COVID-19: Is Nigeria Deceiving Itself and Risking the World?, By Auwal Sani Anwar
What Nigeria must realise is that the credit it got for handling the Ebola virus disease does not give it a license to be a risk to the rest of the world this time through the coronavirus. Until a vaccine is developed, which may take about nine months to one year, any part of the world that is not mass testing and quarantining those infected is actively constituting a risk to the larger humanity.
In July 2014, a Liberian travelled from Monrovia to Nigeria, bringing with him the deadly Ebola virus disease. He arrived in Lagos, a city of more than 11.8 million people, and then went to Port Harcourt. When he fell sick and was presented at a hospital, a brilliant Nigerian doctor quickly detected the disease he was carrying. Nigeria’s healthcare system sprang up immediately and worked day and night. Through quick and thorough contact tracing, isolation of infected contacts and the continuous monitoring of all contacts, Nigeria was able to nip the impending catastrophe in the bud. By executing what the World Health Organisation described as “a piece of world-class epidemiological detective work,” Nigeria saved itself and arguably the rest of the world.
In February, an Italian travelled from Milan to Nigeria, bringing with him the insidious coronavirus, causing the illness known as COVID-19. He arrived in Lagos on February 25, now a city of more than 14.4 million people, and proceeded to his work location. He fell sick on February 26 and presented himself to a hospital in Lagos. Considering his travel history, a test was administered and it returned positive for coronavirus on February 27. Nigeria’s healthcare system that was already sensitised to the challenge marked it and announced it to the world. It quickly pulled its resources, with contact tracing, testing and quarantining, as it did back in 2014.
The problematic reality is that, at the moment, despite Nigeria’s obvious susceptibility profile, it is recording only 210 confirmed cases with four deaths. Is Nigeria just very lucky or is it deceiving itself and putting the rest of the world at risk?
This question must be considered, given the place of Nigeria as a primary consumer of goods and services from almost all the severely affected nations and regions, including China, Europe and the United States. Before the recent restrictions on movement, there have been high movements of people through Lagos and Abuja to and from these parts of the world. In 2018 alone, 15.2 million passengers travelled through Nigerian airports, with Lagos accounting for 61.9 per cent of international passengers. Additionally, Nigeria gives some citizens of the aforementioned countries visas on arrival. This fact was reportedly exploited by some Americans to get to the U.S. when direct flights from Europe were becoming difficult after the U.S. travel ban. Although Nigeria has recently plugged that hole, it is difficult to imagine that considerably more infections had not already occurred before that action was taken.
One primary area of concern is Nigeria’s triaging protocol. Nigeria is apparently only testing (1.) those with travel history who have shown symptoms, (2) those who have contact history with a symptomatic patient and who are showing symptoms; and perhaps (3) those with travel history who are presenting themselves. This means Nigeria is in effect applying the Ebola triaging protocol on coronavirus, while in actual fact coronavirus is a totally different ball game.
…Nigeria’s case is suspect. Definitely, something is wrong somewhere. Either a miracle is afoot, whereby all those untested travelers and their contacts are not carriers of the virus, protected by divine design, or Nigeria is a catastrophe waiting to happen if it does not start mass testing.
While Ebola is mostly transmitted by coming in close physical contact, including exchanging fluid, with an infected person (symptomatic or not), coronavirus does not need this. The virus can be harboured and transmitted by people who are feeling well and not showing any symptom, and who have not had physical contact with others. As such, waiting to test only those who have shown symptoms and those who have come in contact with them, who are also exhibiting symptoms, will not cut it. This is what Italy is finding out painfully, despite its excellent healthcare facilities.
For many weeks, the Italians only bothered to test those who fell into the aforementioned triage categories, while countries like South Korea were busy carrying out mass testing. In the meantime, coronavirus which can be suspended in air for hours or lying in wait on surfaces, door knobs, tables, etc, was having a field day diffusing into the Italian population. Today, while Italy has recorded 119,827 confirmed cases and 14,681 deaths, South Korea has just about 10,156 cases and 177 deaths. It may be of interest that while the distance between Rome and Beijing is a staggering 8,126.64 km, Beijing to Seoul is only 1,301.19 km!
