On Plugged In .. Pandemic challenges... in Africa ... as the continent ... surpasses one million ... confirmed cases of ... COVID-19. Experts believe … there could be many more. ((Dr. Michel Yao)) “There is people denying the disease. There is also a stigma that make it that the people hiding instead of being open and going for testing.” Having dealt with the virus ebola … what are the lessons … that can be applied … to coronavirus? Plus… what some African countries… are doing to rein in… this deadly pandemic… On the… “Coronavirus Challenge in Africa.” (Greta Van Susteren) Hello and welcome to Plugged In. I’m Greta Van Susteren reporting from my home in Washington DC. In Africa, confirmed cases of COVID-19 have reached a new milestone. More than one million people have tested positive for coronavirus. That is a fivefold increase in just the past two months. The Africa Centers for Disease Control says more than 23 thousand people have died. But there is concern that insufficient testing is masking many more COVID cases. The nation of South Africa has the most cases in the continent with more than a half million. And a study there shows a spike in unexplained deaths from early May to mid-July raising concern that South Africa’s death toll is twice as high. With Egypt, Nigeria, Ghana and Algeria - those five countries account for 75 percent of Africa’s COVID cases. (Greta) Africa represents just five percent of the world’s known COVID cases. But Africa’s geography and the diversity of its 54 countries represents a logistical challenge for international health organizations. Dr. Michel Yao leads the emergency response programs at the World Health Organization’s regional office for Africa. I spoke to him about the challenges of helping and educating those who need help. (Dr. Michel Yao interview) MY: This is a challenge in any outbreak, where this is one of the critical interventions for people to have some awareness about the disease that will increase also acceptance of preventive measures. If not, there is people denying the disease. There is also a stigma that make it that the people hiding instead of being open and going for testing when they have a suspect case. So it's a challenge, but it’s better than what we experienced in the past with Ebola in eastern Congo. GVS: What do you do to meet that specific challenge? What can you do? MY: The specific challenge is mainly to implement preventive measures. The preventive measures like hand washing of physical distancing is sometimes a challenge in some of the settings, the crowded settings around the big cities. So in this case is you need what we call enabling interventions. You need to ensure that at least human supplies, a hand washing point, that you can maybe also supply some of the sanitizers or even distribution of masks or setting temporary structure for isolation. But all of those things require resources and that also partners like NGO’s got the right resources to set up these activities that help people to comply more. GVS: Are you finding that you have access to all the areas that you need to get access to? Are some more difficult to reach where there may be outbreaks or where people may be in great need? MY: It is difficult in the DRC to have access to many places for different reasons. It's a huge country. The right infrastructure is not well-developed. So if we take the ongoing Ebola outbreak in the western part in the provinces, sometime we have to use the boats, to use the river to assess some of the areas. So in this case it's difficult to deploy our staff safely as well as equipment; we are using the vaccine in the current outbreak in this part. In some of the areas there is a challenge related to security. It requires some negotiation or working with the different commercial and security forces to have access to this area. So it's a bit complicated, the response. GVS: In the event that we do get a vaccine that's effective or a treatment that's very effective. Is there a good medical infrastructure for distributing it in the Congo? MY: It's a challenge. Just take the example of Ebola where we were using a vaccine that is kept at minus 60 degree, requires a huge logistics, sometimes using helicopters and so on. So for sure, the first people that will benefit will be probably in the big cities. But all of these systems have to be in place. It's one of the things that we are advising countries to work on to start thinking ahead in terms of regulation, even authorizing new medicines as well as a distribution mechanism. GVS: Are there any other challenges that you or WHO is confronting trying to deal with the problem of coronavirus, which is occurring at a time when you're also getting more Ebola cases. MY: there’s an ongoing, for example, cholera outbreak in some of the area in DRC. We have a measles outbreak that started last year, it stabilized a bit, but we still have quite a big number. And COVID may not help because it's reduced access to basic services that could have a major impact. If we have a group of children that cannot be immunized now, they will be exposed in the future and become vulnerable to any