Tolbert Nyenswah, who successfully led Liberia’s National Ebola Response in 2014-2016, as the Incident Manager, joined an International panel of experts at the Center for Global Development in Washington, D.C, on Thursday, February 13, 2020, to discuss the current Coronavirus epidemic in China, under the theme, “Battling Coronavirus: Is the World Ready?” The discussion focused on the U.S. and global preparedness of numerous countries’ with weaker health systems, to handle similar challenges as those occurring in Wuhan, China, the epicenter of the outbreak. The panel is to outline a mitigation-focused strategy, addressing preparedness in developing countries, while highlighting ‘what the world should be doing now to prepare for what may be coming.
According to a release from the National Public Health Institute of Liberia (NPHIL), Mr. Nyenswah spoke about the challenges faced by the Liberian health system during the 2014-2016 Ebola epidemic in West Africa and the lessons that could be applied to developing (low and middle-income) countries’ preparedness toward COVID-19. Reflecting on the Ebola experience, Nyenswah emphasized that weaker health systems in developing countries, lead to serious system wide challenges, a high burden of infectious diseases and significantly high maternal and child mortality, often compounded by socioeconomic disparities. Ebola devastated the health systems in Guinea, Liberia and Sierra Leone, the 3 most affected countries in the West African outbreak. The unprecedented nature of the outbreak led the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC) on August 8, 2014. Cumulatively, there were 28,610 Ebola cases of which, 11,308 people had died by March 29, 2016, when WHO declared that the Public Health Emergency of International Concern was over.
Nyenswah underscored the differences between COVID-19 and Ebola, noting that, COVID- 19 is a new strain of the family of coronaviruses similar to SARS – severe acute respiratory syndrome coronavirus (SARS-CoV), which was first recognized in China in November 2002. It caused a worldwide outbreak in 2002-2003 with 8098 probable cases, including 774 deaths according to the U.S Center for Disease Control and Prevention. Since 2004, there have been no known case of SARS infection reported anywhere in the World. MERS -Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first reported in Saudi Arabia in 2012. It has since caused illness in people from several other countries. Evidence shows that COVID-19 is a respiratory disease, transmitted mostly by droplets through the nose and mouth by coughing or sneezing. As we know it was first identified in Wuhan, Hubei Provinces in mainland, China. Transmission is possible through contact with surfaces (floor, tables, chairs). He said to date, 28 other countries in Asia, North America and Europe have been affected. On 14 February 2020, Africa confirmed its first case as the Minister of Health and Population of Egypt, Dr Hala Zayed, confirmed the first case of the coronavirus disease (COVID-19) in Egypt.
Signs and symptoms include fever, cough, and shortness of breath or symptoms similar to a very bad cold or flu. The incubation period time of exposure to presentation of symptoms range from 2 to 14 days, as seen in SARS and MERS, with the virus reportedly spreading from person-to-person. There is more to learn about the COVID-19, the global situation is evolving. Tolbert Nyenswah told the international gathering, that Ebola virus disease (EVD) is a deadly disease with occasional outbreaks that occur primarily on the African continent. EVD most commonly affects people and nonhuman primates (such as bats, monkeys, gorillas, and chimpanzees). It is caused by an infection with a group of viruses within the genus Ebolavirus. Typically, Ebola virus (species Zaire ebolavirus) is transmitted by blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen) of an infected person who is clinically ill or has died from EVD. Objects such as clothing, beddings, needles, and medical equipment contaminated with body fluids from an EVD infected whether alive or dead person who is sick with or has died from EVD. Its primary signs and symptoms often include some or several of the following: Fever, Aches and pains, such as severe headache, muscle and joint pain, and abdominal (stomach) pain, Weakness and fatigue, Gastrointestinal symptoms including diarrhea and vomiting, Abdominal (stomach) pain, Unexplained hemorrhaging, bleeding or bruising, Other symptoms may include red eyes, skin rash, and hiccups (late stage). Its Incubation period from exposure to appearance of signs or symptoms, ranges from 2 to 21 days, the average being 8 to 10 days.
