Effect of Non-pharmaceutical Interventions on COVID-19 in Rwanda: An Observational Study.

BACKGROUND: On 11 March 2020, COVID-19 was declared as a pandemic by the World Health Organization (WHO). The first case was identified in Rwanda on 24 March 2020. Three waves of COVID-19 outbreak have been observed since the identification of the first case in Rwanda. During the COVID-19 epidemic, the country of Rwanda has implemented many Non-Pharmaceutical Interventions (NPIs) that appear to be effective. However, a study was needed to investigate the effect of non-pharmaceutical interventions applied in Rwanda to guide ongoing and future responses to epidemics of this emerging disease across the World. METHODS: A quantitative observational study was conducted by conducting analysis of COVID-19 cases reported daily in Rwanda from 24 March 2020 to 21 November 2021. Data used were obtained from the official Twitter account of Ministry Health and the website of Rwanda Biomedical Center. Frequencies of COVID-19 cases and incidence rates were calculated, and to determine the effect of non-pharmaceutical interventions on changes in COVID-19 cases an interrupted time series analysis was used. RESULTS: Rwanda has experienced three waves of COVID-19 outbreak from March 2020 to November 2021. The major NPIs applied in Rwanda included lockdowns, movement restriction among districts and Kigali City, and curfews. Of 100,217 COVID-19 confirmed cases as of 21 November 2021, the majority were female 51,671 (52%) and 25,713 (26%) were in the age group of 30-39, and 1866 (1%) were imported cases. The case fatality rate was high among men (n = 724/48,546; 1.5%), age > 80 (n = 309/1866; 17%) and local cases (n = 1340/98,846; 1.4%). The interrupted time series analysis revealed that during the first wave NPIs decreased the number of COVID-19 cases by 64 cases per week. NPIs applied in the second wave decreased COVID-19 cases by 103 per week after implementation, while in the third wave after NPIs implementation, a significant decrease of 459 cases per week was observed. CONCLUSION: The early implementation of lockdown, restriction of movements and putting in place curfews may reduce the transmission of COVID-19 across the country. The NPIs implemented in Rwanda appear to be effectively containing the COVID-19 outbreak. Additionally, setting up the NPIs early is important to prevent further spread of the virus.

Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies.

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification of the index case in March 2020 up to August 2021, three versions of the clinical management guidelines were developed, with the aim of ensuring that the COVID-19 patients treated in Rwanda were receiving care based on the most recent therapeutic discoveries. As the case load increased and imposed imminent heavy burdens on the healthcare system, a smooth transition was made to enable that the asymptomatic and mild COVID-19 cases could continue to be closely observed and managed while they remained in their homes. The care provided to patients requiring facility-based interventions mainly focused on the provision of anti-inflammatory drugs, anticoagulation, broad-spectrum antibiotic therapy, management of hyperglycemia and the provision of therapeutics with a direct antiviral effect such as favipiravir and neutralizing monoclonal antibodies. The time to viral clearance was observed to be shortest among eligible patients treated with neutralizing monoclonal antibodies (bamlanivimab). Moving forward, as we strive to continue detecting COVID-19 cases as early as possible, and promptly initiate supportive interventions, the use of neutralizing monoclonal antibodies constitutes an attractive and cost-effective therapeutic approach. If this approach is used strategically along with other measures in place (i.e., COVID-19 vaccine roll out, etc.), it will enable us to bring this global battle against the COVID-19 pandemic under full control and with a low case fatality rate.

Baseline knowledge and attitudes on COVID-19 among hotels' staff: A cross-sectional study in Kigali, Rwanda.

BACKGROUND: The World Health Organization declared coronavirus disease 2019 (COVID-19) as a global pandemic on the 11th of March, 2020. Hotels and other public establishments have been associated with higher transmission rates. Sensitisation of staff and strengthening of Infection Prevention and Control (IPC) practices in such settings are important interventions. This study assessed the baseline knowledge and attitudes on COVID-19 among hotels' representatives in Kigali, Rwanda. METHODS: A cross-sectional study was conducted among hotels' staff in Kigali in July 2020. A structured questionnaire was self-administered to 104 participants. Baseline knowledge and attitudes were assessed using a number of pre-test questions and mean scores were used to dichotomise the participants' responses as satisfactory or unsatisfactory. RESULTS: All of the 104 hotels' staff completed the self-administered questionnaires. Sixty-seven percent (n = 70) were male and 58% (n = 60) were aged between 30 and 44 years. The satisfactory rate of correct answers was 63%±2.4 (n = 66) on knowledge and 68%±1.7 (n = 71) on attitudes evaluation. Participants with University education were more likely to have satisfactory knowledge (AOR: 2.6, 95% C.I: 1.07-6.58) than those with secondary education or less. The staff working in the front-office (AOR: 0.05; 95% CI 0.01-0.54) and housekeeping (AOR: 0.09; 95% C.I: 0.01-0.87) were less likely to have satisfactory attitudes than those working in the administration. CONCLUSIONS: Hotels' staff based in the capital of Rwanda have shown satisfactory knowledge and attitudes regarding appropriate IPC practices for preventing the COVID-19 transmission. Educational interventions are needed to improve their knowledge and attitudes for better prevention in this setting.

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020.

We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda.