Thinking Aloud – My Thoughts on Liberia’s Current Fight against Coronavirus

The creator, former Overseas Minister Augustine Kpehe Ngafuan

Introduction

On Wednesday, April 8, 2020, President George M. Weah declared a 21-day State of Emergency (SOE) together with a two-week partial lockdown of Montserrado and Margibi counties efficient midnight April 10, 2020. The Legislature would later endorse the SOE and prolong it for a interval of 90-days. The Legislature additionally empowered the President to periodically evaluate the SOE and select whether or not to elevate it or not anytime inside the 90-day interval. Since then, the two-week partial lockdown that embody a de facto curfew from Three PM to six AM and the shutdown of most authorities workplaces and enterprise facilities (with a only a few exceptions) have been prolonged twice. That is the final week of the newest iteration of the two-week partial lockdown, which is anticipated to finish on Friday, Could 22, 2020.


By Augustine Kpehe Ngafuan, Former Overseas/Finance Minister of Liberia


What occurs subsequent? Would the lockdown be relaxed to scale back its crushing influence on the financial system and the livelihoods of the populace, particularly the poor? Or would it not be prolonged to permit for the distribution of the much-trumpeted meals assist package deal that, as some officers of presidency have hinted, would function a palliative to facilitate the imposition of a “whole lockdown” anticipated to be extra restrictive than what’s acquiring at present?

Let me admit that the alternatives that the Authorities faces are tough and are usually not as straightforward as deciding between black and white or good and dangerous.  Not one of the choices or variants of them are totally good and problem-free. Due to this fact, determination making in such a scenario is tantamount to strolling a tightrope and balancing the varied views to tease out the “least problematic” possibility. My alternative of the phrase “least problematic possibility” quite than “most suitable choice” is deliberate as a result of the place all of the choices obtainable are, to some extent uncomfortable, I don’t’ assume it sounds proper to label any possibility “one of the best”. Now the query turns into, what ought to Liberians count on on Friday?

Some Arguments that May Help the Extension or Tightening of the Lockdown

If one had been to place a guess on this, it will be safer to wager that the lockdown could also be prolonged for a further interval, more than likely two weeks. And what might be the premise for the extension? Essentially the most handy purpose that supporters for an extension might proffer could be the uptick within the numbers of confirmed Coronavirus instances and deaths because the imposition of the SOE and the lockdown. The variety of confirmed instances as at April 10, 2020 was 40 and the entire variety of deaths on that date was 5, As at Monday, Could 18, 2020, the variety of confirmed instances had risen to 223 whereas the variety of deaths had additionally risen to 22.   In different phrases, supporters of lockdown extension might level to those figures to make the case that it might not be applicable to elevate or loosen up the lockdown when absolutely the numbers of confirmed instances and deaths are rising.

They might additionally argue thus, “The Authorities promised a couple of month in the past to distribute meals to the inhabitants to facilitate a subsequent roll-out of a complete or tighter lockdown. The meals distribution course of has delayed due to technical or different glitches. Nonetheless, Commerce Minister Wilson Tarpeh, head of the Authorities’s Steering Committee on the meals distribution, has assured that the distribution will begin as soon as modalities, together with enumeration of potential beneficiaries by the Liberia Institute of Statistics and Geo-Info Providers (LISGIS), are accomplished. So till meals distribution can begin most likely within the subsequent couple of weeks, the Authorities has no different possibility than to increase the lockdown. Any lifting of the lockdown earlier than the graduation of meals distribution could undermine the central logic behind the meals distribution- to arrange the populace for a complete or tighter lockdown.”

Nonetheless others in assist of lockdown extension might argue that the 6 AM – Three PM window given to most people to seek out meals and attend to important companies is undermining the combat towards the virus by canceling out the good points achieved in the course of the Three PM – 6 AM stay-at-home interval.  Due to this fact, they might argue that till a complete lockdown is imposed that may require residents within the affected counties to remain at dwelling for not lower than the two- week incubation interval of the virus, we’ll by no means have the ability to defeat the lethal enemy.

In addition to what has been delineated above, apologists for lockdown extension could proffer different justifications.

