Home | Comment & Analysis    Sunday 17 May 2020

Sudan:Rising above COVID-19

By Hussein Malik and Adam Giambrone

Sudan is at a critical crossroads. 2019 marked the most important year in Sudan’s modern history and certainly, since independence in 1956, 2020 is also shaping up to be a pivotal year in which the country and its people are tested in the extreme by Covid-19.

Having done what few other countries have accomplished, Sudan replaced a 30-year dictatorship with a civilian-led transitional government that is working to rebuild the country and prepare for elections in November 2022. The transition has gone smoother than many predicted, but a year from the change in April 2019 the government still faces huge challenges.

The government is led by the intractable Prime Minister Abdalla Hamdok and the resumes of the cabinet are impressive, but Sudan is staring down the barrel of crisis that could come close to the impact of the 30-year Civil War in terms of the number of people affected, only this crisis promises to move much quicker than the half-century on-again-off-again civil war. The window of opportunity to stop a disaster is still open, but to keep it that way it will take critical action and civilian cooperation.

Sudan’s revolution last year showed how effective organized and engaged communities along with civil society and professional associations and trade unions could be in leading structural change. Similarly, these organizations play a major role in reducing the causalities of Covid-19.

Sudan and Africa have not been at the centre of this pandemic to this point as Covid-19 started in China and spread quickly through the links of the global economy. Sudan’s economic troubles, caused by 30 years of crony-capitalism and the ongoing international sanctions (led by the US) have meant that the Sudanese economy is only lightly linked to the international economic order. In addition to the action taken by Dr Akram Ali Altom to close the airport and restricted movement before a wider outbreak. This has led to a buffer against Coveid-19, but the isolation is not complete and the buffer won’t last as community transmission continues to grow daily by 150 to 200 per day.

We know that COVID-19 is very contagious. This allows it to spread quickly without being identified and requires a large testing regime to identify carriers. Sudan currently is only aware of extreme cases that report to hospitals showing symptoms. This only plays about 5% of the total cases. This benign beginning covers the lethal and seriousness of the sickness.

Sudan is currently at the beginning of an epidemic that could claim the lives of hundreds of thousands of its citizens, especially its beloved older generation who are much more susceptible to more severe complications and fatal symptoms.

Minister of Health Dr Akram Ali Altom should utilize mobilizing local communities and youth influencers who had a significant impact during the revolution to raise awareness and most prominently organize communities. Local community leaders should be further engaged to coordinate and plan together with authorities and partners to strengthen institutions, healthcare officials preparedness, ensure effectiveness, and avoid disjointed efforts. It is important from the start to identify leadership in the community, start focus groups and meetings, plan and coordinate with your partners, existing community networks and government counterparts while the window of opportunity is still open to prevent the spread of COVID-19 while numbers are still relatively low.

Covid-19 is coming and will bring with it a double hit, the risk of hundreds of thousands of people dying from the illness as the minimal health system is overwhelmed, the pain of reducing people’s ability to earn money to provide for their family and reducing the international community’s attention to non-COVID-19 local issues as they turn inwards to fight Covid-19 outbreaks.

In countries with strong public health systems, COVID -19 has challenged and overwhelmed the system’s set-up to respond to regular health issues. The key factor to ensuring the survival of the 10% of severe cases is the access to ventilators as no treatment exists and while there is some promising research, widespread access to treatment and potential vaccines are well over a year away, even in the most optimistic scenario.

The challenge for the new government is that after 30 years of mismanagement of the government and the destruction of the economy, the government has neither human or financial resources to substantially mitigate the impacts of the disease or the associated economic carnage that comes with actions to try and control the spread and the temporary collapse of global trade. Only 1/3 of medical facilities offer a complete basic package of care and there are few intensive care beds available and close to nine million people rely on humanitarian assistance. This could turn out to be one of the most serious challenges Sudan has faced since the Ministry of Health was set-up in 1949. With most of the health care services privatized by the former regime, most Sudanese would struggle to pay for treatment even if it was available.

