Authorities in the USA have just announced that they expect about 200,000 thousand deaths on account of the Coronavirus (COVID 19). In the past few days, European countries with some of the most advanced healthcare delivery systems like Spain and Italy have been experiencing a death rate of over 700 people per day on average! These are staggering numbers. Unfortunately, it is not just the numbers but people we are talking about here.
What boggles our minds is that here in Zambia, the PF government, the President and his Cabinet seem so removed from the crisis at hand. Why do they appear to be so impotent to deal with the biggest existential problem of our life time? The answer to this question may lie in the lackadaisical approach with which information is being released by different people and government agencies. One day it is the President giving an update, the next day, it’s the Minister of Health and then it is the Chief Government spokesperson before the Secretary to the Cabinet gives his own position. What’s going on? Who is in charge of this government? Is this a publicity contest or what?
It is sad that our President seems to have failed to provide the much needed leadership on COVID-19. When his counterparts around the region stood up to guide their countries’ response to the pandemic, Mr Edgar Lungu was nowhere to seen until he could not ignore the public demand that he addresses the nation. And when he did finally address the nation, his presentation was lacklustre, uninspiring and depressing, and missing crucial facts.
In South Africa, Rwanda and elsewhere, Heads of State, under their leadership, have first met all the stakeholders the bankers, the retailers, the food suppliers, utility companies, transport operators, to name a few; and after consultations, they announced their COVID-19 combat plans. In Zambia, nothing! The President’s speech amounts to “not much, not much”.
There are critical questions which a Head of State is expected to answer under the prevailing circumstances. Mr Lungu, his Minister of Health and Ministers of Finance and Commerce, among others must take time to give an official position on the concerns that the public is raising.
1. How many Zambians are expected to be in need of quarantine facilities at the peak of the epidemic?
2. How many quarantine bed spaces are available countrywide?
3. How many ICU beds are available countrywide?
4. How many people with COVID-19 will need ventilators and how many ICUs in the country have ventilators?
5.How many ventilators are in the country?
6. How much oxygen is available for patients?
7. How many oxygen cylinders are available and do we have enough at our medical facilities?
8. How much capacity does the country have to produce oxygen and what would it take to rump up production for anticipated increased demand?
9. Do we have enough personal protective equipment for medical staff?
10. What is the testing capacity and how can that be increased?
12. How can the doctors and nurse who recently graduated and have not been employed yet be galvanised to help with the response?
13. What are the business rescue plans?
These are basic questions to which every Zambian is expecting honest answers . The truth is that the COVID -19 outbreak will very quickly overwhelm our healthcare delivery system. The authorities need to be prepared, and they do not seem to be. Basic precautions like banning public transportation can surely be made immediately. The COVID-19 cases have jumped to 35 and have transmitted to another 100 at 2.5 reproductive rate. And our mini-buses are packed like sardines. Mr President, Sir, not everybody lives in a secure environment like State House.
The first case of COVID-19 in Italy was confirmed on 31st January, there were 16 positive cases by 21st February and an additional 60 cases and one death by February 22nd 2020. By beginning of March, the virus had spread to most parts of the country. It is extremely naïve and irresponsible to think the COVID epidemic in Zambia will behave any differently than it has done in Europe. A recent publication from the London School of Tropical Medicine and Hygiene estimates that by mid-May, Zambia will have about 10,000 cases. God forbid we shall have a mortality anywhere near what we are seeing in Italy or Spain. Mr Edgar Lungu needs to show leadership now more than ever to save the lives of Zambians. Let us learn best practices from Asia and others whose countries have arrested the spread of COVID-19 and implement immediately.
If the objective is as it must be, to keep the largest number of people possible healthy and alive, and ensure the post-pandemic viability of the economy, we need an action plan from Government. Where is it? High-income countries are implementing isolation measures in order to delay peaks in the rate of COVID-19 infections. They are doing this in order to spread the wave of hospital inflows over time, allowing the production and distribution of key medical supplies, including test kits, ventilators and personal protective equipment for health-care workers. [Most of the expert guidance indicates that they do not believe that, at this point, the broad infection of the general public can be avoided].
Zambia, with meagre income/resource levels, will need to identify the public health objectives that reflect the constraints that we are facing, which differ from the high-income countries. If it will not be possible to source large numbers of test kits (and health workers to administer tests), ventilators and trained medical staff within a matter of months, Zambia will need to decide on which societal strains are most pressing, and tailor public health rules to the associated objective. No matter what that objective is, a sense of order will need to be maintained, and panic avoided.
There will be critical resources whose operation needs to be maintained, in order to avoid worst case scenarios. This includes health care facilities, public utilities (electricity – such as it is, water, telecoms, and petrol), food supply, and financial institutions. For better or worse, in a crisis, the maintenance of essential services (especially health care, utilities, and fuel) will depend on government organisation and implementation. So, if the government isn’t working on this yet, it should start now. Available government resources should prioritise these activities.
There isn’t any data yet, so it isn’t clear what the mortality rate for COVID-19 will be in Zambia. This makes decisions on the remaining issues difficult. If the mortality rate is around one per cent, 15 per cent of cases experience serious illness, and the general infection rate is about 40 per cent, we are looking at 7 million people getting sick, 2.7 million seriously ill, and 180,000 dying. If social distancing measures can be made to work (Honourable Siliya and Dr Chilufya should lead by example) and the infections can be spread over 12 months, that still leads to something like 8,000 people getting seriously ill and 500 deaths a day, every day for a sustained period. If Zambia can, somehow, manage this, it makes sense to think about the associated economic/monetary steps that need to be taken.
We have some suggestions:
Government should support continued operation of domestic food production: provisions for social distancing; supply of inputs; transportation; marketing plan/provide for critical food imports: this is partly a forex issue and needs to be taken up as part of economic planning. Government should provide emergency access to basic food requirements for low-income individuals/families who have lost access due to pandemic impact (this needs to be a government effort, but could be a public-private initiative)
Government should support the continued viability of families and businesses: Set a temporary (three-month) moratorium on domestic contractual payments due in the private sector (including mortgage payments), with settlement to take place over time, with appropriate interest, after the end of the pandemic;
Government should set a temporary (three-month) delay on tax payments due (VAT, PAYE and NAPSA), with settlement of accrued payments due to take place over time, with appropriate interest, after the end of the pandemic;
An (initial) three-month suspension of foreclosures and evictions; establish commercial bank emergency-related short- to mid-term loan facilities to private sector businesses, supported by BoZ credit facilities to commercial banks; Borrowers would need to provide evidence that loan requirements are due to the epidemic and establish long-term capacity to repay; interest rate on loans would be set at inflation rate, with repayment scheduled to begin at end of the pandemic.