Some Arguments in Favor of Lifting or Rest of the Lockdown

On the different excessive, it might be argued that the lockdown is having a devastating influence on the financial system and the livelihood of Liberians.  Earlier than the Coronavirus disaster, the Authorities needed to recast the price range downward from US$526 million to US$505 million (reflecting a projected income shortfall of US$21 million).  In his letter to the Legislature justifying the declaration of the SOE, the President introduced that the COVID-19 disaster was anticipated to event a further shortfall in authorities income of US$32 million.  Out there knowledge on the efficiency of presidency income is main me to consider that the COVID-19 influence on authorities income shall be far larger than the preliminary forecast of US$32 million.  Already, many enterprise entities have been rendered idle because of the disaster and the pressured shutdowns. Non-public college lecturers and plenty of others employed within the personal sector have been disadvantaged of revenue for almost two months now because of the mandated shutdowns Few days in the past, it was reported that Golden Veroleum Liberia (GVL) could be shedding greater than 400 of its employees because of the stoop within the value of palm oil brought on by a mix of things, not the least of which has been the present COVID-19 disaster.

Proponents of rest of the lockdown would might additionally stress that the lockdowns and shutdowns have additionally disadvantaged many peculiar individuals of the chance to eke out a dwelling from plying their regular trades, ensuing of their incapability to cater for the fundamental wants of their households. The issue has been compounded by the truth that many individuals are afraid to go to the hospitals or clinics when sick for worry that they might contract the virus from well being employees, a lot of whom had been reported to have examined optimistic for the virus. In different phrases, crushing poverty and the insufficient consideration being paid to different regular sicknesses in Liberia might be inflicting extra deaths throughout the nation than have been brought on by Coronavirus.

A Higher Method to Have a look at the Rise within the Variety of Confirmed Circumstances

Certainly, the arguments on all sides of the difficulty have some deserves. Nevertheless, I need to stress that if the first criterion for deciding whether or not to elevate, loosen up or tighten the lockdown is whether or not or not absolutely the numbers of confirmed instances and deaths have elevated as in comparison with what they had been when the SOE and lockdown had been imposed on April 10, 2020, then we should brace ourselves for a protracted implementation of the lockdown. This consequence turns into obvious as a result of, till a vaccine or different globally accepted resolution is discovered, we will count on absolutely the variety of confirmed instances and deaths in Liberia to go up. High scientists and epidemiologists have been quoted currently as saying that it will take between twelve- eighteen months to provide an efficacious vaccine to sort out the virus. However do we’ve got the capability or the suitable shock absorbers to endure the deleterious influence of a lockdown that might final for even six months? The apparent reply is a powerful “NO”.

If all elements together with the devastating influence of a lockdown on the financial system, livelihood and the potential spike in deaths from sicknesses and causes aside from Coronavirus are thought of, there’s a tipping level past which continued extension of the lockdown would start to yield what economists name diminishing marginal returns. Diminishing marginal return on this context is the purpose at which the lockdown, on stability, begins to work towards, quite than in favor of, the higher good.

Essentially the most applicable manner to take a look at the Liberian scenario is to not be fixated on whether or not the variety of instances has elevated from a selected date prior to now as in comparison with the present date or whether or not new instances are reported each day; quite, essentially the most applicable solution to gauge progress is to ask whether or not the variety of instances are rising at an rising charge (exponentially) or rising at a lowering charge. 

In relation to lively testing, if the info exhibits a each day exponential enhance within the variety of new instances, then that could be a critical trigger for alarm.  Conversely, if the variety of instances are rising at a lowering charge or the variety of new instances reported each day is on a downward development, then we will start to heave a sigh of aid as this may increasingly replicate the truth that the transmission of the virus is being contained. 

Utilizing the variety of confirmed instances as a metric, as of Monday, as at Monday, Could 18, 2018, Liberia appears to be performing higher than any of the opposite three Mano River Union (MRU) international locations with regard to the variety of confirmed instances – Liberia has 229; Sierra Leone, 519, Cote d’Ivoire, 2,119; and Guinea, 2,796.  At 22 deaths as at Could 18, 2020, Liberia is reporting the second lowest variety of deaths among the many 4 MRU international locations, though its case fatality charge curiously is the best. It’s worthy of notice that that the variety of recoveries in Liberia has risen from simply Three out of 48 whole confirmed instances as of April 10, 2020, to 123 out of 223 whole confirmed instances as of Monday, Could 18, 2020.  Liberia. The variety of lively instances in Liberia as of Could 18, 2020 was 84.

