Journeying through COVID-19; New normal gives way to the old?

“Zero active cases must remain the overarching goal, and I have no doubt that, together, and with the help of God, this too shall pass, for the battle is still the Lord’s.”

This statement has run through the messages President Nana Addo Dankwa Akufo-Addo has delivered in his 28 updates on the nation’s fight against COVID-19 since March 2020.

It is a message of hope meant to inspire and rally the nation to support the fight against the dreaded coronavirus disease (COVID-19) which reared its head in the country on March 12, 2020 and was met with a raft of swift social, medical and economic measures.

The measures peaked at a two-week lockdown of the country’s two biggest metropolises, the Greater Accra and Greater Kumasi metropolitan areas, which were expanded to cover a wider area, to tame the spread of the novel coronavirus that the world at the time knew very little about.

Current situation

Two years after battling the disease, with its attendant inconvenience of new lifestyles, the evidential decline in the average new cases is an indication that the fourth wave might be over, the pandemic in the country has abated, and the “new normal” is once again giving way for residents to return to the “old normal” lifestyle.

It was a consistent stick and carrot approach to dealing with the disease, declared a pandemic by the World Health Organisation (WHO) on Wednesday, March 11, 2020, and which has since varied itself (mutated) for more than twice, the commonest being “Delta and Omicron”.

Case count

From a case count of two on March 12, 2020 to six cumulative cases by March 15, 2020, the country’s seven-day average new cases peaked at 1,975 on August 2, last year before dropping to eight cases as of March 29, this year.

The active case count as of yesterday was 58. The country has recorded 160,971 cumulative cases.

Out of the number, 159,468 have recovered, while 1,445 people had lost their lives to the disease as of yesterday.

The country has also administered over 13 million doses of COVID-19 vaccines as of last Monday, with more than 2.4 million tests conducted.

For the vaccines, 13.16 million COVID-19 jabs have been administered, according to the Ghana Health Service.

Out of the number, it said 9,014,575 people had received one dose, representing 39.6 per cent of the targeted 22.9 million vaccinations needed to achieve herd immunity, and 28.5 per cent of the national population.

The fully vaccinated are 5.17 million people, also representing 22 per cent of the targeted 22.9 million to herd immunity, and 16.3 per cent of the national population.

Successful feat

This successful feat in the response to the pandemic has resulted in the lifting of all COVID-19 restrictions enacted under Executive Instrument (E.I.) 64.

The evidence of a weakening threat posed by the disease is everywhere. At the Ghana Infectious Diseases Centre (GIDC), set up at the Ga East Municipal Hospital as the primary COVID-19 management centre, its Ag. Director, Dr Joseph Adjetey Oliver-Commey, said the facility was now being used more for outpatient care, as the COVID-19 cases had abated.

“Once in a while we see cases referred here, they are treated and discharged,” the Ag. Director of the centre, told the Daily Graphic last Wednesday.

The Greater Accra Regional Hospital, popularly known as the Ridge Hospital, has decommissioned its COVID-19 Intensive Care Unit (ICU). It now handles cases as and when they come.

Many of the COVID-19 case management centres and holding areas in satellite hospitals have either now returned to their original use or have been converted to serve other purposes.

Old normal in sight

In his 28th update to the nation, President Akufo-Addo said the decision was premised on the fact that countries in the ECOWAS, especially, were also recording very low levels of infections and having significant numbers of citizens vaccinated. It was also on the advice of the national COVID-19 Taskforce and the health experts.

­“All in-person activities, such as those that take place in churches, mosques, conferences, workshops, private parties and events, cinemas and theatres may resume at full capacity, as long as the audience and/or participants are fully vaccinated. Handwashing and hand sanitising points should be made available at these venues.

“Outdoor functions at sporting events, entertainment spots, political rallies and funerals may resume at full capacity, again, as long as all persons at these events are fully vaccinated. From tomorrow, Monday, 28th March, fully vaccinated travellers into Ghana will not take PCR tests from the country of embarkation to allow them entry into the country through the KIA, and will not be tested on arrival”, the President stated.

Land, sea borders

The President also opened all land and sea borders and fully vaccinated travellers will be allowed entry without a negative PCR test result from the country of origin.

What will remain a new normal, health and safety analysts have said, include the hygiene practices such as the regular washing of hands with soap under running water, use of alcohol-based hand sanitiser and its production by local pharmaceutical firms, remote execution of formal tasks, also known as “working from home”, virtual learning in schools, colleges and universities and the building of health systems for resilience against future pandemics.

The measures

Prior to these positive outcomes, the COVID-19 measures, which were also observed globally, imposed a sharp shift in lifestyles, restrictive movements, the wearing of nose masks, the washing of hands with soap under running water and the use of hand sanitiser.

