On the 3rd of March, 2020, this newspaper carried an editorial in which we predicted that it was “not a matter of if, but when” the Coronavirus (COVID-19) would be detected in Zambia. Sadly, a month later, on the 2nd of April, the country recorded the first fatality due to the disease. In circumstances where fatalities could be avoided or prevented by proactive action, we find one death to be too many. To an extent, it borders on negligence on the part of our national health institutions.
On January 30, 2020, the World Health Organisation (WHO) declared that COVID-19 had met the criteria for a Public Health Emergency of International Concern. This was the alarm bell that should have set in motion a cascade of events for countries to prepare for an imminent outbreak, notwithstanding the world media already reporting of unprecedented pneumonia-like illness and deaths in China and Korea for most of December, 2019, and January, 2020.
The Zambia National Public Health Institute (ZNPHI) is a specialized Agency for the Ministry of Health. Their role is to provide disease surveillance and intelligence information to the government. They are also supposed to be the leading Agency in providing technical support and leadership in times of an epidemic or pandemic. The Director at ZNPHI also holds another full-time position as Dean at the School of Public Health at the Levy Mwanawasa University Teaching Hospital. It saddens us a lot that even after we reported about the glaring inadequacies at ZNPHI a month ago, the status quo has continued. ZNPHI still has no detailed plan on how to combat COVID-19 in Zambia.
While we have seen health experts take the lead along with politicians in informing the public on COVID-19 in other countries, the ZNPHI has been conspicuously absent from the daily briefings by the Minister of Health. Ideally, the Director of the ZNPHI should give the technical updates of the COVID-19 status in Zambia. People must hear very little from politicians. It’s time for specialized technocrats and health experts to take the lead. Because the Ministry of Health is run and controlled by politicians, whose primary interest is image building, citizens will be under-served.
An example of what we are talking about is the information that was published on the official Ministry of Health Facebook page stating: “COVID-19 is airborne, it can settle on surfaces. Keep environments clean!” Of course, they deleted this misleading information about half an hour later, leaving people perplexed. But to us and others, who know how to retrieve deleted posts online, this misinformation is still there on the Internet. This is what happens when politicians and their chola boys side-line experts in order to gain mileage from a health crisis.
Our point is that the ZNPHI is the ideal institution to help the Ministry of Health in scaling up the fight against COVID-19. The ZNPHI website (https://znphi.co.zm) should be updated at least three to four times a day with accurate data, not misleading people that COVID-19 is an airborne disease. There is no need for the Zambian public to wait for 24 hours for a Ministerial update from Honourable Chitalu Chilufya and his “press assistant” Honourable Dora Siliya.
Now, while we commend the donations from the corporate world during the daily briefings, we think it would add more value if a separate channel for donations were opened and reserve the daily briefing time to a more detailed technical update to inform and educate the public about COVID-19. And there are a lot of things to update the nation about.
Most Zambians would like to know from ZNPHI what they have projected in terms of number of expected infections. Of these, how many will require hospitalization? How many will require quarantine only? How many bed spaces at hospitals around the country have been created in anticipation of more COVID-19 patients? How many hospitals have fully functioning ICUs in the country? How many patients will need ICU care? Have all needed medical supplies and personal protective equipment been delivered? Have healthcare staff been trained in infection control, specifically in light of COVID-19? When do we expect the cases to peak and what additional support at that time will be needed? How many deaths are expected?
Zambians don’t know all this. In fact, they don’t even know where to go or what to do when they notice symptoms.
We have tried to reach out to the ZNPHI Director to get answers to the above questions, but he has remained unavailable to us. Unfortunately, if the events of the cholera outbreaks two years ago, and the way the ZNPHI conducted itself then, are something to go by, we are afraid this COVID-19 outbreak will be disastrous! It will very quickly overwhelm our healthcare delivery system. Why the ZNPHI has not recommended the ban of public transportation where people sit closer to each other is hard to understand. Why our borders are still open is just as shocking.
Preventing the further spread of COVID-19 will require difficult and sometimes very hard decisions and the technocrats ought to advise the politicians accordingly.
12 Responses
Yes….you know We went to the Ministry of Health, met with the Honourable Minister, introduced an Product that we have that will stop the virus from spreading, we was send down to his Technocrats who had lots of issues…….no need to say or tell…..we reached nothing and got nowhere.
This is not taken very serious at all.
Anyway we are now running around asking Community members and Business Owners to add what they can afford as an donation in order for us to manufacture and bring to the people of Zambia and the world at large this solution.
If any who want to participate financially, we can be reached at:
[email protected]
Haters. Just say you want information which you have been denied. All is well.
