Lives at risk of Covid-19 due to poor health facilities: Khasipe

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LESOTHO Revenue Authority (LRA) Commissioner General Thabo Khasipe (Mr Khasipe) has another feather in his cap after his recent appointment to head the government’s response to the deadly Coronavirus (Covid-19) pandemic.

He was appointed last month by Prime Minister Moeketsi Majoro as the chief executive officer of the National Covid-19 Secretariat (NACOSEC formerly known as National Emergency Command Centre).

The Lesotho Times (LT) editor Herbert Moyo recently caught up with Mr Khasipe to find out his vision and priorities in his new demanding role. Below are excerpts of the interview. 

LT: What is your vision? How do you plan to tackle the Covid-19 crisis? 

Mr Khasipe: That’s a very loaded question deserving a loaded response. So, brace yourself for a detailed answer.

The plan is to minimise needless mortality through a two-pronged strategy of flattening the curve and raising the line. We aim to flatten the curve of infections to prevent it from growing exponentially. The reason is simply because evidence shows that 20 percent of the infected people develop mild symptoms and therefore need an oxygen therapy hospital bed. Five percent develop severe symptoms and therefore need an intensive care hospital bed that is fully equipped with a respirator.

Our country effectively has only two ICU beds at Maluti Hospital recently donated by Standard Lesotho Bank. There are 10 others at Queen ‘Mamohato Memorial Hospital which are effectively not available because they cannot be used for Covid-19 patients. They are used for non Covid-19 patients.

Assuming that a person needs an ICU bed for a week, this means that Lesotho can only afford to have a maximum of 40 positive cases per week because 5 percent of 40 equals the two ICU beds at Maluti Hospital. Any infections above 40 per week means that more than two people will arrive at our health centres needing non-existent ICU beds. They will then lose their lives. For example, if 100 people get infected per week, five people will need these two beds hence three will pass on that week. As infections keep on growing exponentially to 200 in the following week, 10 people show up with severe symptoms and eight die that week.

This example underscores the fact that our country is facing an imminent problem of people dying not because of an act of God, but rather because our healthcare system is not capacitated to deal with a rise in infections. These are needless deaths. Our national strategy is to do everything in our power to raise the capacity of the healthcare system to deal with the virus by acquiring more ICU beds and respirators.

Concurrent with this ICU bed capacity increase, we intend to reduce the rate of infections. This can only be achieved through appropriate behavioural change by all of us. We need to observe social distancing, hygiene and face mask protocols. This we should do voluntarily. Indeed, given our country’s meagre financial resources, we cannot count on “throwing money at the problem” by purchasing a hundred thousand ICU beds. We need to reduce the number of infections through a collective effort. We need to self-police and self-regulate because with this viral infection, an infection to one is an infection to all.

Practically speaking, we need to achieve this strategy through coherent actions. For example, we obviously need to buy and install the beds. To reduce the infection rate, we need to launch an aggressive education and awareness campaign. We need to do a much better job of preventing illegal border crossings, effectively regulate potentially super-spreader social and economic activities such as church, funeral and wedding services, bar and restaurants, sports, textiles manufacturing, mining and government service centres such as traffic and home affairs departments. To achieve this, we will be soon tabling a proposal to cabinet of a risk management framework that uses a traffic light colour coded system (green, yellow and red plus two other colours) that will enable evidence-based decision making.

The tip of our spear in rolling out this strategy is stakeholder engagement. This starts at the village or suburb level where we are already putting in place a management structure that is led by a district administrator, working together with other stakeholders in that district including principal chiefs, members of parliament, district health officers, district council secretaries. Village health workers, chiefs, school principals and priests are some of the key stakeholders NACOSEC will support in their fight to protect their communities.

LT: From the first case recorded on 13 May 2020, we have surpassed the 300 mark and we are close to 400 infections. We have also had six confirmed deaths to date. What do you think we have to fix? 

Mr Khasipe: The exponential increase in the numbers of infections should not be surprising. Anybody who has been paying attention on how this pandemic evolves in other countries will have realised that we are actually just at the beginning. What we need to fix is to buy those ICU beds while also getting Basotho to stop thinking that somehow Lesotho will be spared the worst of this pandemic by some magic. It’s only through a fundamental change in habits that we shall reduce the rates of infection and therefore keep the 5 percent of those who develop severe symptoms at a minimum so that they will not be more patients than our ICU beds.

