Overcome the coronavirus and move forward

36 PROPOSALS FOR TODAY AND TOMORROW

Here we are. Circulation of the COVID-19 is a fact in the most beautiful triangle in the world: Cameroon. The three-color banner floats heavily as the world idles. From north to south and east to west, we are holding our breath as we listen to world news with the promise of our own inevitable fate and death count coming fast. After China, death is ransacking the Western world. Experts globally predict that Africa will be hit very hard. Unfortunately for us, what we believed was the African “anomaly” appears not to be an exception after all. The most optimistic models predict that the worst is yet to come, in a context of prevailing civil disobedience an precariousness. In addition, analysts predict that those who survive COVID-19 will face an unprecedented economic crisis. In front of this apocalyptic picture, far from wanting to add to the general anxiety, let’s first give a technical look at the measures currently taken and then with optimism, let’s dream of a post COVID-19 world because this virus is resetting the world to redistribute the cards. Will we be there?

I- CURRENT FIGHT: BETWEEN PRAGMATISM AND HESITATIONS
The first COVID-19 case in Cameroon was imported and confirmed on March 6, 2020. Today, as of March 25, 19 days later, official communication reports 75 cases and everything suggests that the virus is circulating locally and the epidemic in Cameroon is now evolving for its own. As comparison, the first 2 Italian cases were reported on January 31, 2020. On day 19, the count was only three cases.
All other things being equal, we therefore see that the contagion is evolving more quickly here. Faced with this situation, the authorities have taken salutary measures to contain the disease, which can be summarized by two words: containment and distancing. When these are well managed, they are effective because they break the human-to-human transmission chain while infected people are taken care of. But a certain carelessness is noticed daily as fellow countrymen continue to move around scouring the streets, shops, and their neighborhoods by ignorance or necessity regardless of the rules. The current measures in place are good, but they do not go far enough. We make the below proposals to strengthen them:
1) Tighten the containment in the areas concerned.

In fact, despite the authorities’ orders, the virus can still circulate. Indeed, reducing the number of passengers in public transportation vehicles does not prevent an infected person from leaving Douala for Kousseri for example.
Population movements between infected and non-infected regions must be stopped
completely. In the event of force majeure, an individual must be issued a pass by the administrative authorities. Exception must be made for law enforcement personnel, garbage collectors, medical or paramedical personnel. The Douala-Bangui and Douala-Ndjamena corridors that we want to preserve must be strictly supervised.

2) Make distancing measures mandatory.

Food businesses (except restaurants and drinking
places) and pharmacies, must remain the only open businesses under supervision of law enforcement personnel, the police or the army if necessary.

3) Ration water and food.

Every neighborhood that lacks running water supply should be rationed by tankers or wells drilled for this purpose. The poorest households must be identified by the councils and receive survival food kits. Firefighters, the military and civil protection can be involved.

4) Close places of worship until further notice.

Indeed, the measures to reduce the size of these
gatherings are insufficient.
5) Intensify mass awareness campaigns on all types of media, supports and in all major local
languages.
6) Quickly train health personnel for cases recognition and management.
7) Organize a fundraising (coup de coeur) of national solidarity.

In fact, according to NIS in 2017, the tertiary sector contributes 60% to the GDP and 70% of Cameroonian employees receive less than the minimum wage. A good portion of the Cameroonian population therefore lives by the day in
permanent precariousness. These categories cannot bear containment without assistance. A national mobilization in support of the State’s resources could help these compatriots during the confinement. We are used to it. We did it for the 1994 World Cup and recently to support the war against Boko Haram. The enemy here is more invisible, more devious than Boko Haram.

8) Update case definitions.

Indeed, the virus is already circulating locally. The notion of travel to a foreign country, although important, should no longer be central.

9) Test wide and rigorously.

This is the winning strategy already experienced by China. This has
been recommended by the WHO on March 17. More tests should be ordered. Indeed, the lack
of tests does not currently allow for testing all those who should be.

10) Decentralize the test procedure.

For the moment, there is only one test point for the Coronavirus SRAS-CoV-2 on the national territory, at the Centre Pasteur du Cameroun inYaoundé. This is likely to delay the diagnosis and early management of affected patients. However, as in all respiratory diseases, early treatment ensures a better outcome. We recommend extending the diagnosis capacity to all health districts.

11) Increase case management centers.

There is one case management center per region according
to the current MINSANTE strategy. This implies that patients in every region will need to travel by their own means to reach a unique management center in their region. Such a mobilization is neither desirable nor easy because it would contribute to more spread and might be harmful for patients in severe conditions. This is the reason why some affected countries build new hospitals for the occasion. In our case, we could transform community infrastructure (schools, stadiums, churches, etc.) into treatment centers for this purpose. Ideally, each health district
should have a treatment center that would coexist with public health experts for the identification of cases in the community.

12) Protect health care workers.

The first line of defense against COVID-19 is the medical and paramedical personnel. They are not contained; they are at the frontlines. They are our best chance of getting out of it. Yet, on the ground they are helpless in the face of the pandemic. Regardless of their status (public health experts or clinical doctors or nurses, nursing assistants, hygienists, pharmacists), logistic, organizational, and training lacks are considerable. Many protect themselves as best as they can. Not enough suitable masks (FFP2 and FFP3), or hydro alcoholic solutions. We are not talking about other personal protective equipment (suits,blouses, boots, hats and glasses). This staff is already so few! What will happen if decimated by
this pandemic? There is an urgent need to provide adequate equipment at the treatment centers in all regions.

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