Dakum: For Strict Implementation of COVID-19 Protocols, Govt Should Involve Community Gatekeepers

 Dr. Patrick Dakum is the Chief Executive Office of the Institute of Human Virology of Nigeria.

In this interview with Martins Ifijeh, he said Nigeria can defeat COVID-9 pandemic if all hands are on deck, including government’s involvement of community gatekeepers. Stressing that the use of facemasks, adherence to social and physical distancing, and avoidance of large gatherings can halt the spread of the virus. He also buttressed on IHVN’s role in addressing HIV and TB amidst the pandemic, and why immuno-compromised persons living with HIV must continue to use their antiretroviral drugs to reduce their viral loads. Excerpts:

Nigeria’s COVID-19 numbers are growing by the day. How can we stop community spread of this virus, especially as the country is gradually relaxing lockdown protocols?

I think the fact that community spread is now existing is a thing that has been established and by community spread we are talking about coming down with COVID-19 that they cannot point specifically to wherever they got it from, meaning that somehow somewhere they came in contact with the virus without knowing it and they picked the virus within their everyday lives. It means that we are on a situation that if care is not taken, we will be overwhelmed. Now the measures that are used for prevention of COVID-19 are time tested methods for infectious diseases especially respiratory diseases.

First of all, you don’t catch the virus just by touching somebody only. It is a droplet infection. By droplet, it means it comes from the respiratory tract either by breathing, by coughing or sneezing and then you take it into your own respiratory system or membranes of eyes, ears, nose or mouth, either by touch of your hand on a surface or by breathing it in. So, what do you do? We institute mechanisms for putting a barrier between the virus and human beings.

First of all, I think it should be clear that large gatherings portend danger because close contact is high. It means then that every state and every community must be wary about large gatherings in market, mosques, churches, festivals and parties. If those ones can be maintained as a no-go area for now, we have reduced that close contact. Market is extremely difficult because people will have to eat; churches and mosques are possible because they can be broken down into smaller units.

Next is that you have to come in contact with people so what do you do? The issue of face mask is something that we have talked about severally. Apparently, people are yet to get the fact that the use of face mask is extremely important as far as prevention is concerned. So, we must figure out a way to involve community gatekeepers to accept the idea. It is not normal. Let us not assume that we will throw face masks on them, ‘prevent this, wear this’ and they will go ahead and wear it, no.

They need to understand its importance. They need to believe this disease exists. People that will enable them believe are those they hold in high esteem in the communities. At IHVN, we have worked with community gate keepers in various programmes, either with our Orphans and Vulnerable Children programme, or our HIV programme, or our tuberculosis or malaria programme.

Let the leaders catch the vision, agree to put on face mask in a correct way and then people will follow. What will be our role? Our role as an institute will be promoting these in the communities that we are working with, and then in work places.

As people talk about communities, sometimes, they forget that even though your office and store and the little places you have are not a big spaces, it is also a place that people come in and out. People come, cough, and put their droplets on tables, rails, among others.

For our institute, the protocol is that as you arrive, whether you are the CEO, COO/MD or ED, you go and wash your hands with soap and water. The CEO cannot enter the building without a face mask. The security will not allow me in.

Secondly, the protocol also requires that as you are getting up from your desk, and you are visiting another office, you put on your face mask. In offices, there should be strict protocols. When I hear somebody is coming to my office, I quickly put on my face mask before the person enters. Offices must have protocols that work. Markets must have protocols that work. Community gatherings must have protocols that work.

In my church community now, we are having a meeting. Once they say that church must be reopened but here are the protocols, what do we do, we are looking at places and saying where do we put soap and water. What are the toilets like? We are also looking at the possibility of breaking down the services into four services so that in the event they say only 50 people or 100 people can gather and those 100 people must maintain social distancing. Our church, with social distancing of six feet apart can take up to maybe 250 or thereabout so it means then that we can only have a maximum of 250 and the congregation is like 800 so we will have just short one hour services with a one hour break for cleaners to disinfect places before the next service comes. So, community transmission is here and what the government by relaxing this lock down is telling you and I, is that our lives are in our hands, we either protect them or throw them off.

Many Nigerians do not adhere to NCDC protocol and some believe COVID-19 is not real. Yet, government is relaxing lockdown. Are we moving towards herd immunity?

