Experience of Rwanda on COVID-19 Case Management: From Uncertainties to the Era of Neutralizing Monoclonal Antibodies

Abstract

The management of COVID-19 in Rwanda has been dynamic, and the use of COVID-19 therapeutics has gradually been updated based on scientific discoveries. The treatment for COVID-19 remained patient-centered and entirely state-sponsored during the first and second waves. From the time of identification of the index case in March 2020 up to August 2021, three versions of the clinical management guidelines were developed, with the aim of ensuring that the COVID-19 patients treated in Rwanda were receiving care based on the most recent therapeutic discoveries. As the case load increased and imposed imminent heavy burdens on the healthcare system, a smooth transition was made to enable that the asymptomatic and mild COVID-19 cases could continue to be closely observed and managed while they remained in their homes. The care provided to patients requiring facility-based interventions mainly focused on the provision of anti-inflammatory drugs, anticoagulation, broad-spectrum antibiotic therapy, management of hyperglycemia and the provision of therapeutics with a direct antiviral effect such as favipiravir and neutralizing monoclonal antibodies. The time to viral clearance was observed to be shortest among eligible patients treated with neutralizing monoclonal antibodies (bamlanivimab). Moving forward, as we strive to continue detecting COVID-19 cases as early as possible, and promptly initiate supportive interventions, the use of neutralizing monoclonal antibodies constitutes an attractive and cost-effective therapeutic approach. If this approach is used strategically along with other measures in place (i.e., COVID-19 vaccine roll out, etc.), it will enable us to bring this global battle against the COVID-19 pandemic under full control and with a low case fatality rate.

Clinical and Regulatory Challenges and Opportunities for Monoclonal Antibodies in Low- and Middle-Income Countries: Lessons from COVID-19 and Beyond

“…However, prior to the pandemic, Rwanda had no formal guidance for emergency use of medicines. The Rwanda Food and Drug Administration introduced bamlanivimab for emergency use in February 2021 and only afterwards in May 2021 issued a draft for the Authorization for Emergency Use Products [ 39 , 40 ].…”

“…Material transfer agreements are required in many settings governing the storage of samples, ethics requirements, identification of specific samples, and participant's rights to withdraw samples from the storage facility [35]. Monoclonal antibody studies require complex assays for pharmacokinetic, anti-drug antibody, [39,40].…”

COVID-19 vaccination coverage and linkages with public willingness to receive vaccination prior to vaccine roll-out: Evidence from Rwanda

“…The first case of COVID-19 in Rwanda was reported on 14 March 2020, and since then, 133,021 individuals have been confirmed positive and 1.1% succumbed to the disease by the 31 December 2022 (i.e., 1467 people). Rwanda has shown to be one of few countries in Africa that quickly adopted and implemented early mitigation measures, and progressive capacity building for front-line healthcare workers to fight COVID-19 (Nkeshimana et al, 2022). The magnitude of the pandemic in Rwanda was alleviated by dedicated multidisciplinary intervention, such as coordinated government leadership, flexibility and adaptation of therapeutic guidelines based on the virulence of the circulating strain, and importantly the high level of population adherence to infection control practices and behaviors (Louis et al, 2022; Nkeshimana et al, 2022).…”

“…Rwanda has shown to be one of few countries in Africa that quickly adopted and implemented early mitigation measures, and progressive capacity building for front-line healthcare workers to fight COVID-19 (Nkeshimana et al, 2022). The magnitude of the pandemic in Rwanda was alleviated by dedicated multidisciplinary intervention, such as coordinated government leadership, flexibility and adaptation of therapeutic guidelines based on the virulence of the circulating strain, and importantly the high level of population adherence to infection control practices and behaviors (Louis et al, 2022; Nkeshimana et al, 2022). Rwanda served exemplarily in controlling the pandemic and conducting successful COVID-19 vaccine rollout (Figure 1).…”

Leveraging artificial intelligence and data science techniques in harmonizing, sharing, accessing and analyzing SARS-COV-2/COVID-19 data in Rwanda (LAISDAR Project): study design and rationale

“…After detection of the first case, different public health measures have been implemented by the Rwandan government from total lockdowns, inter-district lockdowns, localized lockdowns and others [14,15]. The classic public health measures to prevent COVID-19 were also emphasized such as the mandatory wearing of masks, social distancing and regular handwashing [16,17]. Rwanda has also joined the rest of the world to secure vaccines against COVID-19 [18].…”