Thursday, August 13, 2020

Mystery over Botswana’s COVID-19 “Patient Zero” deepens

COVID-19 misdiagnosis sparks national alarm, shortage of testing kits gums up processes, Permanent Secretary and his deputy fired mid-battle: The Botswana COVID-19 Task Force has been fighting Murphy’s Law from day one.

However, if there was any one incident that confirmed Batswana’s worst fears that government was never prepared to deal with the coronavirus pandemic, it was the Ramotswa incident.The 79-year-old Ramotswa woman initially believed to be the country’s patient zero was diagnosed COVID-19 positive posthumously.”Patient zero” also known as an index case, is a term used to describe the first human infected by a viral or bacterial disease in an outbreak. 

Curiously, more than a month since Botswana’s suspected “patient zero” was recorded as the country’s first and only COVID-19 death, she does not appear anywhere on the lineage of Botswana’s local transmissions. As Botswana grapples with more questions than answers , three theories have emerged to fill the official explanation void. The first one is that government knew that the 79 year old Ramotswa woman was infected with the coronavirus, but tried to hide the information from Batswana, exposing the country to local transmission.The second theory states that Botswana’s tests posted a wrong negative and second tests from South Africa came back positive. That at the time South Africa released it results, tens of family members, neighbours and medical officers had already been exposed to the virus and government was wrestling with a public relations nightmare.

The third theory postulates that the old woman died from asthma which was misdiagnosed as COVID-19.Unfortunately, all three theories cast government as a bumbling blunderbuss.Information pieced together from interviewing medical officers, family members and neighbours however stack up with the theory that the old woman was misdiagnosed.Her death certificate, signed by Dr Ramotlhwa cites cause of death as “respiratory distress and hypertension.” This is a catch-all report which points to asthma, tuberculosis, coronavirus or any respiratory disease.The deceased (name withheld) hospital cards seen by the Sunday Standard reveal that she was treated for shortage of breath and other asthma symptoms on numerous occasions long before the outbreak of the global coronavirus pandemic.

The Difference between coronavirus and asthma is that coronavirus is highly contagious while asthma is not communicable.A Sunday Standard investigation on the old woman’s close contacts reveal no local transmission. The old woman singlehandedly ran a semausu/ Tuckshop which was popular in the neighbourhood for the delicious mango atchar she imported from Motsweding. Her passport reveal that she had travelled to Motsweding a week before her last trip of March 15th. At the time, South Africa was already emerging as Africa’s epicentre of the pandemic.Sunday Standard investigations have revealed that none of her customers have reported any coronavirus symptoms. The three relatives who travelled with her to and from the family funeral in Metsweding have tested negative to COVID-19.

All mourners who attended the funeral with her in Motsweding have also tested negative. Babereki ka Lorato and Ramotswa Hospital mortuary attendants who handled her corpse have also tested negative. Even her grandson who held her in his arms and drove her to Ramotswa Lutheran Hospital has also tested negative. Curiously, besides her grandson who was quarantined at Grand Area hotel in Gaborone, none of her many close contacts were placed under institutional quarantine. Government officials flouted their own contact tracing guidelines despite the perceived threat to public health. Family members left for their homes and workplaces without testing. Contact tracing has not provided any answers. No trail. The family of the deceased is left to deal with the stigma of a case that probably never have existed (See story on Page 3.)The situation is not helped by government’s new public health response to censor and obfuscate COVID-19 information.

Ironically, the decision was informed by events around the Ramotswa case.In a curious break from its commitment to transparency in the fight against the coronavirus, Coordinator of COVID-19 Task Force Dr. Kereng Masupu disclosed last month that government had taken a decision mask the country’s COVID-19 data.Masupu argued that government’s decision to apply masking to the country’s COVID-19 data field is to protect information that is classified as personally identifiable or sensitive personal data.Answering questions from journalists, Masupu revealed that unlike South Africa, Botswana will not stratify its COVID-19 data, but will instead aggregate it to hide demographic variables that may compromise patients’ right to privacy.“We are a very small society and if we stratify information some people may see through it and guess who the patients are’, he argued.

He cited a recent example where the team received complaints from some Ramotswa residents about disclosing the geographic information of the Ramotswa old woman who tested positive to the virus.Government is now using the new public health response to hide information about the Ramotswa incident. government has been especially cagey on contact tracing developments in Ramotswa, hiding behind the stigmatisation rhetoric to ward off media enquiries.The COVID-19 Task Force have turned down an opportunity to answer a series of questions from Sunday Standard regarding the matter, citing patient confidentiality.

The case about which you enquire has been adequately explained to the public by the health authorities.  Also, in answering the nature of your questions would constitute a breach of doctor patient confidentiality,” COVID-19 Task Force Coordinator Dr. Kereng Masupu said.

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