vaccine preventable disease. This can even include polio as well as the measles. GVS: Has the government been good in assisting you and assisting the W.H.O and trying to fight cholera measles, Ebola and now coronavirus? MY: The government, they are trying their best, but they have some, they have some limitation related to their capacity in the country in terms of health workers and in terms of also financial budget to recruit more people to do so. So the willingness is there, with also the new president, but capacity is low, investment is low, the priorities to address in addition to health, are huge that allocation to health would not be enough to overcome all these challenges that we have. It is why there is a need for continuous support, at least for this situation to stabilize. Unfortunately COVID will worsen this major gap, so the thinking is how can we help the country to recover and become more and more resilient? Do the Five – Help stop coronavirus: Hands - wash them often. Elbow – cough into it. Face – don’t touch it. Feet – Stay more than 3 feet (1 meter) apart. Feel Sick? Stay at home. Do the five – help stop coronavirus. VOA – a Free Press Matters. (Greta) For some African countries that are dependent on imports of food and manufactured goods coronavirus is something that is also crossing the border. Botswana shares a border of nearly two thousand kilometers with South Africa. And truck drivers hauling goods to landlocked Botswana are responsible for 80 percent of the country’s COVID-19 cases. Plugged In’s Mil Arcega has more. (Botswana Border Concerns – by Mil Arcega) Trucker Wisiso Balathi used to look forward to his daily drive from his home in Botswana, to pick up goods in neighboring South Africa. But since the COVID-19 pandemic, border trips for truckers like him have become a nightmare of tests – sometimes waiting five days for results. Balathi says conditions at border checkpoints are miserable. ((Wisiso Balathi, Truck Driver From Botswana)) "It is tough, there are times when we think of quitting. Where we go to South Africa there are high cases of coronavirus. What we are asking for is to be treated with dignity, as we provide an essential service." ((NARRATOR)) With nearly half a million cases of COVID in South Africa, Botswana officials say testing people who cross the border is vital. And with confirmed cases rising in Botswana - truckers – especially those coming from South Africa - are being closely monitored. ((Mandatory courtesy: Botswana Television)) ((Dr Kereng Masupu, COVID-19 Task Force Chairperson)) "These are largely border cases, 80 percent of the 50 cases (recorded in one day) were non-citizens, so it tells a story where the threat level or the pressure of risk is based. It is at the border." ((NARRATOR)) Analyst Lawrence Ookeditse says the pandemic is a wake-up call for Botswana’s reliance on South African goods. ((Lawrence Ookeditse, Analyst)) "This COVID thing has proven that the country is in a precarious position, particularly if you look at its dependence on South Africa. The country needs to get to a point where it can depend on itself for a number of vital supplies. We import literally everything." ((NARRATOR)) Government figures show South Africa accounted for nearly three quarters of Botswana’s import bill as of April this year. And truckers are among the most vulnerable. Of Botswana’s 739 COVID-19 cases, more than 600 have been truck drivers who tested positive at the country’s entry points. (for Mqondisi Dube, in Gaborone, Mil Arcega VOA News.) (Greta) Dr. Linda Mobula is a health advisor with the World Bank for the tenth Ebola outbreak in the Democratic Republic of the Congo. She is an internal medicine physician and assistant professor at Johns Hopkins University. I asked Dr. Mobula what have we learned from infectious disease outbreaks of the past and how those strategies are being used to fight coronavirus. (Dr. Linda Mobula interview) LM: a really good outbreak response involves changing behavior. Outbreaks or diseases are spread by a specific mode of transmission. in this case we think that COVID-19 is spread via respiratory droplets and there are discussions about whether or not it's airborne. And so in order to change behavior, I think it's really, really important and critical to engage with local trusted community leaders, I think that's probably one of the biggest lessons learned from Ebola. It wasn't until we engaged with local community, community leaders pastors traditional leaders that we were really able to change the direction of the response. GVS: Here in the United States if someone's sick you know we're all you know frightened of them, I mean we're grateful to healthcare workers who care for them. On the African continent, when people get sick are some shunned? LM: I think the concept of stigma is something that is unfortunately a concept that is international. It doesn't matter where you are, there's a lot of stigma regarding diseases such as Ebola, as such as COVID-19. And there has been stigma here in the United States as well. and i think you know back to my comments about trust, I think being able to leverage