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Opinions of Thursday, 23 April 2020

Columnist: Dr. Josh Bamfo

Why a proper comparative analysis tends to support the basis for lifting the lockdown in Ghana

Police and military are to ensure that the public observe the lockdown rules Police and military are to ensure that the public observe the lockdown rules

The lifting of Ghana’s partial lockdown as one of the containment measures to combat the spread of COVID-19 has led to mixed reactions from the public. The reactions aren’t surprising given the general anxiety and fear associated with the uncertainties relating to the potential adverse impact of the disease on both public health and the economy, especially the poor.

This article seeks to perform a high-level comparative analysis with countries that are more comparable to Ghana with respect to relevant factors that affect the success/failure in containing the disease to help ascertain whether the Government’s basis for lifting the partial lockdown is reasonable and appropriate. We perform this analysis by answering the following pertinent questions relating to the topic:

Q1 Does the gradual easing of restrictive measures mean that a Government has chosen management of the adverse impact of COVID on the economy over public health?

This is one of the fundamental sources of confusion that tends to lead to erroneous inferences or conclusions. When the President of Ghana succinctly said that clear priority will be given to saving lives over saving livelihoods (or the economy) because we don’t know how to bring lives back but we know how to resuscitate an economy, it didn’t mean that he will focus exclusively on one and be oblivious of the other.

That’s far from it! What every Government is seeking to achieve is to first contain (not eradicate) the spread of the disease and then manage the significant adverse impact of the containment measures on the economy, especially the needy. I call the first objective relating to containment of the spread, the necessary condition; and the second objective relating to the management of the adverse impact on the economy, the sufficient condition. Thus, any combination of containment measures such as banning international flights, banning large social gatherings and lockdowns, like a good concoction, should strive to determine a decent or better still optimal balance in achieving both objectives or conditions!

For example, as noted by UN, for some developing or poor countries that have already fragile economies, the adverse economic implications of the containment measures could result in famine (hunger and starvation) of biblical proportions that could be worse than the disease itself! See link to the CNN article on this:

Thus, it is absurd to hear some people blame the Government of choosing the economy over people’s lives because of the gradual relaxation of the restrictions. Rather, the appropriate question should be whether we’ve maintained the balance we so desperately seek or it has tilted a bit towards one objective than the other.

Q2 Which countries should we be comparing our COVID experience and projections with?

For most Ghanaians, our source of international news are CNN, BBC, Sky TV and to a lesser extent Al Jazeera. Unfortunately, most of the coverage on COVID from these media tend to focus on COVID developments in Advanced Western Countries such as USA, UK, Italy, Spain, France and Germany. As such, the reference point for most Ghanaians engaged in this important discourse are these Advanced Western Countries that have struggled with the containment of the disease. It begs the simple question; are they our best benchmarks to enable us make more reasonable and reliable inferences or conclusions? In my view, the answer is NO, because of the following reasons:

a) The Temperature and Humidity reason

It is generally agreed that the virus thrives better in cold and dry temperatures (common during winter for Temperate Countries) than in hot and humid temperatures (common for Tropical Countries). Ghana’s COVID experience, as a tropical country (closer to the equator), should be compared more to other tropical countries, especially the Southern Asian countries that experienced COVID way before Europe and USA to enable us to make more informed decisions. I focused less on Tropical American countries such as the Caribbean countries and the Northern countries of South America because they registered their first cases of COVID relatively late.

See link to an article on BBC that shows graphs of dates that countries across the world has their first cases of COVID and the containment measures employed:

To perform a high-level analysis, I selected a number of Tropical Southern Asian countries - Cambodia, Indonesia, Laos, Malaysia, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. According to the attached graph, because of their proximity to China, most of these Asian countries experienced their first COVID cases in January, way before the Advanced Western countries.

However, irrespective of an average population size of over 94 Million, the average COVID cases for the 10 countries as of 22 April, 2020 was just 3,663. Pakistan has the highest of 9,749 cases and Laos has the lowest of 19 cases. The average number of COVID related deaths are 160 and the average number of critical cases are 19. These numbers, for countries that are into about 3 months of their respective COVID journey, are more comparable to what we are seeing in Africa and for that matter Ghana now, and should be more helpful with our projections, all factors remaining the same.

For example, we can analyze the results of the worst-performing country, Indonesia, with 50,370 tests resulting in 7,418 positive cases (positive incidence rate of 14.7%); 635 deaths (fatality rate of 8.6%); critical cases of 0 (morbidity rate of 0%) and recovered cases of 913 (12.3%). That is significantly better than the results we are seeing in the averages for UK, USA, Italy, France, Spain and Germany. Obviously, Ghana’s current results are better than those of Indonesia, albeit being in a relatively early phase of its Covid19 journey. But more importantly, it gives me confidence that our trajectory could even be better than Indonesia when we get to our 3rd month if we continue to implement our containment measures effectively.

b) Quickness of Government Response

In addition to our relatively favourable temperatures in slowing down the rate of spread of the disease compared to the Advanced Western countries, Ghana and other African countries had the advantage of learning from the experiences of both the Eastern Asian countries and the Western Advanced countries to quickly implement containment measures before they registered significant numbers of COVID cases.

