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The First Advisory dwelt on designing a programme for disaster resilience before the Coronavirus pandemic was visited upon the continent. Since then, several events have become evident. In Kenya, for example the concern of management of mental health is being taken to another level 
https://www.standardmedia.co.ke/lifestyle/article/2001372457/stressed-nation-anxiety-takes-toll-on-kenyans-as-pandemic-bites. In a recent speech by President Uhuru Kenyatta, he indicated that his government was going to implement an urban renewal programme to ‘..modernize our towns and cities; we want our towns to be clean and green, just like Singapore is..’. A most interesting prospect.

In this Second Advisory issued as the continent experiences the terrible ravages of the pandemic, with massive ramifications on health, social and economic fronts. Cases of COVID19 have now been confirmed in 54 African countries. As a result, countries are at different stages of the pandemic and governments are addressing the crisis differently. Interestingly, it is the unforeseen, the un-intended collateral damage that is causing most havoc.

Several African countries have instituted some form of lockdown protocols with varying results https://www.theeastafrican.co.ke/scienceandhealth/Covid19-africa-dodged-first-bullet-but-hard-times-ahead/3073694-5547070-tj1fnp/index.html. For instance, in Kenya, an initial mandatory lockdown period of 21 days has been completed and the government has ordered for a further period of a similar duration. The compliance to the second lockdown is already facing challenges, as majority of the population is showing fatigue, obstinately refusing to listen to sound advice and are instead resuming their pre-COVID preoccupations.

But it is not all doom. In May, 2020, CNN provided a rare insight on public spaces by the effect of COVID-19 lockdowns in vastly reducing the use of roads and public transit systems, city authorities should be taking advantage by closing streets to cars, opening others to bicycles and widening sidewalks to help residents maintain the six-foot distancing recommended by global health authorities.

One of the collateral effects of COVID-19 is domestic violence.  As some countries are beginning to reopen, billions of people are estimated to still be sheltering at home. When households are placed under the increased strains that come from security, health and money worries, and cramped and confined living conditions, levels of domestic violence spike. Africa is no exception. There needs to be action against gender and domestic violence.

The other damage is the cause of patients who need critical medical services not going to hospital. 

One other collateral effect is the rise in cases of misinformation in the form of hoaxes, half-truths and flat-out lies have proliferated, mostly through social media and is a major issue that needs to be firmly and aggressively counteracted in order not lose the battle to the pandemic. African governments are being called upon to strategize on how they can rely more on scientific evidence, methods and tools that are backed by robust research data to in order to efficiently deal with the pandemic.

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In a recent fascinating article published in `The Conversation’ by  Shadreck Chirikure, Professor in Archaeology, University of Cape Town titled Archaeology shows how ancient African societies managed pandemicshe ably describes says:

`..that the damaging impact of epidemics prompted the abandonment of settlements at Akrokrowa in Ghana during the early 14th century AD. About 76 infant burial sites at an abandoned settlement that now forms part of the Mapungubwe World Heritage site in the Limpopo Valley of South Africa suggest a pandemic hit the people living there after 1000 AD.

Archaeological and historical insights also expose some of the strategies that societies adopted to deal with pandemics. These included burning settlements as a disinfectant and shifting settlements to new locations. Social distancing was practised by dispersing settlements. Archaeologists’ findings at Mwenezi in southern Zimbabwe also show that it was a taboo to touch or interfere with remains of the dead, lest diseases be transmitted in this way. In the late 1960s, some members of an archaeological dig excavating 13th century house floors in Phalaborwa, South Africa, refused to keep working after encountering burials they believed were sacred. They also worried that the burials were related to a disease outbreak…’

So much about what we now know compared to what we knew then.

The trajectory of the COVID-19 curve in Africa tells one story. The national numbers tell another, far more nuanced one. Cases of COVID19 have now been confirmed in 54 African countries. But countries are at different stages of the pandemic and governments have addressed the crisis differently. The coronavirus is coursing through different parts of the continent in different ways, making the crisis harder to predict, control, or understand. As has been seen elsewhere, particularly the US (see Ed Yong a staff writer at The Atlantic, who covers science), there are `three aspects of the pandemic, that make it particularly hard to grasp’ namely:

• The disease progresses slowly;
• The pandemic is shaped by many factors (for instance; social distancing matters, but so do testing capacity, population density, age structure, wealth, societal collectivism, and luck. … etc.  No single factor can explain differences across African countries;
•  The disease spreads unevenly.