or work with survivors of COVID-19 is something that's going to be important in trying to reduce that stigma. This was done quite successfully I think in DRC as well as in West Africa working with survivors to have them move back to the community, to encourage them to prevent transmission so stigma’s something that we really need to address globally. GVS: Have you ever thought that the access to drugs that are available that we don't get the supply to Africa fast enough or enough are they getting the sort of the short end of this? LM: That's a very good question. There's been multiple drugs that have been utilized in clinical trials such as Remdesivir as you mentioned. Dexamethasone which is a steroid has been found to also be effective in a trial conducted in the UK. And in terms of access to drugs and a potential vaccine I think that is a potential fact-- there could be decreased access to some of these therapies, because the priority could be in high income countries like the US and like the UK and others that where supplies are actually directly these countries and you have decreased access to some of these drugs in Africa. So that's definitely an issue. I think with regards to a vaccine once it's been approved, equal distributions to some of these other countries low and middle income countries is going to be something that we need to look at, as well, to ensure that these countries do have access to drugs and supplies and vaccines. GVS: There is a movement of people that call themselves anti-vaxxers. they will take, they will never take a vaccine, no matter what. Do you have is there, have you have you in Africa in your work, come across people who are alike of like thinking that they will not take a vaccine, no matter how safe and effective others might think they are? LM: Absolutely. In fact, during the DRC Ebola outbreak, the vaccine was being-- two vaccines were being as a vaccine produced by Merck and a vaccine produced by Johnson and Johnson. And there were many surveys that were conducted on obtaining community perception on the vaccine. And many individuals stated that they refused to take the vaccine, they couldn't quite understand its mode of action. Lots of rumors about the vaccine especially during elections. And this has created a lot of issues with regards to acceptance of the vaccine so anti-vaxxers are all over the world. And what what was done to address this? As mentioned, increased media engagement working with local health providers increased education about the vaccine, providing more information about the vaccine engaging with communities I think really helped and I think as we look at a potential COVID-19 vaccine, there will be challenges in having communities accept this. I do think that the key is going to be communicating, communicating with community leaders, religious leaders with communities and understanding their fears and concerns as well, is going to be extremely important. GVS: It's never just I mean, it's not just the corona virus but there's sort of a lot of problems that it you know worldwide that are colliding on these nations. LM: Absolutely. I think what we learned from the 10th DRC Ebola outbreak is that you can't effectively respond to an outbreak without having water at health facilities, without having health facilities that have a very strong infrastructure, without having food that's distributed to communities and so one of the things that we learned is that you have to have a multi-sectoral response that includes food distribution to contacts, contacts as cases. As you're doing contact tracing we found that individuals would run away, or they would actually seek food, they would go buy food at market. So if you're actually giving them food, you're encouraging them to stay home. You can't have a strong effective response if health facilities don't have access to clean water. So, these are things that are extremely critical and I think this applies to COVID-19 as well. GVS: Dr. Mobula thanks so much for joining me. LM: Thank you. Greta. (COVID-19: Fast Facts) This is a special presentation of Voice of America. Wash your hands with soap and water before you eat and after using the toilet. After touching anything other people touch like a seat on a public bus. Scrub thoroughly for 20 seconds.. If you cannot wash your hands use a hand sanitizer. Taking these steps can prevent not only coronavirus but also colds and flu and other viruses. (Greta) In Kenya education is among the many casualties of COVID-19. Due to the pandemic - schooling in Kenya is suspended until January. Public school teachers continue to receive their salaries. But those who teach at private schools are being forced to take on other jobs to survive. VOA’s Lenny Ruvaga has that story from Nairobi. (Kenya Teachers Improvise by Lenny Ruvaga) Twenty-six-year-old Keziah Karanja goes about preparing her beauty shop for the day. Karanja and her colleague Rebecca Atuti, both private school teachers, pooled their financial resources and began this business two months ago at the onset of the nationwide lockdown in Kenya. The teachers, who both teach humanities, make