Community-based care model best approach to COVID-19 pandemic
By Dr Alex Awiti, Interim Dean, GSMC
Ten of the world’s wealthiest nations – United States of America, Italy, Spain, Germany, France, United Kingdom, Switzerland, Netherlands, Belgium and Austria account for about 70 and 77 percent of global COVID-19 cases and mortality respectively.
That COVID-19 pandemic has overrun world class medical centres undermines the very idea that a highly medical, patient-centred approach is an appropriate response to a pandemic. Across Europe and the United States of America (USA), hospitals are overcrowded, vital supplies, especially test kits, mechanical ventilators, oxygen, and personal protective equipment are not available.
While hospitals in places like Lombardy, Italy are overwhelmed by COVID-19 cases, regular clinical services like pregnancy care, child delivery, vaccinations and other routine healthcare needs have nearly collapsed. Large populations in Europe and the USA are on the cusp of a very complex public health crisis, one that will undermine health and wellbeing for several years to come.
That Italy and the USA are the global epicenter of the COVID-19 pandemic is not surprising. Politicians dithered and debated expert opinion offered to them by health experts. Remember the slogan “Milan does not stop”? In the USA President Trump used obfuscation and misinformation to down play the public health risk of the disease.
Thanks to erratic leadership, the USA and Italy failed to assemble a comprehensive strategy of testing, contact tracing, isolation and social distancing, which helped to blunt the momentum of COVID-19 in Singapore and South Korea. According to Professor Jeffrey Sachs of Columbia University President Trump bears responsibility for America’s unpreparedness and failed response to the epidemic. In Sachs’s view Trump has systematically taken apart America’s public health system.
In a paper published in the New England Journal of Medicine (NEJM), Catalyst Innovations in Care and Delivery, Dr. Mirco Nacoti and colleagues at Papa Giovanni XXIII in Lombardy, Italy argue that in a pandemic patient-centred care is inadequate. According to the doctors, their hospital is contaminated because they are jam-packed with infected patients, and doctors, nurses and paramedics are exposed and are facilitating transmission.
Italy’s case-fatality rate is about 11 percent; the highest in the world. We can and must learn from them. The experience of doctors in Italy’s wealthy Lombardy causes them to believe that to deal with COVID-19 we need community-centred care, which limits hospitalization.
For Africa’s young demographic, it is likely that most COVID-19 positive will be much younger and immunocompetent, with mild and uncomplicated illness. This is vastly different from the elderly and immunocompromised patients in the Western world who are burdened by preexisting comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease, and oncological diseases.
Africa should adopt a community-centred care model to deal with COVID-19. We should use the vast network of community health services, public dispensaries and public health centres as nodes of syndromic surveillance, isolation and clinical management of mild symptoms, which constitute nearly 80 percent of COVID-19 cases.
COVID-19 presents the developing world with a novel opportunity to show the world how to deal with a pandemic; focus on entire populations through distributed community-centred health models that deliver early therapy such as oxygen and nutrition and limit hospitalization and coronavirus transmission.