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I had the pleasure of working with MOH COVID-19 response team since its inception and I have witnessed the amazing work it has done. From entry airport screening, 14-day follow-up of suspected cases and on-time testing kit, a lot has been accomplished. Despite that though, the speed of this epidemics is no match for any country’s capacity. This is not the time to do things as always at the known pace of Ethiopia. A lot is riding on what we do next! 

The world is witnessing something apocalyptic right now. What we did not do now, we will regret it later. We have to trust science of epidemics, transmitablity and a big peak of the epidemic curve. Corona is just following the same curve. That is what Italy is going through and no question we in USA are following the same curve it seems. If we do not learn from the response during Spanish flu where population who introduced strict isolation and restriction of movement had less than 50% death rates than those who did not, history will judge us.  Ethiopia being in the early phases of this epidemic, need to aggressively deploy things that were unthinkable just a few days back. For this, we need a “Marshall” plan.

At this time I do not see anything much important than COVID-19 for the higher leadership of the country to spend their time on!! Let us have our faith in science and scientist and get done what is needed!

Things that must be deployed include:

1. Start coordinating the public health work of surveillance, isolation, quarantine and contact tracing with the now mandatory clinical work in hospitals.
2. Working with each and every hospital to coordinate activity is critical

Each hospital must now have a clear corona response plan 

1. Phone number in the emergency room dedicated to respiratory symptoms
2. Dedicated room or even a tent for respiratory patients to be isolated while the test is done instead of placing them with all other patients.
3. Plenty of hand hygiene activity including water in a container if we run out of gel
4. Distribution of isolation kits, masks
5. Dedicated ICU beds
6. Dedicated faculty ready to act in a short notice
7. Some kind of surge with rotation of physician, nurses and other health workers
8. Send respiratory specimen of patients with respiratory symptom and not clear etiology for Corona testing
9. Mass gathering must be stopped.  This is a drastic action but must be done- cancel activities that have over 50 or so gathering especially the ones which are not essential like conferences.

All Sporting Events

1. Any conference, meeting scheduled must be canceled.  Communication must be out through the radio and other mass media to cancel those- letter and regular old communication does not work!
2. Weddings and funerals have to be canceled/postponed or the number of attendees minimized to less than 50
3. Religious centers have to start cutting sermons. Churches in Italy which have never been closed ever including in second world war are now closed- This is drastic action but must be done 
4. International organizations in Addis must be told to cancel all activities that require gathering and that are not critical.
5. Start thinking about universities, colleges and schools overall. We might need to make a hard decision quicker than we think
6. Budget, Budget and Budget.- we need to have capacity to push money to EPHI who is directing the surveillance, testing and quarantine activities and hospitals who will soon be seeing patients at their doorsteps. 

The speed of action should be quick, and leadership should be ready to change guidance given in the morning, if needed in the afternoon.

Speed is now the essence. I am sure many of this is being implemented as we speak but I want to re-affirm the critical importance of these steps ASAP.

“Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate.” Mike Levitt. 

When history looks back on COVID-19, let’s all aim to be guilty of ‘over-preparing.

 Best, 

 Dawd S. Siraj, MD, MPH&TM, FIDSA, CTropMed®

Professor of Medicine
Associate Program Director, Infectious Diseases Fellowship
Director, International Travel Clinic

Director, Global Health Pathway for the dept of Medicine
Division of Infectious Diseases
University of Wisconsin- Madison
Madison, WI 53705

Office: (608)263-3691

dsiraj@wisc.edu