Expert Reaction to Covid-19 Case Management and Vaccine Roll-Out: The Hits and Misses in Rwanda


Dr Menelas Nkeshimana, Head of Department of Accident and Emergency at the Centre Hospitalier Universitaire de Kigali, said:

“Vaccinating one part of the world or one country or one continent is very dangerous because you are giving a chance to the virus in a country that has not been vaccinated as strictly to mutate and mutations by the end of the day are going to be moderate and spill over to different countries and eventually circulate globally and invalidate the efforts that you would have done prior to vaccinate at the rate of 100% in certain countries, so it is going to waste their resources in some way. So it is not about 60% of a country that should be vaccinated, it is 60% of the global population, this should happen at the same pace.”

“One of the problems when you let the virus circulate longer and it gets ahead of you, you can’t vaccinate or quarantine or people cannot follow your measures, then you risk to have variants. The variants will come with different behavior from the first or original virus. They might come as more frequent; they might come prone to evade the immune system. So they are classified in three big categories, one, variant of interest,”

“It means you have identified the variant and the variant has interested you because whenever you compute it and put the scientific data around it you find it associated with problems: high infectability, associated with severity of illness, affected with ability to produce symptoms in children for example, which was different from the original virus. Once it does interest you, you list it and put it aside. You categorize it as a variant of interest. As of yesterday, we have three variants in this category B. which was first identified in New York in November 2020, B. which was first identified again in New York in December 2020 and the third one is B2 which was first identified in April 2020 in Brazil,”

“The second category is variant of concern; it means not only did you find association of it with troublesome situation but now you have the evidence that it does so. It is highly infectious, it is highly transmissible, it is leading to severe cases, it is leading to death. Once you have that scientific evidence, you categorize it as variant of concern and in this category we have five strains. One is B.1.1.7 which has been identified in the UK and is called the UK strain, second B 1 which was identified in Japan and Brazil, B. first identified in South Africa and we call it South African strain, B. which was first identified in US, California and B. which was first identified in US, California,”

“So these are the five variants of concern which any country has these variants in a way or another, for example in Rwanda, we have found two of the variants of concern among the travelers who were coming into Rwanda. Fortunately, enough, as per the protocol in Rwanda, any travelers coming from abroad is isolated upon arrival and PCR test is repeated. So these people did not interact with Rwandans, so these variants remained with these people who were quarantined and did not spill over, this was the UK strain and the South Africa strain,”

“Then there are variants in the third category, variants of high consequences. It means they lead to disaster, your vaccine can’t address them, they can evade your immune system leading to high immortality rate, they are leading to very high infectious process beyond what you can contain and usually you should be able to suspect them in countries that are struggling massively with the third wave like high number of people, high number of deaths, uncontrollable disease despite the number of instalment of quarantine, isolation measures and vaccination roll out,”

“Once we have a country with that behavior usually the world health authorities would call up on you to sequence the strain so that you might check if you don’t have variant of high consequences. We don’t have yet as of today but we have variant of concern that may end up in this category anytime from now.”

“A vaccinated person can still get COVID-19 and transmit it and that’s why a vaccinated person should be responsible enough to ensure all the measures are still applied- the distancing, the washing and the facial masks. Being vaccinated, only give you the guarantee that you will not get severe disease and die from it but you can still get it and you can still transmit it; so don’t hug or carry or jump at someone just because they have been vaccinated because they could still be having COVID-19 carried by them.”