COVID-19 continues to put the world in survival mode as cases keep soaring. The top ten countries with the highest number of infections and deaths are; the United States of America, Brazil, India, Russia, South Africa, Mexico, Peru, Chile, and the United Kingdom. So far (as of 17^th August, 2020), over 21.5 million COVID-19 confirmed cases have been recorded worldwide, which has resulted in more than 750,000 deaths. The United States of America continues to lead with a total number of 5,404,500 recorded cases and a death toll of 170,055 (https://coronavirus.jhu.edu/map.html, 17^th August, 2020).

 The total number of cases in Africa currently stands at 1,137,315 with 26,328 deaths. South Africa has the leading case count of 592,144 followed by Egypt, Nigeria, Morocco and Ghana (http://covid-19-africa.sen.ovh/, 19^th August,2020). Ghana now has a case count of 42,653 and a total death toll of 239 with the Greater Accra and Ashanti regions still leading with the highest recorded cases of  21,212 and 10,569,  respectively (https://ghanahealthservice.org/covid19/, 17^th August, 2020). The North East region has the lowest case count of 18.  In terms of gender, males are mostly (60%) infected than females (40%).

Regardless of increasing cases of COVID-19, Ghana has been easing restrictions in phases without compromising on adherence to COVID-19 protocols in order to stay safe and reduce the spread of the virus. The first phase of easing involved lifting of the 3-week ban on the restriction of movement imposed on Greater Accra and Greater Kumasi and their surrounding towns. This resulted in the free movement of people, animals and things across the entire country. Ban on social gatherings was also lifted partially, allowing 100-individual ceremonies to take place, and these predominantly included private burials, marriage ceremonies, and religious gatherings. The 2^nd phase of easing was announced by the President in his 14^th Address to the nation (on 26^th July, 2020). This involved public transport and domestic airlines to operate at full capacity while ensuring that all passengers wear face masks and maintain enhanced hygiene protocols. Others include re-opening of Ghana’s tourist sites and attractions, and open-air drinking spots to visitors. However, beaches, pubs, night clubs and cinemas remain closed until further notice. The 2^nd phase also saw the restrictions on religious gatherings eased to make room for many congregants, with an extended duration from 1 to 2 hours. In the area of sports, only the female under-17 and under-20 national football teams have been permitted to commence training towards the upcoming FIFA and CAF-sanctioned international matches, which begin in September, 2020. At this point, the country’s borders by air, land and sea continue to remain close to human traffic until further notice. Nonetheless, special dispensation has continuously been given by the government for the evacuation of Ghanaians stranded abroad, and these individuals undergo a 14-day mandatory quarantine.

The World Health Organization (WHO) on 27^th May, 2020 provided updated recommendations on the criteria for discharging patients from isolation. The updated criteria according to WHO reflect findings that patients whose symptoms have resolved may still test positive for COVID-19 (SARS-CoV-2) by RT-PCR for many weeks. Regardless, these patients are not likely to be infectious and hence, unlikely to transmit. Criteria for discharging patients from isolation (i.e., discontinuing transmission-based precautions) without requiring retesting;

• For symptomatic patients: 10 days after symptom onset, plus at least 3 additional days without symptoms (without fever and other respiratory symptoms)
• For asymptomatic cases, 10 days after a positive test for SARS-CoV-2

With widespread community transmission, the initial criteria for SARS-CoV-2 posed several challenges:

• Long periods of isolation for individuals with prolonged viral RNA detection after the resolution of symptoms, affecting individual well-being, society, and access to healthcare.
• Insufficient testing capacity to comply with initial discharge criteria in many parts of the world. 
• Prolonged viral shedding around the limit of detection, having negative results followed by positive results, which unnecessarily challenges trust in the laboratory system.

Under this new directive, Ghana has already discharged over 5,925 patients who were in isolation.

Impact of COVID-19 on Schools in Ghana:

COVID-19 has had a severe impact on the country’s educational sector. In an address to the nation on 15^th March, 2020, at which time the country had a record of 6 cases, the President announced the indefinite closure of schools. This came with its own challenges as most schools tried to keep up with the academic calendar through online studies; only a handful or a section of the country who had access to internet and the appropriate technological logistics were able to benefit from these online studies. With students at home, most private owned schools became financially strained and as a result, had to lay off some of their teaching and non-teaching staff as they did not have the means to sustain them on their payroll. Parents have had to suspend work and businesses so they can stay home with children and make alternate provisions for education for them at home; for some children, however, there has been no form of teaching and learning for them since the indefinite closure of schools in March.

Final year university students and senior high school (SHS) students as well as 2^nd year gold track SHS students were told to report to school. This was to enable them to complete their course work for the year and prepare the final year students for the West African Senior School Certificate Examination (WASSCE). This decision by the government received a lot of backlash from the media space with the question of if it was appropriate or perhaps the right time to allow students to return to school. Despite the opposition all these decisions met, the government stood by their decision and these students returned to school.  Currently, most final year students of tertiary institutions have finished their course work and returned home, Gold track SHS 2 students who went to school to complete their term’s work are being sent home in batches to ensure that no one going home is infected.

Final year Junior High School (JHS) students also resumed school to prepare for the Basic Education Certificate Examination (BECE). The exams will commence from 24^th August 2020 to 4^th September, 2020. 584,000 candidates will be sitting for the 2020 BECE.

The gradual easing of restrictions has come with its own challenges, and these are ones that are to be expected once we acknowledge the fact that we are not in normal times. The deputy Health minister in an address to parliament stated that 178 COVID-19 cases had been recorded in JHSs and SHSs since the re-opening of schools with 8 recoveries as at the time of the address. He however stated that no one was in critical condition and all infected students were responding well to treatment. Pulse.com.gh in a 17^th July publication listed 15 Senior high schools that had recorded COVID-19 cases, these include;

Greater Accra Region: Accra Girls SHS and Odorgonor SHS

Ashanti Region: Konongo Wesley SHS

Central Region: Mfantsipim School

Eastern Region: Suhum Senior Technical School and Mpaeso SHS

Western region: Nsein SHS, Archbishop Porter Girls SHS, Ahantaman Girls SHS, Adiembra SHS and Diebere SHS

Volta region: Mawuli School, Bishop Herman College, Dabala Technical School and Mawuko Girls SHS

The WASSCE commenced on 3^rd August, 2020 and currently ongoing with a total of 375,737 candidates in over 796 examination centers. The Ghana Education Service has stated that all COVID-19 protocols will be strictly enforced to ensure the safety of candidates.

Continue to stay in touch with the Centre for Health Systems Strengthening’s (CfHSS) website as we bring you up to speed with the state of COVID-19 in Ghana.