Dr. Sabin Nsanzimana, Director-General of Rwanda Biomedical Centre (RBC), the government agency which coordinates epidemic preparedness and response in the country, on Friday sat down with The New Times’ James Karuhanga to shed light on what the country is doing to thwart the scary COVID-19 outbreak now declared a global pandemic. This was a day before the first case of the virus was confirmed in the country. The RBC boss explained the approach, strategies in detecting, treating and protecting the public from the ailment. Excerpts below: How prepared are we regarding COVID-19 prevention..? The coronavirus disease is now a global pandemic which means all countries are at risk and everyone is requested to take preventive and supportive measures. Rwanda is prepared and our preparedness is progressively improving. What are the specifics in terms of testing kits and equipment, for example? For laboratory capacity, we have one main one for coronavirus testing; that is the national referral lab here at Rwanda Biomedical Centre. It is equipped with different machines and the most popular machine now being used is what is called the ABI machine. We have two of these and they can run simultaneously about 100 samples collected at the same time. So far, this machine has been used to screen over 900 suspected cases and all turned out negative (other than one announced on Saturday). We’ve been working with partners including those who manufacture new test kits, particularly the Robert Koch Institute from Germany, which helped get us some material and trainers who spent two weeks with us training lab technicians. Later on, the Centre for Disease Control (CDC) from the US also brought experts to our lab that also spent some time, as well as the World Health Organisation. Currently, we’ve been increasing our testing capacity but we have also been helping other labs outside Kigali to do testing. How many labs out of Kigali? We are thinking about having a lab in each Province. We call it a lab network. Some of these labs will soon be able to do coronavirus disease testing to support the national lab if we have an increase of demand. So far, there is no such huge demand but we expect it in the near future. Rwanda made steps to acquire tests, how many do we have so far and at what cost? The long test is called the reverse transcription-polymerase chain reaction (RT-PCR) test. Practically, it is like DNA testing. It takes time and costs an estimated $150 per one test but the new one we are talking about will be much less costly; less than $10, depending on the quantities you are purchasing. So, for the first round, we asked for a significant number of tests. I don’t want to mention numbers here. But we can provide comprehensive information as we move along. This is not information I can keep to myself because there is a big shift in the way we are testing for coronavirus. This new testing will not require huge capacity in terms of machines and training. It will be something a nurse can do or a trained lab technician and even outside the lab. You can put a drop of blood on a piece of plastic and then read from the numbers and lines whether you are positive or negative. I can’t wait to see it coming. Can one walk in and test for the virus? But be sure that we have enough test kits to cater for suspected cases. There are some people who have called asking if they can come to get coronavirus tests and we told them they can’t unless they have been in contact with cases, traveled or you have symptoms and you have travel history. So, this is not a test for everyone. It is a test really reserved for those who must be tested. It is about economizing with scarce resources and putting them to the best use? The best use, but also using science, because if you never traveled and you just want to be sure [you are not ill], this is a different scenario. It is epidemiology-based testing. Let’s talk about isolation facilities. How many are they country-wide, where are they and how equipped are they? Let me start with the closest to the community. Each hospital in Rwanda, private and public; we counted about 80 medical facilities around the country. These are the ones that can actually have someone stay hospitalized and all of those have at least two rooms availed and equipped and dedicated for coronavirus. Since two weeks ago, these facilities are in place. So, if we count, we have at least 160, and more. Give us a picture of any such isolation room in an upcountry hospital. What exactly is in there? I will probably explain a few terms so that you understand what needs to be where. One is quarantine. In quarantine, there is a place where you hold people who have been in contact with a confirmed case. Second is isolation. This is a place you hold someone, for a specified period of time, someone you suspect to be infected with coronavirus disease or any other disease while you wait for results or further development of the symptoms. When you isolate a suspected case, mainly you do lab testing and sometimes you may have basic medical practices. All those rooms we talked about in hospitals are isolation rooms, not quarantine rooms. The other term, or level three, is the treatment center. After you have been isolated and tested and results come positive, you go to a treatment center. So, how many of these and where do we have them? We have different treatment centers in Rwanda. There are three already equipped with advanced machines like respirators, and ICU equipment which is prepared for any case confirmed positive. One is in Kigali, another is in Southern Province, and another is between Kigali and the Northern Province. Which exact locations? I don’t want to mention the exact locations for two reasons. We want to keep this exercise as professional as possible; the confidentiality of the patients we could take to those places and to the community in these areas. We don’t want to create any room for bad rumors and other kinds of misinterpretations that may arise. From experience, in dealing with these highly infectious diseases, mentioning a place may stigmatize the entire place or community. This is something we have seen in other countries where the communities would come