Lesotho has just emerged from a terrible second wave of Covid-19 in which 309 people died – and now there are predictions that a third wave may be imminent.
There are fears that a flood of Basotho workers returning from South Africa for Easter could trigger a new surge in the disease, as happened over Christmas.
The Prime Minister, Moeketsi Majoro has closed all border posts and pleaded with citizens not to come home for Easter unless it is “absolutely necessary”.
He said infection risks emanating from cross-border travel remain “elevated” on account of expected inward travel from Basotho migrants coming for Easter holidays, warning the country must proceed with caution.
He announced that Lesotho will not open its borders at Easter, even though the South Africans have done so.
Thousands of Basotho working and living in South Africa returned for the Christmas holidays last year, without being screened or tested for Covid.
As South Africa had recorded 836 764 Covid cases by December 10, this may have exposed Lesotho to widespread infection and sparked the second wave.
The second wave started in December last year, at a stage when there had been only 2 092 infections and 44 deaths in Lesotho.
By February 28 these figures had quadrupled to 10 468 and 292 deaths.
The infection rate appears to be dropping, with the latest government figures indicating that 10 530 have been infected and 309 have died.
Majoro said the mortality rate has dropped from a peak of 47% to 7% during the seven-week lockdown imposed in January, but cautioned of the risk of another spike.
“According to the World Health Organisation (WHO), for a country to have control of the virus, the infection rate ought to be fewer than 5% for at least three consecutive weeks,” Majoro said.
He said Lesotho had not yet reached the 5% in the weeks following the lockdown,saying there were only a few weeks to Easter with the expectation that many Basotho will be coming home for the break.
Majoro also raised concern over the upcoming winter season, saying Covid is more dangerous in cold weather and adding: “We are told the third wave might come this winter season.”
By mid-March, the latest figures showed a significant decline, with fewer new cases and deaths, leaving many convinced the second wave may be over.
However, Baroane Phenethi, spokesperson for the National Covid-19 Secretariat warned: “We cannot say it is over, in fact I don’t think it will be over any time soon.”
He told MNN Centre For Investigative Journalism that the drop in statistics means there may be more compliance with precautions and safety regulations, especially at Covid hotspots such as funerals, weddings and social events.
Phenethi says it is highly likely that the country will be hit by the third wave, especially with other African countries like Kenya and South Africa already warning of it.
“Once it reaches South Africa, there is no way we can avoid it,” he said.
Nacosec says it is ready for the third wave should it hit, indicating that those Basotho who come home will be tested at the border posts across the country.
Phenethi said that due to lessons from previous waves and causes of the last spike, the authorities will tighten security enforcement to ensure that there is no unmonitored crossing at porous borders.
On November 24 last year, 2 092 cases and 44 deaths had been recorded. Then, after the second wave began in December, the number of infections and deaths quadrupled by February 24, to 10 468 and 292 respectively.
The government has admitted that the figure was probably higher, as not all cases were recorded.
On January 12 this year, Lesotho went into total lockdown. Majoro conceded that the country did not have the epidemic under control.
He said the rate of infection was above five percent and that there was an increase in the number of deaths, both confirmed and “probable” – meaning those that may not be captured by the Ministry of Health.
The country moved to a modified “red stage” in terms of the government’s Covid risk determination plan, an indicator of high community transmission.
Transmission had transitioned to the community, posing the risk of the virus raging out of control in Lesotho, the last country in Africa to record its first infection.
The new status entailed the implementation of a curfew and restrictions on all activities except the provision of essential goods and services.
Unlike the strict red stage, which restricted all movement, the modified red stage introduced a curfew from 6am to 5am. However, schools and institutions of higher learning and churches were closed, and weddings, places of indoor and outdoor entertainment, sports venues, gyms and liquor stores were also forced to shut their doors.
This came days after the government acknowledged that community transmission was taking place by declaring an “orange stage” on January 5, when there were 3 558 cumulative cases.
It then moved back from modified red to orange 21 days later, relaxing the lockdown. Schools remain closed, as do gyms and venues of indoor and outdoor entertainment and sporting activities.
Some businesses such as restaurants and liquor stores are allowed to operate on a takeaway basis on certain days only.
Government failures are likely to have contributed to the tide of infections over December, January and February. Critics complain that since the World Health Organisation declared the coronavirus pandemic in March last year, Lesotho has had three different health ministers, meaning that policy-making and administrative continuity have been disrupted.