On the long run, yes you can talk about herd immunity and that’s a very long shot. When I say long, I am talking about long in terms of years. To have immunity will require that 80 per cent of the people would have had the virus and developed anti bodies against it.

For vaccine, which is to develop mass immunity, we are yet to know when this will be out. Are we going to have a vaccine that will be long acting? Will it be like a flu shot that would only act for that season, and next season you need to get it again? Will it be something that will be administered easily, transported easily and made available? In terms of vaccine, I don’t think we would be talking about getting vaccine to the population of Nigeria anywhere less than the next two years. It means that that is also a long shot. So, we should be headed in the direction of personal protection or neighborhood protection rather than thinking about life immunity as the way out because that is still a long shot.

It’s easy to forget other areas of healthcare with COVID-19 being the major focus for now. For people living with HIV and TB, do you have measures to ensure they are not being neglected?

For IHVN, there are measures. We have a lot of measures that span around case detection and we are still working in the communities using all kinds of methods to ensure that we still go on with identifying people. We use patients themselves to reach out to others. We use community-based organisations for continued case detection. We use what we call key population to continue case detection in the COVID-19 era. The most important I think is that every patient that has TB or HIV still continues to get their drugs uninterrupted. We use all kinds of methods to get to them. Sometimes, we use the patients themselves to get to other patients. We are in partnership with the Network of People Living with AIDS and we are utilizing their people in the clinics, where they get their drugs. We also utilize what we call support group members meaning that I collect from five people within my support group.

How has COVID-19 pandemic affected treatment, care and support for people living with HIV in places where you have interventions, especially in Rivers State where you are the leading HIV implementation partner?

Initially, we had challenges with patients coming to pick up their drugs. But like I did say, we have been able to surmount that now by using their network and other methods to get to them.  We also had challenges of patients coming for their lab investigations but now we are beginning to get around that. So the challenge they have faced is, as a result of lockdown are addressed.

We understand IHVN is spearheading the public private sector partnership against TB and drug-resistant TB?  How much progress have you made in engaging the private sector?

We have done a lot in terms of reaching out to private sector and private not-for-profit. We work in partnership with several organisations, the CARITAS Foundation is our partner in supporting the TB interventions in the faith-based organisation, that is private, not-for-profit and then we do have the German Leprosy and TB Relief Agency and the Netherlands Leprosy Relief and four others that we utilize.

We also use our services directly in private sector hospitals. We have already set up the system with patients already being seen in some of these places. We are beginning to see about 10 to 15 per cent increase in total case detection in the country as contribution from the private sector as a result of the Global Fund support. Now we are moving into utilizing technology for the purpose of reporting. So that our reporting will be more error free and will be more real time. We have an app called MATS which will be deployed to the private sector healthcare providers so that real-time and online information can be obtained.

Last year, Nigerians celebrated reduction in HIV prevalence. What role did IHVN play on this, and what further plans are you putting in place to ensure the country comes down to the barest level of HIV burden?

We are involved in prevention, care and treatment. Right from 2004 with the University of Maryland, IHVN has been involved in prevention, care and support for HIV.  We started intervention in 23 states in Nigeria and then as a result of delineation by the funding agencies, we came down to four states. We are currently working as partners with USAID and we are scaling up in states, both in the North-east and also in the North-west. So cumulatively over the years, we have been part and parcel of the behavioral change communication strategies that have been developed in terms of policy.

When it comes to treatment, one of our signature contributions will be developing the capacity of healthcare workers in the detection and monitoring of HIV/AIDS through the laboratory infrastructure.

Over these several years, IHVN has been involved in providing treatment for almost 250,000 patients or close to 300,000. We have handed over some of the sites with the patients to other partners.  I think treatment is also prevention because if you are virally suppressed, you do not transmit the disease to another person. We have also contributed through research, which has contributed in knowledge and guiding the epidemic thus far.

We know those that are immune- compromised are more at risk of dying of COVID-19, are there special drugs people living with HIV are taking or can take to reduce the effect of COVID-19 in their system?

Not that I am aware of, but I do know that being immuno-compromised makes it worst for you and therefore, if you take your anti-retroviral medications as a HIV patient, your immune status is better and therefore, you are able to fight disease better. I think for any advice to the HIV community is to ensure viral load suppression amongst patients so that their immune status will be high enough for them to fight whatever comes their way.