Monday, June 1, 2020

How Botswana diced with COVID-19 death

Batswana returning from COVID-19 high risk countries were allowed to join their families and friends without putting them through quarantine, risking pre-symptomatic local transmission – it has emerged.

As it turned out, hardly a day after the first COVID-19 case was reported in the country, Botswana found itself battling a double whammy of imported and local transmissions.

Basking in the COVID-19 infection free window, Botswana decided to dice with death, allowing returning citizens from high risk countries to join family and friends with nothing but a piece of advice to “self-isolate.”

By the beginning of last week, it was evident that the country had craped out.

Even after the UK risk level was raised from moderate to high and American president Donald Trump had announced that he would be adding UK to the list of countries banned from U.S. travel, Botswana immigration and health officials were allowing returning citizens from the UK to join their families without isolating them to ensure that they’re not harbouring the virus.

The result was Botswana’s first recorded imported COVID-19 case and the country’s first local transmission being reported almost at the same time.

Two days after the UK COVID-19 risk level was raised from moderate to high, a 27-year-old pre-symptomatic Motswana young man arrived from the UK. At the time, the UK had registered a total number of 1,140 cases with at least 21 deaths.

He was however allowed to go home after being ‘advised’ to self-isolate and monitor his health. On March 28th he tested positive for the virus and the following day his partner tested positive too.

This has set Botswana apart from other countries fighting the coronavirus. With a distinct COVID-19 transmission dynamic where the country’s imported transmission phase coincided with the local transmission phase, Botswana has for the past two weeks been fighting a rearguard battle against a COVID-19 Trojan horse.

Minister of Health Dr. Lemogang Kwape could barely hide the disappointment on his face as he took the nation through the sequence of events leading to the first local transmission of the virus. The young woman (by the Minister’s own admission) had no travel history.

The ‘couple’, according to the Minister, tested positive for COVID-19 a day apart on March 28 and 29 following admission at Scottish Livingston Hospital (Molepolole). It was only two weeks following the gentleman’s arrival from the UK.

President Mokgweetsi Masisi told the nation recently that the government was working round the clock to trace at least 46 people who are believed to have had contact with the pre-symptomatic returning citizen, who was one of five confirmed COVID-19 case in Botswana.

This however was not an isolated case. Sunday Standard investigations have revealed that this was part of an emerging pattern in which COVID – 19 pre-symptomatic returning citizens managed to slip past Botswana’s health and immigration coronavirus buffer, exposing family, friends and relatives to local infection.

In another case, a pre-symptomatic Ramotswa old woman returning from South Africa with family members were on March 15 screened at the border and advised to self-isolate. A few days later she was admitted to Ramotswa Lutheran Hospital, where she was tested for the virus. Her results were released post-humously, revealing that she was COVID-19 positive.

The country was in a tailspin Thursday morning following announcements of more local transmissions. Kwape sent shockwaves through parliament and the nation when he announced a nurse who had been in contact with members of the National Assembly, tested positive. The Minister of Health explained that the nurse had previously undergone a precautionary routine test given her recent history of working with suspected cases. Six more new COVID-19 cases were reported.

Among them was a 57 year old asymptomatic police officer who arrived in the country from the UK in February and was sent home, an asymptomatic couple that arrived from Botswana and was put on quarantine upon arrival, a 53 year old pre-symptomatic man who was quarantined upon arrival from South Africa and a 28 year old man who was also on quarantine. All of them do not show any symptoms of COVID-19 and would most likely have slipped past the country’s shaky buffer were they not put under institutional quarantine.

There are at least 291 people on home – quarantine in Botswana with some (according to government officials) still disobeying quarantine orders.

At the time of going to press about 2,081 people had been placed in institutional quarantines.  This week President Masisi told the nation that a total of 1154 people had been tested out of which 966 have tested negative. Those awaiting results, the President said, were 149. 

According to experts, cases of pre-symptomatic COVID-19 that fly under the radar without being detected may have fuelled the rapid spread of the virus. Experts say, ppeople with the virus but without symptoms or diagnosis because they did not feel very sick in the earlier stages, were the source of at least two-thirds of documented COVID-19 cases in China during the early days of the outbreak.

As the country learns of the recent incidents of the local transmission as a result of the lax measures in monitoring people on self-quarantine,

Sunday Standard recently reported about the fatal error in Botswana’s testing systems that resulted in an initial false negative diagnosis of a Ramotswa old woman who eventually succumbed to coronavirus. It was only following a second test at a South African laboratory that the results came back positive. The patient had already passed on and been laid to rest.

“To facilitate testing locally, the National Health Laboratory (NHL) and the Africa Centre for Disease Control are finalising validation of final protocols, quality control and result correlation.  If successful, the NHL will be granted permission to test, confirm and release results without the National Institute of Communicable Diseases based in the Republic of South Africa’s confirmation,” President Masisi informed the nation of new developments this past week.  

Global COVID-19 cases stood at 1,446,557 with 83,148 deaths and 281,396 recoveries at the time of going to press.

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