High Coronavirus spread in Ghanaian and other African communities and its implications

BY: Prof Dr. Ir. Peter Twumasi

The 2019 outbreak of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2), the virus that causes Coronavirus disease-19 (COVID-19), which originated from Wuhan in China achieved a pandemic proportion in the first quarter of last year, 2020. Currently, all countries on Earth, in one way or the other, have reported of COVID-19 cases among their people, either home or abroad. Ghana, like her other African nations, is of no exception. As at today, Ghana’s total COVID-19 cases stands at 58,065, however, with impressive recoveries of about 56,000.

Coronavirus has low Case Fatality Rate (CFR)
The Coronavirus, an RNA-dependent zoonotic virus, has exceptionally high infectivity rate among humans but also of relatively low global Case Fatality Rate (CFR) of 1.15% (i.e. 12 deaths per 1000 infected cases) and even with a much lower CFR of 0.6% in Ghana (i.e. 6 deaths per 1000 infected cases similar to many other African countries). With the over 58,000 infected cases reported since March 2020, Ghana has recorded only about 350 deaths compared to other countries like Italy, United States and United Kingdom where daily reported deaths due to COVID-19 are in their thousands. Case Fatality Rate (CFR) is the proportion of deaths among all infected persons in a community. Notwithstanding, these CFR figures for COVID-19 from all countries are much lower than those for other known notoriously deadly virus outbreaks in humans such as Ebola virus with 90% CFR and Marburg virus which recorded 40% CFR.

Ghana's situation is no different. Although health authorities or independent researchers have not embarked upon any general screening exercises in the Ghanaian populations to establish the actual coronavirus infection prevalence, limited studies and testing of persons sampled from the population using either antibodies or PCR methods have shown high prevalence of COVID-19 among the population. Fortunately, most of these people carrying the virus and therefore tested Positive or those who have already cleared the virus from their bodies leaving antibodies signatures, were generally asymptomatic. A case in point is the recent testing of about 30 randomly sampled individuals with all testing Positive for the Coronavirus except one person. The good news is that all these COVI-19 Positive individuals cleared the virus within a week, and without manifestation of the disease symptoms.

Severity of COVID-19
Data available to scientists since the outbreak of the Coronavirus indicate relatively low severity of the disease globally among young people, African populations on the African continent, as well as persons with history of vaccinations against other viral diseases. Aged population and people with chronic diseases such as diabetes, cardiovascular diseases, hypertension and asthma are the most vulnerable groups with very high COVID-19 fatality rates.

Factors behind the seemingly rising trends in COVID-19 cases in Ghana
The recent concern raised by authorities and the public about the rising trends in the Coronavirus infections in Ghana is of no scientific novelty as it had been forecasted long time ago. Firstly, like all winter flu diseases, Coronavirus infection was expected to intensify with the advent winter as temperature drops. The harmattan experienced in Africa during winter also induces colder temperatures as dust in the atmosphere reduces the sun radiation. This is why most countries currently dealing with the low temperatures, some experiencing high levels of snow in the northern hemisphere are recording high infections and deaths related to COVID-19. Some of these high hit countries have resumed nationwide or provincial lockdowns to curb the infection.

Secondly, all the new infections are mainly reported from our hospitals by the Ghana Health Services. At the beginning of the outbreak, the panic created by the scare of COVID-19 patients being quarantined, and refusal of government to return bodies of COVID-19 victims, discouraged families of severely ill relatives from receiving treatments especially at government hospitals or clinics. The restoration of confidence to seek medical services in hospitals and clinics, only in recent time due to intensive education and fight against stigmatization, is significantly contributing to increasing hospital visits as well as increasing records of positive COVID-19 cases.

These findings tell us that the virus has completely spread out in our communities and that any effort to conduct mass testing, either with the use of PCR or immunological methods for antibodies, will reveal hundreds of thousands if not millions of Ghanaians who unknowingly live with the virus or have recovered its infection.

We are therefore not to be scared as a nation by these reported rising numbers of COVID-19 cases but rather to ensure that adequate provisions are made to strengthen our health system to treat all patients with other diseases (comorbidities) which tend to make individuals more susceptible to severe forms of COVID-19. Alternatively, programmes such as healthy eating, and the use of vitamin and mineral supplements including Vitamin C should be encouraged among communities as earlier advocated by the President, H. E. Nana Addo Dankkwa Akufo-Addo.

Community spread of COVID-19
Globally, scientists have established that, most communities have already become exposed to the Coronavirus, a virus responsible for COVID-19. Antibodies of COVID-19 have been found in millions of persons who did not report of any symptoms of the Coronavirus. These antibodies only come about as a result of entry of the virus into the body. With nearly 95% of persons who are asymptomatic upon infection with the Coronavirus, these findings are not surprising.

Effectiveness of facemask and handwashing
Although the spread of respiratory viruses can be reduced by the wearing of facemasks (with no protection at all from faceshields), the practice is less effective in our community settings. The highest efficacy one can derive from wearing of a standard facemask in the open is 70%. Frighteningly, over 90% of facemasks available on the Ghanaian markets have meshwork pore sizes several times bigger than the diameter of the virus. A simple light microscopic examination can reveal these observations. These masks are thus not full proof from the prevention of Coronavirus infection aside from the wrong wearing and contamination of the facemasks by users.

However, we cannot overlook the psychological comfort and security that comes with the mere wearing of even an ineffective facemask. Hand washing practice is also best for short-term management of infectious diseases like the coronavirus. However, this too is not a full proof.

Vaccination as the ultimate solution
Like all viral diseases that persist in their hosts, a long-term treatment is achieved by vaccination. ‘Natural vaccination’ could occur to induce herd immunity when an individual recovers from first exposure to a naturally occurring pathogen such as viruses. The individual develops antibodies for protection against any future infections of the same or similar pathogen. Alternatively and more conventionally, a part or a weakened form of a virus (pathogen) could be injected into a healthy individual to induce antibodies for long-term protection against the pathogen.

Many individuals who have unknowingly become exposed to the Coronavirus may have better chance of dealing with the virus than those who remain uninfected. The world has advanced in the production of Coronavirus vaccines to manage the disease. Many countries have rolled out either targeted or mass vaccination of their citizens. It is expected that a global coverage of Coronavirus vaccination would be achieved in the next two years.

Authored by Prof Dr. Ir. Peter Twumasi (Biochemist/Biotechnologist)