COVID-19: Malawi’s next normal

There’s textbook medicine and then there’s the real world. This public health message to take your wife to the hospital by bicycle or ox cart captures how healthcare needs and messages vary significantly based on the setting. So, let’s acknowledge that how we live with COVID-19 in Africa will vary as well.

COVID-19 is here to stay as the virus mutates and continues to infect the world with new strains.  Over time, we will build some immunity either through immunizing or catching a mild version of the virus.  As immunity increases worldwide, then cases should also drop worldwide.  

Only 4 % of the population in Malawi is 65 years of age or older. Since people over the age of 65 are 90 times more likely to die of COVID-19 than younger adults, we can expect that only a small percentage of the population is at high risk of death from COVID-19 in Malawi.  Also, the Malawian population is much healthier than the American population.  While genetically, Malawians are at higher risk of hypertension, diabetes, and heart disease, they generally live a heart healthy lifestyle.  Malawians walk and ride bicycles regularly. While their diet may lack enough variety to provide important micronutrients, it is low in saturated fats and cholesterol.  This means that COVID-19 is not as big of a health risk for the average Malawian who is typically younger and healthier than it is for the average American who is typically older and living with chronic illnesses.  For that reason, reaching natural herd immunity may be more of an option for Malawi than for other countries. Until enough people have caught the virus or have been immunized and the numbers go down, we must protect our more vulnerable elderly population.

While influenza is a different virus, we can anticipate how Malawi will respond to COVID-19 over time, by looking at how Malawians live with influenza.  From my observation, influenza does not have enough of a disease burden on the general population’s health compared to other diseases (malaria, pneumonia, typhoid, bilharzia, STI’s, and HIV) to merit attention.  For that reason, influenza is often overlooked when diagnosing and treating patients. Testing for influenza is not even available in Malawi.  The yearly influenza vaccine is only occasionally available by purchase through private pharmacies.  I expect that in the future, like the flu vaccine in developed nations, we can expect to see a yearly COVID vaccine offered to protect from the current strains.  I anticipate that, like with the influenza vaccine, Malawi will have too many other health concerns to vaccinate their population yearly. I’m curious to see if the testing capabilities for COVID will remain as the numbers decline.

Realize that vaccination is a privilege that can protect you and others.  While I realize that Malawi will most likely reach natural immunity before vaccine based immunity, I want to encourage people to vaccinate for both influenza and COVID-19 any chance they get whether through the government, private pharmacies, or by traveling abroad.  If you have access to the vaccine in your home country, please do not travel to Malawi until you have been vaccinated from COVID-19 to protect those that don’t have that privilege.  

Follow the government’s public health guidelines. I appreciate that public health experts are weighing the needs of the entire population.  Wearing masks in public, social distancing, avoiding groups, and hand washing are still very important to reduce deaths among the vulnerable population until the numbers come down. As the risk of spreading the virus decreases then the public health recommendations will adjust as well.

Embrace the opportunities to boost your general health when living in Malawi.

Get natural Vitamin D with time outside.  (Fair skinned people need to balance this with protecting yourself from skin cancer.) The virus is also less likely to spread in outdoor spaces.

Eat foods that are rich in vitamin C- Tomato, guava, mango, pineapple, papaya, and any citrus fruit.

Eat foods that are rich in zinc- Red meat, chicken, beans, nuts, and whole grains.

Eat whole grains-  Nsima wa m’gaiwa has more fiber than plain white Nsima. Fiber helps your body build the normal gut bacteria found in probiotics that help crowd out new viruses.

Live a healthy lifestyle.  Exercise regularly. Don’t smoke. Avoid foods that are high in saturated fats and cholesterol.  Make sure your chronic illnesses are well controlled. 

Invest in development that promotes community health.

The push for handwashing has raised public awareness.  Don’t be quick to get rid of the handwashing stations when the numbers go down.  Promote handwashing with soap.

Support local fruit and vegetable production and consumption.  Buy local produce. Teach how to grow small vegetable plots and plant fruit trees. Promote healthy diet education initiatives. Talk about eating healthy. Model eating healthy.

The COVID-19 crisis has caused health facilities to evaluate and improve their infectious disease diagnostic and treatment services. Malawi has more capacity to care for critically ill patients than ever before. We have relied on Malawi’s health care system more than ever as travel out of country for general medical needs has become more difficult.  Health care providers have collaborated to improve care across the spectrum. Let’s continue to appreciate and invest in Malawi’s healthcare services.

Let’s not quickly forget the general health lessons we learned when the numbers go back down.

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