Just How is COVID 19 likely to Evolve within the broader health system?

That COVID-19 will leave a lasting impact on health is not in any doubt; Health as defined by the World Health Organization in 1946 being ‘the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Whereas we may have the absence of infirmity once the ‘COVID 19 curve gets flattened’ by most countries, the footprints that this may leave on the health systems and the infected and affected persons will forever be ingrained in our minds.  We postulate that the COVID 19 disease will go through 4 key waves in its ‘lifetime’:

1st Wave: This is the current state for most countries where we have an upsurge of infections and deaths across, initially starting of as imported cases, then clustering of cases with ultimate community infections within the country
2nd Wave: In non stable health systems, the diversion of resources towards COVID 19 is likely to lead to a ‘collateral damage’ with an incessant upsurge in acute ailments such as other causes of pneumonia, maternal and perinatal complications, malaria etc; this will be partly due to the crowding as a result of the ‘lock downs’ especially in semi urban populations and failure to access emergent health care services  
3rd Wave: A slightly more protracted wave will follow, characterized by an upsurge in the acute on chronic ailments that hitherto have been under control. This ‘opportunity cost’ in the chronic care model is likely to present as an episodic rise in opportunistic infections among patients with HIV, acute diabetic and hypertensive emergencies and rapid disease progression among cancer patients, largely because of the collapsed chronic care model (clinics have been shut down, outpatient services are only covering emergencies, with rudimentary staff establishment).
4th Wave: This is likely to take a much more protracted course, raking mental havoc and anguish to an already overwhelmed health system; the overall well being of the general population is likely to be grossly affected; at a personal level, mental, economic and psychological effects of losing a loved one, the stigma associated with COVID 19, and the inadvertent loss of revenue that has come with the lock downs will be on the rise. At the national level, governments will be grappling with the social and economic impact of COVID 19 that has led to diversion of resources, shutdown of major businesses, borrowing by some countries hence further plunging the nations into debts.

All in all, we posit that COVID 19, unlike other SARS viruses, is unlikely to run an ultra short sprint, but rather run a marathon with long lasting implications on the already weakened and struggling health systems in Africa; how long this will take to recover, only time will tell


Dr Chris Barasa (MBChB, MBA, HSMP)*

Dr Richard Ayah (MBChB, MSc, PhD)*

*School of Public Health, University of Nairobi, Kenya

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