199 Days Into Covid-19 Pandemic

By Dr. Ngwa Wilfred, Dr. Denis Foretia, Dr. Mbuwir Charlotte, Dr. Asahngwa Constantine, Dr. Kibu Odette, Dr. Ronald Gobina , Dr. Nkengafac Fobellah. (Download the Pdf Version)

1. Context

The outbreak of the novel coronavirus disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first reported in Wuhan (Hubei province) China in December 2019. The virus has since then spread to all the 7 continents of the world, infecting over 14 million persons and killing over 600,000 [1] (as of July 19th, 2020.) By 30 January 2020, WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC) [2]. The highest concentration of infected persons has shifted several times since mid-February 2020 from China to Iran, and then to Italy and Spain and is presently in the United States of America [3]. According to the Lancets, it is inevitable that Africa and Latin America will be experiencing the next wave of infections [4]. Since the introduction of the first case on February 14th, 2020, Africa as of July 19th, 2020, counted 683,905 infected persons and 14,684 deaths, thus contributing to 5% of the global caseload and to a little above 2% of the global death roll [5]. Although yet to be proven, several conspiracy theories have been proposed to explain these fewer cases observed in Africa [6].
Cameroon as of the 19th of July had recorded 16,157 cases with 373 deaths with 13,728 recovered cases [7]. This translates into a case fatality rate of 3.6% and a COVID 19 patient recovery rate of 85%. This ranks Cameroon as the 65th most affected country worldwide, the 7th in Africa [10] and the first [5] in Central Africa. The situation in Cameroon has pushed decision makers in Cameroon into taking a number of measures aimed at limiting the spread of the disease [8] in the country while at the time mitigating its impact on the economy [9]. Commendable efforts have been made by the government so far so such as the decentralisation of testing to 9 out of the 10 regions of the country (Rapport de Situation COVID 19 au Cameroon, Sitrep No 38).
This report looks into COVID 19 situation in Cameroon with regards to the distribution of COVID 19 cases, the situation of health workers, some key mortality and morbidity indicators as well as the weekly evolution cases; making use of data from the beginning of the pandemic up to the 3rd of July 2020.

2. Government’s efforts/reforms to tackle COVID.

Government has been stirring up efforts to curb the spread of COVID-19 across the country. According to the “Rapport de Situation COVID 19 au Cameroon, Sitrep No 38”, a total number of 17,777,261 persons (from March 6th to June 26th) across the country, have been sensitised on preventive measures as part of government efforts to curb further propagation of the disease. In an effort to boost testing, 15 laboratories, distributed unevenly in 9 out of the 10 regions (exception of the South region) having Polymerase Chain Reaction (PCR) capacity to test for COVID-19. In the same light, a total number of 94,161 diagnostic tests (49,765 PCR and 44,396 rapid tests) have been realised across the national territory of July 3, 2020 (Rapport de Situation COVID 19 au Cameroon, Sitrep No 38).
According to worldometer (a reference website that provides counters and real-time statistics for diverse topics), the current population of Cameroon is estimated at 26,545,864 inhabitants [10]. This suggests that 94,161 tests for such a huge population of inhabitants can be considered as considerably low, especially as the quick identification, isolation and treatment of cases is paramount to preventing the spread of the virus; a strategy adopted by Cameroon
and coined as the “3Ts” for Track, Test and Treat.

3. Distribution of COVID 19 cases in Cameroon (July 3rd , 2020)

As of July 3rd, 2020, Cameroon had a total number of 14,524 cases, 324 deaths (cases fatality rate of 2.4%) with 11,360 recovered cases (recovery rate of 78,2%).

Figure 1: Covid-19 Situation In Cameroon

Figure 1 shows the regional distribution of COVID 19 cases in Cameroon. It can be noticed from the map that 6 regions (Centre, East, Littoral, South, West and South West regions) out of the 10 have an infection rate (or attack rate) above the infection rate threshold of 20 cases per 100,000 inhabitants set by European countries to restrict travellers from Africa [11]. The Centre Region and the East Regions have the highest attack rates (187.7 cases per 100,000 inhabitants and cases 111.3 per 100,000 inhabitants respectively). The North West, Adamawa, North and Far North regions respectively have infection rates of 13.8, 11.2, 5.1 and 2.7 cases per 100 000 inhabitants. According to Cameroon’s 38th situation report on COVID-19 in Cameroon 118 (62%) of its 190 health districts have recorded at least a COVID-19 case (Rapport de Situation COVID 19 au Cameroon, Sitrep No 38), a true confirmation of widespread local transmission of cases.
Most regions, like the East, Littoral, South, West and South West regions despite having very high infection rates have a single diagnostic laboratory whereas the Centre region alone has up to 5 testing laboratories.

