Absence of geo-mapping, disease modelling and therapeutics development derail Nigerian response to Covid-19, By Prof. Malachy Ifeanyi Okeke
It is no longer news that Covid-19 is a highly contagious virus with a clinical spectrum that is probably more diverse than any other virus. Plagued with a virus that has a reproduction number, R0, of 3 and above, it not surprising that the virus has successfully spread to all parts of the globe leaving in its trail death, destruction and economic ruin. Covid-19 virus is so vicious in its infection biology that if an effective vaccine or therapy is not found in the next couple of months, the virus is capable of destroying human civilization as we know it. Faced with this apocalyptic but realistic forecast, nations in North America, Europe and Asia have deployed the best technologies in the areas of geo-mapping, infectious disease simulation and modelling, and cutting-edge biomedical research to help break the transmission of the virus and develop an effective vaccine. These countries were able to deploy the technologies because of their decades of investment in Science, Technology, Engineering and Mathematics (STEM). In Nigeria and Africa, the lack of investment in STEM for decades has left us bereft of technological innovations and solutions to fight this 21st century pathogen. Thus, we are fighting a very sophisticated virus with bows and arrows of historic times. In this essay, I will show that the lack of modern technologies like geo-mapped contact tracing, infections disease modelling and therapeutics development are derailing an effective Nigerian response to Covid-19.
To test, trace and isolate infected individuals require that the interval between test and result should be short. In Nigeria, this turn around can last for up to two weeks or more. A young Nigerian pharmacist with respiratory symptoms waited for more than two weeks from the time the sample was taken to the time the result was delivered. This happened at IDH isolation center Yaba and the case of this Nigerian young pharmacist is actually the norm, not an exception in IDH Yaba and other isolation centers across the country. Such long waiting time completely undermines the ability to break the virus transmission because by the time the result of COVID-19 test is known and the individual isolated, the virus would have been spreading unabated. NCDC does not have enough personnel for collection of samples as well as contact tracing. However, this limitation in personnel can be solved with technology.
NCDC is still doing manual contact tracing while proactive institutions in Europe and American have migrated to geo-mapping. Manual contact tracing is not only inefficient but relies on the unreliable memory of infected individuals to recall their contacts. Proactive early response would have been for the Nigerian competent authority to develop a geo-mapping app for contact tracing. Mobile network database is quite extensive in Nigeria and NCDC could have leveraged on such a massive data base to develop a privacy responsible contact tracing app that will enable NCDC Covid-19 response team track the location and contacts of any Covid-19 infected individual as well as alert non-infected individuals when they are within 5 to 10 meters of an infected person. Norway and Germany for example in collaboration with their network carriers and public health authorities have developed such apps and that have not only helped them in contact tracing but in mapping of the place and location of infection clusters. In Norway in particular the geo-mapping app have been combined with real time modelling that has enabled Norwegian public health authority to know which section of the population to ease the lockdown. Based on such data and simulation, Norway has eased the lock down in a safe and evidence-based manner, not blind as we are doing here in Nigeria. The Norwegian carrier Telenor, the Norwegian public health authority Helse Norge, and Norwegian scientists were responsible for this geo-mapping app. I hope that such a collaboration can be replicated by Nigerian institutions and scientists as we need technology to break the virus transmission and it is high time we migrate from ineffective manual model to public health intervention to a technology driven model.
Nigeria and indeed Africa have not incorporated Covid-19 simulation, modelling and forecasting as part of the response ecosystem. Without simulation, modelling and prediction, it is not possible to forecast the virus transmission dynamics and its effect on the healthcare system resources including demand for hospital beds, ventilators and ICU units among others. And without forecast informed by reliable models, healthcare interventions as is happening in Nigeria is simply blindfolded. Policy makers and politicians are swayed to change course as advised by scientists when they see the forecasts of the impact of Covid-19 on their population. The alarming data forecast by the Imperial College MRC Center for Global Infectious Disease Analysis persuaded the UK government to change course; migrating from a containment strategy to a full-blown mitigation strategy. Donald Trump, the US president underestimated the impact of Covid-19, equating it to a seasonal flu that could easily be contained and ignored the dire advice of leading experts in infectious diseases until he was shown the forecast by The Institute of Health Metrics and Evaluation (IHME). IHME predicted that 200,000 Americans will die by August if ruthless mitigation strategies (lock down and social distance measures) are not implemented. Following the introduction and implementation of the mitigation strategies in the US, IHME then projected about 74000 deaths in the USA by August 4. However, in the last one to two weeks many states in the USA have lifted or eased the lockdown measures in other to “open up the economy and save millions of livelihoods”. IHME have now included the ease of restriction in the affected states in the USA in their model and now projects 134475 deaths in the USA by August 4 2020.The doubling of the number of deaths in the USA modelling projection due to relaxation of lockdown mitigation measures should be a serious reminder to NCDC and the Nigerian government the probable, macabre consequences of easing the lockdown which Nigeria embarked on this week.