As we speak, we expect about ten ICU beds any day from as well as personal protective equipment (PPE) for health workers. We are also in discussions with some donors to provide respirators which would enable us to convert a lot of our normal hospital beds into ICU beds. We aim to ramp up our capacity to between 1000 and 3000 ICU beds.

LT: What are the challenges have you experienced or observed with regards to the Covid-19 response? 

Mr Khasipe: Frankly, the slow grind of the civil service is frustrating. Urgency is totally none existent. My own appointment took at least two weeks to action.  Passing a gazette that establishes NACOSEC also took what felt like forever. As we speak, NACOSEC still hasn’t got a bank account to enable it to start buying PPE, ICU beds, paying health workers’ salaries and allowances.

How can these challenges be tackled? I’m totally clueless. It’s really shocking that to some people, there is really no need to be doing anything with urgency.

LT: Prior to the lifting of the lockdown on 5 May 2020 by then Prime Minister Thomas Thabane, the National Emergency Command Centre recommended the extension of the lockdown to allow the country to roll out mass testing. With the vantage point of hindsight, as Covid-19 cases continue to increase, was it a good idea to lift the lockdown? 

Mr Khasipe: My problem with that lockdown, and I made my view very clear within the NECC structures, was that we never quite defined the objective we were trying to achieve with it. When we were asked whether or not we should lift it, I said that I could not say because there was no basis for judging its success or lack thereof. I then opined that we needed a national Covid-19 strategy which would enable us to make informed decisions towards a specific target. That way, a lockdown would become a means to an end and not an end in itself.

Due to its deleterious effects, a lockdown should be understood to be the ultimate nuclear bomb option. We should define exactly when and why we shall resort to it. At the same time, we should design it for maximum impact on the infection rate with the minimum negative consequences on the economy and society.

Perhaps with the benefit of hindsight, I think the lockdown was rendered ineffective by the fact that it was not used to achieve some objective. As a result, continuing it any further would have caused more socio-economic damage with no commensurate gain from the reduction of the prevalence of the pandemic in our country. As such, lifting it was an inevitable decision.

LT: The mass testing of people for Covid-19 still has not been rolled out? Why is this so? When will it be rolled out if at all? 

Mr Khasipe: It’s a simple matter of the incredibly suffocating bureaucratic red tape of how the government machinery operates or frankly, doesn’t operate. I can assure you that Health Minister (Motlatsi Maqelepo) wanted to commence mass testing a long time ago. However, there have been a series of minor obstacles that, taken together, end up as a mountain that stands in the way of progress. I am learning lately that this matter has been hampered by decision making on whether or not to allow testing to be also done by private entities. Due to legitimate risks of bio-safety, decisions were taken to prevent private entities from doing the testing. The government retained a monopoly and this has created a bottle neck.

We are currently in conversations with health professionals who have advised that we must decentralise testing to all capable and well-regulated entities including private laboratories outside the country. Our conviction is that risk should never be an excuse to not act. We should act with due regard to mitigation of such risk.

We should therefore be seeing mass testing soon.

LT: You have spoken about the likelihood of a million or more Basotho contracting the virus if firm measures are not put in place. What exactly needs to be done and by who? 

Mr Khasipe: First and foremost, we all have to flatten the curve of infections by washing our hands or sanitising, social distancing and wearing our masks religiously. This is a voluntary choice that each and everyone of us has to make in their own interest and also that of their loved ones. This behavioural change is really where we will win or lose the fight against this pandemic.

I talked about the responsibility of the government in beefing up the capacity of our health system. Over and above this, we need to mount a well-managed testing, tracing and isolating strategy. The logic of it being that we want to be ahead of the pandemic rather than chasing it from behind. With massive testing, we will identify positive cases early enough before they spread the virus to more contacts. By so doing, we will prevent an exponential growth in infections. Contact tracing also seeks to catch and isolate cases in their early non-symptomatic phase to prevent secondary infections.

The last and perhaps most important responsibility is that of the community leaders throughout the country. Communities have a responsibility to ensure that we change traditions, culture and practices that expose us to infection. Our elaborate funeral culture has to change since it poses a great risk of spreading the virus. The same applies to our churches, bars, sports and public transport where people are crammed inside small vehicles without any ventilation and face masks.