Sudan’s younger population is both a blessing and a curse. While the effects of Coveid-19 are less severe on the majority of young people, young people are much more active and mobile. Due to the family structure in Sudan that sees multi-generations of large families co-inhabiting in the same house and sleeping nearby and sharing all meals. Once Covid-19 gains a foothold, it will spread very quickly with catastrophic results.

Minister of Health Dr Akram Ali Altom has taken decisive actions, closing the borders on March 17 and instituting a lock-down of the country in an attempt to reduce the spread of the disease to rural regions and within the populations. The government has unveiled an $82 million strategy and held 86 education sessions in public markets. This is a great start but not engaging enough.

The government’s strategy, which in outline is similar to other countries, however, does not stop the disease and as in other countries is only intended to slow the spread of the disease until health systems can ramp up. But “ramping up” to the needed level is not an option in Sudan.

The key to survival is to limit the speed of infections as serious cases need ventilators which are in short supply worldwide. Countries with 35 ventilators per 100,000 like the US and German struggle so Sudan with 1-2 per million has very little chance of ramping up to meet the demand. Ventilators now cost upwards of $15,000 or more and require trained staff to use them in a hospital setting. Some countries have used special powers to order the production of ventilator units, but few manufacturers in Sudan could likely step-up and the cost of such a program would likely be prohibitive. The Giad factory comes to mind as one of the only likely candidates for this type of temporary production.

At the end of the day, likely the best possible option is an attempt to limit the spread of the disease through various quarantine methods and possibly keep it out of the rural areas where 60% of the population lives but has even less access to medical facilities. Without resources to operate ventilators and other elements of intensive care units, the approach being used in developed countries to slow the infection rate to “flatten the curve” will not be as valuable as there are almost no resources to apply to this crisis considering other serious health issues of poor childhood nutrition, ongoing issues with tuberculosis and malaria and other infectious diseases abound. It seems likely that Sudanese doctors have tough decisions ahead of them, similar or worse than scenes and stories we have heard coming out of places like Italy and elsewhere that have been overwhelmed.

Apart from early advocacy of social distancing, health awareness campaigns in other countries that have confined the contagion and succeeded had one thing in common. They depended on strong public management. They used large-scale testing to quarantine carriers, track interactions, and break chains of transmission by creating effective rules obliging the positive patients to remain in isolation.

Perhaps Sudan’s best hope is to use strong quarantine methods backed by provision of basic food supplies to people so that the number of those who contract the virus can be minimalized until at a cure or vaccine will be developed as there is a strong push going on with some promising starts. While there are some promising results by labs around the world, a commercially available product is still over a year away, meaning while this may be the best option, it may still lead to many deaths.

The question, especially in a Sudanese context is whether the economic toll on the many people who have little means to live on without daily income and are forced to stay home can be justified as health impacts of poverty (already 25% of the population suffers from malnutrition) can be severe. In this context food distribution and delivery programs like the ones that are being done in India to support a countrywide lockdown and reduce the need for people to work for several months or in such a way as to prevent the need for people to congregate collect distributed food seems unlikely within the current capacity of the government. For the government to continue the lockdown further than May 20th, funding should be allocated to food distribution and delivery programs. The generation of a government relief program will allow individuals a buffer to remain at home.

The only real hope is that a vaccine and treatment protocol will be developed quickly and that most of the cost is covered by drug companies or international agencies. Once ventilators production is ramped up in countries in Asia, Europe and North America, that sufficient ventilators can be provided. If this appears to be possible, training programs should be initiated by the ministry of health and more frontline workers should be trained presumptuous that the worst is yet to come. Engaging leadership and local community youth influencers showed results in the past with the uprising against the regime. It will be essential in organizing emergency relief programs and with raising awareness during the COVID 19 fight.

Hussein Malik is the president and managing partner of MSG Ltd. A consulting firm that supports developing countries with public policy and public management. Adam Giambrone former elected city councillor in Toronto Canada.