COVID-19: How unprepared are we?

Originally published on LinkedIn.

This is an experiential post from a traveler who just returned from #Nigeria.

On Friday, Feb 29. 2020, WHO raised the global risk assessment of the COVID – 19 infection to “very high.” A large part of the #globalhealth #community agrees that we are not adequately prepared for #COVID- 19. So I start with how unprepared we are for this “very high” risk situation.

I am not talking about low and middle-income countries (LMIC). I am talking about the most powerful, richest, and advanced country in the world – the United States of America.

I flew from Dulles, Washington, DC, and arrived in Abuja via Istanbul on Wednesday, Feb 26. At the Abuja airport, I was screened for fever, cough, and cold. Over the weekend, I was planning to fly from Abuja to Lagos when the news broke about the first case of Coronavirus in Lagos. The man, Nigeria’s first confirmed coronavirus case, entered the country on a Turkish Flight via Istanbul. I flew on the same airlines and via the same airport a day later than he did. After confirmation of the diagnosis, he was transferred to a containment facility in Yaba, Lagos, on Feb 27, 2020.

The lack of global leadership, unclear and inconsistent messaging, the ambiguity of global and national plans, and unpredictability of the reaction from airlines and governments are some of the factors that spin us into a panic even if we want to take a scientific approach. The thought of canceled airlines, being sick or quarantined thousands of miles away from family, and unsure of the support system in a foreign country led me to return instantly rather than fear of getting the virus with one case in Lagos. While waiting at the airport, I started to develop a headache, cough, and cold. By the time I boarded the plane after a layover in Istanbul, I began to have a severe headache and fever.

As soon as I landed at IAD, I called my family to prepare them that I may be delayed or held up for the screening. After clearing customs, I thought there would be some screening station. I was returning from Nigeria within three days, feeling very sick, in addition to being jet-lagged and exhausted. It was the first time that I didn’t mind spending additional time at the airport for screening to ensure that I was not putting my family and others at any risk of passing coronavirus. Alas, there was no screening station.

I took all the precautions an individual can take to the extent possible. I got home ready to pass out. Most of the information available was geared towards what an individual can do. I called the nurse helpline available via Blue Cross Blue Shield Health Insurance. I was given all the general suggestions and to report to the emergency if I start having difficulty in breathing. Labored breathing, which I had, was not enough to warrant a checkup. The nurse did not offer any opinion if waiting until difficulty in breathing would worsen my prognosis if, indeed, I was infected with Coronavirus. Of course, she was sure to recite all the lines to ‘free’ themselves of any liability.

I self-quarantined myself at home. In the morning, I called urgent care and then the emergency room at Holy Cross Hospital. Holy Cross is supposed to be second in line to receive coronavirus patents if needed. I was shifted from one extension line to another three times, and then half an hour later, it got disconnected.

The end of the story is not as crucial in this case, as the journey to the end is. I am 99.99% sure that it is a ‘normal cough and cold’ made worse by stress, sleeplessness, and traveling to and back from Nigeria in three days. But the most disappointing is the lack of preparedness in the most powerful and resourceful country in the world. The narrow approach to screening travelers coming from certain countries is ridiculous when people can be exposed at the layover airports. An abject lack of screening and early detection to prevent and control the spread of the pandemic and shifting complete focus on individual responsibility is endangering us all. Individual responsibility is central and crucial to the preparedness, but it is not a replacement for the abdication of the role government agencies have.

According to the WHO report, “Joint External Evaluation of IHR Core Capacities United States of America,” our ready score is high at 87. The USA scores quite well on the capability at Risk Communication and Port of Entry.

WHO says on USA’s capability on risk communications, “The United States is able to identify, develop and disseminate public messages that rapidly and efficiently communicate risks, strategies and actions to appropriate stakeholders and targeted populations through multilevel and multifaceted mechanisms, processes and tools, including social media, crowd sourcing and other technology-based networks for information dissemination, even specifically designated for communicating with the public about health emergencies. Indeed, community engagement before, during and after a major public health event is a component of the national approach to public health security.”

People following the government agencies messaging and news coverage can make up their minds on how effective the risk communication has been. Some leaders talked about miracles and others about the infection going away just like that. The ones I could make sense of were focused on individual responsibility. They addressed good hygiene and general prevention in infections spread through respiratory droplets.

Some cities, such as New York, have set up helplines for people to reach out for medical information and assistance if needed. Others, like the Washington DC metro area, have no such mechanisms.

WHO says on USA’s capability on the port of entry, “The USA has an effective system to detect, assess, report and respond to potential threats and events at points of entry.” I beg to differ.