Covid-19 is not Airborne but AEROSOL meaning small moist droplets in the air which only get there when you either cough or sneeze without you covering yourself or without a mask. Remember someone carrying the virus can be infectious even before they show signs of illness if they cough or sneeze without taking any precautions. This is why the mask is important to prevent these Projections get into the air but remember to attach the anion strip inside your mask so you don’t have to breath in and out the germs continuously in case you are infected because you don’t know when you are infected. The anions help create a wrong environment on the mask worn as it enhances alkalinity which environment the virus can not survive on. For more info call +260961579903
The part of preventative measures is for the government to pass a law that no citizen is allowed to walk or trade in public without a face mask and gloves if found without this protective kit you shall be sentenced to jail for a month.I believe that could help instead of a total lock down which this economy can’t handle.
It is airborne but only for about two hours. Tell the whole story or you’ll create panic and fear. All the information about the virus can be found on the WHO website. Don’t listen to WhatsApp where a lot of lies spreading around. Social distancing is important, not mixing with crowds, hygiene. I am confident that end of April or mid May a medicine will be found.
And to Mr Sikalumbi as I cannot reply your message directly. All is definitely not well.
Diggers stop news of hatredl. If WHO can commend the MOH and the AU who are you to speak ill about the good practices that have been put in place? Its now evident that this paper is politically motivated. Stop misleading the masses during this difficulty moment.
Yes it’s airborne that’s why you have a wear PPE with N95 mask when dealing with an active patient. Information was accurate and it’s you at diggers misleading the readers. People will get infected believing in your sloppy journalism. PLEASE LOOK UP THE FACTS YOU IDIOTS.
02 APRIL 2020
Is the coronavirus airborne? Experts can’t agree
The World Health Organization says the evidence is not compelling, but scientists warn that gathering sufficient data could take years and cost lives.
Dyani Lewis
A woman walking her dog crosses the street wearing a face mask, New York City
Some scientists say masks could reduce the risk of coronavirus infection. Credit: Pablo Monsalve/VIEWpress/Getty
Since early reports revealed that a new coronavirus was spreading rapidly between people, researchers have been trying to pin down whether it can travel through the air. Health officials say the virus is transported only through droplets that are coughed or sneezed out — either directly, or on objects. But some scientists say there is preliminary evidence that airborne transmission — in which the disease spreads in the much smaller particles from exhaled air, known as aerosols — is occurring, and that precautions, such as increasing ventilation indoors, should be recommended to reduce the risk of infection.
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In a scientific brief posted to its website on 27 March, the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient.
But experts that work on airborne respiratory illnesses and aerosols say that gathering unequivocal evidence for airborne transmission could take years and cost lives. We shouldn’t “let perfect be the enemy of convincing”, says Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota in Minneapolis.
“In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air,” says aerosol scientist Lidia Morawska at the Queensland University of Technology in Brisbane, Australia. “This is a no-brainer.”
Confusing definitions
When public health officials say there isn’t sufficient evidence to say that COVID-19 is airborne, they specifically mean transported in virus-laden aerosols smaller than 5 micrometres in diameter. Compared with droplets, which are heftier and thought to travel only short distances after someone coughs or sneezes before falling to the floor or onto other surfaces, aerosols can linger in the air for longer and travel further.
Most transmission occurs at close range, says Ben Cowling, an epidemiologist at the University of Hong Kong. But the distinction between droplets and aerosols is unhelpful because “the particles that come out with virus can be a wide range of sizes. Very, very large ones right down to aerosols”, he says.
And if SARS-CoV-2 is transmitting in aerosols, it is possible that virus particles can build up over time in enclosed spaces or be transmitted over greater distances.
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Aerosols are also more likely to be produced by talking and breathing, which might even constitute a bigger risk than sneezing and coughing, says virologist Julian Tang at the University of Leicester, UK. “When someone’s coughing, they turn away, and when they’re sneezing, they turn away,” he says. That’s not the case when we talk and breathe.
A study of people with influenza found that 39% of people exhaled infectious aerosols5. As long as we are sharing an airspace with someone else, breathing in the air that they exhale, airborne transmission is possible, says Tang.
The evidence so far
Evidence from preliminary studies and field reports that SARS-CoV-2 is spreading in aerosols is mixed. At the height of the coronavirus outbreak in Wuhan, China, virologist Ke Lan at Wuhan University collected samples of aerosols in and around hospitals treating people with COVID-19, as well as at the busy entrances of two department stores.
In an unreviewed preprint1, Lan and his colleagues report finding viral RNA from SARS-CoV-2 in a number of locations, including the department stores.
The study doesn’t ascertain whether the aerosols collected were able to infect cells. But, in an e-mail to Nature, Lan says the work demonstrates that “during breathing or talking, SARS-CoV-2 aerosol transmission might occur and impact people both near and far from the source”. As a precaution, the general public should avoid crowds, he writes, and should also wear masks, “to reduce the risk of airborne virus exposure”.
Another study failed to find evidence of SARS-CoV-2 in air samples in isolation rooms at an outbreak centre dedicated to treating people with COVID-19 in Singapore. Surface samples from an air outlet fan did return a positive result2, but two of the authors — Kalisvar Marimuthu and Oon Tek Ng at the National Centre for Infectious Diseases in Singapore — told Nature in an e-mail that the outlet was close enough to a person with COVID-19 that it could have been contaminated by respiratory droplets from a cough or sneeze.
