GHANA’S COVID-19 CURVE PLATEAU THREATENED BY A SUPER SPREADER

Siapha Kamara
Accra, November 30, 2020

“Our daily infection rates are no longer in the hundreds as they were sometime back. Presently, they are in the tens, averaging twenty-five (25) new cases per day, in the course of last week.” This was Ghana’s President Nana Akufo-Addo, giving his 18th (on October, 18 2020) address on measures taken to combat the spread of Coronavirus to the nation. Regrettably, as shown by Figure 1, since the last week of October, Ghana’s COVID-19 curve has started to slope upwards. According to Mr. President’s 19th Address, delivered on the November 8th, 2020, approximately 130 confirmed COVID-19 cases were being recorded daily. Ghana’s average daily COVID-19 cases increased over five times ( i.e. by 420%) between mid-October to 8th November, 2020.

This article analyses the 6 key approaches that in combination enabled Ghana to successfully reduce the COVID-19 infection rates from August to mid-October 2020. This success, however, is threatened by an increase in COVID-19 super-spreading events. These are “events in which an infectious disease is spread much more than usual.”(I) Ghana is in the midst of preparations for the 7th December, 2020 General Elections, as Ghanaians will be going to the polls to vote for the President and 275 Members of Parliament, who will lead the country for the next four years.
First, the direct assumption of the day to day leadership for the prevention and management by the Presidency has been a major factor in Ghana’s effectiveness in curbing the spread of the COVID-19. President Akuffo Addo’s hands on political leadership has been key to Ghana’s ability to flatten the COVID-19 curve. From day one, an Inter-Ministerial Coordinating Committee (IMCC), chaired by Mr. President, has had overall policy-making, planning, monitoring and coordination responsibility for the implementation of measures to fight COVID-19 in Ghana (II). The Vice President also chairs the monitoring sub-committee of the IMCC. Additionally, the President articulated a “Whole Ghana Approach” (WGA) characterized by two key actions. First through the WGA, the machinery of the Government of Ghana (GOG) at national and local levels were steadily mobilized, aligned and resourced against COVID-19. Second, galvanizing and educating relevant major social groups and professional associations to fully back GOG’s COVID-19 prevention policies and programs. The social and professional groups targeted were: Christians and Islamic faith organizations, Trade Union Congress of Ghana, Ghana Medical Association, National House of Chiefs, University Teachers Union, Artists and Painters Union, Association of Ghanaian Industries, National Union of Ghanaian Students and Ghana Nurses Association. The President regularly negotiated COVID-19 policies and management activities with the leaders representing these influential social groups at the Jubilee House (ie office and residency of the President of Ghana). The President’s direct engagement of these varied social groups helped to quicken endorsement by a large segment of the population of the COVID -19 preventive measures introduced by GOG. More importantly, communication of GOG’s COVID-19 policies and programmes to the citizenry has been led by Mr. President himself. The President and not the Minister of Health, (MOH), or Minister of Information (MOI) has been the chief spokesperson for COVID-19 to Ghana’s 31 million population. This has earned the President the popular nickname: “Fellow Ghanaians,” the salutation to all his COVID-19 addresses to the nation.

