Covid-19: emergency actions required to manage the pandemic more effectively, transparently and accountably

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The process at vaccination centres needs to be streamlined such that the population may be effectively vaccinated in the shortest possible time, suggests the interviewee.

The process at vaccination centres needs to be streamlined such that the population may be effectively vaccinated in the shortest possible time, suggests the interviewee.

In your opinion how do you think we got ourselves into this situation regarding Covid-19? 
First, I would like to wish plenty of courage to all patients with Covid-19 and to convey my condolences to those who have lost their loved ones. I also salute the strength of my colleague healthcare staff engaged in the war against Covid-19. 

According to figures first submitted in parliament on the number of positive rapid antigen tests in October, it seems that Covid-19 had already been circulating fairly widely in the community by then. It would throw light on the evolution of the pandemic in Mauritius if the daily figures for the rates of positivity for PCR (rather than absolute number of positive PCR tests) and for rapid tests and the progression thereof over August, September and October were to be made available for further analysis. Furthermore, the Delta variant was apparently detected in Mauritius in September 2021. Given the high number of positive antigen tests announced and the presence of the Delta variant, it seems that the decision to downscale restrictive measures as from 1 October 2021 with 30 persons being allowed on public beaches without masks and 100 at weddings was not sound. This decision seems to have led to the situation getting out of control resulting in sufferings and deaths. It is a perception that this decision may have been influenced by the compulsion to create an atmosphere that Mauritius was Covid-safe with the planned opening of borders. 

As there has been deaths as a result of such a decision do you think an independent inquiry is required? 
I would say that there is a case for an in-depth inquiry as to whether the lifting of restrictions was timely and as to the consequences thereof and also as to how this decision was motivated. 

Are you satisfied in the way that the Ministry of Health and Wellness is communicating with the public? 
The Ministry of Health and Wellness needs to share on a daily basis with the public data collected in terms of new cases of Covid-19 both as estimated by PCR and rapid tests preferably as rates of positivity, number of symptomatic cases seeking medical attention, number of cases requiring admission, number of cases requiring intensive care, number of cases under supervised treatment at home, bed occupancy rates in wards and in intensive care units, number of persons dying having been tested positive within 28 days prior to deaths. Ideally this data needs to be presented in form of graphs with estimated projections. I invite the public to see on social media how the UK communicates information about Covid-19 to the public. Such a transparent approach will reinforce the confidence of the public and will also serve to engage the population and all stakeholders in any future restrictive actions required. It will also give clear indications as to the need for a lockdown or not. 

There is a lot of controversy regarding the figures for the number of deaths due to Covid-19. What is your opinion on this matter? 
In a reply to a question in the Assembly it appears that there have been significantly more deaths, I believe for the months of August 2021 to October 2021, as compared to previous years. The excess number of deaths cannot be accounted for by the official figures for Covid deaths. It is therefore the responsibility of the Ministry of Health and Wellness to analyse these figures in depth and make the findings public. In fact, an independent analysis of our mortality figures, by say a team from WHO, for the year 2021 to date as compared to previous similar periods in previous years is desirable. It is furthermore recommended that we analyse these mortality figures in relation to positivity to Covid-19 within 28 days prior to death, vaccination status and types of vaccination received. 

You said that the decision regarding a confinement depends on an analysis of the figures. Short of a confinement what other measures can be taken? 
All public gatherings at beaches, shopping centres etc. should be carefully monitored by police officers and officers of the S.M.F to ensure physical distancing and wearing of masks. Ideally there should have been physical distancing in public transport. However, if this cannot be implemented for whatever reasons, it is proposed that only persons going to work should be allowed to use public transport during peak hours to facilitate physical distancing. 

It is also long overdue that there is quality control of masks being made available to the population. 

Are you satisfied with our vaccination strategy? 
The vaccination strategy needs to be urgently reengineered such that there is prioritization of the vaccination of persons in relation to risks. In simple terms, those most at risk should receive the best available vaccine as soon as possible. Furthermore, all those above 60 years who received Sinopharm should be urgently recalled and be more effectively vaccinated. In effect, these persons are technically not fully vaccinated. It will need to be explained to them that they will not actually be receiving a booster dose but they will be vaccinated with a vaccine of proven efficacy for their age. Additionally, the process at vaccination centres needs to be streamlined such that the population may be effectively vaccinated in the shortest possible time in order to urgently decrease deaths in the population. The paperwork in relation to personal data entry can be completed online just like in the case of the submission of returns for the MRA. 

There are a lot of questions being raised about the efficacy of the Sinopharm vaccine and about whether we should have used this vaccine. What is your opinion? 
I understand that the Sinopharm vaccine has been proven to be efficacious in those persons in the age group between 18-60. However, for those above 60 years, the WHO document published on 7 May 2021 on the Sinopharm vaccine suggests that there is a lack of evidence of the efficacy of this vaccine in this age group. Besides, it seems that in Seychelles this vaccine was consequently not used for those above 60 years. 

This sounds serious. Should we therefore not have used the Sinopharm vaccine for those above 60 years? 
I believe that an independent inquiry needs to be carried out in order to establish as to whether there has been negligence in the process of due diligence whereby a decision has been taken to use the Sinopharm vaccine for those above 60. Furthermore, the failure to inform people who received this vaccine about the information on its efficacy at the time of signing the consent need also to be looked at. 

