by Alagi Yorro Jallow
Mamudu: No country has a medical system equipped or large enough to handle a runaway illness effectively. Epidemics and pandemics devastate communities on scales that no one can design a permanent public health system for it. That is because epidemics and pandemics are exceptional. Nothing in the past tells the authorities how to handle discrete elements of the crisis.
The gloomy atmosphere of those times can be re-lived in Daniel Defoe’s creatively fictionalized chronicle, “A Journal of the Plague Year,” which describes the Great Plague of London in 1665. It is a poignant read- it can be read for free at Project Gutenberg, the vast collection of classics. Defoe’s is full of recognizable emotions, fears, and the usual collection of human foibles under the stress of the unknown. Defoe notes that people did a “thousand weak, foolish, and wicked things” including “running to fortune-tellers, cunning men, and astrologers” with the result that London was soon swarming with “a wicked generation of pretenders to magic, to black art” and “a thousand worse dealings with the devil than they were really guilty of.”
The Gambia must prepare to live with the consequences of the epidemic for some time to come. The Black Death peaked between 1347AD-1351AD. That meant that Europeans had to live with the plague, at its peak, for four years. In the typical disasters- flooding, earthquakes, etc.- people can be moved to shelters where they hunker down for a month or two. That is not always possible with an epidemic: if the epidemic can be managed within or close to the environment in which people live, it should be. That is so because once it is contained, people should be able to continue with their lives. A health and public order dislocation on this scale could hardly be managed with the unprepared medical facilities in place at the time.
Mamudu: A public order crisis when erupted as law and order collapsed, unemployment and hunger led to looting and plunder; starvation led to violence and brigandage. People turned to quacks, astrologers, and religion. We need to plan and prepare for the next scenario. As prices soar while sources of income go to the ground, the next thing is a crime (theft/robbery) going high. Adherence to staying home will soon become very difficult. It is hard to keep a starving person indoors, because for them, either way, it would be a risk of death.
Mamudu: Coronavirus pandemic in the Gambia is hurting the Gambian people. The coronavirus outbreak has exposed the cruelty of greedy power holders that visited on the poor Gambians. We have seen with our naked eyes the power addicted politicians masquerading as democrats and patriot’s exploitation and vulnerability of the powerful rich. We will chart our way out. We may not get to the total lockdown phase. It is five weeks since about the coronavirus situation in The Gambia. So it is time to update Gambians again on the medical, economic, and psychological outlooks of the situation.
Mamudu: The introduction of the plague measures marked the first time in history that humanity had beaten back an epidemic through public policy measures. What can we learn from it? Indeed deadly epidemics are black swan events- Swans are white birds, but black swans do exist. Nassim Nicholas Taleb popularized the term in his must-read book, The Black Swan – to described a sporadic, unpredictable event that is beyond what one would expect of the situation that, potentially, has very severe consequences. That usually means that nothing in their experience gives them the tools to deal with it.
Since the World Health Organization (WHO) officially declared the coronavirus outbreak a pandemic. This means that while the situation in the Gambia remains under control, the coronavirus threat will be with us for a long time. We cannot be complacent. Epidemics and pandemics are mostly public health – and often public order- rather than clinical problems.
Mamudu: The exceptional nature of pandemics invites exceptional measures, and some of the measures adopted to deal with the plague can be draconian and extreme. However, in a crisis that combines the unfamiliar and the exceptional, the authorities will neither always know how to calibrate what is proportionate nor always have the time to weigh the costs and benefits of particular measures calmly.
Epidemics and pandemics disrupt livelihoods, create economic desperation and terrify people, sometimes into flight. A crucial part of lockdown must involve creating workable safety nets- like the control of markets in the plague measures – to ensure supplies to the population. The Government must deploy most of its resources to this task: redirect budgets; use the military to handle supply logistics (they are the only organized state institution with the capability to do this well).
Mamudu: There are some baseline precautions we must get used to, like maintaining good personal hygiene and not holding large gatherings. We must also plan in case a significant outbreak happens in our neighboring country, Senegal, or from direct foreign invasion by migrants from coronavirus ravage countries. If a major outbreak happens, we will need more stringent social distancing measures, such as suspending schools and compulsory telecommuting. These will slow down the rate of transmission and prevent our system from being overwhelmed.
This coronavirus outbreak will hit a good number of Gambians in from both sides of the divide. We should prepare for the revolt that is fomenting. The Government eviscerated resources for healthcare: where they imported Sthethiscopes in foreign money but with no adequate medical supplies -inhalers for chest cases or protective clothes. We doubt whether the Government even has two-hundred fully equipped with the latest technology for sophisticated medical care Intensive Care Unit (ICU) beds in all the Gambia. They refused to ascent to the requests of medical professionals health workers to stay in the industry—a nation with limited equipped health facilities in the event of a pandemic. We have seen 6,500 healthcare workers have tested positive for the Coronavirus in Spain. The story is the same in several other countries devastated by this pandemic and injured in the line of duty. When thousands of healthcare workers are taken off service at critical times such as this, millions are placed at risk of certain death. Coronavirus is waging a war of attrition against healthcare workers.
