As the second wave of COVID-19 infections surged in early 2021, Senegal stepped up measures to cope with the anticipated rise in the number of patients needing critical care. Professor Daye Ka, Infectious and Tropical Disease Expert and member of Senegal’s COVID-19 task force, explains the steps taken to avert hospitals being overrun by a drastic rise in critically ill patients.

What measures were in place to better handle a rise in COVID-19 infections?

The whole country was affected during the second wave of COVID-19 in February when around 300 cases were being reported daily. We were faced with a shortage of beds, especially resuscitation beds. We had 311 beds that had oxygen supply and an occupancy rate of 73%, with only 76 resuscitation beds that had 56% occupancy rate. So we added around 20 beds in [the capital] Dakar and in the regions. Medical oxygen supply in terms of quality and quantity was also overstretched. We set up additional temporary sites in some COVID-19 treatment centres in Dakar and in the regions as well as increased oxygen supply to avert shortages.

With the rise in cases came an increase in mortality, notably among older patients with underlying conditions such as hypertension, cardiovascular diseases, diabetes, obesity, asthma or chronic respiratory illnesses. To improve treatment and reduce deaths, in addition to increasing the number of beds, especially resuscitation beds, we also brought in more experts in critical care. They included resuscitation specialists, respiratory disease experts, cardiologists, diabetes and kidney doctors, gynaecologists and obstetricians as well as experts in the care of older patients.

We also developed a treatment protocol to determine which patients were to be hospitalized and which were to be cared for at home, the type of treatment depending on disease severity raging from mild to moderate, severe to critical, as we as depending on comorbidities. By closely monitoring the treatment centres we were able to determine weaknesses and areas to reinforce with equipment, supplies and personnel.

How were these measures implemented and what difference did they make?

All treatment specialists working in treatment centres or in home-based care service were trained in the new treatment protocol. In anticipation of a surge in cases a new resuscitation centre was set up, but it was never used as cases began to drop. It is not easy to assess the impact of these measures they were ready when infections started to decline. So it is not possible to make a correlation between the measures put in place and their impact. Further analysis may be necessary to determine any link.

What lessons have been learnt in stepping up readiness for COVID-19 upsurge?

Firstly, it is important to share the treatment procedures and protocols with everyone in the health sector. It is also pivotal to include a variety of specialists to improve COVID-19 treatment because those most affected have comorbidities. Thirdly, we had to regularly provide guidance to all the treatment specialists so that they were up to date with the latest scientific advancements about the virus as well as the therapies. Without ramping up personnel, especially resuscitation experts, COVID-19 treatment would not have been efficient. Improving oxygen production, in quality and quantity, played a crucial role thanks in better equipping treatment centres. We also stepped up diagnosis and patient monitoring, particularly analysis and imaging.

What can be further improved to avert a new COVID-19 surge?

To forestall a new COVID-19 surge we need to work on several fronts. We need to strengthen disease surveillance at all levels to swiftly detect cases – this is critical for isolation and monitoring. From the onset of the first wave, Senegal opted for home-based case for mild cases with no comorbidities as well as for those aged below 60 years to avoid overwhelming treatment centres. A proper home-based care and observance of preventive measures are therefore very important to limit the spread of the virus. Additionally, people who have been in contact with COVID-19 patients must be monitored. Crucially vaccination must be expanded as much as possible. Despite the COVID-19 fatigue among the population, preventive measures such as wearing of masks, physical distancing as well as working with communities and educating people more about the virus must be stepped up.