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A plea: take COVID-19 very seriously

There were 121 cases of COVID-19 in Spain on March 2. Since then, the number of total cases has doubled every other day, like clockwork. 228 total cases on March 4; 401 on March 6; 1,231 on March 9; 2,277 on March 11; 5,232 on March 13; and 11,409 on March 17. If unchecked, how quickly will 1 million people (two percent of Spain’s total population) get infected?

Answer: about 40 days from the first detected case. By Day 42, that number will be 2 million people. 4 million people by Day 44, and 8 million people by Day 46. That is the horrifying mathematics of exponential growth.

If there are 1 million infected people and this disease has a two percent death rate – a conservative estimate – 20,000 people will die. If there are two million infected people, 40,000 people will die. Not everyone who succumbs to COVID-19 is old, infirm or has pre-existing conditions. Perfectly healthy young people are dying too. In fact, recent studies indicate that about 40 percent of hospitalized patients are age 20 to 54. And more importantly, the lives of the elderly, the differently-abled, the chronically ill, and the immunocompromised are just as valuable as anyone else’s.

Spain has a total of about 5000 ICU beds, and assuming a 60 percent prior occupancy rate that number falls to ~2000 free ICU beds that can be used to treat patients with severe respiratory failure. Note that this is still many times more than the number of ICU beds available in Ethiopia. The current estimate for the percentage of people requiring this kind of intensive care after developing COVID-19 is five percent. This means that Spain will run out of ICU beds when there are approximately 40,000 cases of COVID-19. If the current rate of infection continues, Spain will get there in the next few days.

Once that threshold is reached, doctors will start turning patients away, or having to make difficult ethical decisions. Who gets the ventilator? The 34-year-old doctor who could save more lives, or the 50-year-old parent of two? The collapse of the health-care system will then significantly increase death rates. In addition to COVID-19, other serious conditions like cancer, strokes, and car accidents will be under-attended.

This impending catastrophe has caused Spain to go into lockdown. This is where Italy has been for the past few days. Unfortunately, it looks like this is where the United Kingdom and the United States are heading.

This is also what Japan, Taiwan, Hong Kong, Singapore, and South Korea have, so far, successfully avoided. I implore all Ethiopians and the Ethiopian government to learn from these successes and implement the necessary measures to contain this pandemic. Here are some ideas.

Country-wide Measures

  1. Institute the necessary travel restrictions. Limit travel to and from highly affected regions. Require all travelers to Ethiopia to self-isolate for 14 days. It is now clear that superficial screening at ports of entry is insufficient to track and contain COVID-19. The severely delayed and potentially immoral decisions made by Ethiopian Airlines thus far may already cost us dearly. Let us not continue to add to that. 
  2. Cancel all programming on national television and radio stations. Instead, broadcast verified information about preventing infection in multiple languages, including sign language. These tips include frequently washing one’s hands, not touching one’s face, avoiding crowds, and constantly standing at least a meter away from other people (something that many Ethiopians are currently ignoring). Televise news conferences held by the Ministry of Health and other branches of government. Inform the general public about COVID-19, and dispel erroneous and potentially dangerous information. Additionally, use these outlets to explain the need for drastic measures that will be undertaken, such as a ban on public gatherings. Calm the Ethiopian populace’s panic, but do not ill-inform us.
  3. Strictly enforce the temporary closure of all institutions of learning, including public and private universities. Although remote learning is not an option for most Ethiopians, students can make up for missed classes in the future. We cannot make up for the lives that will be lost if we continue to conduct business as usual. 
  4. Ban ALL public gatherings immediately. Unfortunately, this must extend to congregations at places of worship. Join forces with religious leaders to temporarily close churches and mosques, and encourage devotees to pray at home. This ban must also extend to meetings held by government officials in various parts of the country. 5K races, fundraisers, campaign rallies, group tours of Unity Park, and meetings attended by hundreds of people are now huge public health risks.
  5. In addition to aggressively encouraging all citizens to socially distance themselves, mandate the self-isolation of the most at-risk groups. This includes the elderly, the chronically ill, and the immunocompromised. Utilize the army of youth volunteers that have mobilized since the outbreak to deliver life-sustaining supplies to these groups. 
  6. Ensure that EthioTelecom is functioning at maximum efficiency for the duration of this pandemic. Ramp-up internet services and extend service to areas that are currently in the dark. Cut rates for phone calls, text messages, and internet browsing. In addition to providing access to potentially life-saving information, this ensures that not all businesses stop functioning. It also makes staying home a little more bearable for many.
  7. Ban sit-in dining. At the very least, instruct all cafes, restaurants and eateries to remove their seating, and rearrange their tables to ensure proper social distancing (1-2 meters between patrons). Enforce the closure of nightclubs and lounges, temporarily.
  8. House the homeless in hotels, pensions, and hostels (particularly in cities). If this pandemic has taught us anything, it is that we are only as strong as our most vulnerable.
  9. Enact measures that will alleviate the economic burden of this pandemic. Enact a moratorium on evictions in the city. Cancel water and electric bills for the duration of the pandemic. Waive interest on government loans. Provide daily meals for the socio-economically disadvantaged. Encourage private business to contribute, financially or otherwise, using incentives such as tax cuts for companies that actively participate in aiding their communities.
  10. Ensure that supply chains for food, water, and life-sustaining goods and services remain uninterrupted. Properly compensate workers who are potentially risking their lives to provide these necessities. Utilize the army, if necessary, to ensure that these supply chains are as unaffected as possible.
  11. Mobilize the country's police force to transport the sick to hospitals and to facilitate testing, as well as to ensure that public mandates are being followed
  12. Drastically reduce population density in prisons and jails by freeing prisoners. Prisons tend to be epicenters for pandemics because of their population density, poor sanitation, and reduced access to health-care facilities.
  13. Frequently sanitize our public transportation infrastructure and enforce rules regarding maximum passenger capacity. Buses, vans, and trains that are packed beyond capacity will increase the infectivity of SARS-Cov-2 (virus that causes COVID-19) many-fold. A single infected person endangers tens, if not hundreds of fellow passengers. As it currently stands, it is impossible to even attempt social distancing on public transportation in Ethiopia.
  14. Continue to rapidly expand our health infrastructure: 
    1. Continue to expand national testing capacity. The WHO has stated that rapid and expansive testing is imperative if we are to have any chance of containing this pandemic. There are already reports of insufficient testing and inadequate follow-up.
    2. Prepare hospitals and wards for the influx of COVID-19 patients. Institute clear national protocols for treating patients, including potentially triaging patients. Set up centers to test and treat COVID-19 patients only. Quickly train staff.
    3. Source and provide additional equipment. Expand ICU care capacity in hospitals and centers designated to care for COVID-19 patients. Expand the supply of ventilators--absolutely essential instruments in this crisis--in the country. Actively pursue avenues for borrowing equipment and welcoming trained staff from countries like China that have overcome the peak of this pandemic. Distribute personal protection equipment (PPE) to all hospital staff, and create stocks in case there is a severe shortage. 

