On 6th Dec 2020, ERADA held a virtual consultative meeting with H.E. President Ashraf Ghani, H.E. First Vice President Amrullah Saleh, Minister of Health Dr Osmani and President of the Afghan Medical Council Dr Nasrin Oryakhil. During a two-hour discussion around the second wave of COVID19, lessons learned from the first wave and its implications, ERADA made the following recommendations, which were welcomed by HE President Ghani and his team. Summary of the recommendations are:
General recommendations on coordination and governance:
- To ensure overall transparency and accountability. The system should apply business management tools at central and provincial levels to regularly update the public, partners, and media on expenditure, supplies and the use of resources during pandemic or health emergencies
- In order to make rapid decisions, overcome bureaucratic and operational bottlenecks, the establishment of regular (daily or 3-4 times per week) meetings, e.g. Jalsa-e- 7:30?; which should include establishment of a single well-equipped Command and Control Center, inclusive of all relevant sectors (health, social affairs, emergency response, governorates and municipalities etc.)
- Collaboration mechanism with internal and external stakeholders should be in place, and each ministry and governmental authority fully understand and own their roles and responsibilities. This is important that will help in smooth and quick response without duplication and waste of time and resources
- Anti-corruption measures should be in place to ensure transparency and accountability during the fight against COVID19 and other health emergencies. The system should identify risk areas and apply risk mitigation measures to avoid the misuse of resources
Communication and public awareness:
- Establishment of a single hotline in larger cities with central data on bed capacity and resources availability, e.g. equipment of all hospitals. Publicizing it so all patients can call a single number to find out which hospital has the capacity of accepting new patients, this will save lives by saving time of moving from hospital to hospital. Trained health professionals should staff these call centers to be able to counsel and advise on initial assessment, diversion and direction of patients in need
- Preventive measures should be in place until 80% vaccine coverage is achieved, so public education and key messages on social distancing, mask (homemade okay too), hand washing, contact tracing, isolation if exposed, quarantine if sick
Quality of care:
- Availability of medical oxygen, and technical capacity to deliver low and high flow of oxygen with and without mechanical ventilation. All hospitals should be equipped with a central system for the supply of oxygen. In case that is not possible in short run, a buffer system for storing adequate oxygen in the hospitals should be in place
- Expansion of the Tele-education/e-health infrastructure to all secondary and tertiary facilities
- Establishment of 24/7 resource center (in one of the referral or university hospitals in each of the major cities) to provide remote advice and guidance on specific complicated cases to doctors in charge
- Promotion of tele-education that Afghans abroad can provide online lectures and guidance on specific topics
COVID19 testing:
- Improving lab processes enhances testing capacity. This will require strengthening the management capacity of the lab
- RT-PCR is gold standard, but it is expensive, trained personnel is scarce, and it takes time from sample to result. We must think about other test options too (Rapid Antigen test)
- Only focusing on lab capacity is not enough. The spread of infection is fast, and the number of cases can easily overwhelm lab capacity
- Introducing Rapid Test: Rapid antigen test is a reliable way to reduce the load on lab and provide. If used within 7 days of onset of symptoms, the sensitivity could be around 85%. The specificity of these test is high. The two Rapid Antigen tests are:
- Abbot PanBio Rapid Antigen Essay
- Bionax Now COVID 19 Antigen CardEssay
- A transparent online system should be established that all officials can easily see the number of used and available test kits, level of supply and demand, which should match the number of reported cases
- In order to use limited resources efficiently, check a cohort of patient every 2 weeks for Flu and COVID and if no Flu in circulation at community level then COVID-19 diagnosis can be made clinically based on ‘COVID case definition’. Test only those who require intervention (20% of suspected COVID cases)
- Contact tracing for COVID19 should be implemented only if the prevalence rate is lower than 10%
COVID19 Vaccines:
- Eligible countries are expected to submit their vaccine request (by 7th Dec 2020) to GAVI for 20% under COVAX-AMC mechanism and additional 5% through cost-sharing
- The Russians and Chinese had a limited approval for the similar Viral Vector Vaccines a few months ago. If the Government reach out to Russians and Chinese, they might be able to secure some additional doses. China is already testing similar VVV vaccines in UAE
- Prioritization for COVID19 vaccinations:
- Populations with significantly elevated risk of severe disease or death (e.g. elderly, people with comorbidity); or infection (e.g. health workers, social groups unable to physically distance such as refugee camps military personnel, detention facilities etc.
- Economically critical sector, government leaders
- Hard to reach people, people living in poverty, essential workers outside health sector
- Identification of risks and developing a risk mitigation plan
Supply management:
- Development of Supply Chain Management Plan from procurement to utilization. Training of all health managers and health administrators in Supply Chain Management
- Identification of risks and developing a risk mitigation plan
- A stock management system should be digitalized and linked to all provinces and health facilities
- Hospitals should be equipped with essential PPEs and infection prevention supplies, and its use should be regularly monitored via a central digital inventory system
Social Protection:
- Provide subsidized fuel/gas to those who cannot afford
- The idea is if a COVID-19 positive or suspect is to be isolated or quarantined in the house, the household has sufficient resources to provide heating in an additional room! as 80% of patients will remain in their homes.
- Identify those areas that are at high risk for food insecurity, hunger and starvation
- Create emergency strategic resources/stock in those areas before the first snow
- Provide subsidies to those vendors/traders who want to supply hard to reach areas
- Involve provincial and district government (including law enforcement) in all steps of the planning, because the central government won’t be able to reach there on time
ERADA welcomes the decision of the Cabinet of the government of Afghanistan, who adopted recommended actions as mater of priority to fight against the second wave of COVID19, during its 7th Dec 2020 session.
Please see below President Ghani’s speech at the Cabinet meet of 7th Dec 2020: