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Family medicine

Teledoctor COVID-19: Updates

Corona Virus also known as COVID-19 was first reported on 31st December 2019 in Wuhan City
of Hubei Province in China. WHO has since declared COVID 19 a global pandemic going by the
number of cases reported and the number of countries affected globally. Currently the number
of confirmed cases globally are 156,573, number of reported deaths 5,947 and recovered cases
67,003. In Africa, 156 cases including 3 deaths have been reported in 15 countries from all
subregions. In Zambia, 28 alerts involving individuals who travelled from areas with confirmed
COVID-19 cases have been investigated. More than 29,000 passengers have been screened at our
international airports. Of these, 2,300 travellers arriving from high-risk areas have been
identified and are being tracked for 14 days. The risk of COVID-19 spread has been determined
to be Very High globally.
Clinical presentations: Symptoms and signs
COVID-19 may cause non-specific symptoms including, upper respiratory symptoms, lower
respiratory symptoms, and, less commonly, gastrointestinal symptoms. Most patients will
present with non-specific symptoms and lower respiratory symptoms (e.g. fever and cough)
Fever pattern:
The frequency of fever is variable between studies (ranging from 43% to 98%)
It should be noted that the – absence of a fever does not exclude COVID-19.
Gastrointestinal presentations:
It has been reported that up to 10% of patients can present initially with gastrointestinal
symptoms including diarrhoea and nausea, which might come before development of fever and
difficult breathing.
“Silent hypoxemia” – some patients may develop lower oxygen in blood(hypoxemia) and
respiratory failure without difficulty breathing (dyspnoea)
Physical examination: When patients are examined little might be found, but sore throat or
enlarged tonsils have been report in about 2% of the cases.
What has been thought to be the underlying reaction to the virus?
(Pathophysiology):
1) Acute Respiratory distress Syndrome (ARDS), i.e severe breathing difficulty
The primary pathology is ARDS, characterized by diffuse alveolar damage (lung damage) with
associated respiratory distress
2) Immunize system reaction (Cytokine storm)
Emerging evidence suggests that some patients may respond to COVID-19 with an exuberant
“cytokine storm” reaction (with features of bacterial sepsis) Often shown in raised C-reaction
protein (CRP)
What are the stages of illness observed?
Stages of illness
There seem to be different stages of illness that patients may move through.
1) Replicative stage – Viral replication occurs over a period of several days. An an early response
called, “innate immune’ response occurs, but this response fails to contain the virus.
Relatively mild symptoms may occur due to direct viral cytopathic effect and innate immune
responses.
2) Adaptive immunity stage – An adaptive immune response (late response) eventually kicks
into gear. This leads to falling titres of virus(reduced viral load). However, it may also
increase levels of inflammatory markers (cytokines) and lead to tissue damage – causing
clinical deterioration. This progression may explain the clinical phenomenon wherein
patients are relatively OK for several days, but then suddenly deteriorate when they enter
the adaptive immunity stage
Important clinical implications:
1) Initial clinical symptoms aren't necessarily predictive of future deterioration. Sophisticated
strategies may be required to guide risk-stratification and disposition
2) Anti-viral therapies might need to be deployed early to work optimally (during the
replicative stage).
Zambia’s response:
The Ministry of health working with partners have developed a Corona response as
follows:
1) Established the National Public Health Emergency Operations Center (PHEOC) located at
the ZNPHI
2) Active surveillance is ongoing at points of entry and in healthcare facilities. All
international passengers are being screened and those from high risk countries followed
up for 14 days.
3) Isolation facilities to safely manage cases and limit spread of disease have been
designated at district level across the country.
4) Laboratory testing capacity for COVID-19 has been established at the University Teaching
Hospital Virology Laboratory and at the School of Veterinary Medicine at the University
of Zambia.
5) Infection prevention and control measures are being strengthened, with procurement of
disinfectants and Personal Protective Equipment (PPE) including gloves, face masks,
aprons and hand hygiene supplies.
6) A Call Centre has been established for the public to report concerns and also receive
information on the disease. Dedicated Call Centre numbers are 909 (toll-free),
0953898941, 0964638726 and 0974493553.
In line with the Public Health Act Cap. 295 of the Laws of Zambia, the Ministry of health has
invoked two Statutory Instruments with the following key implications and among others:
• Mandatory reporting of all individuals suspected to have COVID-19 to health officials.
• Mandatory quarantine of all travellers from high-risk areas for a minimum period of 14
days.
• Mandatory isolation of all suspected and confirmed cases of COVID-19.
• Closure of any premises that pose a public health threat linked to COVID-19.
• School authorities, leaders of religious institutions, employers and community leaders are
required to disseminate information on health practices, including for the prevention of
COVID-19, to their constituents.
Key Corona message for Zambia:
Although Zambia has not confirmed any cases of COVID 19, it is found in a high-risk zone because
of several factors including several Chinese and Zambians travelling to and from China. Several
Europeans and Americans working in Zambia with children in several public schools. The eight
neighbours with cross-border trading and travel. It must be noted that air travel from risk
countries has not been restricted in Zambia. This remains a major source of risk more than
any other.
Finally, lack of awareness and poor public health hygiene in general provides a fertile ground for
such epidemics.
Assuming the disease came to Zambia, our health system may quickly be overwhelmed if several
people need ventilation and our limited health personnel might become overwhelmed, sick or die
from the Disease.
Therefore, prevention remains our best ammunition. We recommend the following actions at
individual and community level:
1) If you have been to a risk country, the best is to stay there but if you can’t and you arrive
in Zambia, declare this to immigration and health officers at the point of entry. Don’t hide
please!!
2) If you enter Zambia, please isolate yourself and any other family members who have been
to risk countries for at least 14 days.
3) If you have kids, who travelled outside Zambia and may be exposed, please keep them at
home at least 14 days.
4) Let your work place and school know if you have travelled to a risk country and explain
your isolation plan and when it ends.
5) Please check for signs: General malaise, fever or diarrhoea and make sure to alert your
doctor via phone. Don’t go to the clinic before you alert the medical team so they prepare
where you will be kept, while they are investigating you.
6) The general good hygiene practices of washing hands, hand sanitizer use, avoiding over
crowded places should be observed.
7) You can also call the Ministry of Health call centre
The good news it is in our power to fight and prevent this, if only we all can do our part!
Good luck and all the best of health! From the Teledoctor team in Zambia.
If you have questions, please feel free to get in touch with us on: admin@teledoctor.co.zm

About Author

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Wilbroad Mutale
Member Since: Feb 15, 2020