The United States is another good example of a nation that began treating the coronavirus challenge using protocols similar to what Nigeria is using now. But as soon as the first few deaths were reported, they had to change began and mass testing. From small numbers before testing became wider, now the numbers have jumped to 277,491 confirmed cases, with 7,144 deaths. These are the reasons why Nigeria’s case is suspect. Definitely, something is wrong somewhere. Either a miracle is afoot, whereby all those untested travelers and their contacts are not carriers of the virus, protected by divine design, or Nigeria is a catastrophe waiting to happen if it does not start mass testing.
At present, there are about five testing locations in Nigeria – Lagos, Oyo, Osun, Edo and Abuja. If there is a suspected case in Kano, even under the present protocol, the sample has to go to Abuja. Perhaps this pathetic level of preparedness is the reason why some proactive governors, like that of Kaduna, decided to impose a curfew and lockdown on their states. Lagos has the highest number of confirmed cases, with 108 out of 210 nationwide. Ominously, it was reported that when it was announced that the State was going into lockdown, which should have come much earlier, many northern boys who were bike (achaba) operators decided to ride back home. They all rushed northwards through Lokoja and Kaduna into the nooks and crannies of the north. How many of them may have already contracted the virus? Nobody knows.
Nigeria needs to step up and save itself and the rest of the world by commencing on the mass testing of its teeming populace. As the problem is reported to be the paucity of test kits and capabilities, Nigeria may want to make a case to the World Health Organisation (WHO), which must facilitate the acquisition of these kits and indeed the technology, so as to save the clearly impending situation.
What Nigeria must realise is that the credit it got for handling the Ebola virus disease does not give it a license to be a risk to the rest of the world this time through the coronavirus. Until a vaccine is developed, which may take about nine months to one year, any part of the world that is not mass testing and quarantining those infected is actively constituting a risk to the larger humanity. One unknown coronavirus carrier, in one obscure corner of the world, could possibly reignite a whole new cycle of infections. That is why even after the vaccines are developed, testing is likely to remain the order of the day, due to the ability of coronavirus to incubate for up to two weeks without symptoms. One may anticipate a post-coronavirus pandemic world where all travelers would be required to present their coronavirus clearances – just like the yellow fever – before being given access to cross international borders.
Given the above scenario, a situation whereby you have just about eight ventilators in Kaduna State, and perhaps less than 400 nationwide, underscores the calamitous level of our preparedness. Indeed our medical doctors and other health workers are just sitting ducks waiting for coronavirus to show up and have its way with them. How many personal protective equipment (PPEs) are there in Nigerian hospitals? A packet of 50 regular surgical masks that used to cost between N350 and N500 is now N7,500. Hand gloves that used to cost N1000 for a pack of 50 pairs is now going for N5000, if found. This is what is happening.
For how long would Nigeria’s poor, who constitute more than 69 per cent of the population (about 130 million people), involuntarily remain locked down? What with hunger eating them up and with other illnesses ravaging their families? What with some misguided, selfish clergy telling them that their coming out for religious congregation is a sign of the strength of their faith?
Nigeria needs to step up and save itself and the rest of the world by commencing on the mass testing of its teeming populace. As the problem is reported to be the paucity of test kits and capabilities, Nigeria may want to make a case to the World Health Organisation (WHO), which must facilitate the acquisition of these kits and indeed the technology, so as to save the clearly impending situation. Nigeria could pay South Korea for the testing technology and that of producing the PPEs. Nigeria could turn the laboratories of its teaching hospitals and federal medical centres into testing labs. It could also mobilise automobile manufacturing factories like Innoson, PAN, ANAMMCO and so on to re-purpose their manufacturing lines for the mass production of ventilators. Our textile manufacturers could equally be empowered with complementary technology to venture into surgical mask production.
Nigeria’s stitch in time may yet save itself and the world.
Auwal Sani Anwar writes from the Kaduna Polytechnic; @auwalanwar.