an average of $10 in sales each day. However, Karanja says that due to the fact that both are on indefinite unpaid leave from their jobs, finding the money to keep their shop running is quite the challenge. ((KEZIAH KARANJA, PRIVATE SCHOOL TEACHER)) “We don’t have enough stock so that we can sell the products. You see when you are starting a business you should have enough stock so that you can sell to the customers. But we are having challenges that if someone comes for a certain product we don’t have because we don’t have the money to have the stock.” ((NARRATOR)) In mid-March the government suspended learning in all institutions in a bid to stem the spread of COVID-19. While public school teachers are still drawing their salaries, many private school teachers are not. Peter Ndoro the chief executive officer at KPSA, wants the government to offer financial support to the private schools. Ndoro told VOA that about 1,400 teachers have lost their jobs as a result of the closure of schools. The rest are on unpaid leave. ((PETER NDORO, KENYA PRIVATE SCHOOL ASSOCIATION)) “During this period what is it that will be happening? There will be no revenue coming in but private schools closed because they wanted Kenya to be safe heeding to the president’s call that all schools should be closed. So what is it that needs to be done? These institutions need to be supported by the government.” ((NARRATOR)) With a workforce of around 300,000 teachers, private schools have requested a $7 million grant to pay salaries and offset mounting costs. Zack Kinuthia the Education Chief Administrative Secretary, says the request is under consideration. ((ZACK KINUTHIA, CHIEF ADMINISTRATIVE SECRETARY FOR EDUCATION )) “If we can say that they want to be removed from a gridlock that is almost decimating them, it can be considered at higher levels and agreements can be made. You know there’s no money, taxes are not being collected as they used to we are struggling to get income, but just something can be done so that we also save them.” ((NARRATOR)) For now, Keziah and thousands of other teachers drawn from private schools across the country are turning to alternative sources of income and vocations to support their families. Lenny Ruvaga, for VOA News, Nairobi. (Greta) Finding safe ways to go to school, to go to work, go on holiday - will be the key to returning to social and economic normal. In South Africa it means cleaning up so-called “moving incubators” that transport about 14-million commuters to and from work. VOA’s Anita Powell reports from Johannesburg. (Commuting Amid Coronavirus by Anita Powell) The humble minibus taxi is a lifeline for more than 70 percent of South Africa’s workforce. But health experts worry this system is a breeding ground for coronavirus because of riders’ close quarters and the high volume of passengers. A new South African non-profit initiative, led by a businessman who is also the eldest son of President Cyril Ramaphosa, is trying to address this gap. ((Andile Ramaphosa, Co-Founder, SDI Force)) “When we insisted, as business, and as South Africans, ‘let’s open this economy,’ by not dealing with the commute, we basically undid what was happening with lockdown. So if you deal with the transport sector, because COVID is a virus that moves through the transport sector, if you deal with that effectively, you can actually put in an artificial lockdown.” ((NARRATOR)) HIV researcher Dr. Jenny Pfeiffer-Coetzee, founder and director of the African Potential Foundation, says her team has come up with several solutions, ranging from simple to complex: ((Dr. Jenny Pfeiffer-Coetzee, African Potential Foundation)) “What we're looking at is a system very similar to what's been used in ambulances, and that is to adapt a UVC air filter that allows the airflow to be encouraged within the taxi using various fans within the filter And it passes through the filter where it's then irradiated within a matter of seconds, and it’s then transmitted back into the taxi to be circulated out of the taxi.” ((NARRATOR)) Her team is also considering an alarm system that alerts passengers to open the windows to allow fresh air to circulate; at sanitizing stations that passengers can use to clean their hands before boarding, and at a divider between the driver and passenger. That last intervention, says Ramaphosa’s business partner Brad Fisher, is especially crucial. He says the government’s efforts at sanitizing taxis only works up to a point. ((Brad Fisher, Co-Founder, SDI Force)) “You can spray this rank to death. Unless you get into the taxi, where there’s a closed environment, there’s a capsule, with, whatever it is -- whether there’s three or 10 people, it’s academic -- if that driver gets sick, statistically, that driver sees 2,000 people a month -- he’s going to get sick.” ((NARRATOR)) These measures, say Ramaphosa’s team could decrease the risk of infection by up to 80 percent. So far, SDI has fitted out 5,000 school transport taxis and 1,000 commuter taxis, at an estimated cost of about $340,000 which works out to about $60 per vehicle -- much of it provided by donors. ((Andile Ramaphosa, Co-Founder, SDI