Musings on Coronavirus

BY IJEOMA NWOGWUGWU (BEHIND THE FIGURES)

So much has happened since the outbreak of the novel Coronavirus, labelled by scientist COVID-19 because of the year of its discovery in China five to six months ago. We have all watched in absolute horror as the disease spread like wild fire across the world. Not even the remotest outposts have been left unscathed by this rampaging pandemic. With about 1.22 million Coronavirus cases globally and over 66,000 untimely deaths caused by the disease, it has left the living subsisting in morbid fear, suspicious of any and everyone around them, stretched the best healthcare systems to breaking point, led to millions of job losses, catapulted billions into the poverty bracket, and pummelled the world into a recession. The Coronavirus pandemic is a crisis like no other in recorded history.

Nigeria has not been immune to the virus. Its leadership is struggling and flailing in a race against a virus that always appears to be 1,000 steps ahead of its pursuers attempting to put a lid on this pestilence. To be clear, let no one be deluded into thinking that it’s going to be a breeze beating this virus like we did the Ebola outbreak in 2014. The Ebola virus may be deadlier, but the Coronavirus is infinitely nimbler and more contagious. This puts the Nigerian government and the health authorities under immense pressure to learn immediately from other countries battered by the virus and at the same time adopt homegrown remedies that factor our socio-economic peculiarities. Essentially, the federal and state governments need to start thinking outside the box, always bearing in mind that there can be no one-size-fits-all approach to beating the virus.

This columnist may not be a medical practitioner or public sector administrator, but below are some suggestions that just might make common sense:

Funding for COVID-19

First, the federal and state government must as a matter of urgency restructure their 2020 budgets by diverting funding meant for capital expenditure to the healthcare sector. All tiers of government will need to stop acting like this is a walk in the park and temporarily abandon infrastructure projects. They must all focus completely on the health and well-being of Nigerians immediately. The federal government could also consider borrowing from the domestic sector if only the Central Bank of Nigeria can relax its rules barring individuals and companies from participating at its weekly OMO Auctions. Financial resources must be deployed like it’s a matter of life and death to hospitals, clinics and makeshift isolation centres springing up across the country.

More resources are also required for test laboratories in every state of the federation (possibly one in each senatorial zone), ventilators, healthcare workers, ad hoc personnel, protective suits, gloves and masks, among other medical supplies.

The only areas of infrastructure that can and should be funded are the utility sectors comprising power and water resources. Without electricity and pipe borne water necessary for keeping the hospitals and makeshift isolation centres functioning, the fight against the Coronavirus will be futile. Access to clean water, including the deployment of mobile toilets and mobile water dispensers to reduce open defecation, is also necessary to keep the environment clean and sanitized at all times.

Funding should also be provided to the National Orientation Agency and other not-for-profit organisations for education and enlightenment on the Coronavirus and the measures all Nigerians must observe to protect themselves against the disease and slowdown or stem its spread. Right now, there is this erroneous impression that the Coronavirus is a disease of the rich, just because it was imported initially by the upwardly mobile strata of the society. It is not; it is no respecter of anyone. Even though Ministry of Health claimed last Friday that it had increased testing to 1,500 cases daily, that number is minute relative to the number of asymptomatic COVID-19 super spreaders that may be carrying the disease and potentially infecting their families, colleagues, friends and secondary contacts. Today is exactly two weeks since international flights were barred from landing at the Lagos and Abuja international airports – the last two that were left open to passengers flying into the Nigeria from overseas, after the Enugu, Port Harcourt and Kano airports were closed. What this indicates is that there will be a drop in imported cases of the Coronavirus and an exponential growth in the community spread of the disease, hence the need for mobilisation and sensitisation on the threat posed by the virus nationwide.

This is no longer a joking matter! A perfect pointer to the gravity of the situation was a story published in the UK’s Daily Mail newspaper at the weekend. The news report stated that Germany and France were incandescent with rage after the United States had allegedly seized millions of masks that were to be shipped to the European nations from a Chinese manufacturer, amid the coronavirus crisis. Not only did the two countries accuse the US of “modern day piracy”, France was equally frustrated that the US had paid three times the going rate to secure the shipment of face masks from China that were due to be dispatched to France. Though the US denied the allegation, it showed how desperate countries have become as the virus ravages their citizens.

Preparing Hospitals and Clinics

It is apparent that Nigerian hospitals and clinics, as well as the personnel that work in them are unprepared for the Coronavirus from a professional and ethical point of view. The federal and state Ministries of Health must compel all hospitals and clinics operating in the 36 states and Abuja, including clinics in the 774 local government areas in the country, to isolate or cordon off sections of their clinics and hospitals to accommodate and cater to patients who walk in exhibiting COVID-19 symptoms so that they can be treated and tested.