What China’s coronavirus response can teach the rest of the world
A similar study by researchers in Nebraska found viral RNA in nearly two-thirds of air samples collected in isolation rooms in a hospital treating people with severe COVID-19 and in a quarantine facility housing those with mild infections3. Surfaces in ventilation grates also tested positive. None of the air samples was infectious in cell culture, but the data suggest that “viral aerosol particles are produced by individuals that have the COVID-19 disease, even in the absence of cough”, the authors write.
The WHO writes in its latest scientific brief that the evidence of viral RNA “is not indicative of viable virus that could be transmissible”. The brief also points to its own analysis of more than 75,000 COVID-19 cases in China that did not report finding airborne transmission. But Ben Cowling says that “there wasn’t a lot of evidence put forward to support the assessment” and, an absence of evidence does not mean SARS-CoV-2 is not airborne. The WHO did not respond to Nature’s questions about the evidence in time for publication.
Scientists in the United States have shown in the laboratory that the virus can survive in an aerosol and remain infectious for at least 3 hours4. Although the conditions in the study were “highly artificial”, there is probably “a non-zero risk of longer-range spread through the air”, says co-author Jamie Lloyd-Smith, an infectious-diseases researcher at the University of California, Los Angeles.
Gaps to fill
Leo Poon, a virologist at the University of Hong Kong, doesn’t think there’s enough evidence yet to say SARS-CoV-2 is airborne. He’d like to see experiments showing that the virus is infectious in droplets of different sizes.
Whether people with COVID-19 produce enough virus-laden aerosols to constitute a risk is also unknown, says Lloyd-Smith. Air sampling from people when they talk, breathe, cough and sneeze — and testing for viable virus in those samples — “would be another big part of the puzzle”, he says. One such study failed to detect viral RNA in air collected 10 centimetres in front of one person with COVID-19 who was breathing, speaking and coughing, but the authors didn’t rule out airborne transmission entirely6.
Another crucial unknown is the infectious dose: the number of SARS-CoV-2 particles necessary to cause an infection, says Lloyd-Smith. “If you’re breathing aerosolized virus, we don’t know what the infectious dose is that gives a significant chance of being infected,” he says. An experiment to get at that number — deliberately exposing people and measuring the infection rate at different doses — would be unethical given the disease’s severity.
How the coronavirus pandemic is affecting the world’s biggest physics experiments
Whatever the infectious dose, length of exposure is probably an important factor too, says Tang. Each breath might not produce much virus, he says, but “if you’re standing beside [someone who’s infected], sharing the same airspace with them for 45 minutes, you’re going to inhale enough virus to cause infection”.
But capturing those small concentrations of aerosols that, given the right combination of airflow, humidity and temperature, might build to an infectious dose over time, is “extremely difficult”, says Morawska. “We could say that we need more data, but then we should acknowledge the difficulty of collecting the data,” she says.
Cautious approach
The assumption should be that airborne transmission is possible unless experimental evidence rules it out, not the other way around, says Tang. That way people can take precautions to protect themselves, he says.
Increasing ventilation indoors and not recirculating air can go some way to ensuring that infectious aerosols are diluted and flushed out, says Morawska. Indoor meetings should be banned just in case, she says.
Meanwhile, Lan and others are calling for the public to wear masks to reduce transmission. Masks are ubiquitous in many countries in Asia. In the United States and some European countries, however, health officials have discouraged people from wearing them, in part because supplies are low and health-care workers need them. The Czech Republic and Slovakia, however, have made it mandatory for people to wear masks outside the home. Tang thinks those countries have taken the right approach. “They are following the southeast Asia approach. If everyone can mask, it is double, two-way protection,” he says.
But Cowling thinks masks should be recommended for the public only after supplies have been secured for health-care workers, people with symptoms, and vulnerable populations such as the elderly.
doi: 10.1038/d41586-020-00974-w
References
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Liu, Y. et al. Preprint at bioRxiv http://doi.org/dqts (2020).
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Ong, S. W. X. et al. J. Am. Med. Assoc. http://doi.org/ggngth (2020).
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Santarpia, J. L. et al. Preprint at medRxiv http://doi.org/dqtw (2020).
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van Doremalen, N. et al. N. Engl. J. Med. http://doi.org/ggn88w (2020).
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The article is well written. i totally agree that convid 19 is not an air born disease but the virus can move in the air when somebody with the virus coughs or sneezes, through little or sometimes unseen droplets. if the virus was air bone the face mask have no use because even with face mask you need oxygen.
it is very difficult to ask the government to prepare adequately in the fight against this deadly disease because our governments is simply not prepared for anything, for instance load shedding, what is the plan? waiting for God to provide.
let us do our very best in acquiring accurate information on this novel or new disease.
It’s no lie. Covid 19 is airborne. Just ask Italian and Chinese doctors
I don’t agree with the author because the British government is doing the same through the health Secretary. Allow the government to do its work . The health organisation you’re talking about shoulder work with the minister.