Force)) “It’s been quite a journey of discovery, for us non-scientists, to bring all these people together with one thing in mind: we need to get our people to work safely, and we need to save lives.” ((NARRATOR)) Pfeiffer-Coetzee says the team is also looking at how to scale the model to fit other African countries, which use similar transport systems to move millions of people each day. Anita Powell, VOA News, Johannesburg. (Greta) Anita Powell joins us now from Johannesburg where she’s been covering the coronavirus pandemic. (Anita Powell Interview) AP: So we are now in month five of our coronavirus story here in South Africa. And right now, as I speak, I'm in the epicenter, the province of Gauteng. we're getting the fastest growing caseload in the country. And that might be because you know, this is home to the Pretoria Johannesburg Metroplex, the two most arguably important cities in South Africa. And so we're seeing huge growth in cases today. The health minister reported three thousand four hundred new cases of Corona virus. Which brings us to about five hundred twenty thousand cases across the country. GVS: is the city locked down? AP: We are in level three of Coronavirus restrictions. We are in actually modified adjusted level three of Corona virus restrictions. So the answer is partly yes partly no. So for example we have a curfew of 9:00 p.m. to 4:00 AM. We have a total ban on sale and distribution of all alcohol and tobacco products, that came back a few weeks ago when the president reintroduced that. And we have other restrictions on large gatherings. And, for example religious services are limited to 50 people and so on and so forth. You have to get special permits if you want to go to funerals outside of the province. So it is, as the government might say, mildly restricted. But as the people might say, quite restricted. GVS: Is the no alcohol. Is that a controversy there? AP: Yes. Colloquially, anecdotally, South Africans are upset over this complete ban on alcohol sales distribution that was enacted in the middle of July. So there's a lot of grumbling about it online. But the health minister and other officials in the cabinet have held a very firm line on this. And the reasoning is very interesting. And it's not without merit. It is that South Africa's public health system is overburdened by alcohol related injuries. And without those, they can focus on the work of dealing with covid patients instead of dealing with people with head wounds with broken limbs, people who've been stabbed. The health minister said recently since the alcohol ban was enacted, they've seen a dramatic decrease in stabbings. This country has the highest HIV burden in the world with a known 6.6 million person caseload. So we are also dealing with that. And you know what's interesting about that Greta is that South African officials on the National Coronavirus Task Force, a lot of them cut their teeth on the HIV epidemic. And so they say “actually the fact that we have such a high saturation of HIV has actually prepared us to deal with this pandemic.” We've already done one pandemic. This is not our first pandemic. We can handle this one. And they've taken a lot of lessons they've learned from HIV and also from tuberculosis, which is another very serious illness that we have in high quantity here. GVS: Is it mandatory masking where you are? AP: Yes. Mandatory masking in public. And here in Johannesburg. And also to some extent on the other metropols, for example, Cape Town, there's a fairly high level of adherence to the mask guidelines. In the rural areas what I'm hearing is it's not as tightly adhered to. And that's for a number of reasons, largely economic. People are saying, you know I'm already struggling enough as it is And now you want me to go buy an extra article of clothing. And the president refuted that in a recent speech and he said it's cheap, you can make your own mask. But even so, what we're hearing is that there's pretty good adhesion to mask policies in the capital cities, in the metropols and less so in the rural areas. GVS: Is there an indication when this lockdown, where your restrictions are going to get lifted or are they sort of indefinite? AP: Greta, I would give anything for you to pose this question yourself to Cyril Ramaphosa. Nobody knows. CR is not saying and it's very interesting because the level three restrictions which are the eased restrictions, the modified restrictions, he's given no end date for this. At first we had the hard lockdown. It was it was at first five weeks then it was extended. Then we had a slightly less hard lockdown. And now we're in level three, which has been going on since June. And there's no sign there's no sign whatsoever There's no indication of when it might end. There's no benchmark that anybody knows of. (Greta) That is all the time we have. Many thanks to my guests: Dr. Michel Yao, Dr. Linda Mobula and VOA’s Anita Powell. For the latest updates on COVID-19 in Africa and around the globe - please visit our website at VOANews.com.  And don’t forget to follow me on Twitter @Greta.  Thank you for being Plugged In. #####