Introduction

COVID-19 has since been rapidly spreading from the time (late 2019) and place (Wuhan Province in China) it was first discovered. According to the World Health Organisation (WHO), the global confirmed cases reported as of 10:23 am CEST, 13 August 2020 were 20,405,695, including deaths. Statistics from WHO reviewed an exponential increase in the number of global cases. The question now is why is there a surge, and not a decrease in the number of confirmed cases, given the publicity the COVID-19 pandemic is given and lockdown measures being implemented across the world.

Social behaviour

A recent study RCIEEN conducted in the city of Harare, Zimbabwe, one city where the number of daily confirmed cases is rising at an alarming rate, reviewed the following:

  • Although the Government is trying to ensure dissemination of crucial information to keep people safe from COVID-19, most of the people are just reluctant or rather ignorant to keep observing the regulations, as with the first (Phase 1) lockdown. People are relaxing the safety guidelines, especially that of keeping good social distance in public, whenever there is no strict control.
  • Almost everybody in the public space is wearing a mask, but over 50% of the people are wearing the masks wrongly, posing a health threat. In addition, most of the masks are unstandardized masks whose effectiveness is scientifically unknown. Potential victims are on the increase as most people are developing a habit of using one mask throughout the day and often spending a couple of days before washing or changing the mask. There are people washing and reusing disposable medical masks that are meant to be used once, over short time intervals.
  • Social circles are being held on the base of trust, and people are developing a tendency of relaxing COVID-19 regulations, especially when there are with people they often spend time with. These social circles include but not limited to workmates, neighbours, church mates, family members, and friends. What people do not fully understand is the fact that a person can get infected and transmit the novel virus before COVID-19 symptoms show. In fact, according to WHO, an infected person is highly infections in the last moments (day/s) before symptoms show when the viral load is at its maximum. This means a highly positive probability of infection withing the social circles prior to the carrier’s development of symptoms and confirmation of COVID-19 status by health officials. People develop a sense of responsibility and become very cautious when a close case is confirmed positive, or continue in their relaxed condition until experience teaches them the reality of the pandemic.
People socialising at a bus terminus: Harare

Kind of lockdown

From an analysis of the global statistics on the WHO website, it can be reviewed that the most effective lockdown is the one in which there is a total shutdown of everything other than the health sector, as in China.

A case study of Zimbabwe reviewed that under Phase 1 lockdown and early phase two lockdown with most sectors at near-complete shutdown (31 March to Mid-May), very few confirmed cases were recorded each day. The few confirmed cases were mainly imported cases of external origin, and close to zero cases were recorded because of local transmissions. The first lockdown was very effective, but later, when some restrictions got lifted to allow the economy to regenerate, the cumulative number of confirmed cases increased gradually until early July, when the increase skyrocketed, leading to a review of the lockdown regulations on Tuesday the 21st of July 2020.

COVID-19 Statistics: Extract from the Zimbabwe Ministry of Health and Child Care website

Infection by undocumented cases

COVID-19 does not affect all people similarly; to the ageing people and those with underlying medical conditions, the risk of becoming seriously ill and needing hospitalisation is very high, but children and young adults often develop minor to mild conditions which may often go for a while without being noticed or documented as confirmed cases. These undocumented cases are likely to contribute to the transmission caused by the unquarantined group. While those who develop major symptoms contribute to the majority who quickly get tested and confirmed these low-risk groups can remain infectious but yet undocumented, leading to a great bias on the response by authorities on the active cases.

Working environment

Studies conducted in japan reviewed indoor transmission is 19 times more risk compared to outdoor transmission. Most people, especially sedentary workers are more accustomed to working inside of their offices and do not consider open office as the new way to operate, posing a risk of infection to all who share or visit the office of an infected person, especially when the office is not well ventilated or if openings are closed because of weather.

Mode of transmission

According to WHO, the COVID-19 Virus is highly contagious and spreads by so many modes of transmission, which include contact, droplet, airborne, fomites, faecal-oral, blood-borne, mother-to-child, and animal-to-human transmission. Unlike other diseases that spread by fewer transmission modes, the numerous modes of transmission of COVID-19 present a great challenge to prevent possible transmission completely.

Having all this said, an additional question now arises, what is it that is required to curb the spread of the novel virus?

The first and most important thing is to have responsible citizens, people who follow instructions given to them by their Governments, or Health agents, such as lockdown regulations. People should not require a law enforcement agency to:

  • stay home,
  • avoid public gatherings
  • keep good social distance (greater than 2m) when in a public environment
  • practice good social hygiene (wash hands frequently, avoid surface contacts and ensure appropriate environmental cleaning and disinfection)
  • avoid social contact such as handshaking of hugging
  • remain isolated if not feeling well
  • wear a mask and properly in public areas
  • avoid confined and enclosed spaces, especially those with poor ventilation;

On the other hand, Governments should

  • put measures to identify cases in the early stages, test and isolate victims
  • Contact trace and quarantine all close contacts of the victim
  • Ensure the safety of all frontline health workers by providing all safety requirements and support
  • Ensure appropriate environmental cleaning and disinfection of all public settings.

References

https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions

https://covid19.who.int/

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19