The COVID-19 Complacency Trap

The world is going through a second wave of COVID-19 and the noise currently is about what is driving the latest spike. The leading reason is the acceptance that, globally, people are fatigued with complying with the protocols that are geared to keep the virus at bay. Thus, countries especially in Europe are reintroducing measures to compel compliance with the hygiene and social distancing protocols required.

This phenomenon, intriguing as it is can be said to be consistent with humans. It is because, no one can dispute that this virus has demonstrated its ability to cause disruption. Apart from the death and morbidity associated with COVID-19, economies around the world have been decimated to a point where some well-resourced countries are beginning to wonder how long social interventions required to assist citizens who lose their jobs or are furloughed can be sustained. For lower-middle-income countries, these constraints became apparent much earlier in the first wave as lockdowns could not be sustained. The socioeconomic impact was judged in these countries to be more of a risk to citizens than the virus could be. Thus, many began gradual easing of restrictions and the reopening of economic activities.

Most countries acknowledge that irrespective of the risks in this second wave, educational institutions need to be kept open to ensure that academic progress is not disrupted and the supply of fresh talent to the labour market is not constrained. However, it is now becoming apparent that the people between the age range of 17-30 years are the most likely to spread the virus this time around. Data from the United Kingdom’s Office of National Statistics indicates that the latest spike of infections in that country has originated within this age group and coincided with the reopening of tertiary educational institutions

This new development has also led to further complacency as the likelihood of serious ill-health or death amongst people below the age of thirty is very low. Globally, the risk of people below fifty years dying after contracting SARS-CoV-2 has been estimated to be 0.4%. Unfortunately, above this age, the probability of dying begins to rise significantly. For example, those between the age of 60-69 years have a probability of 3.6% which more than doubles to 8% for those between 70-79 years and again almost doubles to 14.8% for people above the age of 80 years. Hence, as infections have spread to the older generation, the death toll has begun to increase.

Apart from the increased risk of death for the elderly, this complacency must be a cause of concern even for the 17-30-year olds as the data on post COVID-19 syndrome is only emerging. Post-viral syndromes have been studied considerably and are known to persist in some patients for between 6-8 weeks following a bad case of influenza (flu). However, when that happens, the effects are often limited to the respiratory system and could manifest with patients complaining of tiredness, fatigue and with some having a lingering cough. With COVID-19, on the other hand, reports suggest that the aftereffects can be more widespread, affecting the renal and cardiovascular systems as well as the blood. Currently, it is estimated that 60% of people who have recovered from the acute phase of COVID-19 have persistent fatigue, for as long as three or four months after, with some developing diabetes and early-stage renal failure subsequently.

This is making researchers concerned that the public health hangover of this pandemic could be even more debilitating for health systems compared with the acute disruption we are experiencing currently. For Africa, this should be of interest as most countries have very little fiscal space in their health expenditure envelope annually to accommodate a public health addition to their disease burden. Also, many health systems in these countries are incapable of managing some of these chronic diseases long term.

A look at Ghana’s health expenditure distribution amongst sectors makes this even more apparent. In 2019, health expenditure as a percentage of GDP for Ghana was 4.1%; meaning total expenditure on health was approximately $2.75 billion. Of this, 52.3% ($1.43 billion) originated from the private sector, 31.7% ($0.87 billion) from the government, and the remaining 16% ($0.44 billion) obtained from development assistance. Also, of the total contribution by government, 62.4% (approximately $0.54 billion) was spent on salaries and emoluments. This indicates that any post COVID-19 constraints on our disease burden in the long term may require further development assistance in the short to medium term to cope. However, that could be a cul-de-sac too, as many of our development partners may cut back on assistance due to the impact of COVID-19 on their economies.

In the Financial Times, on the 12th of October 2020, Ghana’s Finance Minister Ken Ofori-Atta argued for the doubling of the International Monetary Fund’s lending capacity suggesting that more assistance was needed for African countries. This he said was required because, African economies had not been spared by the negative economic contagion of COVID-19. He went on to say that “across the continent, governments are facing falling revenues, rising expenditures, increasing debt distress, and significant reversals in development indicators.”

It is therefore important that African countries increase public education to ward off the complacency that is setting in. Already, some of the scenes from mass gatherings in Ghana points to a significant decrease in the number of people using face coverings, and there is major neglect for social distancing. With the number of daily new cases being reported being relatively low, many believe that the virus is all but defeated. However, data emerging from other countries where serological studies have been undertaken make me think that this could be a fallacy. Rather, I would argue that the low numbers could be more to do with either a high proportion of mildly symptomatic cases who never seek healthcare or a higher exposure rate of the general population than our cumulative numbers seem to suggest. Whichever reason it is, our exposure to any post-pandemic hangover is concerning.

It is possible that just as the acute phase of this pandemic has not impacted African health systems as it has on other continents, the public health impact may spare us too. Should that not happen, and with Africa having a higher proportion of mildly symptomatic cases (over 85%) in some countries, the burden on our health systems, human resource and economy could just be a legacy we may want to avoid. Therefore I worry about the carelessness that is creeping in locally as the pandemic rages on. For many engaging in reckless behaviour, the data currently suggests there is a high likelihood that even if they get infected, they may not know or may get off lightly. But that is no saving grace. By their actions, they could end up with burdening themselves, the health system, and our country in the long term with a chronic disease.

Edited by Winifred Awa