That was not the case for the Western Advanced countries that we are used to comparing our COVID experience and projections to. Trump’s reactions to COVID warnings in January and February are well chronicled. We all watched well-attended football games in Italy, Spain, UK and Germany at periods when they were already recording significant COVID cases whiles not testing enough.

However, for these 10 Tropical Asian countries, as well as other Temperate Asian countries such as Taiwan, Hong Kong and Japan, because of their prior experience with the SARS virus epidemic in the early 2000s, the Governments responded quickly in implementing containment measures such as bans of international flights from China, strict bans of large social gatherings, appropriate personal hygiene protocols and in some cases lockdowns.

As a result, Ghana’s case should once again be more comparable to those of the Asian countries than the UK, USA, France, Italy, Spain and Germany cases that we watch more frequently on CNN and BBC.

Q3 Are Lockdowns Absolutely Necessary to Contain COVID-19 Spread?

There are a number of containment measures that Governments across the globe have employed to curb the spread of the disease. As World Health Organization (WHO) has stressed, there is no one-size-fits-all approach to combating COVID. Countries need to consider their peculiar characteristics and challenges in determining a suitable approach.

However, there are some generally accepted containment measures that most countries have employed with varying success depending on the timeliness and effectiveness of implementation.

First, Ghana, along with most countries have banned international travels and continue to monitor their borders to prevent imported COVID cases. This approach is common across Asia and the Western countries, and is effective in achieving the stated objective.

Second, Ghana and most countries have banned large social gatherings to help ensure proper social distancing. For example most schools remain closed and if in session, teachings are conducted virtually. Same can be said for sports, religious gatherings etc. This measure has been effectively implemented by most countries to achieve appropriate social distancing and Ghana continues to have it in place.

Third, appropriate personal hygiene protocols such as washing of hands as well as wearing masks are highly encouraged by most jurisdictions, including Ghana.

Fourth, Ghana’s strategy of ramping up testing significantly just before commencing its partial lockdowns in Accra and Kumasi and their environs, has proven to bring much success in Asian countries such as South Korea ( 583,971 tests) and Vietnam (206,254). The key is not just the large number of tests, but how quickly you implement this strategy to identify cases early, especially asymptomatic cases, quarantine them to stop them from spreading the disease and treat them early to help curb the number of critical cases. For countries like South Korea, Taiwan (58,003) Hong Kong (131,786) and Japan (130,587), that did not implement lockdown measures, significant testing along with the effective implementation of the other measures were key to their success with the containment of the disease.

Finally, a number of Asian, European, African and American countries have at some point implemented some form of lockdown that restricts the movement of individuals, with most of them still being place. Lockdowns are generally viewed as the most extreme form of containment measure. It has the ability to grind economic activities of the city under lockdown or the nation under lockdown to a halt. Thus. a number of countries such as South Korea, Taiwan, Hong Kong and Japan in Asia; Sweden and Iceland in Europe; and Uruguay and Mexico decided against implementing lockdowns but focus on other containment measures. Interestingly, most of these countries have been relatively successful in containing the spread of the virus.

This proves that although partial and full lockdowns might be necessary containment measures, especially when the spread of the disease is getting out of hand, it is not absolutely necessary if a country implements the other measures timely and effectively.

Concluding Remarks

From the above analysis, it is clear that considering that Ghana is a tropical country with year-round high temperatures and high humidity for the most part of the year, was quick to implement effective containment measures, ramped up testing early to proactively identify positive cases (especially asymptomatic carriers) to quarantine and treat them, and still has other less extreme containment measures in place such as ban on large social gatherings, it is reasonable to infer that our Covid-19 trajectory will be more similar to the success stories of the more comparable Tropical Asian countries than the experiences of the Advanced Western Countries such as US, UK, Italy, Spain and France.

To help achieve the much-needed balance of containment of the spread and effective management of the adverse impact of containment measures on the economy, especially the poor, countries such as Vietnam have been able to achieve that optimal balance by gradually easing their restrictions by lifting their partial lockdown after less than a month. Even more European countries with lesser success such as Austria, Belgium, Czech, Denmark and Germany have started to gradually relax some of the containment measures, especially the lockdowns.

For Ghana, considering the ineffectiveness of the lockdown in poor communities where people rushed for food being distributed without practicing proper social distancing as well as the associated economic hardships being faced by the poor, the lifting of the partial lockdown appears reasonable to achieve the balance between the two stated objectives.

However, to ensure that we continue to achieve the dual objectives of saving lives and managing livelihoods, Government should continue to effectively enforce appropriate social distancing at the markets, by commercial drivers, and other public places; Businesses should implement appropriate social distancing measures and personal hygiene protocols at the workplace; and individuals will have greater responsibilities of adhering to appropriate personal hygiene protocols, social distancing measures and wearing masks when they leave home to deal with essential activities. With a united effort and a clear sense of purpose, our results will tend to be more comparable to the success stories of the Tropical Asian countries than the Advanced Western Countries.