The response was targeted at limiting and stopping the importation of the virus, containing its spread, providing adequate care for the sick, limiting the impact of the virus on social and economic life, inspiring the expansion of our domestic capability and deepening our self-reliance.

Deserted streets

Because knowledge on the novel coronavirus was scanty, the atmosphere was filled with fear and anxiety, with the first set of Ghanaians who contracted the infection, facing a high level of stigmatisation.

The response in the country, which included avoiding crowding and ensuring social distancing and ventilation, caused many to stay in the house, with companies and public institutions resorting to shift systems of work, while majority of employees worked from home, a practice which is still going on in some companies.

Telecommunication companies, banks, financial institutions, public sector institutions, the media and many more organisations still have their staff fully employed by working from home.

The government backed the response plan with an initial $100 million budget, announced in the President’s first update to the nation on Wednesday, March 11, 2020.

Fellow Ghanaians

In that address, which quickly became known as “Fellow Ghanaians” because of the frequent use of the phrase, he indicated that COVID-19 which had then affected about 118,000 people across the world, resulted in the death of about 4,000 persons and was wreaking havoc on the global economy.

As of March 11, 2020, the country had recorded 57 suspected cases which all proved negative.

However, the President said it was imperative that the country stepped up its preparedness to ensure that beyond the initial satisfactory measures, the government had adopted “a whole of Ghana approach” to adequately prepare for a possible hit within the country’s borders.

“In order to do so, at my prompting, the Minister of Finance has made available the cedi equivalent of $100 million to enhance our coronavirus preparedness and response plan.

“That is to fund the expansion of infrastructure, purchase of materials and equipment, and public education. I have as of yesterday ordered the suspension of all international travels except for critical assignments which would have to be authorised by the Chief of Staff at the Office of the President,” the President said.

Our journey so far

The outbreak of the novel coronavirus was announced in China in December 2019.

On January 12, 2020, WHO confirmed that the novel coronavirus was the cause of a respiratory illness that affected a cluster of people in Wuhan City and the Hubei Province in China, causing COVID-19.

In a few days, the disease crossed from China to other countries, with a high fatality rate.

Aside from the high associated deaths recorded in China, which locked down Wuhan, the Hubei and adjoining Provinces, the disease wreaked similar havoc in countries such as the United States of America, France, Brazil, the United Kingdom and Germany.

This prompted the Ministry of Health to activate a red alert national disease surveillance system, on the back of warnings from the WHO that the African continent could be the worst affected in view of its general weak health systems, infrastructure and low medical research and development.

Suspected cases

On February 6, 2020, the country recorded two suspected cases of COVID-19 at the Korle Bu Teaching Hospital (KBTH), but they turned out negative.

The two, a Chinese and an Argentine, who had been staying together in Accra for some days reported to Korle Bu on Wednesday evening with symptoms suspected to be similar to the virus which had killed more than 500 people in China at the time.

There were nine more suspected cases of COVID-19 which all turned out to be negative. These cases fuelled suspicions and created anxiety among the population, leading to the stigmatisation of the disease.

As of February 6, 2020, there has been 28,280 confirmed cases and 565 deaths globally and by March 11, the country had its first set of cases.

Kotoka International Airport

Since the first two cases entered the country through travellers arriving in the country, surveillance was intensified at the airport.

A readiness assessment was conducted and a response strategy was developed by the National Disease Surveillance Department of Ghana Health Service (GHS).

The response strategy included intense public education, particularly, at the Kotoka International Airport (KIA), and other land borders.

The Ministries of Health, Information and the media instituted aggressive mass education and campaigns to create the necessary awareness in Ghana.

At the KIA, the Daily Graphic observed initially that electronic screens displayed information about the virus, emphasising the preventive measures such as social distancing, washing of hands regularly and sanitising of hands.

Gradually, the interventions were broadened to include the checking of the temperature of all arriving passengers with walk-through thermal thermometers, with further checks with the non-contact gun-like thermometers.

A medical declaration form to be filled mandatorily by all arriving passengers, detailing where they had been coming from, any records of flus, and fever, among other information, was added to the preventive mechanisms at the KIA.

Even before the country recorded a case, key medical facilities such as the Greater Accra Regional Hospital, the Tema General Hospital and later the Korle Bu Teaching Hospital were designated as initial case management centres.

Later, the Police Hospital and all teaching hospitals in the country were included as case management centres — all these were prior to the country’s first case.

Price hikes

The disease also came with instant increases in the prices of essential hygiene products, particularly hand sanitiser, which was the first common resort in containing the disease.

In March 2020, prices of a tiny portable bottle of hand sanitiser went from about GH¢5 to about GH¢20 or GH¢10 worth to about GH¢60 for the 250ml quantity of sanitiser.