Figure 2 President Akuffo at Election Rally

Secondly, the fast-tracking of investment in the health sector has expanded and equipped the infrastructure to respond appropriately to the spreading of COVID-19 cases. At the inception of the pandemic, the health sector had a weak baseline in key areas: inadequate budget, two under-resourced infectious disease centers and unmotivated health staff due to poor working conditions. The President admitted the deplorable state of the health services and, therefore, prioritized investment in the sector as an integral part of the COVID-19 prevention strategy. This decision to invest in the health sector and especially in infectious disease management facilities strengthened Ghana’s ability to slow down the spread of COVID-19. By early November 2020, the country had 16 functioning infectious disease centers scattered throughout the country. This has been accompanied by various incentives: tax relief, salary top-ups and a health insurance package for frontline health workers, particularly, for those posted at COVID-19 laboratory and treatment centers. Government investment in local pharmaceutical industries has also transformed the Personal Protective Equipment (PPE) situation in the health sector. Initially, Ghana was dependent on imported PPE for health workers and the general population, but currently the majority of the COVID-19 PPEs used by health centers and the public are produced locally.
Third, strict implementation of the World Health Organization (WHO) recommended best practices and standards for the prevention and management of COVID-19. This has included various social and physical distancing protocols: wearing of face mask, and closure of places of worship, schools, sea, land and air borders. These were followed for several months by the partial lockdown of Greater Accra and Kumasi, Ghana’s two most populous metropolis and the epicenter of the pandemic. These measures created an enabling environment for Ghana Health Service (GHS) staff to institute a robust tracking, testing, isolation and treatment (TTIT) regime. By implementing these policies, Ghana emerged among the most COVID-19 tested country in Africa and certainly the highest in the 16-member Economic Community of West African States (ECOWAS).

Fourth, the provision of social mitigation support has helped to cushion the population against the economic disruption caused by the social distancing protocols. The social mitigation support has focused on water and electricity bills payments by the government. Water bill payments will cover all households connected to the national supply system up to December, 2020.(III) For electricity bills, the government has promised to extend payment for one million active lifeline consumers ( ie uses 50 kilowatts of power per hour or about GH¢20 worth of power in a month) until December 20203. Food relief was distributed to vulnerable groups during the partial lockdown of the two largest metropolis – Greater Accra and Kumasi (IV). These made the citizenry, especially those in urban communities amenable to government COVID-19 prevention policies.Targeted economic stimulus package for large scale, medium and micro-enterprises have also been established and are being operationalized. However, Ghana’s poor who make up about 19 % (7 million) of the population have not been properly targeted for support by the different social and economic mitigation interventions by GOG. As discussed in the article “The poor are paying for the WGA” most low-income households are not connected to the national electricity grid or water supply system and, therefore, are not qualified for the GOG relief on utility bill payment.(V)
Fifth, the WGA enjoyed immediate and favorable responses from the international development financing organizations: International Monetary Fund (IMF), World Bank, USAID and Department for International Development (DFID) UK, and European Union (EU). Ghana was among the first countries in April 2020, a month after it recorded the initial COVID-19 case, to benefit from the IMF “Rapid Credit Facility” of US$1 billion.(VI) This is how the Deputy Managing Director of the IMF justified the loan “the authorities’ response has been timely, targeted, and proactive, focused on increasing health and social spending to support affected households and firms”(VII) This loan and other support from various bilateral partners have enabled GOG to implement the COVID-19 prevention and management programs discussed above, especially investments in the health infrastructure.
Finally, the GOG approach to opening the country and economy, in particular, has been gradual, measured and targeted. This has helped to ensure that the slowdown in the spread of the virus is not undermined. School opening, for example, started with senior students at different levels (Junior, Senior high and University) who had to write final examinations. More than 700,000 students returned to their schools and universities for several months to prepare and later successfully wrote their final examinations.(VIII) GOG provided the schools with the required PPE and related supplies. GHS ensured that all suspected COVID-19 incidences in schools were promptly diagnosed and appropriate remedies administered. Also, the opening of Ghana’s airspace started with domestic flights and few months later, the international airport opened whilst sea and land borders remain closed.(IX) The phased approach has allowed the government to monitor, learn and realign COVID management strategies without disrupting the slowdown in the spread of the virus.