An Dr. Richard Munang, a prominent African thinker and urban practitioner has this to say on the COVID impact in Africa:

…it has been more to foment an economic crisis. The health impacts have largely evaded Africa. Just as an example, Africa with 1.2billion citizens, has had only a fraction of infections suffered by the USA for instance, which has far less people – 300million – and remains the only super power of our times. Some have argued that Africa was shielded because of its minimal integration to global tours & travel. While this may be the case, one cannot forget that initial projections of infections, which factored in these realities, turned out far lower than was modelled. We cannot deny the fact that, the rate of infection / replication of infections, that occurred once the first cases were reported on the continent, have not been as high as otherwise projected….’

Duncan Omanga and Bartholomew Ondigo,  writing in a newsletter from Next Generation Social Sciences-Africa program and the Africa Peacebuilding Network at the Social Science Research Council (SSRC) are even more poignant. In their piece titled ` Sub-Saharan Africa Will Most Likely Ride Out the Covid-19 Storm’ https://kujenga-amani.ssrc.org/2020/05/14/sub-saharan-africa-will-most-likely-ride-out-the-covid-19-storm/; they pose as follows:

…..the progression of Covid-19 infections and fatalities in the region appears to be upsetting earlier epidemiological predictions and mathematical models. Africans are not dying in the streets, and the chances of widespread deaths are decreasing with time. Although the most optimistic scientists are cautious, the Covid-19 crisis on the African continent is more in the economic and political space. Not only are hospitals virtually empty, even the everyday emergencies and medical procedures that surgeons and physicians encounter are few and far between….

One thing is sure. the impact of policy responses to curb the spread of the coronavirus pandemic is expected to last for a long time. One such measure is the closure of schools, which has affected more than 90% of enrolled learners around the world. Although early in the spread of the disease in Africa, it is important to take stock by asking some hard questions;

1. What are some measures that African governments being put in place to fight COVID-19?

2.  What have been the results of these measures?

3.  What’s the way forward?

4) What has been the role of science and scientists in shaping their country’s respective COVID-19 responses? 

A safe and effective vaccine remains the best hope of ending this pandemic. Just this month, several global leaders including the current and former presidents and prime ministers, wrote an open letter to the World Health Assembly calling for a “People’s Vaccine”. The letter asks that when a safe and effective vaccine is developed, it is produced rapidly at scale and made available for all people, in all countries, free of charge. The same applies for all treatments, diagnostics, and other technologies for COVID-19. 

“Solidarity” is an international clinical trial to help find an effective treatment for COVID-19, launched by the World Health Organisation and partners. The trial is scheduled to test four treatment options against the standard of care for effectiveness against COVID-19. The trial will enroll patients in multiple countries. Burundi has expelled World Health Organisation officials coordinating the country’s coronavirus response. Kenya has closed its borders with Tanzania and Somalia because of the high numbers of truck drivers that are testing COVID-19 positive.

Nigeria’s medical and pharmaceutical research institutes say the long delay in conducting research or clinical trials in relation to covid-19 is due to poor funding. Nigerian senators are mulling a new bill that seeks to repeal the present quarantine act and control infectious diseases. There have been several criticisms of this bill including that it is a draconian bill and allocates inordinate powers to health authorities. With a capacity of around 3,500 bed spaces and over 4000 positive cases of Coronavirus, the Nigerian government is already considering treating some COVID-19 patients at home. But this is raising concerns among health care professionals. A  lot of research during the covid-19  has focused on countries where mental health and access to care is prevalent. How do countries like Ghana where mental health comes with significant stigma in addition to non-existent protocols for covid, going to cope?  A golden preventive rule of the COVID-19 pandemic; maintaining physical and social distancing, has limited social workers’ direct practice support for older people who are considered as an at-risk population. Ghanaian authorities are pondering on the best way to reopen pre-tertiary schools in the country amidst the covid-19 pandemic. The decision by Prime Minister Abiy Ahmed to postpone the elections in Ethiopia has created a constitutional crisis. The COVID-19 pandemic is the context for this but not the cause.

Given the above status, we see current policy imperatives for African Governments to be:

• Find a more responsive evidenced-based tool to make decisions on lockdown of the population, be it partially or wholesome; 
• Reimagine the design and use of public space; and
• Deal with the enormous crop of misinformation about the virus and its effects;

So, Firstly, how do governments make rational evidence-based decisions on lockdown?