Interestingly, the trading community which made windfalls from the price hikes, particularly of hand sanitiser and nose masks, which shot up about 1,000-fold, is the same segment that is counting its losses as the prices of the hygiene products have plummeted drastically.

Ghanaian students in Wuhan

A major national concern at the time was the welfare of Ghanaians studying in Wuhan and other provinces in China.

There were agitations on the need for the government to evacuate the students who were about 400 in Wuhan alone.

However, on February 14, 2020, the Ghana Health Service came out to explain that evacuating Ghanaian students in Wuhan, China, where COVID-19 started at the time, was not advisable.

It said stakeholders in Ghana and beyond had described that move as counter-productive.

It said that was because China had a better capacity than Ghana in dealing with the disease in terms of prevention, management and treatment.

The Director-General of the Ghana Health Service, Dr Patrick Kuma-Aboagye, gave an assurance that no Ghanaian had been affected or was in danger.

At a media engagement to provide updates on the national surveillance programme, he noted that the government was monitoring the situation closely and was ready to evacuate Ghanaians without hesitation, once that became necessary.

The then Ghana’s Ambassador to China, Edward Boateng, said the Ministry of Foreign Affairs and Regional Integration, immediately after the lockdown of Wuhan and the Hubei Province from January 23, 2020, granted approval for the embassy to expend 100,000 Yuan, the equivalent of $14,326, to enable the embassy to purchase nose masks, sanitiser and some groceries for Ghanaian students in the Hubei Province and others across China.

First two cases recorded

A day after the disease was declared a pandemic and the first national presidential address, March 12, 2020, the country recorded its first two cases, which were among international travellers.

The GHS intensified its public education on the preventive measures while putting its community surveillance mechanism on red alert for any possible community spread.

Intensive contact tracing was conducted which initially showed no sign of a community spread.

Despite the preventive interventions, the disease quickly spread through the community and within a week of the first cases, the country confirmed cases in individuals with no links to foreign travel.

The majority of cases were in the two most populated cities of Accra and Kumasi.

It was at this point that the government introduced its three-prong response policy: the trace, test and treat, which was implemented vigorously.

Intensified measures included a ban on all public gatherings, closure of schools, churches, mosques and other places of worship on March 16, 2020.

The lockdown

Others were a ban on entry for travellers coming from a country with more than 200 confirmed COVID-19 cases within the previous 14 days on March 17, a mandatory quarantine of all travellers that arrived in the country 48 hours prior to the closure of the country's borders on March 22, 2020; a partial lockdown of Accra, including Kasoa in the Central Region, and Kumasi on March 30, 2020.

The restrictions on Accra and Kumasi were lifted on April 20, and the use of face masks was made mandatory on April 26, 2020.

During the period of the lockdown, an enhanced surveillance in the form of active case search and contact tracing strategies were activated to early detect, isolate and treat all confirmed cases.

The Ghana Health Service mapped out all existing cases, conducted a risk assessment, and sampled members of households within a two-kilometre radius of a cluster of cases.

The enhanced surveillance and contact tracing strategy helped the country to identify a significant number of cases, of whom about 93 per cent were asymptomatic.

Approximately 63 per cent of the total confirmed cases in the country had been detected through this approach.

Relief during lockdown

The Ministries of Gender, Children and Social Protection and Local Government Decentralisation and Rural Development, as well as the National Disaster Management Organisation (NADMO), worked with metropolitan, municipal and district chief executives (MMDCEs) and faith-based organisations to provide food for up to 400,000 individuals and homes in the affected areas of the restrictions.

This began in Accra on April 5, 2020 and in Kumasi the following day. It was dry food packages and hot meals, delivered to vulnerable communities in Accra, Tema, Kumasi and Kasoa.

This was informed by some head porters (kayayei) who were travelling outside Accra to their hometowns in the northern part of the country because of hunger.

The government also directed the Ghana Water Company Ltd and the Electricity Company of Ghana to ensure the supply of water and electricity free of charge to the population. This continued for about six months.

Again, the Ghana Enterprises Agency (GEA), formerly the National Board for Small Scale Industries (NBSSI), worked with business and trade associations and selected universal and rural banks to provide soft loans, amounting to about GH¢600 million to small and medium businesses.

Incentives for frontliners

The government also announced an insurance package of GH¢350,000 for each health workers and allied professional at the forefront of the fight.
Personnel engaged to do contract tracing were paid a daily allowance of GH¢150.

All health workers were also excluded from paying taxes on their emoluments for the next three months—April, May and June.

The frontline health workers also received an additional allowance of 50 per cent of their basic salary per month for March, April, May and June, among other incentives.