In the light of the findings of the independent inquiry those above 60 vaccinated with Sinopharm and who have unfortunately succumbed to Covid-19 may need to be considered for compensation. 

What is your take regarding information provided by the Minister of Health and Wellness during the PNQ on the treatment of Covid-19 patients and how can we improve matters? 
It is clear from figures shared by the Minister of Health and Wellness in parliament that the outcomes of patients requiring invasive ventilation is unacceptably worse than the outcomes in many other countries. It was announced that in a cohort of 24 patients invasively ventilated, 22 passed away. The mortality rate is therefore more than 90% whereas internationally, mortality rates around 50% are quoted going down as low as 30%. 

It is recommended that we immediately recruit at least 3 Consultants in Intensive Care or Critical Care medicine to take charge of patients in the intensive care at the ENT Hospital and to advise on respiratory support being provided to Covid-19 patients in all Regional Hospitals. There should be clear protocols regarding treatment and indications for ventilation. 

In the meantime, and with immediate effect the care of patients at the intensive care should be supervised by senior consultants in anesthesia especially those with a wide experience in intensive care medicine. A 24-hour Hotline should be set up at the ENT and be dedicated to providing information to relatives of patients. 

In your opinion, which expensive medications should be readily available for treatment of Covid-19 patients and how can we ensure equity in the use of these medicines? 
The Ministry should fast-track the procurement of all medications proven to decrease the need for ventilatory support and to decrease deaths such as Tocilizumab, Ronapreve, Molnupiravir amongst others and eventually Paxlovid if and when it is duly registered. These medications should also be readily available in private clinics accepting patients with advanced Covid-19. We should preferably use taxpayers’ money to procure expensive medicines with proven efficacy in decreasing mortality rather than waste scarce resources on medicines with unestablished efficacy or proven just to reduce symptoms. (…) 

There is a growing lack of confidence of the general population in our public health services and at the same time there is a lack of capacity in the private sector for provision of care to patients with Covid-19? What do we need to do to address this matter? 
It has been observed that, over the past few weeks, there is an increasing number of persons being brought to private health institutions providing treatment for Covid-19 who are already dead on arrival. (…) 

We need to sensitise the population of the need to seek medical advice and treatment early rather than late. We need to vulgarize the use of oximeters at home. We need to increase the number of beds available in the private sector for treatment of Covid-19. There is an urgent need to put all measures and protocols in place for the facilitation of the smooth transfer of patients between the private and public sector as required. 

What needs to be done to improve care of Covid-19 patients at home? 
There is an urgent need for reengineering the unit responsible for treatment of patients at home. The unit seems to be overwhelmed at present. It needs supportive staff and equipment to enable better home monitoring and management. The private sector could be called in to help out. 

In a letter leaked out recently, we were requesting the urgent help of Reunion Island for provision of oxygen supply. What is your opinion on this matter? 
With regards to oxygen supply to our public hospitals, an in-depth inquiry is required to look at the way decisions have been taken regarding tender procedures and awarding of contract for this service going back 10 years. It appears that there has been a sole supplier until we recently reached the point of pending crisis. An investigation needs to be carried out as to why we went for a sole supplier rather than multiple suppliers at a time when we are dealing with a pandemic of an infectious disease whereby the respiratory tract is affected. Have we made projected estimates of our oxygen needs in view of the pandemic? We also need to conduct independent quality control on oxygen being supplied in order to ensure maintenance of quality at times of high production. We may consider using equipment now available for monitoring the quality of oxygen at the point of delivery.

Are we sufficiently addressing the concerns of the health care staff? 
The morale of healthcare staff is at an all-time low. We need to listen to them. Urgent measures need to be taken to address their concerns, to support them and incentivise them. They are our frontline warriors. If they fall, we all fall. 

What should we be doing regarding the new variant Omicron? 
With regards to the variant Omicron (B 1.1.529) as of Friday 26 November, we should have urgently closed our borders with South Africa and other countries where this variant has been identified as circulating in the community pending more information on this variant becoming available. We should have got an urgent report from our embassy in South Africa regarding the situation on the grounds there (n° of cases, n° of serious cases, n° of deaths, vaccination status of the cases etc.). 

We should be carrying out field testing for this new variant in Mauritius. We should be testing and monitoring tourists and other persons who have travelled from or through South Africa and other countries where the variant has been identified to be in circulation in the community over the past 14 days and we should be considering putting these persons in quarantine. As we chose not to close our borders, we should already have informed passengers arriving from the concerned countries that they will be put in quarantine. 

In summary, what do we need to do to win the war against Covid-19? 
In summary, in order to win the war against Covid-19, actions are urgently required on four fronts: implementation of barrier measures and restrictions, swift efficacious and effective vaccination of the population, evidence-based management of Covid-19 cases and establishing good governance, accountability and transparency in decision making. Establishing accountability would ensure that decision making is guided by sound evidence based technical information rather than be driven by the need to be politically correct and thus sufferings and deaths resulting from inappropriate decisions can be halted.

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