June 17, 2020
Much of the news coverage of COVID-19 has focused on countries such as the U.S., those in Europe, and the epicenter in China. These countries are experiencing their own challenges as leaders and scientists rapidly try to find solutions, both non-pharmaceutical interventions to slow the virus’ spread and research to develop drugs and understand the disease.
But as with a global pandemic, many other regions are affected, including developing countries and low-resource regions. How are they responding to the crisis? Our SPARK GLOBAL affiliates in Africa gave us their perspective and response.
Dr. Justen Manasa is co-director of SPARK Zimbabwe, director of diagnostics at the African Institute of Biomedical Sciences (AiBST) and a senior lecturer at University of Zimbabwe. He was recently appointed University of Zimbabwe Innovation Hub Manager.
Takudzwa Marembo is a medical microbiology lecturer at Midlands State University, an African Union-CDC medical laboratory scientist, and a volunteer medical laboratory scientist at AiBST.
SARS-CoV-2 testing in Zimbabwe: SPARK laboratory expertise mobilized to respond to testing needs
Despite various warnings from leading epidemiologists and infectious disease specialists on a potential pandemic caused by coronaviruses, most governments were caught unprepared by the Wuhan, China outbreak of SARS-CoV-2, which was declared a global pandemic in March 2020 by the World Health Organization (WHO). COVID-19, the disease caused by SARS-CoV-2, has stretched the health care systems of some of the most developed countries including the U.S., Italy and U.K.
Most of the challenges have been to do with inadequate testing to identify infected patients so as to provide them with care and to prevent further transmission. Furthermore, most of the countries did not have enough ICU beds to manage the critically ill patients. As of June 8, 2020, there have been approximately 7 million confirmed SARS-CoV-2 infections and 400,000 fatalities globally.
Africa as a continent has not been spared by the SARS-CoV-2 pandemic, though at the moment, the burden has not been as high as in western Europe, the U.S. and Brazil. There were fears that with Africa’s poorly funded and under-resourced health systems, COVID-19 was set to wreak havoc on the continent.
To date, Africa’s response, led by South Africa, has been more than remarkable. With lessons from HIV and Ebola, the continent was swift in implementing strict public health measures to control the pandemic, including total economic shutdowns.
In Zimbabwe, the shutdowns came into effect on 30 March 2020, for an initial period of 21 days, which were further extended by four more weeks, though with progressively reduced restrictions. At the moment, most government offices are open, parastatals (government-affiliated agencies) are open and so are a number of key industries that have been deemed essential to the COVID-19 response. Furthermore, the government and its partners as well as different stakeholders are in discussions to start slowly opening the economy, which is dominated by informal traders, such as people employed in day to day economic activities like open markets and home industries, who depend on these daily incomes for their day to day upkeep.
As of June 8, 2020, Zimbabwe had 282 confirmed cases of SARS-CoV-2 infection, with four fatalities. This is from approximately PCR 22,000 tests over a period of two months.
In order to provide a coordinated response to COVID-19, the government of Zimbabwe set up an inter-ministerial committee to provide the necessary leadership. Operationally, the government set up eight strategic response pillars led by technocrats ad academics from various disciplines.
The African Institute of Biomedical Sciences (AiBST) is supporting Pillar Number 5, which focuses on National Laboratory Systems and coordinates SARS-CoV-2 testing. This Pillar is led by the Directorate of National Laboratory services in the Ministry of Health and Childcare, represented by deputy director Dr. Raiva Simbi. SPARK Africa Director Prof. Collen Masimirembwa, as well as Dr. Manasa, the co-director of SPARK at University of Zimbabwe, are part of a team of highly experienced medical laboratory specialists who have been working with different partners, including WHO, CHAI, U.S. CDC, AU CDC, and ASLM, to ensure that SARS-CoV-2 testing is accessible in Zimbabwe.
From the time our National Microbiology Reference Laboratory started testing, it was obvious that they would not be able to cope with the level of testing required in order to control the pandemic. It was also obvious that it was going to take some time to capacitate the provincial and district hospitals to be able to start testing. Unfortunately, most of the private diagnostic laboratories in Zimbabwe did not have the technical capacity to provide SARS-CoV-2 molecular testing. That capacity existed in academic research institutions.
Dr. Manasa, a molecular virologist, mobilized research labs in Harare, including AiBST, the Biomedical Research and Training Institute (BRTI), and the National Virology Laboratory at University of Zimbabwe’s College of Health Science to support the NMRL in order to cope with the testing demands. These three labs were later joined by the National TB reference lab supported by the National University of Science and Technology. The AiBST lab supervised by Dr. Manasa was mostly manned by a team of highly skilled volunteers, including Takudzwa Marembo. These volunteers came from both private and public institutions to provide their services pro-bono.
Though there have been sporadic shortages of consumables for testing, the capacity of the network of PCR labs that have been set up to support testing has not yet been fully stretched. The five labs mentioned above can collectively test 1000 samples in an eight-hour shift.
In addition, a number of provincial laboratories have been activated to start testing. The introduction of GeneXpert SARS-CoV-2 cartridges is potentially a huge game changer of the diagnostic landscape in Zimbabwe and probably the rest of Africa. This will enable the leveraging of the huge GeneXpert installation base, already set up to support TB programs, for COVID-19 testing. In Zimbabwe more than 150 GeneXpert instruments are already in place in both public and private institutions. The GeneXpert network also provides an opportunity to set up mobile labs to ensure everyone who needs testing accesses testing.
COVID-19 response is incomplete without strong operational research. A number of SPARK members from AiBST and UZ, including Prof. Masimirembwa and Dr. Manasa, are leading some of the research efforts in Zimbabwe. Though there are very limited research funds in Zimbabwe, the research community in Zimbabwe came up with some key strategic locally relevant research protocols including epidemic modelling, virology (diagnostics and molecular epidemiology), host genomics, biobanking, and ethnomedicine. The researchers have also adopted a number of international COVID research protocols such as the ISARIC protocol and are participating in a number of international clinical trials.
For further reading see Walker et al. (Science 2020), which found that LIC/LMIC countries – with typically limited health care capacity and higher burdens from infectious diseases such as HIV/AIDS and TB – initiated shutdown procedures earlier than UMIC or HIC. “Many lower income countries have acted while transmission remains at low levels which is likely to have substantially slowed the spread of the virus.”