During these uncertain times of coronavirus lockdown, we are expected to look towards our leaders for advice and guidance. Critically, the instructions should be as simple and accurate as possible, to ensure that people follow the advice. This is in the context of the fact that

`…The world’s best scientists are currently deployed in a war-like effort to counter the coronavirus pandemic, devising vaccines, treatments, modelling outcomes and advising the rest of us. This is a fast-moving contagion, borne of our 21st-Century globalised society, and it calls for the very latest evidence-based science. On this, we all agree, because we’re rational 21st-Century people, right?… poses BBC’s Future analysis of Gaia Vince ideas posed in her book TRANSCENDENCE: How humans evolved through fire, language, beauty and time. https://www.bbc.com/future/article/20200505-why-its-so-hard-to-be-rational-about-covid-19

`..Since Covid-19 is an infectious disease, it depends entirely on human hosts to carry and spread it – the more people act as regular socialising humans, the more chances the virus has to replicate and spread, and the worse the epidemic. That’s the science. Only by recognising the threat of the disease, will people be mobilised to change their innate social behaviours, to actively slow its spread…’

The US government has been accused of making decisions on partisan grounds. Whatever ones political persuasion, the Covid-19 virus will not discriminate as it seeks more lungs to infect. But, because contagion is inherently social, it may well turn out that those populations who continue to socialise undeterred might end up experiencing worse epidemics. In other words, ones voting record may well influence your fate.

As a whole, pandemics raise questions about the processes of decision-making and prioritising, more so among African countries. One hard question that governments is making decisions whether the coronavirus lockdown justified? One school of thought holds that any societal cost is worth paying to save a life. This seems sensible at first, but we do not honor this dictum in normal times. We tolerate people dying for lack of resources, often on a mass scale, in developing countries.

Against this background, economist Sanjay Reddy published an opinion on the `The Print’ challenging Modi’s decision on ordering lockdown in India (https://theprint.in/opinion/lockdown-or-not-covid-19-raises-key-questions-on-decision-making-in-a-democracy-like-india/391725/).

Reddy says `.. it is not easy to make full sense of the coronavirus lockdown. It’s not that we should not try to avoid premature deaths due to the current pandemic. But if we care so much about avoiding deaths, we should have done, and should do, a great deal more to avoid those that arise from other sources too…’

UK’s Prime Minister Boris Johnson, soon after his resumption of office after recovery from a COVID-19 infection, announced a new five-tier system for how the UK will move through the rest of the coronavirus pandemic. The threat level of the pandemic will be categorised on a scale of one to five in different parts of the country. The system is designed to mirror the independent terror alert system, which ranks the threat to the public from low to high, and is colour coded from green to red.

The UK government explained the alert level by an equation: “COVID alert level = R (rate of infection) + number of infections”.

The South African `The Conversation’ has scathingly declared the equation as `baffling’, `bewildering’ and `..nonsense for a number of reasons…’ https://theconversation.com/coronavirus-why-the-maths-behind-covid-alert-levels-makes-no-sense-138634

That opinion did not deter South Africa who released one of their own soon after. 

Clearly, lockdown-induced economic and social disruption has consequences for health and well-being because restrictions on freedom of movement make it hard to maintain health programmes, to run schools, to ensure that people are nourished, or that they avoid domestic violence. A state that claims to value equally all lives, or years lived by different people, must express that commitment in its actions. It should do so at the least by designing measures to safeguard the public health which do not worsen it.

In his opinion, Reddy posed `Are we asking the right questions?’The COVID-19 pandemic does not merely demand an answer, but it also raises a question: What exactly is public health? Taking sensible decisions in the presence of deep uncertainty requires more than decisiveness. It requires rational evaluation of the difficult choices to be made. And in a democracy, it also demands efforts at justification, before and after the actions are taken, informed by different societal perspectives.

Whatever the trajectory of the disease, one should ask that choices made in the name of the public are justifiable to them, including the most vulnerable. A pandemic is a rare instance that seems to call for a strong executive, even in a democracy, but it also brings to the fore its potential weaknesses. An informed, reasoned and robust public discussion of what is right to do, at each phase of the crisis, must take place.

The decision-makers appear to pay little or no attention to the difficulty that people would face in maintaining livelihoods and gaining access to food. These sudden restrictions have triggered mass movements and brought about crowding in neighbourhoods, increasing the potential for disease transmission. They also appear to have overlooked the prospect that the police forces charged with enforcement of the ban would implement it with untargeted brutality, thereby themselves becoming a danger to the public health.

Secondly, why is it important for Africa to re-imagine the public space?

The first advisory urged that we need to ‘put into place a different protocol and culture of management of resources provided by the commons for the post-COVID-19 era. That is true for Africa as it is true for the rest of the world.’ Planners worldwide are asking what will shape the post-pandemic city?

Oscar Holland of the CNN published a thought-provoking piece on 10th of May 2020 precisely on this topic. See https://edition.cnn.com/style/article/cities-design-coronavirus/index.html  Holland graphically narrates how ‘Covid-19 lockdowns vastly reducing the use of roads and public transit systems, city authorities.. are taking advantage by closing streets to cars, opening others to bicycles and widening sidewalks to help residents maintain the six-foot distancing recommended by global health authorities…’. Poetically, he says:

…And, like jellyfish returning to Venice’s canals or flamingos flocking to Mumbai, pedestrians and cyclists are venturing out to places they previously hadn’t dared.