Retaining all different elements fixed together with variations in testing capability, Liberia’s comparatively low variety of confirmed instances appear to recommend that the nation is making good progress in its combat towards the lethal virus in contrast with its neighbors. The truth that Liberia registered its first case on March 16, 2020, two weeks sooner than when Sierra Leone did and the variety of its confirmed instances is lower than half of Sierra Leone’s, is a sign that Liberia is faring comparatively higher in the mean time in its combat towards the virus than its western neighbor.

Meals Distribution and the Imposition of a Complete Lockdown – Some Points to Contemplate

It’s a recognized proven fact that the Authorities started mulling over the potential of a complete lockdown earlier than the declaration of the SOE however pulled away from making any such proclamation more than likely as a result of the federal government might need come throughout as insensitive had it imposed a complete lockdown of a section of the inhabitants with out firstly offering these affected the means (meals) to mitigate the tough penalties of staying at dwelling for greater than seven days or presumably two weeks.  So the plan to distribute meals assist to the affected populations has been within the works for greater than a month now and is anticipated to not actualize for extra weeks so as to allow LISGIS enumerate focused beneficiaries in 4 focused counties – Montserrado, Margibi, Nimba, and Grand Kru.

The a lot rumored plan to impose a complete or tighter lockdown to be preceded by meals distribution could also be good-intentioned however it’s fraught with lots of sensible challenges. Firstly, given the depth and breadth of poverty within the land, a complete lockdown of the inhabitants is just about not possible. It’s obvious that no matter meals distribution being contemplated might not be adequate to cowl the primary 4 counties focused within the President’s letter to the Legislature (Montserrado, Margibi, Nimba and Grand Kru), not to mention all of the fifteen counties as contained within the Legislature’s decision endorsing the SOE.

The administration is reportedly planning to focus on the “susceptible” inhabitants within the authentic 4 counties, prompting issues about what is going to decide vulnerability. It’s not tough to foresee that any group of individuals unnoticed of the meals distribution program could really feel much less obligated to respect the restrictions to be imposed throughout a potential whole lockdown on grounds that they “must exit to hustle for meals”.

Moreover, it’s almost not possible to conceive of a lockdown state of affairs the place some lodging will not be made for these beneath lockdown to buy meals within the markets. However sadly, any such lodging for the operation of markets has an enormous potential for abuse as it might give the mandatory alibi to a major variety of individuals who could need to exit for causes aside from the acquisition of meals, thus finally limiting no matter public well being good points beforehand anticipated from the lockdown.

The worth of a complete lockdown is maximized in the course of the starting phases of a public well being problem as there seems to be a time worth for the imposition of whole lockdowns – the earlier they’re carried out, the upper the general public well being dividends to be accrued. Liberia could seem very odd certainly to be seen bulking the worldwide development by imposing a complete lockdown greater than two months after its first confirmed case and at a time when almost your complete world, together with many West African international locations (Ghana, Nigeria, Senegal, and many others) are enjoyable their very own lockdowns. The imposition of a complete lockdown will definitely not jive with the Authorities’s current determination to permit for a restricted opening of church buildings and mosques. The Authorities runs the danger of coming throughout as whimsical and inconsistent had been it to be seen ordering the ban of worship companies at church buildings and mosques as a part of a complete lockdown simply few weeks after it had given the all clear for spiritual companies to go forward.

Suggestions

Given all of the above, I might need to suggest the next to the Authorities:

  1. Develop clear, measurable, and easy-to-communicate indicators for evaluating progress made within the combat towards the virus, which might function the premise for figuring out what to do with lockdowns. When President Weah prolonged the lockdown on Could 8, 2020, he said, “Well being authorities have suggested that within the wake of the unresolved disaster, the necessity for the measures to stay in place nonetheless is pertinent.” When the lockdown was first prolonged on April 24, 2020, the President additionally premised his determination on the recommendation of well being authorities pointing to the “unresolved disaster.”   Relying extra on the recommendation of well being authorities throughout a well being disaster is the prudent factor to do. Nevertheless, the Liberian individuals deserve extra concrete and detailed indicators to justify the extension of a lockdown than the nebulous “unresolved disaster”.  So far as we all know, the Coronavirus disaster will stay unresolved for the following yr or so till the worldwide neighborhood develops an answer by the event of an efficacious vaccine or drug.  Due to this fact, the Authorities could not need to proceed to press the pause button on the financial system and the livelihood of its individuals for months on solely on account of the “unresolved disaster.” Nearly all of the international locations all over the world which have lifted or relaxed lockdowns nonetheless have “unresolved disaster”.

