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CARTA, a multidisciplinary driving force leading the way on COVID-19

This blog post was first published on the AAS blog as part of a series that explored how the eleven DELTAS Africa-funded consortia were able to leverage on the TOC and pivot in real-time to support an Africa-wide response to COVID-19, influencing research and policy across the continent and beyond.

In this blog, they looked at the impetus and breadth of the work performed by African researchers and institutions supported by CARTA. 

Children, the indirect COVID-19 casualties
Adesola Olumide, a CARTA graduate and part of the WHO–UNICEF–Lancet Commission, investigated the future for the world’s children after the pandemic. She and the team found that the pandemic exacerbates many other threats to children like climate change, harmful substances, unstable housing, inadequate education, and social protection. The pandemic will also jeopardise child welfare gains, causing a global crisis in which children will be the prime casualties.

It is only now that research from developed countries is highlighting the effects of the pandemic on children. A study by the OECD found that “school closures, social distancing, and confinement increase the risk of poor nutrition among children, exposure to domestic violence, rise to anxiety and stress, and reduce access to vital family and care services.”

COVID-19’s impact on African health systems
Across the continent, there are many examples of fragile health systems; when the pandemic hit, they became the weak points in the response. Chinenyenwa Ohia, chose to focus on Nigeria’s national health systems unable to effectively respond to the growing needs of already infected patients requiring admission into intensive care units for Acute Respiratory Diseases and SARS COV-2 pneumonia. She discussed the urgent need to consider Nigeria’s context and explore available collective measures and interventions to address the pandemic.

Faustin Ntirenganya, (University of Rwanda), was part of an international cohort researching mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection. They found that postoperative pulmonary complications occur in 50% of patients with perioperative SARS-CoV-2 and are associated with high mortality. During the COVID-19 pandemic, thresholds for surgery should be higher than standard practice, particularly in men aged 70 years and older, and non-urgent procedures should be postponed.

Ntirenganya also tackled COVID-19 preparedness within the surgical, obstetric, and anesthetic ecosystems in Africa. Working with a group of researchers, they found that the major challenge is balancing the need to maintain provisions for emergency and essential surgery while preserving precious resources and minimizing exposure to health care workers. They suggest a plan be developed for providing essential operations during the pandemic.

While, Omotade Ijarotimi, (Obafemi Awolowo University), sought to review what was already known about COVID-19 and highlight gaps in the context of Nigerian obstetric practice. Her research found that both in and out of hospital, obstetricians and obstetric patients are at risk of exposure to the COVID-19 because of ineffective or non-existent testing, and lack of preventive measures. She suggests increasing the budget allocation for health in Nigeria from the current 4% to the recommended 15% of the total budget.

Cost of COVID-19 on elective surgery
Jean de la Croix, (University of Rwanda), analysed elective surgery cancellations across the continent. The study was based on global predictive modeling, finding that a vast number of operations would be canceled or postponed because of pandemic-related disruption. It recommended that governments mitigate patients’ burden by developing recovery plans and implementing strategies to restore surgical activity safely. Globally, studies found similar cancellations. Similar results have been reported from western countries.

CovidSurg Collaborative investigated global guidance for surgical care during the pandemic and determined that hospitals should prepare detailed, context‐specific pandemic preparedness plans addressing the provision of staff training, support for the overall hospital response to COVID‐19, the establishment of a team‐based approach for running emergency services, and recognition & management of COVID‐19 infection in patients treated as an emergency and those who have had surgery.

COVID-19 and the elderly
Since the start, the disease’s profound effect on the elderly and those with underlying conditions have been stressed. Including one by Mueller et al (CARTA) which demonstrated that “advanced age is by far the greatest risk factor for COVID-19 fatality, independent of underlying co-morbidities.” While research by Eniola Cadmus et.al on caring for older adults during the pandemic describes the experience of attending to the healthcare needs of both the acutely ill and clinically stable patients. The study emphasizes the importance of empowering patients to be actively informed about their clinical condition and safely carry out self-management.

Testing and diagnosis
Several CARTA fellows were at the core of building national testing capacity, with CARTA graduates leading the setup of diagnostic laboratories. Tonney Nyirenda, for example, led one of the four active COVID-19 diagnostic centers in Malawi at the College of Medicine, University of Malawi.

Alongside facilitating COVID-19 research, CARTA was also involved in improving responses and strengthening research capacity during the pandemic. CARTA partner institutions – the University of Witwatersrand-South Africa, University of Ibadan-Nigeria, the University of Nairobi-Kenya, Makerere University-Uganda, Moi University-Kenya, Obafemi Awolowo University-Nigeria, University of Rwanda, the University of Malawi, the African Population and Health Research Center, Kenya Medical Research Insititute (KEMRI), Agincourt and Ifakara Health Institute-Tanzania were involved in the national taskforce responses in their countries, collaborating on research projects on epidemiology, diagnostics and clinical trials on vaccines or treatments. Most partner institutions also engaged in direct service provision to healthcare professionals and the community, preparing information briefs and educational materials, training professionals on the use of PPE, and even producing masks and other necessary equipment for distribution among healthcare workers. Some went as far as setting up a drive-through testing facility.