Personal Measures

I beg you, my fellow Ethiopians, to put aside your yearning for individual comfort and drastically change your lives for our collective good. I ask you to inconvenience yourself quickly so that our country can wither the coming storm. None of these measures are easy. They require us to forgo many of our deeply instilled customs. They require us to see the faintest shadow of catastrophe and prepare for the brunt of it. Do not be fooled or lulled into a false sense of security. We are not immune, and unless we act now, it could be the end of us.

  1. Xenophobia (the hatred and suspicion of foreigners) has no place in Ethiopia. The one quality we must hold onto now, perhaps more than ever, is our kindness and love for humanity. COVID-19 does not have a nationality, ethnicity, or race. Ethiopians have contracted COVID-19, and some have already died of it.
  2. Your personal hygiene matters. Wash your hands frequently for at least 20 seconds. Avoid touching your face. Sneeze into your elbow or a disposable tissue. Do not shake hands with, kiss or hug people. If you are feeling sick or have flu-like symptoms, stay home and call the helpline that has been set up (8335). If you have COVID-19, isolate yourself from your friends and loved ones. Isolate yourself from the public.
  3. Minimize your social interactions and talk to your friends and family about doing the same. This includes talking to them about avoiding physical greetings, kisses and hugs. Avoid shaking hands crowded restaurants, and cancel or postponing social gatherings such as weddings, Maheber, and Eder. Stand at least a meter away from other people.
  4. Students who are no longer in school, please do NOT treat this like a vacation. Do NOT go to your friends’ houses. Do NOT go to the movies or to malls. Do NOT socialize in-person. Stay in your houses. Stay put unless you have to get essential supplies like food from the store. Your effective social distancing significantly reduces the risk that essential personnel will face over the course of their duties. It also protects the most vulnerable in our communities. Don’t be a spreader.
  5. Do not post or forward unverified information. If the information you are about to share is not from the World Health Organization, the Center for Disease Control, the Ministry of Health, or other trusted sources, keep it to yourself. If you are not a trained medical professional, refrain from giving people advice about cures on social media. 
  6. Doctors, scientists, health care professionals and experts in fields pertaining to this pandemic, please combat misinformation when you see it

These measures may seem unnecessary right now. Why should we change the very fabric of our lives? Heed this: South Korea took drastic action early, and is now all the better for it. Italians ignored warnings, evaded authority, and downplayed this pandemic. Italy now has one of the highest COVID-19 mortality rates in the world, and its citizens are gripped by unending guilt and suffering. We have mere days to prepare. Exponential growth will get out of hand quickly if it is not handled with an iron fist. 

As for you, Dear Ethiopian, don’t worry about not knowing anyone who has contracted COVID-19. If we do nothing differently, if we don’t change our lives urgently and unquestioningly, we will very soon be one degree of separation away from multiple infected people. That is, if we are lucky enough not to contract COVID-19 ourselves.

Ed.’s Note: Amanuella Alemayehu Mengiste is an Ethiopian chemical/biological engineer and chemical biologist. After receiving a Bachelor of Science (B.S.E) in Chemical and Biological Engineering at Princeton University, she is now pursuing a PhD in Chemistry at the Massachusetts Institute of Technology (MIT). The views expressed in this article do not necessarily reflect the views of The Reporter. She is currently in self-isolation in Boston, and can be reached at [email protected]

Contributed by Amanuella Alemayehu Mengiste