Figure 3 Opposition Presidential Candidate: John D. Mahama

Unfortunately, Ghana is in the season of a COVID-19 super spreading: Electioneering and related political rallies combined with the reopening of our bars and restaurants! Typically, during super spreader events, people do not wear face masks or observe any meaningful physical distancing as they sit shoulder to shoulder. Indoor- and -outdoor parties, bars, restaurants, meetings, sporting events and family gatherings are the most commonly cited super-spreaders of COVID-19. During these events, one infected person could unknowingly pass on the virus to 6 or more persons.(X) And those 6 or more persons would end up also infecting 6 or more individuals, i.e. relatives, friends or workmates.(XI)
The Daily Graphic, Ghana’s leading newspaper, reported in the 26th November, 2020 edition, the Director General of Ghana Health Service saying this about political rallies and COVID-19 cases: “the risk of infection was low because they are held outdoors”.(XII) This view is challenged by experiences elsewhere, especially in the USA. The most talked about COVID-19 super spreader event was held on 26th September 2020 in the Rose Garden of the White House, the Office and Residency of the American President. Hundreds of top American Officials participated in this Rose Garden Ceremony during which President Donald Trump nominated a new judge to the American Supreme Court. They walked around shaking hands, laughing and hugging, with only a handful wearing a face mask.(XIII) After a week of the event, 11 of the officials were tested positive of COVID-19! Furthermore, Cable News Network (CNN) Dr. Sanjay Gupta, reviewed COVID-19 cases in relation to political rallies during the recent US Presidential elections and concluded “there was a rise in coronavirus cases linked to counties that hosted President Donald Trump’s rallies”.(XIV)
As shown in Figures 2 & 3 above, 12 presidential, vice presidential and more than 550 parliamentary candidates in Ghana are currently crisscrossing the country holding political rallies to solicit votes. Ghana’s cities and big towns are hosting a daily minimum 574 electioneering activities.(XV) Hundreds of citizens anxious to hear their candidates attend these political gatherings without adhering to basic COVID-19 preventive protocols. As seen in Figure 2, even Mr. President is guilty of holding electioneering events in breach of COVID-19 prevention protocol legislated and promoted each day by his government. Also, a GHS Survey of the percentage of Ghanaians wearing face masks dropped from 44% in October to 5% in November.(XVI) It should, therefore, come as no surprise the jump in positive COVID-19 cases in early November 2020.
Truly, as the elders in my village, Varyarhquelleh in Liberia are fond of saying, “the fish starts to get rotten from the head.” Our political leaders should become good public role models, showcasing the very behaviors their policies are preaching to the ordinary Ghanaians.

(I) https://en.wikipedia.org/wiki/Superspreading_event
(II) https://www.unicef.org/media/82351/file/Ghana-COVID19-SitRep-15-April-2020.pdf
(III) https://www.graphic.com.gh/news/general-news/ghana-news-govt-to-spend-gh-200m-on-lifeline-electricity-consumers-amew
(IV) See the COVID-19 # 19 Address to the nation by the President of Ghana
(V) https://www.africaproactive.com/blog/the-poor-are-paying-for-the-whole-ghana-approach-in-the-fight-against-co
(VI) https://www.imf.org/en/News/Articles/
(VII) https://www.imf.org/en/News/Articles/2020/04/13/pr20153-ghana-imf-executive-board-approves-a-us-1-billion-disbursement-to-ghana-to-address-covid-19
(VIII) https://sendwestafrica.org/nu/blog/covid-19-seven-lessons-from-the-reopening-of-schools-for-senior-students-in-basic-secondary-and
(IX) See President Address to the nation on COVID-19 # 16
(X) https://news.mit.edu/2020/super-spreading-covid-transmission-1102
(XI) https://www.sciencedaily.com/releases/2020/11/201102173232.htm
(XII) Daily Graphic. Page, 22, 26 November, 2020
(XIII) www.usatoday.com/story/opinion/todaysdebate/
(XIV)https://www.youtube.com/watch?v=YHKxmjjz1Z4
(XV) Note these figures are based on 275 parliamentary candidates for 2 main political parties and does not include that of the minor political parties also contesting election
(XVI) https://www.ghanahealthservice.org/covid19/archive.php

Author

Siapha Kamara | CEO, SEND West Africa has affiliate in Ghana, Liberia and Sierra Leone./www. sendwestafrica.org