Stopping COVID-19 on its Tracks In Somali: Proposal of Aggressive Mitigation Measures Learned From the USA and Other Countries.

From Jan. 20th to April 17th, 2020, 672,300 cases of COVID-19 have been confirmed and over 33000 Americans lost their lives to COVID-19. America, is just one of the many countries that COVID-19 wreaked havoc on, globally claiming over 147,000 lives and infecting over 2.1 million people in a very short time. Furthermore, COVID-19 has halted the global economy and crippled the richest economies in the world. COVID-19’s global impact in both human lives and financial losses is yet to be understood or correctly estimated.

However, the speed of the infection, the severity of the illnesses, the lack of global preparedness, the lack of treatment and vaccination and how difficult it has been for the most developed countries to prevent and treat COVID-19 paint a grim picture. 

Reflecting on the current disease history and the abovementioned challenges, it is difficult to imagine the impact COVID-19 could have in Somalia. Thankfully the Federal Government of Somalia (FGS), Federal Member States and partners have preemptively put in place strategies and preparedness plans early on.  Outlining the risks and identifying mitigation strategies for different scenarios (e.g. testing at entry points, quarantine and isolation facilities), activating surveillance systems, training health works and acquiring the needed health equipment.

These measures coupled with the FGS’s travel restrictions, schools and universities closures and the ongoing public health campaigns will slow down the disease spread, however, will they be enough to prevent a surge in COVID-19 cases, hospitalizations and unprecedented death rate that will  devastate Somalia’s already fragile health system? If what happened in the USA, Italy and Spain are any indications, the answer is simply no. So far, the only mitigations that have shown to slow down COVID-19 spread have been very aggressive human movement and interaction restrictions.

Different levels of restrictions including travel bans, educational institutions closures, business closures, stay home orders and complete lockdown of cities have been implemented around the world and evidence suggests that most aggressive restrictions have a significant impact on the disease progression. Differences in how China and Italy implemented these restrictions and resulting outcomes provide reasonable comparison on these restrictions’ impact on reducing COVID-19 spread and saving lives.

Implementing the most aggressive measures is easier said than done, for it requires strong government capacity and resources; it is very expensive, and it is devastating to the economy. Considering the complexity of Somalia’s developing government capacity, limited resources and fragile security situation, current most aggressive measures might not be feasible. Nonetheless, implementing the most aggressive measures, is the only opportunity Somalia has to beat this killer virus.

Building on current measures, Somali leaders need to implement the following aggressive measures in order to halt the recent surge of COVID-19 cases, protect health workers, and to preserve the current health system. Along with banning mass gathering including prayers, government needs to close all venues for gathering (e.g. restaurants, cafeterias, event centers, meeting halls, etc.);  all non essential shops (e.g. clothing, furniture, household, electronics, beauty shops, etc.); all contact based services (.e.g. barbers and Salons); all big congested markets (e.g. Bakaraha in Mogadishu, Suuq Yare in Kismayo, Ilji in Garowe, and similar markets in other cities). In addition, the government needs to issue a stay at home order for all non-essential workers at least for 30 days, and enforce social distancing and mask for everyone outside the home.

Of course, the majority of the businesses that need to be closed are the only source of income for millions of Somali families and one week of closure could push the country on the brink of a famine, since the vast majority of these small business owners already live in desperate poverty. Thus, the FGS, member states and international partners need to realize the urgent need for a timely stimulus package. The cost of implementing the aforementioned measures and providing Somali families minimum necessary financial support for a few months is hundred times cheaper than the unimaginable damage a full blown COVID-19 could leave behind.

Based on the latest UN population data, there are approximately 2.5-3 million families in Somalia and providing each family $300 a month for two months will cost less than two billion dollars ($2B), which is a small change considering what it will prevent and what other countries are spending on these measures. Although Somalia’s under funded and less than a decade old government can not afford a $2B stay home incentive for its people,  its partners and international donors who know that there is no other option will have to step up intime and save the day.

Alternatively, there is COVID-19 emergency funding for underdeveloped countries through the World Bank and IMF that the FGS could request. Timely implementation of these aggressive measures coupled with rapid health system strengthening (e.g. training current health worker, recruiting retired health worker, new graduates and close to graduation clinical students, ensuring supply and appropriate use of personal protective gear, and increasing ICU capacity, etc.) and innovative, engaging and emotional public health campaign will drastically reduce the impact of OCVID-19 in Somalia. It is now or never.  It is an opportune time for all who have Somalia’s best interest at heart to unite and act swiftly to safe lives.

Maryan Abbi Dualle,  M.P.H.
Global Health Education & Development
duallem1@gmail.com