COVID-19 Response in Zimbabwe: The Need for a Paradigm Shift?

Zimbabwe reported its first case of coronavirus disease 2019 (COVID-19) on 20 March 2020 and the country's response has largely adhered to international protocols. From the outset of the pandemic, most control measures were premised upon knowledge of breaking infectious diseases' chains of transmission gained from previous experiences with comparable pathogens. As relatively little was known about the novel virus, and the prospects of effective vaccines were not on the horizon, these tough control measures were deemed appropriate. Two years into the pandemic, a massive evolution of knowledge has transpired, and safe and effective vaccines against the virus are now available, are administered to billions of people, and can significantly reduce new infections, severe disease, hospitalisation, and death from the disease. Based on the understanding of the pandemic and the need to restore socio-economic activities, in this review we propose a paradigm shift in addressing the challenges of the COVID-19 pandemic. The COVID-19 response should take into consideration the local context and tailor-make a response that addresses local challenges.

Risk of mortality in HIV-infected COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: The relationship between HIV infection and COVID-19 clinical outcomes remains a significant public health research problem. We aimed to determine the association of HIV comorbidity with COVID-19 mortality. METHODS: We searched PubMed, Google Scholar and World Health Organization library databases for relevant studies. All searches were conducted from 1st to 7th December 2021. Title, abstract and full text screening was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality in HIV-infected COVID-19 patients was computed using a random-effects model. All analyses were performed using Meta and Metasens statistical packages available in R version 4.2.1 software package. The quality of included studies was assessed using the GRADE approach, Egger's test was employed to determine the risk of bias. RESULTS: A total of 16 studies were included in this review. Among the COVID-19 patients with HIV infection, the mortality rate due to COVID-19 was 7.97% (4 287/53,801), and among the COVID-19 patients without HIV infection, the mortality rate due to COVID-19 was 0.69% (127, 961/18, 513, 747). In the random effects model, we found no statistically significant relative risk of mortality in HIV-infected COVID-19 patients (RR 1.07, 95% CI 0.86-1.32). The between-studies heterogeneity was substantial (I2 = 91%, P < 0.01), while the risk of publication bias was not significant. CONCLUSION: Findings did not link HIV infection with an increased risk of COVID-19 mortality. Our results add to the conflicting data on the relationship between COVID-19 and HIV infection.

Emerging SARS-CoV-2 Variants, Inequitable Vaccine Distribution, and Implications for COVID-19 Control in Sub-Saharan Africa

Since the onset of the COVID-19 pandemic, four SARS-CoV-2 variants of concern have emerged, which have shifted the clinical and epidemiological characteristics of the disease. Of concern is the impact of the emerging variants on COVID-19 vaccination programmes, with vaccination perceived as a key global pandemic control strategy. Variants of concern can reduce the effectiveness of the currently available vaccines, shift herd immunity thresholds, and promote wider vaccine inequities as richer countries hoard vaccines for booster shots for their populations without accounting for the needs of the underdeveloped countries of sub-Saharan Africa. Currently, Africa lags far behind the rest of the world, with most sub-Saharan Africa countries still to reach 50% vaccination of their eligible populations against global herd immunity thresholds of 70–90%. As long as the vaccination gap between sub-Saharan Africa and the rest of the world persists, SARS-CoV-2 will most likely persist as a significant global health threat, with continued emergence of variants of concern. Therefore, strategies to ensure wider reach of different types of vaccines on the African continent are urgently required alongside fighting vaccine hesitancy and logistical barriers to access for the marginalized populations. Sub-Saharan Africa must look for opportunities to manufacture vaccines on the continent and enhance genomic sequencing capacity as key pandemic-control strategies.

Optimising COVID-19 Vaccination Policy to Mitigate SARS-CoV-2 Transmission within Schools in Zimbabwe.

The COVID-19 pandemic has disrupted the learning of millions of children across the world. Since March 2020 when the first cases of COVID-19 were reported in Zimbabwe, the country, like many others, has gone through periods of closing and re-opening of schools as part of the national COVID-19 control and mitigation measures. Schools promote the social, mental, physical, and moral development of children. With this viewpoint, the authors argue that schools should not be closed to provide a measured and efficient response to the threats posed by the COVID-19 epidemic. Rather, infection prevention and control strategies, including vaccination of learners and teachers, and surveillance in schools should be heightened. The use of multiple prevention strategies discussed in this viewpoint has shown that when outbreaks in school settings are adequately managed, the transmission usually is low. The information presented here suggests that schools should remain open due to the preponderance of evidence indicating the overriding positive impacts of this policy on the health, development, and wellbeing of children.

COVID-19: Comparison of the Response in Rwanda, South Africa and Zimbabwe.

The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefit having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.

Coronavirus Disease 2019 (COVID-19) Response in Zimbabwe: A Call for Urgent Scale-up of Testing to meet National Capacity.

Control of coronavirus disease 2019 (COVID-19) heavily relies on universal access to testing in order to identify who is infected; track them to make sure they do not spread the disease further; and trace those with whom they have been in contact. The recent surge in COVID-19 cases in Zimbabwe is an urgent national public health concern and requires coordinated efforts to scale up testing using the capacity already in existence in the country. There is a need for substantial decentralization of testing, investment in better working conditions for frontline health workers, and the implementation of measures to curb corruption within government structures.

Zimbabwe's prison facilities: Preparedness for institutional COVID-19 outbreaks.

Covid-19 cases and death are on the rise in Zimbabwe and other Southern African countries. This increase poses a major risk of outbreaks in institutions such as prisons and detention centers. Zimbabwe has a total of 46 main prisons that are overcrowded and without adequate running water, hand sanitizers, and face masks for both prisoners and warden officers. Although the country has released some prisoners, it is still not enough to decongest the prisons and mitigate the Covid-19 risk. There is a need to further decongest the prisons, ensure facilities have adequate tap water, and consider the use of video and audio technology to minimize visitors to inmates.

Maintaining robust HIV and tuberculosis services in the COVID-19 era: A public health dilemma in Zimbabwe.

Coronavirus disease 2019 (COVID-19) has challenged health systems worldwide. In Zimbabwe, the COVID-19 response has seen the diversion of human capital, equipment, and other resources that were meant for the HIV and tuberculosis (TB) programmes. In a country with one of the worst HIV and TB burdens globally, the authors discuss this public health dilemma of sustained HIV and TB services in the context of a new threat - COVID-19.