4. Situation of Health Workers (July 3rd , 2020)

Figure 2: Covid-19 Situation of Health Workers In Cameroon on July 3th 2020

As of the 3th of July 2020, 624 health workers (constituting up to 4.3% of the total number of cases) in Cameroon had been infected with SARS-CoV-2 in Cameroon with 7 (1.1%) of them losing their lives (Figure 2).reference needed here This is an indication amongst other things of either scarcity of Personnel Protective Equipment (PPE) among this high-risk group or poor use of the PPE among the personnel themselves either due to a high work load or lack of adequate training on the appropriate use. Whatever the case may be, it is important that efforts be made in this direction to reduce significantly the number of health workers infected by the virus within the country as this doesn’t only constitute a great loss to the nation but also could scare off patients infected with the virus from seeking care.

5. Mortality/Morbidity Indications Amongst COVID-19 cases in Cameroon

The overall mortality rate (deaths/total cases) in Cameroon as of the July 3rd, 2020 stood at 2.4% whereas that amongst closed cases [deaths/ (deaths + recoveries) stood at 2.9%. The mortality rate worldwide as of the date of this report (19th July 2020) stood at 4.2% and 2.6% among closed cases [10]. The mortality rate of 2.4% observed in Cameroon is an indication that 2 to 3 out of 100 patients infected with COVID-19 in Cameroon die from the disease (a similar
situation for those who go through the full course of the disease).
Although the overall mortality indicators are found to be low when compared to global figures, the case fatality rate for the West, South West, North, North West and Far North regions are high than the observed global values. Mortality rate amongst closed cases is higher in 9 out of the 10 regions when compared to the global mortality rate suggesting that much still has to be done in Cameroon as far as case management is concerned.

Table 1: Case Fatality Rate, Attack rate and Mortality rates amongst closed cases by region (July 3rd, 2020)

6. Evolution COVID-19 cases in Cameroon (July 3rd , 2020)

Since the first case of COVID-19 was registered in Cameroon, the country has observed a continuous increase in the number of cases. As shown in Figure 3, this case peaked between the 12th and 17th week into the pandemic. The country observed a decrease in the number  of cases from week 17 to 18. With a low testing rate observed within the country so far, the big question that needs to be clarified is if this observed decrease is a progress towards an effective control of the epidemic within the country or if this is as a result of insufficient testing.

7. Conclusion and recommendations

• With 6 (Centre, East, Littoral, South, West and South West regions) out of the Cameroon 10 regions having an infection rate of above 20 cases per 100,000 inhabitants coupled with 118 out of its 190 districts affected by COVID-19, there is an urgent need to increase testing capacity within the country. In this light government has been making commendable efforts but more still has to be done if this pandemic it to be significantly contained. There is need to create more laboratories equipped with the ability to test for COVID-19 in other regions especially those with an infection rate above 20 cases per 100, 000 inhabitants (Centre, East, Littoral, South, West and South West regions).
• The situation of health workers has to be urgently looked into especially as their protection from infection is concerned. Research to investigate why the infection rate amongst health workers is relatively high could better inform measures taken to minimise the risk of infection amongst this high-risk group. There is need for constant refresher training of health workers on the correct use of PPE while ensuring adequate supply of essential protective equipment within health facilities (primary health facilities included and not only treatment centres). This should be accompanied by the stepping up of Infection, prevention and control measures at the level of all health facilities.
• With 9 out of the 10 regions of Cameroon having a mortality rate amongst closed cases above the mortality rate observed at global level, there is need to step up the management of cases as far as COVID-19 is concerned. This amongst other things include continuous training of health workers on case management, constant case review of COVID-19 patients to identify drawbacks and make improvements, as well as furnishing health facilities with essential medication and equipment to enable them better manage cases.
• Continuous community engagement needs to be taken into consideration. Media houses have to ensure that correct and accurate information is communicated to the public. If possible, this information should be reviewed by health experts before communication to the public to avoid misinformation.