Dakar – As the second wave of COVID-19 infections increased in early 2021, Senegal has stepped up measures to deal with the expected increase in the number of patients requiring intensive care. Professor Daye Ka, expert in infectious and tropical diseases and member of the COVID-19 working group of Senegal, explains the measures taken to prevent hospitals from being overrun by a drastic increase in the number of critically ill patients.
What measures were in place to better manage an increase in COVID-19 infections?
The whole country was affected in the second wave of COVID-19 in February, when around 300 cases were reported daily. We faced a shortage of beds, especially intensive care beds. We had 311 beds supplied with oxygen and an occupancy rate of 73%, with only 76 resuscitation beds that had an occupancy rate of 56%. We have therefore added about twenty beds in [the capital] Dakar and in the regions. The supply of medical oxygen in terms of quality and quantity was also overloaded. We have set up additional temporary sites in some COVID-19 treatment centers in Dakar and regions as well as an increased supply of oxygen to avoid shortages.
The increase in cases has been accompanied by an increase in mortality, especially in older patients with underlying conditions such as hypertension, cardiovascular disease, diabetes, obesity, asthma or chronic respiratory disease. To improve treatment and reduce deaths, in addition to increasing the number of beds, including intensive care beds, we have also brought in more intensive care experts. They included resuscitation specialists, respiratory disease experts, cardiologists, diabetes and nephrology physicians, gynecologists and obstetricians as well as experts in the care of elderly patients.
We have also developed a treatment protocol to determine which patients should be hospitalized and which should be treated at home, the type of treatment depending on the severity of the disease ranging from mild to moderate, severe to critical, as we do depending on the comorbidities. By closely monitoring the treatment centers, we were able to identify weaknesses and areas for strengthening with equipment, supplies and personnel.
How were these measures implemented and what difference did they make?
All treatment specialists working in treatment centers or in home care services have been trained in the new treatment protocol. In anticipation of an increase in cases, a new resuscitation center was set up, but it was never used as cases started to decline. It is not easy to assess the impact of these measures, they were ready when the infections started to decline. It is therefore not possible to make a correlation between the measures implemented and their impact. Further analysis may be required to determine any link.
What lessons have been learned from stepping up preparedness for the COVID-19 upsurge?
First, it is important to share treatment procedures and protocols with all stakeholders in the health sector. It is also essential to include a variety of specialists to improve COVID-19 treatment, as those most affected have co-morbidities. Third, we had to provide regular advice to all treatment specialists so that they were up to date with the latest scientific advances regarding the virus as well as the therapies. Without the ramping up of staff, especially resuscitation experts, COVID-19 treatment would not have been effective. Improving oxygen production, in quality and quantity, has played a crucial role thanks to better equipment for treatment centers. We have also strengthened the diagnosis and follow-up of patients, particularly analysis and imaging.
What can still be improved to avoid a new wave of COVID-19?
To prevent a new wave of COVID-19, we need to work on several fronts. We need to strengthen disease surveillance at all levels to quickly detect cases – this is essential for isolation and follow-up. From the start of the first wave, Senegal opted for home care for mild cases without comorbidity as well as for those under 60 to avoid overloading treatment centers. Appropriate care at home and compliance with preventive measures are therefore very important to limit the spread of the virus. Additionally, people who have been in contact with COVID-19 patients should be monitored. Vaccination should be extended as much as possible. Despite the fatigue related to COVID-19 among the population, preventive measures such as wearing masks, physical distancing as well as working with communities and educating people about the virus must be stepped up.
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