I don’t doubt the brilliance of the present well being crew of presidency – Dr. Mosoka Fallah, the Director Common of NPHIL, was a classmate of mine on the College of Liberia within the early 1990’s and Dr. Francis Kateh, Liberia’s Chief Medical Officer, is a giant brother whose medical credentials {and professional} astuteness are stellar.  Well being Minister Wilhemina Jallah, JFK Administrator Jerry Brown and the remainder of the well being of us are all top-notch professionals.  I encourage them to deconstruct the “unresolved disaster” and inform us extra concerning the epidemiological curve of Coronavirus instances in Liberia, as such a curve will present, even on a tough foundation, how the numbers of confirmed Coronavirus instances and deaths are anticipated to evolve in Liberia over time, beneath varied eventualities, which might embody 1) a no lockdown, enterprise as typical state of affairs, 2) a extra relaxed lockdown state of affairs affecting a number of the measures, presumably the comfort of the curfew and the opening of extra companies and authorities establishments, 3) a partial lockdown state of affairs (as exists presently) and 4) a complete lockdown state of affairs as has been hinted by authorities officers. 

Understanding beforehand exactly what the execution of any one of many eventualities is anticipated to yield by way of confirmed instances and deaths will give us the mandatory metrics to gauge whether or not or not we’re making progress in our combat. Additionally, would we be asking for an excessive amount of to request our well being of us to develop, or share with most people if they’ve already achieved so, a tough guidelines or tips on what concrete developments or indicators will inform our determination on whether or not to completely elevate, partially elevate, or considerably tighten the present lockdown?

  • Don’t hyperlink, in any respect prices, the distribution of meals to the imposition of a complete lockdown As said earlier, the Authorities’s determination to distribute meals might need been pushed largely by a good-faith intention to assuage the influence of a possible whole lockdown on the populace.  Two months down the highway because it made its meals distribution intention public, the Authorities must step again and ask whether or not or not meals distribution ought to essentially be married to the imposition of a complete lockdown. Because it seems, the ship might need already left the harbor on whole lockdown; due to this fact, imposing it solely as a result of the unique thought, two months in the past, was that it was inextricably linked to meals distribution, might not be essentially the most advisable factor to do. In strategic determination making, the circumstances, elements, or variables of the current and their potential impacts on the longer term are extra related in informing a correct plan of action than these of two months in the past.

The Authorities can nonetheless distribute meals with out essentially upgrading to a complete lockdown.  In spite of everything, the tough realities of dwelling beneath a lockdown, albeit partial, for greater than a month can justify the distribution of meals. Delinking meals distribution from whole lockdown comes with the additional benefit of averting the chance of confusion and push-back throughout a whole or whole lockdown by some disgruntled individuals denied meals rations on account of not being thought of “susceptible”. Denying a section of the inhabitants meals even in the course of the partial lockdown could also be problematic; however denying them meals and on the similar subjecting them to the tough realities of a complete lockdown could also be critically problematic.

  • Direct Authorities’s scarce sources extra on actions and expenditure instantly linked to the Coronavirus combat and the well being sector generally.  Though the World Financial institution has dedicated to offering a bit of upwards of US$15 million to instantly help with our combat towards the virus, that quantity pales compared to the gargantuan useful resource requirement for a more practical response towards the virus. To flatten the curve or elevate the road, we have to enhance well being care capability and our mitigation efforts by spending more cash on the recruitment and correct remuneration and incentivization of extra contact tracers, case investigators, Group Well being Volunteers (CHVs), Group Engagement Volunteers (CEVs). We additionally must direct more cash to enhance our testing capability throughout the nation by establishing some county or regional testing facilities with the right testing machines and ample cartridges for such machines in addition to gas to energy the required turbines. We additionally must recruit and prepare extra laboratory technicians to man our testing labs. After all, we have to buy sufficient Private Protecting Gear (PPEs) for our well being employees throughout the nation; procure extra beds for remedy facilities and different common hospitals and well being facilities in addition to extra ambulances to be stationed within the counties. There may be additionally a must ramp up spending on Coronavirus consciousness and sensitization campaigns, utilizing a number of modes of communication together with the radio and the social media.