He further emphasized the unprecedented nature of the 2014-2016 Ebola outbreak couple with societal impact, regional dimension, international spread, fear, desperation, confusion like the world is experiencing now with the COVID-19. He noted some of the challenges to be weaker health systems, occasion by protected civil war in Sierra Leone and Liberia, limited health care workers, cripple supply chain system, lack of capacity for isolation of confirmed cases, Lack of diagnostic capacity at the time of the outbreak spanning from 30-90days before test results were available for confirmed cases.
Mr. Nyenswah said since the West African Ebola outbreak in 2014, lessons learned showed, several developing countries have taken concrete steps. In Liberia, the National Public Health Institute of Liberia and other NPHIs on the African continent have been established with support from international donors (United States Government through the U.S Center for Disease Control and Prevention (CDC), USAID, through the Global Health Security Agenda and the National Institutes of health (NIH) for constantly working on Medical countermeasures for emerging and remerging infectious diseases. Additional capacities include the development of national action plans for health security, establishing of emergency operations centers and testing capacity for EVD, Lassa fever and other VHF diseases. While expressing deep concern about the lack of adequate capacity to treat critical cases of coronavirus, he said the good news is that many African countries are still screening passengers arriving at their ports of entry for Ebola. Countries that dealt with the Ebola outbreak still have the isolation facilities and expertise in controlling infectious diseases.
Also, Dr. Samuel Wai Johnson, Jr., a Professor of Economics at the Delaware State University said: “There is an ever pressing need to address the health emergency created by the new coronavirus, given the disruptive effects of the disease on global economic production”. Nyenswah commended the Africa Center for Disease Control and Prevention (Africa CDC) and its Director, Dr. John Nkengasong, for establishing the Africa Task Force for Novel Coronavirus (AFCOR), to oversee preparedness and response to the global COVID-19 outbreak, in February 2020, through the African Union and National Public Health Institutes (NPHIs) from African Union Member States. Activities are focused on training on laboratory diagnosis of COVID-19 for 15 African Union Member States; specimen transport and referral system; surveillance, air screening, isolation, provision of testing supplies for selected laboratories in Africa that have the capacity to test for coronaviruses; and the development of information materials on infection prevention.
Panelist Nyenswah proffers some recommendations on preparedness for developing countries toward the COVID-19. He advised countries to conduct simulation exercises, activate or reactivate IMS systems and EOCs to be on standby mood, screening at ports of entry, increase testing capacities, emphasis of diagnostic capacities, preposition of personal protective equipment/materials and training of rapid response teams. He cautions against taking people infected with COVID-19 in health care facilities that are not specialized to treat respiratory illness, noting this will jeopardize other patients and spread nosocomial infection (hospital-acquired infection. He called on rich nations to support developing countries to meet the challenges ahead of the evolving health crisis.
The Panel of Experts included Dr. Dan Hanfling, Vice President, on the technical staff, In-Q-Tel, Dr. Jennifer Nuzzo, Senior Scholar, The Johns Hopkins Center for Health Security, Dr. Prashant Yadav, Visiting Fellow, Center for Global Development at INSEAD and Moderated by Jeremy Kondyndyk, Senior Policy Fellow, Center for Global Development.
Tolbert Nyenswah is a Senior Research Associate in the department of International Health at the Johns Hopkins Bloomberg School of Public Health. Prior to joining John Hopkins’ faculty, Nyenswah served as founding Director General of the National Public Health Institute of Liberia 2017-2019; Deputy Minister of Health (Liberia) for Public Health Emergencies and Epidemic Control 2016-2017; Assistant Minister of Health & Social Welfare (Liberia) / Deputy Chief Medical Officer for Disease Prevention (2014-2016). In this role, he became the Incident Manager for the Liberia’s National Ebola Response, chaired the Incident Management System, managing a multinational team responding to the world’s largest unprecedented Ebola Outbreak (2014-2016). Nyenswah is also a member of the Global Health Index International Panel of Experts which assesses the overall health of nations globally based on a myriad of health indicators.