Mamudu: Unfortunately, Dr.Ahmadou Lamin Samateh and his team are working in a system that is congenitally immunized against ethical ideas. In its most pig-headed moments, it treats knowledge like a deadly infection that must be safely quarantined away. The coronavirus infection rates in the Gambia are following a pattern that is all too familiar, and one case becomes four become nine become sixteen become fifty become one hundred and fifty become four hundred become thousand, and then we lose track. In ten cases, Coronavirus is a clinical problem; in a hundred cases, it is a severe public health problem. After a thousand cases are both a public health problem and a public order problem, when we have ten to-hundred cases, our medical infrastructure and clinical systems will be tested. A hundred to five hundred, our public health system – communication and outreach, health information, delivery of testing equipment, emergency health facilities- will also be under test. Past one thousand both our public health system and the public order institutions- especially logistics- delivery of essential services- water and power; management of public transport systems; will also be tested for efficient and effective service delivery. Designing a response entails putting these different parts together.
The picture of a confident and clear-headed Ahmadou Lamin Samateh with his Ministry of Health officials holding regular media briefings on what they are doing to beat back Coronavirus- and occasionally inform of the positives and negatives for official missteps- has been both reassuring and refreshing: reassuring because an insidious sense of desperation and helplessness has crept in. Most of us want to feel that someone is doing something, anything. At the same time, Gambians are so used to bungling and mendacious politicians that they distrust, viscerally, anything officials say. In fearful times such as these, distrust of science and officials leads people to seek silly and inept solutions: advice from quacks with miracle cures; auguries from astrologers and seers; life-saving gadgets from knaves ready with end-of-days’ prep-kits or repentances from avaricious clerics offering fake comfort to the terrified – remember the calls for prayers? As the denizens seek ways to propitiate the heavens so that the gods can hold back their terrible wrath, most of us have been hoping to see a competent official strategy. We are not there yet, but it is very refreshing to see a cabinet minister or opposition politician talk without politicking, accompanied by their technicians. That last is an implicit admission that there is much that they do not know. We come from a history in which ill-read, often misinformed politicians liberally offer advice on any subject whatsoever: from the impact of native liquors and uncustomed spirits on the national libido to when farmers should start sowing their fields.
Mamudu: Some low and middle-class Gambians eke a living out of working at companies or self-employed. Now that the companies have stopped hiring over the Coronovirus pandemic, the lives of these people have been plunged into a quandary. As the legislative body consider haggling over the terms of a stimulus package, these are the people one hopes will be considered. We hope the Gambia government will consider Coronavirus emergency a package of economic stimulus loans through commercial banks at a specific interest rate with some conditions to help them keep employees and businesses running for the next 3-4 months. This loan should be restricted to salary payments to staff and essential overheads to keep the businesses afloat.
Mamudu: Any stimulus package approved for special temporary relief schemes for the companies affected must ensure that employee’s salaries are continuously paid. Tax compliant businesses allowed to delay 20% of their tax the next 3-6 months. Businesses in distress to benefit from tax subsidies under the employment tax incentive. Unemployment fund to support the unemployed. Banks to put measures for debt relief for 3-6 months. Informal businesses will benefit from the set safety net to cushion their survival. Solidarity fund set for vulnerable people besides various reliefs—capital allocation for the critical sectors to the economy through a simplified access process.
Mamudu: The Government must innovate to deal with the Coronavirus. It is not a choice anymore. South Korea, China, Israel, and other countries have innovated by building ‘drive-through’ and ‘phone-booth’ test centers, detection of mobile applications. What can the Gambia do? To begin with, there should be mobile test centers. Those old shipping containers which were corruptly procured for millions to be used as clinics but are still lying idle in the Banjul port can be converted into testing points by retrofitting them with the necessary tech and then put on trailers.
People in the transport business who have trailers that are now idle can lease them to the Government to carry these containers and spread across the country into all counties. Over ninety percent of Gambians have and actively use mobile phones and mobile money.
The State can use the service providers to track people, especially suspected and confirmed positive cases, disburse ‘welfare’ weekly, use census data to set up food and water collection and distribution points in each ward and constituency to be used for the duration of a lockdown.
Mamudu: Any private enterprise which has to assist the Government in this period, for example, offering accommodation for quarantining people at its own cost, should bill the State and be rewarded in other ways later, for example, a generous tax relief, etc. It is not business as usual. Necessity is the mother of invention, they say. Instead of copy-pasting innovations being created elsewhere, we can make and use our own.
by Alagi Yorro Jallow