Earlier than the onset of the Coronavirus disaster, information of the dearth, or inadequacy, of gas, medicine and different important provides at some hospitals and well being facilities was widespread. Directing extra of presidency’s personal sources to the Coronavirus combat and the well being sector generally is akin to robustly preventing the enemy on the frontlines. This may also enormously enhance confidence within the society that no matter progress we’re making is sustainable, and never only a fluke. This leads me to my fourth advice.

  • Contemplating the crying want for additional cash for the coronavirus combat and the well being sector generally, step-back and re-assess whether or not it serves the higher good to dedicate a whopping US$35 million on the food-aid program. Within the Liberian context, dialog regarding rice or meals generally is all the time a delicate topic and an space “the place even angels worry to tread”.  However love for nation would compel us to confront this elephant within the room and ask some laborious questions. To make sure, I assist meals assist to the populace throughout such a disaster, because it helps complement the combat towards the virus. And if sources are ample, I’ll soar for pleasure if we devoted vital sums on actions that complement our combat towards the virus.  My pleasure will, nevertheless, be dampened once I understand that spending on core actions within the Coronavirus combat could probably play second fiddle to spending on a complementary or tangential exercise. My pleasure may also be dampened once I understand that the US$35 million that’s anticipated to be devoted on the complementary exercise (meals distribution) is being sourced from a mortgage to be supplied by the Worldwide Financial Fund (IMF), the cost of which is able to take up a major fiscal house in ensuing budgets.

Additionally, let’s think about if we had been to seek out comparable US$35 million and pump it instantly in direction of the core parts of the Conovarius combat (testing, contact tracing, isolation, PPE’s, and many others) and the well being sector generally. We will certainly obtain great bang for our buck.  The place spending US$35 million on a non-sustainable, low long-term return food-aid program will go away us with much less cash to spend on well being, we should enable ourselves to rethink and reorder our priorities by slicing the meals assist price range downward considerably and upping the price range for core actions within the combat towards the virus and to well being generally, realizing totally properly that adequately funding well being won’t solely assist us make fast good points in our battle towards the virus however may also assist enhance the robustness of the well being sector and can profit our populace even after the current disaster.

  • The President ought to contemplate, as a part of no matter determination he’s considering on making with regard to the lockdown, the comfort of the necessary stay- at- dwelling interval (the defacto curfew) by revising it from Three PM – 6 AM to six PM to six AM. As paradoxical as it might appear, the additional three hours that this rest will give the general public to take care of their fundamental meals, banking and different wants will improve social distancing, as a substitute of undermine it. A detailed remark of what occurs between 6 AM and three PM in Monrovia and different elements of the nation beneath partial lockdown will reveal that due to the quick time window supplied for individuals to exit, these companies and establishments allowed to function have adopted very restricted opening hours, thus prompting a rush for his or her companies by most people who cluster and clamor in droves outdoors such premises to be served. This example is especially grave at enterprise facilities and at industrial banks and their ATMs. This clustering of an enormous variety of individuals truly undermines social distancing. The additional three hours will allow companies and establishments allowed to function to increase their interval of operations, thereby making it extra sensible for them to implement social distancing at their premises.

Conclusion

I’ve tried on this piece to distill a number of the points attending our combat towards the lethal Coronavirus by placing them on the scaffold of important considering and evaluation.   My determination to make my ideas public springs from my conviction that the ideas I’ve proffered herein are usually not “absolute truths” or “The Ten Commandments” acquired by Moses on Mt. Sinai. My ideas can actually be enriched, refined, or amended by sensible contributions and views of different well-meaning individuals in our society. I strongly espouse the assumption that the very best consequence is finally derived after we as a rustic and a individuals topic problems with nationwide significance to wholesome nationwide debates.  Little question, the choices and selections to be made by the President and the Authorities within the coming days and weeks shall be tough and sophisticated, reminding us of the truism of the biblical assertion, “Uneasy lies the pinnacle that wears the crown”. I hope by this text I’ve helped in a bit of solution to reduce that uneasiness.


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