ACADEMIA Letters Strategies to cope with COVID-19 pandemic and priorities for assistance in low testing capacity countries Patrick Milabyo Kyamusugulwa, Institut Superieur des Techniques Medicales de Bukavu COVID-19 pandemic has become a multi-sectoral problem. In underserved or developing countries especially in Sub Saharan Africa, different government-issued restrictive measures were enforced to prevent and control the disease. This is amidst the continuous spread of the Severe Acute Respiratory Syndrome Coronavirus (SARS-COVID-19) that resulted to more positive cases and more deaths. In big countries such as the Democratic Republic of Congo (DRC), more attention is given to the capital city-Kinshasa, which is seen as the epicenter of the disease. Other provinces, especially in eastern country that share borders with affected countries, face a challenge in fighting the disease as well. Factors that hinder the response in these countries revolve around: (i) the unpreparedness of Ministries of Health to fight the disease due to the lack of conducted tests. Previous strategies done with all acute respiratory syndrome remain to be ineffective on COVID-19. (ii) The nature of the new syndrome, given its respiratory mode of transmission is being approached like the Ebola disease, by some countries with the experience of fighting it. (iii) The weak economies are less resilient and more vulnerable. What works for robust economies in developing countries might not work in these settings. (iv) The widespread fake news and rumors about COVID-19, leads some people to believe that the pandemic is non-existent and remain to be the business of health managers. Others fuel the belief that it requires no effort except for prayers and faith in God alone can heal. In other extreme and isolated cases, people who wear facial masks are beaten and quarantine centers are attacked by those who do not believe in the existence of COVID19. (v) More attention is focused in finding a treatment that will cure the disease rather than prioritizing prevention and control. These difficulties, among others call for more specific strategies that would produce better Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: Patrick Milabyo Kyamusugulwa, pmilabyo@gmail.com Citation: Kyamusugulwa, P.M. (2021). Strategies to cope with COVID-19 pandemic and priorities for assistance in low testing capacity countries. Academia Letters, Article 1730. https://doi.org/10.20935/AL1730. 1 results in areas and underserved countries in Sub Saharan Africa. Our reflections lead to four key strategies, that when combined have the potential to be successful in reducing the risk of contamination and of deaths in most underserved areas or countries. 1. Decentralization of the testing capacity. In countries such as the Democratic Republic of Congo (DRC), where the only testing Laboratory for confirmatory tests is based in the capital city- Kinshasa, people in eastern DRC- Goma and Bukavu in the North-Kivu and South-Kivu provinces as well as in other isolated cities of the country deserve the right to have access to test results at the shortest time possible. Hence an advanced site of laboratory for confirmation test is sine qua non to prevent and have an epidemiological surveillance of the outbreak. In the decentralized mode, one of the key assistance priorities is more attention in supplying the required equipment to prevent any shortage and diminished laboratory testing capacity. 2. Primary Health Care strategy by decentralization of epidemiological surveillance. This strategy allows health zones to monitor, trace, investigate and refer cases either for laboratory testing, quarantine or for treatment centers. In every health center catchment area, there are community health workers (CHWs), who live in the area and know everyone. Their ability to participate in investigation, tracing, prevention and control of cases is of higher importance if they are well-trained and supervised by the Ministry of Health/Division of Health and Health Zones teams. Attention must be made to the number of CHWs (at least 100) to be deployed depending of the size of the health zone, and the quality of training and preparedness they must undergo, before they can be on the frontline fighting the disease. Considerable strategies must go beyond giving alerts on symptomatic cases such as surveillance and contact tracing to help curb the risk of outbreak. This second item of the key assistance priorities is the proactive deployment of CHWs. 3. Control frontiers and exit and/or entry points of big cities. There is a need to set up a team composed by at least one hygienic staff and one community health worker (CHW) at every border or exit and/or entry point of a big city with specific tasks such as: (i) routine verification of the temperature of every passenger or traveler with a thermo laser; (ii) routine enforcement of barrier measures – wearing of facial mask, hand washing or disinfection, social distancing when people are in crowd; (iii) notification of the laboratory team for testing in case of suspected cases and when needed, for referral to quarantine or treatment; (iv) communication through smartphone about verified and correct information about the COVID-19 mode of contamination and preventive measures. This is to counter all fake news and rumors about the disease. The public can be Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: Patrick Milabyo Kyamusugulwa, pmilabyo@gmail.com Citation: Kyamusugulwa, P.M. (2021). Strategies to cope with COVID-19 pandemic and priorities for assistance in low testing capacity countries. Academia Letters, Article 1730. https://doi.org/10.20935/AL1730. 2 addressed and encouraged through social media to comply with the barrier measures. There is also a need of reinforce collaboration between the frontier/boundary team and the supervision teams of the Health Ministry/Division and Health Zones, as well as with CHWs to investigate, trace, and refer cases to hospitals and quarantine centers. This third of the key assistance priorities is on the supervision by the Health Ministry teams and the support to the frontier/boundary teams. 4. Enforcement of barrier measures. In many underserved countries or developing countries, key measures or restrictions have been taken, among others (i) ban church services for more than 20 participants; (ii) ban nursery, primary, secondary schools and Universities based on the premise that a crowd increases the spread out risk of the disease; (iii) obligatory facial mask wearing; (iv) lockdown of some municipalities or restrict the mobility of people 60 years-old and more. There are however some challenges associated with: (i) banning access to churches and schools while allowing people to get into markets, banks and alongside the road. In these situations, they do not often comply with those restrictions, thereby the contamination by COVID-19 continue to affect more people. Note that in sub Saharan African, more people walk alongside the road rather than using public transport, which is either lacking or not well-organized. Moreover, since wearing a facial mask has been compulsory, officials distributed a few facial masks for the public’s use. On the first day the restriction was set in place, people tried to produce for themselves some facial masks alternatives without following any recommendations on what specific cloth or material to use. In some cases, some men were seen using a piece of bra, instead of a standard facial mask. Similarly, even in more restrictive spaces as in a bank, social distancing of at least one meter is being strictly followed. However, only three of ten people would comply with the proper wearing of facial masks, while the others would prefer either to put the mask under the chin or on the mouth out of discomfort. These practices would still leave many susceptible to the risk of COVID-19 respiratory infection. In some instances, when the police try to enforce barrier measures, fines were imposed to those who refuse to wear facial masks. The ineffectiveness of the police is a manifestation of lack of social accountability vis-à-vis the imposed restrictions. The fourth of the key assistance priorities is on the enforcement of proper behavior compliance measures. Clearly, some of these strategies require more resources such as laboratory testing capacity. While others prove to be simple, it is but worthy to give attention on these measures. There is a potential to have control on COVID-19 if more efforts and resources are focused on these strategies. This provides the chance to prevent more infections and more deaths. In addition to Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: Patrick Milabyo Kyamusugulwa, pmilabyo@gmail.com Citation: Kyamusugulwa, P.M. (2021). Strategies to cope with COVID-19 pandemic and priorities for assistance in low testing capacity countries. Academia Letters, Article 1730. https://doi.org/10.20935/AL1730. 3 the treatment, officials, development, and international agencies and experts need to allocate more efforts on prioritizing more inputs for more testing; decentralizing investigation; tracing capacity to health zones with more CHWs on the frontline; controlling frontiers and exit and /or entry points of big cities, as well as aggressive measure on the persuasion of compliance with barrier measures. However, it is recommended to consider more extensive research on these proposed strategies. References Buekens P., Alger J, Bréart G., Cafferata ML, Harville E., Tomasso G. A call for action for COVID-19 surveillance and research during pregnancy. Comment. Lancet Glob Health 2020 Published Online April 22, 2020. https://doi.org/10.1016/ S2214-109X(20)30206-0. Graeden E., Carlson C., Katz R. Answering the right questions for policymakers on COVID19. Correspondence. 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Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: Patrick Milabyo Kyamusugulwa, pmilabyo@gmail.com Citation: Kyamusugulwa, P.M. (2021). Strategies to cope with COVID-19 pandemic and priorities for assistance in low testing capacity countries. Academia Letters, Article 1730. https://doi.org/10.20935/AL1730. 4