Too many stories abound of medical personnel in hospitals who should be the frontline workers against the virus turning back suspected cases out of sheer ignorance and fear. Instead, they refer them to infectious disease hospitals and isolation centres set up to combat the disease that may be far flung and not within the reach of sick persons. This is unacceptable and only helps to facilitate the community spread of the Coronavirus. It also reinforces the case for the deployment of more funding for all hospitals and clinics so that they can be better equipped with medical supplies, even if it is to the barest minimum, to administer palliative medication to suspected cases while they await the results of tests for COVID-19.

Besides, by isolating or cordoning off a section or some rooms in hospitals and clinics, and assigning and preparing dedicated medical personnel to attend to suspected cases of COVID-19, this will help to reduce a lot of the apprehension among health workers, enable them to handle cases with mild symptoms of the disease, and lessen the burden on infectious disease and isolation centres that may be over-burdened with severe cases. Cordoning off sections will ensure that other departments in hospitals and clinics can continue to function and cater to patients with others ailments, especially for childbirth and maternal health issues.

Living in Denial

As of last week, the Nigeria Centre for Disease Control (NCDC) and health ministry had announced that 2,000 people had been tested for COVID-19, testing had gone up to 1,500 a day, but 6,000 persons were being traced having been in contact with persons that had tested positive for the disease. What this means is that even as Nigeria is ramping up its testing capabilities, the number of persons who have been in contact with those that have been infected is growing exponentially. Mind you, this number does not include persons that are outside the contact-tracing sphere of the health authorities, are carriers of the disease, but are asymptomatic. These are the super spreaders and they are infecting thousands more people. Then, there is the class of Nigerians who start to show symptoms but would rather remain in denial. Instead, they either self-medicate or go to hospitals to get treated for malaria, typhoid caused by the Salmonella bacteria or for the influenza virus, commonly known as the flu. All three ailments common to Nigeria, quite frankly, present similar symptoms to the Coronavirus.

The last class of suspected cases and super spreaders of COVID-19 are equally dangerous. While the super spreader will show no symptom, will have no reason to self-medicate or go to the hospital and cannot be entirely blamed for what he/she is ignorant about, ill patients who mistake the symptoms that they are presenting for malaria, typhoid and the flu will continue to spread it intentionally. Even when they are advised to self-quarantine and call the NCDC helplines to get tested, their immediate response is, “Coronavirus is not my portion.” What is worse is that the hospitals or clinics that such ill persons visit, typically test and treat the patients for malaria or typhoid, forgetting that 90% of persons that are not ill but resident in the tropics, where both diseases are prevalent, will test positive for the malaria parasite and salmonella bacteria in their blood stream. The added danger is that when hospitals test and treat for common maladies that typically afflict Nigerians (that is malaria, typhoid and the flu), while ignoring the possibility that they may be infected with the Coronavirus, not only are they helping the spread of COVID-19, they are also exposing their medical facilities and other patients to contamination.

A way out is for the Nigerian health authorities to expand the protocol for COVID-19 by ordering all persons who show malaria, typhoid or flu-like symptoms to self-quarantine along with their families for the same duration applicable to the Coronavirus, that is, 14 days. With respect to hospitals, clinics and pharmacies that dispense over-the-counter and prescription drugs for the treatment of these common maladies, their personnel should report all such cases to the NCDC and other infectious disease centres for monitoring and possible testing for cases where the illness persists.

Social Distancing and Lock Downs

Since the onset of COVID-19, social distancing and lock downs, as recommended by health authorities and scientists the world over, have been the hardest to achieve. It is a battle all countries are contending with and struggling to implement. I watched the daily briefing on the Corona pandemic given by Mr. Andrew Cuomo, the governor of the State of New York last week, where he lamented that social distancing was proving to be a tall order in the Boroughs of Queens, The Bronx and Brooklyn in New York city. According to him, all three boroughs had thousands and possibly millions of families living in one-room or two-room dwellings, rendering social distancing impossible.

If Cuomo is worried about the situation in one of the most advanced cities in the world, I wonder what he would have done if he was an African leader? Bringing it home, I also don’t know how social distancing can be achieved in Nigerian towns and cities where slums dot the landscape and relatively large families are forced to hurdle together in single rooms and share bathrooms and toilets, where clean water just to wash their hands and keep their surroundings clean is a pipedream, and where the regular mode of transportation is typified by cramped mini-buses, motorbikes, rickshaws and dilapidated taxis. If we must be honest, rural dwellers living in mud huts with thatched roofs but have more rooms at their disposal, are better off than slum dwellers in Nigerian cities.

As a solution, the ANAP Foundation Think Tank headed by Mr. Atedo Peterside is suggesting that where one-room dwellings are prevalent, the authorities should encourage the separation of the elderly who are more vulnerable in the event of COVID-19 infections from younger members of their families. This, the foundation recommends, will entail disparate families cooperating with one another. What the foundation is proposing is for, say, Family A to vacate their room but leave behind their aged relatives in that room and encourage other elderly relatives living with, say, Family B in another single room to move into the unit belonging to Family A. After vacating their single room, younger members of Family A will now move in to live with Family B younger family members in the single room vacated by their elderly relatives, and so on and so forth.

