COVID-19 Task Force should beware of knee jerk lockdowns!

When one’s nation is faced with a pandemic of such proportions as COVID-19, one has to be as supportive as possible to all efforts geared towards fighting such an enemy.

This does not, however, mean that where there are shortfalls such should not be brought to the fore. Recently, I wrote an article through which I argued that though the war against COVID-19 has not yet been won, Botswana should be commended for the fight it has thus far waged against COVID-19.

Among the successes I stated were the  timely declaration of COVID-19 as a public health emergency; the timely declaration of a national lockdown; the establishment of the COVID-19 Solidarity Response Fund; the establishment of such relief measures as food hampers, wage subsidies, tax deferment, etc.

Perhaps most importantly, Botswana has managed to contain the pandemic, having very few local transmissions, high recoveries and only one death to date.

As at 17th June 2020, after about seven months since the COVID-19 outbreak, Botswana had 79 confirmed cases; 49 transferred out; 25 recoveries; 4 active cases and one death. This is indeed commendable for a country of such humble means as ours.

After the said article, I feared that I may have blown the trumpet too soon when it appeared we had no clear and deliberate strategy to deal with the risk that was posed by those coming into the country or transiting through the country, especially truck drivers mostly from South Africa.

Following a reported stand-off between some truck drivers and our officials at our borders, and threats that the truck drivers would stop any truck from entering into Botswana, there were fears that we would run short of food, fuel and other goods because we get most of our supplies from South Africa.

Reportedly, the stand-off was because the truck-drivers were aggrieved by the sanitary conditions at the border, the long wait while awaiting the COVID-19 results, and the fact that once they had gained entry into the country they were escorted by the Police and not allowed to stop and rest until they had transited the country.

However, once again the COVID-19 Task Force came to the party, and the stand-off was resolved speedily and amicably.

Following this success, the country lifted its lockdown on 21st May 2020 after it ran since 2nd April 2020. It is worth noting that prior to the national lockdown, the people had, on 31st May 2020, been given notice of the impending lockdown.

Also, though the national lockdown was later extended to 21st May 2020, it was initially scheduled to end on 31st April 2020, allowing people to make plans.

As a result of the two-day notice and the definite time frame given for the national lockdown, though many Batswana were aggrieved by the national lockdown and the State of Public Emergency (SoPE), they were somewhat prepared for the national lockdown since they had occasion to stock pile on such essentials as food.

Companies and businesses were able to make arrangements with respect to continuing operations at home, albeit in a limited manner. For instance, some took such equipment as computers and printers to their homes for business continuity.

Of course, when the national lockdown ended on 21st May 2020 many rejoiced and thought the worst was over. Such celebration was nearly short lived when following reports of possible infections in Mogoditshane, there was fear of a lockdown, at least for the Greater Gaborone COVID-19 zone. But that was not to be.

Then came Friday, 12th June 2020, 8:30 pm, when, without notice, a lockdown was declared for the Greater Gaborone COVID-19 zone, reportedly because there were cases detected by a private hospital in Gaborone.

Unlike the national lockdown, the Greater Gaborone COVID-19 zone lock down was done without notice, late at night and for an indefinite period of time. It was to effect at 12 midnight, only three hours thirty minutes from the time of the announcement.

People had no time to prepare themselves by buying such necessities as food and medication in case the lock down lasted longer. Farmers, for instance, had no time to buy medication for their livestock; buy food for their herd boys or buy oil and lubricants for their boreholes.

Businesses had no time to make arrangements for working at home. Unlike with the national lockdown, they had not taken any equipment home; they had not made any arrangements with their employees.

On Monday, 15th June 2020, again at 8:30 pm, after two days of emotional stress and anxiety, the COVID-19 Task Force announced that the Greater Gaborone COVID-19 zone lock down will be lifted at 12 midnight that very day.

Suddenly, people had to start preparing themselves to go back to work the following day. The few business people who had managed to take some equipment home could not take it back to the office until after 12 midnight.

Those in the food and catering industry had no time to buy the ingredients they need to prepare meals for the following day. To them, that the lockdown was lifted that night was of no consequence because they would still lose the next day’s business in any case.

Remember, these had also suffered a loss on 12th June when the Greater Gaborone COVID-19 zone lock down was announced late at night because some of them had already prepared meals for sale for the following day and they could not sell them to anyone because of the lockdown.

Granted, people were aggrieved by the short notice as well as the fact that the lockdown was for an indefinite period of time, but they became even more aggrieved when they were informed that the cases that necessitated the lock down were probable cases.

As if this was not enough, a day or two later, the COVID-19 Task Force announced that a second test for the cases that had necessitated the Greater Gaborone COVID-19 zone lock down  returned a negative result.

In its defence, the COVID-19 Task Force argued that it would rather have erred on the side of caution, arguing that the lockdown was necessary since some of the contacts for the probable cases had left the hospital, with some having left the Greater Gaborone COVID-19 zone.

But when the national lockdown was declared on 2nd April, we were informed that that was to allow the health sector to enhance its preparedness, for instance through procuring ventilators, PPE and increasing hospital beds.

It was the people’s understanding that the national lockdown was lifted because such readiness had been attained, at least to a large measure. In fact, the COVID-19 Task Force never took the country into its confidence regarding the exact extent of the country’s preparedness. They only mentioned, in passing, that we have not been able to procure all we need because of global demand.

Of course, the COVID-19 Task Force warned us that depending on the extent of the pandemic, a lockdown, either nationally or zonally, remains an option.

But people did not think that anytime there are reported new cases the country would revert to a lockdown. I think what the COVID-19 Task Force failed to do was to tell Batswana the criteria it would use (e.g. the number of new cases) to decide on whether or not to invoke a lockdown.

It is needless to state that COVID-19 is yet to remain among us; that we will continue to have new cases, even deaths. What we need, as a country, is a clear plan known by our people of how we will respond in the face of new cases.

Otherwise, our people will always live in the fear that every time new cases are detected there may be a lockdown. This cannot be good for our people’s wellbeing, nor can it be good for our economy.

There is no doubt that saving our people’s lives through prevention, detection and isolation should be everyone’s priority. Yet, these people need food, clothing, shelter, education, etc, none of which is assured if our economy collapses because of such knee jerk reactions as ill-timed and disproportionate interventions.

This is all the more the reason why Economists should be well represented and listed to in the COVID-19 Task Force lest we give disproportionate attention to the health argument at the expense of the economic argument, for instance.

One last thing, while we should, no doubt, learn from the lessons of fighting the cattle lung disease that nearly decimated our cattle herd, we should not wholly use, in people, the measures we use in animals.

We should, as we declare lock downs and set restrictions, leave room for human decision making and intuition, things that are lacking in animals. At the end of the day, COVID-19 will be defeated not only because of government interventions, but by the choices people make as they learn to live with COVID-19.

*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

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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.

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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.

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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

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