out and say ‘oh, you brought this virus to us’ and this creates unnecessary panic. So, for how long is a quarantine period in the case of the coronavirus? Once one is infected it takes one to 14 days to show symptoms. If you don’t have symptoms by 14 days it means you don’t have the virus or your body’s immune system has cleared the virus naturally. Our natural immune system can clear the virus by up to 80 percent rates. Sometimes you may be infected and not develop symptoms and unfortunately, you can transmit the virus. What about the quarantine facilities then? We have two quarantine facilities in Kigali. And we have one in Southern Province with a capacity of close to 150 beds. This one in Southern Province has both isolation and quarantine. The two in Kigali are not that big. Both have a capacity of about 25to 30 beds. But we have a list of other isolation and quarantine locations in preparation for being operationalized if we need to. But assuming the worst came to the worst and an entire District needs to be quarantined, there are other options. One is to keep everyone at their homes. Second is moving people, highly suspected groups of people, to public places such as stadiums or school. We are observing situations in other countries where public infrastructure is used as health or public health centers. And we have examined the possibility of all these scenarios and we can move from one to another depending on how the situation evolves. How about the situation regarding treatment centers? There is no magic about the treatment of coronavirus. Internists would know better how to treat any respiratory infection because this is also a viral respiratory infection that affects the lungs and the respiratory system and may also affect other organs. But we have a few country hospitals well prepared to deal with such cases if they get confirmed. Give us a picture of precautionary measures at our points of entry; land borders and the airport in Kigali. New instructions were recently issued but what exactly is going on considering that Rwanda has not banned international arrivals especially from highly affected countries like Italy. How is a visitor from such countries handled at the airport and at other points of entry? Rwanda is screening everyone from these countries and this is something we started doing, thoroughly, earlier in January. Everyone with a symptom or arriving from a country with coronavirus will be taken for laboratory sample tests. At the airport, your temperature is scanned automatically without you knowing. We installed highly effective equipment at the airport early last year as we screened for Ebola. And it is not only at the airport but at all land border crossings. We have heat cameras everywhere. If someone has higher than 38 degrees the alarm goes off and that person is taken out of the line and into a clinic at the airport. It has a doctor who can do more tests and then, just behind, there is an ambulance should there be a need for the person to be taken to hospital. Such a person does not appear at the immigration desk again. Their entry and language are facilitated as we have established a mechanism for that too. Such a person enters the country in a clinical way so that he or she does not infect others. But the cause for worry, from what you noted, is that from day one to 14 of infection, one can have the coronavirus and ably spread it before signs or symptoms show. Doesn’t this mean one can arrive at our airport showing no signs yet they can spread the virus? Yes, the risk is there. But the risk is, maybe, small, and for one fact. Over 100 people infected by coronavirus, 98 percent develop symptoms within 48 hours. So, someone may be infected, travel at night and arrive the same day without showing symptoms. And that’s why instead of detaining the entire airplane or passengers because they came from a country affected by the disease, we record and actively follow up such passengers for more than 14 days without necessarily retaining them in a hospital. What message would you want to give to the general public today? I have three messages. Number one; this virus is the most contagious we have ever had among all coronaviruses in history. And this is the first time that a coronavirus, since it is a big family of coronaviruses, is declared a pandemic. Therefore, prevention and protection is easy. And better than cure. But what I want to say is that the practice is such that now the community in Rwanda is better prepared than before. Hand washing, not touching your face, not shaking hands, not getting closer since there is evidence that you will be infected if you get into less than one meter with an infected person. If people keep a safe distance they will not be infected. And, if the worst comes to the worst, and a case is confirmed here because we are not immune to that and it could happen, people should not panic. Even now, before it happens, people should not panic. They should follow instructions and guidelines by health authorities because we have been prepared and set up teams of experts ready to be deployed anywhere, any time and in any situation. Panic can actually compromise epidemiology response. How can panic be dangerous? I will give you an example. A rumor, for example, that someone heard a case in a market. In such a situation, the entire market runs away. That message could be provided differently. It could be, instead, that we are suspecting a case in a crowd and everyone should remain where they are while experts examine the case instead of running off to places where they can actually contact it. The virus is not visible. Last, but not least, my other message to the public is about partnerships and cooperation. We shall need partnerships with different people. Everyone should be ready to intervene when called for service. We have seen doctors and nurses being overwhelmed in some countries in Europe. They called back thousands of retired doctors to service and even now paramedics. And they are running short training for citizens on how to help so that doctors focus on serious cases. But, hopefully, there will be no case. It is better to be prepared than have the situation other countries have now.
