Health

COVID-19: Which way Nigeria?

It the dawn of a new century, the world is facing a pandemic. The first known case of the novel coronavirus disease (COVID-19), is traced back to December 1, 2019 in Wuhan, Hubei, China. As at April 1, the virus has been reported in five continents, 212 countries such as Italy (12,428 deaths), Spain (8,464 deaths), China (3,312 deaths) and the United States of America (4,075 deaths); being the worst hit. Globally, there are over 859,000 cases with 42,322 deaths.So far, 178,101 people have recovered from the disease. The World Health Organisation (WHO) declared the outbreak a public health emergency of international concern on January 30, 2020 and recognized it as a pandemic (a disease that has spread across a large region, such as multiple continents) on March 11.

For emphasis, the disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly-discovered virus closely related to bat coronaviruses, pangolin coronaviruses and SARS-CoV (causative agent of influenza). The virus is mainly spread during close contact and by respiratory droplets produced when an infected person coughs or sneezes. People may also be infected with COVID-19 by touching a contaminated surface and then their faces. It is mostly contagious when people are symptomatic, although spread may be possibly well before symptoms appear. Common symptoms include fever, cough, and shortness of breath.

Complications may include pneumonia and acute respiratory distress syndrome. The time between exposure and onset of symptoms ranges from two to 14 days.

Recommended non-pharmaceutical interventions include hand washing, maintaining personal hygiene, social/physical distancing, monitoring and self-isolation of possible contacts. To date, there is no known vaccine or specific antiviral treatment. Treatment remains largely symptomatic and supportive therapy, a dire situation that the United Nations Trade and Development Agency, projects that the disease will likely cost the global economy US$1 trillion this year.

Coming home, Nigeria confirmed its first case of COVID-19 in Lagos State on February 27.

The index case was an Italian citizen working in Nigeria, who returned from Milan, Italy. Unfortunately, the foreigner came in close contact with colleagues at work before his status was confirmed.

The Nigeria Centre for Disease Control (NCDC) has reported that  confirmed cases in the country had risen to 131 as of March 30, making President Muhammadu Buhari to sign the COVID-19 Regulations 2020 declaring the disease as a “dangerous infectious disease”. It is indeed time for sober reflection.

Though Nigeria managed the Ebola outbreak well, we were not really prepared for COVID-19. Nigeria has an existing health surveillance system established for eradication of Polio in 2012 for contact tracing, thus the level of management and escalation of surveillance at all entry points (land, air, water or rail) and the logistics involved should be well-coordinated.

The rapidity of implementation of actions, the observation of all primary and secondary contacts for signs of infection, the level of management and escalation of surveillance at all entry points to the country and the logistics involved are huge.

With the financial and logistic assistance received from the WHO, US Centre for Disease Control and Prevention, other international organisations and business moguls, there should be better coordination among the federal, state, local governments, and security services.

We have ample financial and material resources, as well as well-trained and experienced staff. More isolation wards should be immediately constructed alongside designated treatment facilities.

Vehicles and mobile phones, with specially adapted programmes, should be made available to aid real-time reporting as the investigations move forward. Other than increased surveillance at the country’s borders, the Nigerian government should also attempt to control the spread of the disease through an improvement in tracking, provision of appropriate health education to avert the mounting myths and misinformation about the pandemic, and teach the appropriate hygiene measures to adopt.

Since scientists do not seem to have a clear understanding of the virus’ behaviour, transmission rate, and the full extent of contagion, a coherent, coordinated, and credible policy response would provide the best chance at limiting the economic fallout. Such response should be large enough to reduce the effects of the pandemic, which has taught us that the world is a global village.

As a continent, African countries need to make adequate preparation and need to focus on the following.  Firstly, our healthcare and public health systems should be reinforced. At present, Nigeria has four doctors to 10,000 patients, which is abysmally low against the WHO recommendation of 1:1000.  Prevention, they say, is better and cheaper than cure.

State-of-the-art facilities should be provided at local government areas. Secondly, a prosperous country is measured based on the quality of its scientific research.

Nigerian tertiary and research institutions should be adequately funded to be able to do cutting edge research and address situations according to our needs. Thirdly, as the effect of the pandemic could still be seen in months to come, the Nigerian government should have generous palliative measures for its citizenry.

Fourthly, stakeholders in the education sector must show sincere concern and commitment at revitalising and repositioning the Nigerian education sector to stem the downward drift. Lastly, the importance of the media cannot be over-emphasised.

The media has the power to help protect the public by educating them and equipping them with the right knowledge to protect themselves and others. Sensationalising the situation will only make matters worse.

Coronaviruses are thought to be zoonotic and have been reported by a group of scientists from China as far back as 2007 as agents of emerging and re-emerging infections.

They have been implicated as the cause of pandemics before. This brings to fore the importance of the animal, human and environment interface.

Veterinarians and physicians have long dealt with many viral diseases in their daily routine, following parallel, but often non-convergent pathways.

What can make a difference is an integrated control, particularly for those of zoonotic concern.

This should be geared towards an effective management of these diseases by filling the gaps in communication between physicians and veterinarians to accelerate diagnosis, to expedite treatment decisions and the implementation of preventive measures at local, regional, and national levels.

It is gladdening that clinical trials of a COVID-19 vaccine are underway. Rigorous studies on our indigenous natural products should not be overlooked.

Nigeria has a rich flora, though, the vast array of available plants, which could serve as sources of novel drugs with possible new mechanisms of actions, have not been exploited.

A recent discussion with a public health colleague has brought to fore, the use of our indigenous herbs.

She and other medical colleagues drink a decoction of garlic, ginger, honey and turmeric during their breaktime to boost their immune systems.

Worthy of note are our health workers who are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infections such as exposure to the virus, long working hours, psychological distress, fatigue, occupational burnout, stigma, physical and psychological violence.

To our frontline workers, you remain our heroes and heroines. The Italian Prime Minister, Giuseppe Conte once observed that “… Our only hope remains in the sky”. Yes, that is where our hope truly lies – The Supreme Being – who can indeed save us!

Dr. Adenubi is of the College of Veterinary Medicine, Federal University of Agriculture, Abeokuta.

 

 

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