The Ministry of Sanitation and Water Resources, together with some 400 personnel drawn from the security agencies in April 2020, embarked on cleaning public spaces including de-silting of gutters, collection and disposal of garbage from homes, public places, markets and vehicle terminals.

Alleviation support

The Minister of Finance was directed by the President to prepare for approval by Parliament, a Coronavirus Alleviation Programme to address the disruption in economic activities, the economic hardship and to rescue and revitalise our industries.

He was to immediately make available a minimum of one billion cedis (GH¢1 billion) to households and businesses, particularly small and medium-scale enterprises.

The commercial banks were provided with incentives to lend to industry, especially in the pharmaceutical, hospitality, service and manufacturing sectors.

The government provided additional reliefs such as extension of the tax filing date from April to June, the granting of a six-month moratorium of principal repayments to entities in the airline and hospitality industries,made up of hotels, restaurants, car rentals, food vendors, taxis, and Uber operators.

To improve the laboratory turnaround time for confirming suspected cases, the testing sites were increased to include the National Public Health Reference Laboratory (NPHRL), National Veterinary Service Department (VSD) Laboratory and Centre for Scientific and Industrial Research (CSIR) Laboratory in Accra; Public Health Reference Laboratory, Tamale; the Tamale Teaching Hospital Laboratory, Navrongo Health Research Centre in the northern part of the country, the University of Health and Allied Sciences (UHAS) Laboratory in the Volta Region.

Private laboratories also joined in the testing for COVID-19.

To address the challenge of providing data in real time, the Ghana FELTP, in collaboration with the Department of Geography at the University of Ghana, quickly developed an interim real-time data collection and reporting tool.

Update 2

Following the surge in cases within communities, President Akufo-Addo on March 15, 2020 delivered his second address, providing measures taken by the government to combat the pandemic.

He announced that all public gatherings, including conferences, workshops, funerals, festivals, political rallies, sporting events and religious activities such as services in churches and mosques had been suspended for the next four weeks.

Private burials were permitted, but with limited numbers, not exceeding 25 people in attendance.

All universities, senior high schools and basic schools, made up of public and private schools, were to be closed from Monday, March 16, 2020. They were reopened fully in January 2021.

The Ministry of Education, in collaboration with the Ministry of Communications, was tasked to roll out distance learning programmes.

However, BECE and WASSCE candidates were to be allowed to attend school to prepare for their examinations, but with prescribed social distancing protocols.

Businesses and other workplaces were permitted to operate, but under prescribed social distancing guidelines between patrons and staff.

The President also tasked the Attorney-General to submit, immediately, to Parliament, emergency legislation in accordance with Article 21 (4) (c) & (d) of the Constitution of the Republic, to embody the measures.
The Minister of Health was also to exercise his powers, under section 169 of the Public Health Act, 2012 (Act 851), by the immediate issuance of an Executive Instrument, to govern the relevant measures.

Update 3

On March 27, 2020, in another address, President Akufo-Addo did not only lock down Accra and Kumasi but also asked residents to, as much as possible go out only to get essential items such as food, medicine, water, undertake banking transactions or to use public toilet facilities.

Individuals and institutions providing certain services were exempted from the restrictions.

The affected areas, and, indeed, all other regions earmarked as designated isolation and treatment centres for the management of suspected and confirmed cases, as well as the selection of facilities for mandatory quarantine were beefed up.

An intensive public health education and community awareness of social distancing and handwashing was also carried out.

The government at the time said it had taken delivery of additional PPEs and more were being procured to protect healthcare workers.

COVID-19 Trust Fund

President Akufo-Addo inaugurated the Board of Trustees of the COVID-19 National Trust Fund on Sunday, March 29, 2020, at the Jubilee House, the seat of government.

The Board of Trustees, which was chaired by the former Chief Justice, Sophia Akuffo, has been coordinating donations to support the response plan.

The President added that the work of the Board would complement the efforts being made by the state in catering for the poor and vulnerable, stressing that “whatever money we raise, that is the target”.

Global shortage and production

The global community recorded a shortage in personal protective equipment (PPE), particularly nose masks, which had become the basic protective gear.
Necessity, indeed, is the mother of invention, as the sense of enterprise and innovation of Ghanaians was brought to bear.

The government actively engaged with local manufacturing companies to assist in the domestic production of PPE, including head covers, surgical scrubs and gowns.

Additionally, the production solar-powered handwashing systems, ingenuities of local artisans, began alongside the mass production and use of Veronica buckets.

Jude Osei from Kumasi produced the solar-powered sink, while Kelvin Owusu Dapaah and Richard Boateng, both students of Obuasi Senior High and Technical School, produced the COVID-19 prevention electronic bucket.