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Opinions of Monday, 8 June 2020

Columnist: Dr. John Acuaye-Awah

Coronavirus: Ghana's enigma

Is Ghana Out Of The Woods?

Long before the Coronavirus arrived in Africa, it was predicted by many health organizations that, most african countries, with their meager healthcare system, would face a disaster on such a scale that has never been seen in recent memory.

A lot of african countries are, clearly, ill-prepared because of poor infrastructure in the
healthcare delivery system. Also, these countries have been a pet to the so-called
globalization and dependent on imports for their survival. And a debilitating pandemic of
this nature, leading to closure of borders, would strangulate even further countries
whose survival is dependent on imported goods and services.

No matter what happens, after the wave of Covid-19 is contained, the whole continent
should wake up and reassess our healthcare systems and reliance on foreign goods
and services.

Ghana is a developing country and statistically has met all the criteria for a major
disaster. When the first few cases were announced, the country was sent into shock
and panic. The whole country, watching the carnage in Spain, was preparing for the
worst to arrive.

With this backdrop,Ghana’s citizenry largely praised the President’s leadership for his
timely intervention and willingly obeyed the measures put in place to contain the
situation. I am particularly impressed to see the law enforcement bodies at their best.

As the counts continued to rise in Ghana, there was continued panic and expectation of
the disaster that would overwhelm our meager healthcare system.
By far, the doom and gloom expected in Ghana have yet happened.

Is Ghana still waiting for the disaster to happen or should we say the storm has passed
over our head?

To answer these questions I have reviewed the statistical facts and tried to make sense
of it all.

Ghana is probably a good representation of a typical african country and the analogy
may be extrapolated to our african neighbours.

FACTS
Ghana recorded 4 cases of coronavirus March 4th 2020. On May 17 (9 weeks after) it
recorded 5,735 cases.
The United States recorded 291 cases March 12, 2020, On May 17 (9 weeks after) it
recorded 1,409,452 cases.
The United Kingdom recorded 27 cases February 3 2020. On May 17 (11 weeks after)
it recorded 236,715.
Spain recorded 10 cases February 26th. On May 17, 2020 (11 weeks) it recorded
230,183.
Australia recorded 847 cases March 20th. On May 22, 2020 (9 weeks) it recorded
6,801.

Covid-19 tests performed per million population as at May 17th, 2020 .
Ghana 5,165
USA 35,903
UK 38,040
Spain 64,977
Australia 45.91

How many tests performed per one confirmed case as at May 17th, 2020.
Ghana 13.63
USA 15.67
UK 19.43
Spain 39.23 (May 14)
Australia 2002.39

Death rate for Covid-19
Ghana 0.48%
USA 6.01%
UK 14.39%
Spain 11.99%
Australia 1.42%

Physicians per 10,000 population
Ghana 1
USA 25.7
UK 28.3
Spain 38.7
Australia 35

Hospital beds per 1,000 population
Ghana 0.9
USA 2.9
UK 2.8
Spain 3.0
Australia 3.8

Covid-19 infection velocity ( average number of cases developing per
week)

Ghana 636
USA 156,573
UK 21,517
Spain 20,924
Australia 661

Population
Ghana 31 M
USA 331 M
UK 67.9 M
Spain 46.75
Australia 25.5 M

Percentage of Population above 65 years
Ghana 2.9%
USA 16.2%
UK 18.7%
Spain 19.7%
Australia 15.9%


FACTS ANALYSIS
I have taken cognizance of the fact that sampling methods for Covid-19 tests in various countries may vary and this may slightly affect the published data. However, this is the only means available for analysis.

The incidence of coronavirus infection in Ghana appears to be linear and not
exponential as compared to the developed nations. This means the number of
people infected by one person is much less than any of the developed nations
selected.

Clearly, all the strict measures instituted by the government of Ghana
has largely contributed to this. The government proved a point that if you do not
move, the virus does not move and the battle front is at your step, to paraphrase
the message that echoes in the head of every Ghanaian citizen!
With regards to the test per million of population, Ghana has performed the least
compared to developed nations.

However, on the continent of Africa, Ghana has performed the most tests per million of population.

Ghana performed the fewest tests to find one case compared to the developed
nations. This means Ghana may have a higher prevalence of the coronavirus
infection, but statistically, not too different from the selected developed nations.

In consideration with section b above, should we have tested a bit more like the
advanced countries selected, we would have seen many more cases than
recorded.

Death from coronavirus infection in Ghana is amazingly very low. One death is
too many but Ghana’s rate is almost negligible by comparison.
Ghana has far fewer Doctors compared to the developed nations; UK has 28 doctors per 10,000 people and Ghana has one.

Ghana has the least hospital beds per 1,000 people; UK has about 3 per 1,000
and Ghana has one.

Ghana has the slowest velocity of infection compared to the selected developed
nations; again fewer people are infected by one person.

Ghana has a population of 31M compared to UK 67M. However, the velocity of
infection, taken into account the differences in population, is comparatively much
slower in Ghana.

Percentage to people above the vulnerable age of 65yrs in Ghana is the least.
2.9% in Ghana and 19.7% in Spain.

Summary
The Covid-19 is more widespread in Ghana than the numbers are showing and should
we have tested a lot more people, the case load would have been more alarming.
However, since the incidence of disease appears to be linear, the burden of disease on the meager healthcare system is very minimal.

There have been no reports of mysterious deaths in Ghana. This gives credence to the
Covid-19 death rate reported in Ghana. In this regard, Ghana has defied the ill-prepared healthcare system to weather the disease naturally. Fewer people are dying from the virus.

Perhaps, we can explain the low death rate by looking at the population pyramids.
Ghana is a young population and the percentage of 65 years and older is very tiny.
Comorbidity, which is a risk factor of disease severity and mortality, is usually seen in the age of 65 or older. Ghana does not have a whole lot of such a population.

Life expectancy in Ghana is about 65. We have already paid our toll of death due to our poor healthcare and lack of education in Primary Health Care. We die of preventable diseases before 65. We need not over-rejoice about the low Covid-19 death rate in Ghana.
Had we had a good healthcare system in Ghana, we would have had a lot more
at-risk groups and the death rate from Covid would have been much higher.

Nevertheless, there is a silver lining when we look at the mortality in the younger
population. Experience from other countries tell us that young people are not spared
from the wrath of the virus.

Clearly, this group is taking the virus in their stride and shaking it off like a common cold.

I believe that the factors that have contributed to less Covid-19 severity and mortality in Ghana include the following:

A resilient Ghanaian population probably from an ever-ready heightened immune
system. It is observed that when there is an out-break of the seasonal influenza in the temperate world, it is hardly noticed in Ghana. This is attributable to the rampant exposure to the readily available disease causing agents in our society that always put our immune system on alert.

The negligible geriatric population in Ghana has limited the people that would be seriously ill from the disease.

Strict early government measures on the backdrop of largely compliant Ghanaian
population rallying behind a good leadership.

Probably too, though I have no scientific proof, the virus may have lost its potency in the hot and humid country of Ghana.

So we can say, with some certainty, that the Covid-19 is not as deadly in Ghana as compared to other developed nations. The reason being multifactorial, we must continue to observe all the cautionary measures put in place by the government in order to continue enjoying these sentiments.

We have a wake up call to develop our healthcare system with emphasis on disease prevention than treatment. To do this we need more healthcare providers and doctors.

We have a wake up call to develop our industries to be self sufficient and less reliant on foreign goods and services.

References:
https://ourworldindata.org/coronavirus-testing
WHO WEBSITE
ECDC WEBSITE
CDC WEBSITE
STATISTA WEBSITE

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