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Madagascar seems to be back at square one. After instituting an early lockdown in March, the Malagasy authorities gradually relaxed the measures in place, permitting schools and stores to reopen and significantly reducing curfews, allowing life to virtually return to normal in Antananarivo.
However, as of Monday 6 July, the Analamanga region, which includes Antananarivo, is back under lockdown. Only essential businesses are open and they are required to close at noon. Non-essential travel is prohibited and no less than 500 military personnel have been deployed to enforce the new measures. Madagascar’s economy has thus ground to a halt, with all of the social consequences that that entails.
Why another lockdown?
The authorities are responding to a worsening health situation. Based on official statistics, the number of coronavirus cases jumped 52% last week and deaths rose 65%. As of 9 July, Madagascar had reported 3,782 cases and 33 deaths.
“The new lockdown was instituted primarily due to the rise in the number of deaths,” said Lova Ranoromaro, the president’s chief of staff.
According to Lalatiana Rakotondrazafy, government spokesperson: “We implemented these new lockdown measures at the right time, in light of the projections coming out of the Ministry of Health.”
Clearly, the authorities have shifted their strategy. Back in March, they had moved to take preventive steps: international flights were cancelled as early as 20 March and then President Rajoelina announced the precautionary lockdown of the capital on 22 March, at a time when the country had reported just 12 cases and no deaths. Today, the government is responding to developing events.
The new lockdown is expected to take pressure off of the healthcare system.
“Hospitals are saturated and we still can’t know with certainty when the epidemic will peak,” said Charlotte Ndiaye, WHO representative in Madagascar.
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“We’re already working twice as much as usual,” said Lova Randriamanantsoa, who is director of Andohatapenaka Hospital and currently treating COVID-19 patients. All of her hospital’s 38 beds equipped with oxygen support are occupied, and several members of the nursing staff have already been contaminated.
Elsewhere in the city, medical staff often lack masks and protective gowns. On 8 July, the government promised to open, as early as this Friday, a centre that can accommodate 200 severely ill patients.
Were lockdown measures relaxed too soon?
In Ranoromaro’s view: “A majority of Malagasy citizens were demanding a gradual return to normal. Our population is vulnerable, they live from day to day.”
Since March, the authorities have stepped up their efforts to support the most vulnerable members of society. What’s more, they increased hospital capacity and testing capabilities (more than 500 tests were performed these past few days, compared with 100 at the beginning of the outbreak), and have worked to break disease transmission chains. On 14 July, during a television appearance, Rajoelina declared that the epidemic was “under control”.
Nevertheless, Ndiaye takes a critical view of how the pandemic has been managed over the past three months: “We got off on the right foot in March. But after that, we became too lax and went back to business as usual too soon. Citizens thought the problem was resolved, whereas we should have been more forceful about practising social distancing and other protective measures. We were too lenient about wearing masks.”
Naturally, the number of cases gradually began to trend upwards.
“The criteria for lifting lockdown orders had not been met, so it was inevitable that we would end up where we are now. Today, we are backing this new lockdown because the situation got away from everyone. It’s a courageous step,” Ndiaye said.
The WHO representative is now advocating for the strict enforcement of social distancing and other protective measures, even within households, without which the lockdown may not produce the desired effect.
Does the new lockdown confirm the failure of Covid-Organics (CVO)?
On 20 April, Rajoelina launched CVO, a “preventive and curative” artemisia-based remedy against COVID-19, just as health measures began to be eased. Ranoromaro has said that “CVO still plays an important role” in the government’s current strategy.
As of a few weeks ago, the remedy is no longer being provided to the population free of charge, unlike at the beginning of the pandemic, but is instead sold for €0.35 per bottle, about the price of a meal.
“CVO is still costing the government,” said Rakotondrazafy. “But we can’t continue to give it out for free to everyone, only to patients.”
Nevertheless, the free distribution of CVO will ramp up again starting on 9 July.
However, many are questioning the efficacy of the remedy given the significant rise in cases and the return of lockdown measures.
As Rakotondrazafy puts it: “It’s in bad faith to say, ‘Since we have a remedy, we’re going to go about our lives as normal’. To make an analogy, just because we discovered antiretrovirals doesn’t mean we have stopped protecting ourselves against AIDS. There are no medications in the world that are 100% effective, and 90% of COVID-19 deaths in Madagascar are people who couldn’t take CVO because of contraindications such as diabetes.”
As for the president, he “still firmly believes in the remedy’s efficacy and his entourage encourages him in that direction”, a person close to Rajoelina said. On 30 June, the head of state visited the construction site of a plant that is set to begin producing CVO+, the gel capsule version of Covid-Organics, at the end of July.
The following day, he also launched clinical trials on artesunate, an injectable derivative of artemisia, in combination with vitamin C. However, since 20 April, no validated scientific results have proven CVO’s efficacy.
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