Why Rwanda Is Doing Better Than Ohio When It Comes To Controlling COVID-19

Jul 15, 2020
Originally published on July 20, 2020 8:46 am

In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you're going down the street.

"So whenever someone is driving a vehicle, bicycle, motorcycle or even walking, everyone is asked if you wish to get tested," says Sabin Nsanzimana, director general of the Rwanda Biomedical Center, which is the arm of the ministry of health that's in charge of tackling COVID-19. Health officials in personal protective equipment administer the test. Nsanzimana says the testing is voluntary, although some others say refusal is frowned upon.

The sample collection — from a swab up the nose — and filling out the contact information paperwork takes about five minutes.

"All these samples are sent that day to the lab," Nsanzimana says. "We have a big lab here in Kigali. We have also six other labs in the other provinces."

Despite being classified by the World Bank as a low-income country, and despite its limited resources, Rwanda has vowed to identify every coronavirus case. Anyone who tests positive is immediately quarantined at a dedicated COVID-19 clinic. Any contacts of that case who are deemed at high risk are also quarantined, either at a clinic or at home, until they can be tested.

Nsanzimana says health workers call or visit every potential contact of someone who tests positive.

"We really believe that doing so is important to make sure we detect and trace where the virus could be," he says.

Comprehensive contact tracing is a task that has overwhelmed countries with far more resources than Rwanda. Rwanda's per capita income is roughly $2,000 per year. Yet all testing and treatment for the virus is provided for free.

It costs the government between $50 and $100 to run a single coronavirus test, Nsanzimana says. In order to test thousands a day, Rwanda has started using a process called "pool testing." Material from 20-25 nasal swabs are all put into one vial and run through the machine. This allows them to test far more samples at once. If they get a positive result, then all the swabs that went into that initial vial are tested individually to pinpoint the person who's infected.

Nsanzimana says Rwanda's experience dealing with other infectious disease outbreaks is helping it now during the pandemic.

The country is using systems and equipment it already had in place to address HIV.

"The main machines we are using for COVID testing are the HIV machines that were (already) there," he says. "We are using the same structure, same people, same infrastructure and laboratory diagnostics, but applying it to COVID testing."

Since recording its first case in mid-March, the country of 12 million has recorded just over 1,500 cases. Ohio has a similar size population and has recently been reporting roughly 1,200 cases a day.

"Rwanda did a few things that are quite smart," says Sema Sgaier, the head of the Surgo Foundation, which has just launched a new data tool to analyze trends around COVID-19 across Africa. "One is they responded really early. They put some of the most stringent lockdowns in place compared to every other African country. In fact, we've been monitoring physical distancing data across the continent and Rwanda fares, I think, second; they've physical distanced the second most across Africa" — a conclusion based on mobile phone movement data. South Africa is No. 1.

Rwanda mobilized community health care workers and police and college students to work as contact tracers. It set up national and regional command posts to track cases. It's even using human-size robots in the COVID-19 clinics to take patients' temperatures and deliver supplies.

Tolbert Nyenswah, who ran the Liberian ministry of health's response to Ebola in 2014, gives Rwanda high marks for how it has been handling COVID-19, even if at times it's heavy-handed.

"Rwanda, from all indications, is a success story for Africa," Nyenswah says. The strong leadership from President Paul Kagame, which Nyenswah says can even be authoritarian, has been effective during this crisis. Kagame demands accountability from his health ministry.

Whether the people trust or fear the government, Rwandans listen to their government and have been following the orders regarding masks, washing hands and staying home.

Nyenswah worries that the worst is yet to come in Africa with this pandemic.

"No country is out of the woods yet," he says. However, he adds that Rwanda is an example to other low-income countries that even with limited resources, this virus can be contained. "So what needs to be done is to follow the (prevention and containment) measures. Political leadership is very, very crucial. Rwanda should continue what it is doing now. And other countries should emulate Rwanda."

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RACHEL MARTIN, HOST:

Coronavirus cases are rising across much of Africa, but one country on the continent, Rwanda, has managed to keep the virus in check. NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: Rwanda is listed by the World Bank as a low-income country, and yet, when it comes to COVID-19, it has accomplished what even some of the richest countries in the world have failed to do, and it's done it by making smart use of its scarce resources and responding aggressively to the virus - so aggressively that if you happen to be going down the street in the capital city Kigali, there's a chance that you might randomly get tested for the coronavirus.

SABIN NSANZIMANA: So whenever someone driving a vehicle, bicycle, motorcycle, even walking, everyone is asked if you wish to get tested.

BEAUBIEN: Sabin Nsanzimana runs the Rwanda Biomedical Center, which is the arm of the ministry of health that's in charge of tackling COVID. Lab technicians in personal protective gear take nasal swabs from people as they stand by the side of the road or sit in their cars. The tests and filling out the contact information paperwork takes about five minutes.

NSANZIMANA: All of these samples are sent to the lab. We have a big lab here in Kigari. We have, also, six labs there in other provinces.

BEAUBIEN: Mass testing is a crucial part of how Rwanda is containing the coronavirus. But in order to test thousands of people per day, Rwanda had to switch to a process called pool testing. They test samples from up to 25 people at once, which enables them to increase their testing volume on limited equipment. It's faster and also much cheaper. If someone does test positive, a community health worker tracks them down and then sends them to quarantine at a clinic dedicated to COVID patients. Close contacts have to quarantine as well.

Nsanzimana says Rwanda has mobilized an army of community health care workers and police and college students to do this work.

NSANZIMANA: We really believe that doing so is important to make sure we detect and trace where the virus could be.

BEAUBIEN: Rwanda's experience dealing with other infectious disease outbreaks is paying off now during this pandemic. Nsanzimana says they're benefiting from the procedures and equipment and knowledge they've acquired dealing with malaria, hepatitis, the threat of Ebola from neighboring Congo, HIV.

NSANZIMANA: The main machines we are using for COVID testing, generally they are HIV machines that are there. We're using the same structures, same people, same laboratory diagnostics to apply quickly to COVID testing.

BEAUBIEN: Since March, this country of 13 million people has recorded just over 1,200 cases. The state of Ohio, with a similar size population, has recently been reporting that same number of cases every day.

SEMA SGAIER: Rwanda did a few things that I think are quite smart.

BEAUBIEN: Sema Sgaier is the head of the Surgo Foundation, which has been analyzing data and trends around COVID across Africa.

SGAIER: One is they responded really early. They put some of the most stringent lockdowns in place. And in fact, we've been monitoring physical distancing data across the continent and even within regions in the country, and Rwanda, they've physical distanced the second most across Africa.

BEAUBIEN: And some say this is due to steady national leadership on the crisis. Tolbert Nyenswah, who ran the Liberian Ministry of Health's response to Ebola in 2014, gives Rwanda high marks for how it's been handling COVID.

TOLBERT NYENSWAH: Rwanda, from all indications, is a success story for Africa.

BEAUBIEN: Nyenswah says President Paul Kagame demands accountability from his health ministry and even takes an authoritarian tone to get things done. Whether the people trust or fear the government, Rwandans have been following the orders regarding masks, washing hands and staying home. Nyenswah worries that the worst is yet to come in Africa with this pandemic, but he says Rwanda is an example to other countries on the continent that, even with limited resources, this virus can be contained.

Jason Beaubien, NPR News.

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