However, when Peterside was confronted with the impracticality of encouraging unrelated families to live together temporarily, his response put paid to any initial reservations. He asked: “When confronted with the choice of seeing thousands of people die because they want to hold on to their old living arrangements and seeing fewer die because of temporary living arrangements, which would you choose?” It was pretty obvious which of the choices, no matter how inconvenient, made sense. Another option will be to move the elderly to the rural areas. But that should never be contemplated by the authorities, as this could lead to the spread of COVID-19 to far-flung villages and hamlets that will be much more difficult to access.

Enforcing the lock down in many states, especially in congested parts of Lagos is also proving to be a tall order for the authorities. People who have to leave their homes daily to eke a living are afraid that keeping them indoors will render them completely destitute. This is a genuine concern that the Lagos State Government is attempting to address by distributing food packs to the impoverished. Sadly, this has been marred by its officials and politicians who are either diverting the food packs for their personal use, or where the food packs manage to get to the poor, utter chaos and mayhem ensures, effectively defeating the need for social distancing.

The government in Lagos State must address this problem urgently. It will have to work out measures to ensure that the palliatives it has rolled out for the poor reaches them, if they must keep them indoors. If the initiative fails, poor and hungry Lagosians will succumb to their primal instincts for survival by leaving their homes to look for food and money through any means possible, including resorting to looting and riots that will be difficult to contain. Equally important is the need for the authorities in Lagos to use megaphones in markets to educate traders and shoppers alike. Videos emerged at the weekend showing bustling, chaotic scenes at food markets in the state like it was business as usual. While it may be necessary to keep markets and shops selling food and other essential items open for limited periods, the state government must, through the market associations, maintain discipline and work with them to stem the spread of the virus. Should it explode, we will remain shuttered for much longer. I shudder to think of what a prolonged lock down will do to our psyche, mental well-being, and an already battered economy.

Optimizing Scarce Resources

Another area worth looking into is the need for all tiers of government and the health authorities to stem the waste of limited resources at their disposal needed to confront the Coronavirus. While not wishing the virus on anyone, it is disheartening to see top government functionaries and politicians such as the Central Bank of Nigeria governor Godwin Emefiele, Lagos State governor, Babajide Sanwo-Olu and his family, the Information Minister, Lai Mohammed, and Senator Musiliu Obanikoro announcing that they have tested negative for COVID-19.

If these scare and precious testing kits are being wasted on otherwise healthy-looking government functionaries and the rich, what will be left for ordinary Nigerians that need to be tested? As I write this, so many people trying to reach the COVID-19 helplines are not getting the attention that they need. If anyone in government feels that he/she may have come in contact with an infected person, the same NCDC protocol of self-quarantining for 14 days that applies to other Nigerians should also apply to them, period! During the period of self-quarantine, they can continue to work from home and run their offices. It is only when they start to show symptoms for COVID-19 that they should submit themselves for testing. Otherwise, the testing kits should be preserved for others that need them the most.

It is important to reiterate that this is not a time to be flippant and to start broadcasting the names of persons that have tested negative for COVID-19 like it is a badge of honour. When these same persons test negative for other diseases after medical check-ups, the public is kept in the dark. Accordingly, they should keep their COVID-19 negative status to themselves. The only persons that the public needs to be made aware of their health status, be it negative or positive, is the Nigerian president and his deputy.

The health authorities may also have to review the protocol for the admission of every person that tests positive for the Coronavirus as we run out of bed space in hospitals and isolation centres. As is evident, many persons, even the elderly such as The Prince of Wales, Prince Charles, was never hospitalized after he showed mild symptoms and tested positive for the disease. He self-isolated and recuperated at his Scottish retreat on the grounds of Balmoral Castle, but was never hospitalized. So did the UK Health Secretary Matt Hancock who tested positive but is now negative and is out and about; so is British Prime Minister Boris Johnson who is self-isolating and recovering at Number 10 Downing Street; so is CNN anchor Chris Cuomo who is self-isolating in the basement of his home in New York.

The reason many people with COVID-19 are self-isolating at home in Europe and the US instead of being treated in hospitals is because of the scarcity of bed space, ventilators and other medical supplies that are desperately needed to treat severe and critical cases afflicted by the disease. Knowing that 80% of COVID-19 cases will be mild, what the authorities in those countries are doing is encouraging people to self-isolate and take palliative medications to relieve and treat the symptoms that they are presenting. In the same breath, the Nigerian authorities may have to consider the same measure, seeing that quite a number of the confirmed cases in the country so far are mild. But this measure should only be contemplated if the number of confirmed cases in the country explodes to unmanageable proportions and the healthcare system is over-stretched.