This pandemic is a catalyst. The Coronavirus will re-shape the cities. Africa cannot afford to be left behind this time round from dealing with the ills we face in our current city system.

Thirdly, why must African governments deal decisively with misinformation about coronavirus and its effects

Since the first cases of a then-unidentified pneumonia were reported in late December, hoaxes, half-truths and flat-out lies have proliferated, mostly through social media. BuzzFeed News for several days kept a running list of misinformation, including wildly inaccurate reports that the death toll in China was 112,000 as of late January (reality: around 80 at the time); claims that Chinese people eating bats were the source of the outbreak (a viral photo of a woman biting a bat was not taken in China); and false suggestions that the virus was lab-engineered as a kind of bioweapon.

Calling it `a misinformation ‘fire hose’, Kim Bellware, who write for the Washington post, says that `…Many of the inaccurate reports spreading around bear a resemblance to a disinformation model used by hostile governments of any nation, but known as the “Russian fire hose” strategy. The goal isn’t to convince people of one wrong thing, such as the false claim that vitamin C destroys coronavirus, said Bergstrom, who studies how misinformation travels across networks and spreads like pathogens through populations https://www.washingtonpost.com/health/2020/02/10/coronavirus-is-spreading-rapidly-so-is-misinformation-about-it/

“The idea is to put out so much [bad] information that people feel as if they can’t get to the truth. That creates a kind of power vacuum that leads to what, I guess, is in the interest of certain regimes,” Bergstrom told The Post. “If you can go from 1 percent of the population believing nutty conspiracies to 5 percent, that’s a win,” he said.

Bergstrom said the endgame for some hostile regimes is to disrupt the smooth function of commerce in rival countries by stirring up anxiety that leads to trade or travel disruptions; within China, hypothetical agitators could be motivated by a desire to make the communist government look bad.

Fourthly, why is there increase in domestic violence, especially gender based

A major collateral effect of COVID-19 is increase in domestic violence, especially gender based.  As some countries are beginning to reopen, billions of people are estimated to still be sheltering at home. When households are placed under the increased strains that come from security, health and money worries, and cramped and confined living conditions, levels of domestic violence spike. Africa is no exception. There needs to be action against gender and domestic violence. UN Women, the United Nations entity dedicated to gender equality and the empowerment of women, launched the ‘Shadow Pandemic’ public awareness campaign, focusing on the global increase in domestic violence amid the COVID-19 health crisis. Phumzile Mlambo-Ngcuka, Executive Director of UN Women has been quoted to say:

“..Even before the pandemic, violence against women was one of the most widespread violations of human rights. Since lockdown restrictions, domestic violence has multiplied, spreading across the world in a shadow pandemic. This is a critical time for action, from prioritizing essential services like shelter and support for women survivors, to providing the economic support and stimulus packages needed for broader recovery….”

Fifthly, why are patients who need critical medical services not going to hospital?

Several private and mission hospitals are struggling to break even for lack of both in-patients and out patients. One popular hospital that has bed capacity of 120 and has always had 100 plus at any given time has been having in patients fluctuating between 10 to 20 since March. Out patients were between 400 to 500 daily but now even getting 50 is a miracle. A medical practitioner explained in a blunt and surprising response:

….most illnesses are driven by the entertainment industry. Bars and restaurants. That is where illnesses emanate from. Cholera, typhoid, amoebiosis and other food poisoning as well as a myriad others are mostly from unhygienic hotels. Accidents, robberies, syphillis, gonorhea, HIV, herpes etc. start after visit to bars. Many level-4 hospitals have wards for `boda boda’ accident victims. Lack of money, alcohol and curfew has made consumption of it plummet and consequently the accidents. Those wards are almost empty. The rest, that are lifestyle illnesses e.g. diabetes and hypertension can be managed at home and only severe cases need hospitalization. The health industry is reliant on entertainment industry. As long as entertainment is muzzled, health industry will continue suffering massive loses. Actually, some hospitals are laying off clinical officers, nurses and doctors. A strange phenomenon, but that is where the tragi-comedy of the coronavirus begins….

Concluding Perspectives:

Repeatedly, this series of advisories has stressed that although the current COVID-19 pandemic is — first and foremost — a physical health challenge, it runs the risk of also creating a major mental health crisis if not managed and addressed correctly. But more than that, this advisory looks into more of the collateral damage effect of the pandemic.

^[1] The ideas discussed in this paper are a result of discussions held with several senior colleagues in various fora. The conclusions and emphasis are my very own.