LT: Do you think the government is doing enough to deal with Covid-19? 

Mr Khasipe: At NACOSEC, we are the government’s arm for dealing with Covid-19. Are we doing enough? Far from it. We haven’t actually started. However, our ducks are slowly getting in a row and we will soon be making an impact. This week we will start to see the impact with the arrival of health workers’ PPE and more hospital beds. More will be procured as soon as NACOSEC has access to the COVID-19 funds.

LT: Your appointment has coincided with a crippling strike by health professionals. Why has the government moved slowly and apparently failed to address their seemingly justifiable demands for protective equipment and risk allowances? 

Mr Khasipe: I can’t say why the government has delayed over the past few months but what I can tell you without a shadow of doubt is that both the prime minister (Moeketsi Majoro) and the Health minister are very clear that our health workers must be provided with PPE as a matter of urgency. I share the same sentiment. To that end, strides have been made to ensure that the establishment of NACOSEC, as a much nimbler entity designed to respond much more quickly without the excessive red tape of government ministries, is expedited. We are almost there because the gazette is out. Hopefully, the path will now be cleared to move the Covid-19 funds to NACOSEC. Once that happens, I assure you that the first priority is to purchase enough PPE for health workers and to pay their allowances at M3500 per health worker.

It is a pity that it appears that due to the bitter experiences they have had in the past, health workers have lost faith in negotiations. Speaking to their leadership, one can’t help but notice that they are not prepared to listen to any promises from the new prime minister or the new Health minister.

However, I am very hopeful that the government will rise to the occasion and surprise them by fulfilling its promises. Of course, there is still a point of divergence between them and the government as regards tax free salaries for six months.

LT: How much is actually available for the Covid-19 fight? 

Mr Khasipe: The last time I was briefed, we were talking about a budget of about M690 million. This was before expenses for the consignment of PPE that should be arriving this week. There have also been some recent purchases of PPE and medicines that would have reduced this amount. Therefore, I do not have the exact figure now.

LT: We have seen other countries receiving assistance from the International Monetary Fund and World Bank to fight Covid-19. Why hasn’t Lesotho received anything? Did the government apply for assistance?

 Mr Khasipe: I am aware of conversations happening with a number of donor and multi-lateral agencies such as the World Bank and some UN agencies.

LT: How much will be needed to mount an effective fight against Covid-19? 

Mr Khasipe: It should not be more than the M690 million if we all do a great job at suppressing the pandemic through behavioural changes. As a poor country, we can’t adopt a throw-money-at-it strategy. That’s simply not our strength. In fact, it is our weakness. Our strategy should be to leverage our collective action at community level and mix this with some common sense interventions at policy level such as well targeted socio-economic impact mitigation measures.

So, let’s leverage the little that we have by adopting effective strategies such as the curve flattening and raising of the line discussed earlier.

Most of the budget will go to purchasing health supplies including ICU beds, PPE, medicine and as well as paying health workers’ allowances.

LT: The government has previously spoken about plans to set up a M500 million relief fund to support the private sector to cope with the economic impact of Covid-19. What is the progress towards implementing the fund? 

Mr Khasipe: Such a fund is best established and run by the private sector. To that end, the Lesotho Chamber of Commerce informed me that they have started a solidarity fund for Covid-19. We have already engaged with the private sector to set out our strategy and share ideas about how they can contribute to the fight against the pandemic. Subsequently, we have seen a notable rise in contributions from companies. The likes of Econet Lesotho and Maluti Mountain Brewery have offered test kits and PPE.

LT: The three-month debt relief measures that have been put in place to cushion the private sector will lapse at the end of July. Is the government considering advising their extension given the lingering economic effects of Covid-19 on businesses? 

Mr Khasipe: Let me not preempt the decisions that will soon be made on that matter.

LT: How is the government tackling the issue of illegal crossings into the country which are helping to import the virus into the country? 

Mr Khasipe: The deployment of the army and police to our border posts to stop illegal border crossings is the best strategy of dealing with this difficult challenge. Lately, we have been thinking of complementing this strategy with facilitating donations of food parcels and other basic needs to vulnerable Basotho, especially in South Africa. It is hoped that with this strategy, the incentive to come return home out of desperation will be lessened.

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