When Covid broke, the ministry was led by Nkaku Kabi. Motlatsi Maqelepo succeeded him months later, and now Semano Sekatle holds the fort.
Phenethi said the change in administration had not affected the response to the
However, the secretariat had been obliged is to bring three new administrations up to speed, outlining to them the progress, the challenges and plans for the future.
Letsatsi Sephepha, an economic analyst, also argued that Lesotho’s Covid response depended on a range of factors, and was not wholly dependent on the minister.
But Sephepha emphasised that Lesotho’s health system had already been under pressure before Covid struck.
“Placing people with no expertise in health issues has left the system crumbling because of various long-standing challenges in health care facilities,” he said.
He added that the changes in the healthportfolio were purely politicaland had nothing to do with whether the incumbent minister was doing a good job.
“Maqelepo, for example, was doing quite well, in fact, better than Kabi. He kept the public informed at all times about Covid-19”, said Sephepha.
The country’s poor health infrastructure was overwhelmed by the large number of patients.
The worst shortcoming has been the lack of oxygen in hospitals, which has been the cause of many deaths.
Majoro and former health minister Maqelepo publicly clashed over the oxygen shortage, with the former dismissing it as hearsay.
However, in late January Majoro acknowledged the challenge hospitals are facing due to lack of oxygen and the suffering this has caused.
He said “the public is rightfully worried about the oxygen supply situation at our hospitals, as [it] has emerged as a critical problem”.
Majoro said the government met daily to assess the situation at hospitals and claimed that the supply would stabilise soon. The government was working with suppliers to minimise any shortages in health facilities.
He claimed that the availability of oxygen and recovery of patients have significantly improved.
He added that the demand for management of severe cases by health facilities is still high and continues to put pressure in the country’s limited health resources.
In partnership with the World Health Organisation and its development partners, Lesotho obtained its first batch of free vaccine through Covax. Covax, co-led by WHO and the Coalition for Epidemic Preparedness Innovation, is designed to make the Covid vaccine available to poor countries.
The newly appointed health minister, Sekatle, said on February 28 that the vaccine would arrive in batches from AstraZeneca, Johnson and Johnson and Pfizer.
On March 3, Lesotho received 36 000 doses of vaccine as part of the initial tranche of deliveries of the AstraZeneca vaccine.
The vaccine was rolled out on March 10 in Scott Hospital, Morija, and was administered to His Majesty King Letsie and the royal family, the Prime Minister and other dignitaries.
Sekatle said Lesotho will receive a total of 64 000 fully subsidised doses from AstraZeneca, which will cover 20 percent of the population, and that the government will cover operational costs.
The Minister also said that the government had procured additional doses of the vaccine through the African Union credit facility that would cover 16 percent of the population, while a further 24 percent would be vaccinated through the AU’s long-term credit agreement.
The government may have to source additional funding for vaccine procurement.This is because it has mainly been allocated the Pfizer vaccine, which costs US$20per dose, unlike the AstraZeneca product, which costs $4 a dose in the United States.
This has raised eyebrows, with critics questioning where Lesotho is buying its vaccine from and if the price is inflated.
‘Makhoase Ranyali-Otubanjo, one of the medical doctors tasked with spearheading the country’s fight against Covid, said the ministry is ready to receive the vaccine.
This indicates that the ministry has proper storage facilities in the form of the National Vaccine stores in all districts and clinics across the country.
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“We will have appropriate cooler boxes available for packages when we start rolling out,” Ranyali said.
Sekatle said the rollout will be in three stages, with the first batch being frontline health workers, workers in the ministry of health from doctors to cleaners, border post personnel, and people with diabetes, asthma, tuberculosis, HIV/AIDS and related illnesses.
“Overall, 430 115 people will be vaccinated from the first batch”, said Sekatle.
The second batch will see 394 000 people vaccinated from factories, mines, the police service and correctional services staff and prisoners, as well as teachers and students, home affairs officials and traffic officers.
The third batch will be 591 000 people from the general public who do not fall in the other categories.
This vaccine will be administered free of charge to 1.4-million people aged sixteen and above.
It will be administered at workplaces for workers and schools for pupils.
While the vaccine it is not mandatory, Sekatle advised everyone to take it.
The Ministry of Health is confident that if 60 percent of the population is vaccinated, this will be protect the mass of Basotho while the government works on raising funds for the rest of the population.