Of course, models are dynamic and as more data come in, the forecast and predictions are constantly adjusted. The job of government scientists working in national public health institutions is not to make policy but to provide extensive, reliable data to our elected officials. Politicians and elected government officials do make policy and it is essential that they are presented with reliable and compelling data to make an informed decision. Thus, in the absence of modelling projections, one wonders what type of data NCDC and the Presidential Task Force on Covid-19 present to our politicians on the virus transmission dynamics and its impact on population health and healthcare system resources. There is no scientific reason why Nigeria cannot produce a reliable model for Covid-19. Data published by NCDC on infections, recoveries, and fatalities can be combined with other parameters like hospitalization, population density, etc to generate a reliable, dynamic model. We have more than enough professors of statistics, mathematics, virology, epidemiology and bioinformatics in our Universities to help develop such a model. Besides, modelling can also be done in a low key way by testing for the presence of the virus nucleic acid in sewage and use that information to estimate the prevalence of Covid-19 virus in a population.
Once again, we have no national strategy on the development of therapeutics and vaccines for Covid-19. Across the world, particularly in the northern hemisphere, more than 100 candidate drugs and vaccines are currently undergoing clinical trials. In the USA, Remdesivir has shown an early promise while in the UK, the University of Oxford adeno virus-vectored Covid-19 vaccine is undergoing phase 1 clinical trials. It is very sad that as a Nation, we are again spectators waiting for others to develop a vaccine or a drug and then we scramble for importation license. Why can we not extract hyperimmunoglobulin and T cells from the plasma of recovered Covid-19 patients and see if the antibodies or T cells are protective or not? Why can we not screen thousands of medicinal plants in Nigeria for antiviral activity to Covid-19 virus? Why can we not screen existing drugs for anti-Covid-19 activity? What exactly was NAFDAC set up for? These experiments do not require any complex experimental methodology. A simple biosafety level 2 lab with tissue culture facility can easily perform these experiments and present a proof of concept data that can be expanded and refined. It is a damming verdict on our collective rejection of scientific research, experiment and rigor that no therapeutics or vaccine is even undergoing preclinical evaluation in Nigeria, not to talk of clinical trials. Our collective revulsion to scientific method and innovation is best exemplified by a Nigerian governor who unilaterally approved the use of hydroxychloroquine and azithromycin for the treatment of Covid-19 in his state. It is beyond comprehension that a politician will side track regulation and due scientific evaluation and magically approve a drug. We teach students scientific method in their first year and any first-year student of biology is well aware of the damaging consequences of ignoring the scientific method. All the spectacular discoveries in science were made possible by the scientific method. Ignoring it or inventing our own voodoo science is an open invitation to disaster. NAFDAC should as a matter of national emergency exercise the regulatory role and put a stop to the reported approval of hydroxychloroquine as treatment for Covid-19 in the said state.
From the paragraphs above, it should be clear that Nigeria is responding to Covid-19 virus epidemic blindfolded. Grouping in the dark, we have zero chance of breaking the virus transmission. Just like a jumbo jet flying blind and will inevitably crash, our coronavirus response has not and will not keep our people safe, for it is based on hope and not scientific evidence, rather the strategy of easing the lockdown is a willing invitation to the virus to run amok. It will overwhelm us and our rickety health system resources and the consequences in terms of mobility and fatality will be monumental. We will not recover from it for decades. Those who are championing the easing of the lock down measures on economic grounds have valid points but they fail to see that a premature easing of the lockdown as is the case in Nigeria will give the virus a free run and the economic and health consequences will simply obliterate whatever economic gain that might have resulted from the premature exit strategy. I will speculate that If Nigeria loses 100 billion dollars due to the lockdown, we will lose a trillion dollars by premature easing of the lock down measures. As a matter of national emergency, I urge NCDC to convince our President to reintroduce lockdown in Lagos, Abuja, Ogun, Kano States and other parts of the country until the virus reproduction number, R0 (Rt) is less than 1. It is my hope that our government, private institutions and Nigerian dollar billionaires, will come out to fund massive testing of the Nigeria population both by RT-PCR and antibody profiling, development of therapeutics, simulation and projection models and well as geo mapping applications for contact tracing It is a national health emergency and hopefully we will all rise to the challenge.
Professor Malachy Okeke is a virologist. He teaches microbiology and molecular genetics at the American University of Nigeria. He can be contacted via email at: firstname.lastname@example.org