COVID-19: Overcoming the challenge of community transmission

We have witnessed an exponential growth of COVID-19 infections lately and it has become a source of worry and pain for public health authorities and the rest of us. Coronavirus disease is a dangerous scourge and health challenge threatening everyone – it does not matter whether you live in urban or rural area. It is no longer news that COVID-19 has been declared as a public health emergency of international concern (PHEIC) by the World Health Organisation (WHO).

Apart from observing social distancing, washing your hands with soap and wearing face masks, now is the time for everyone to take responsibility and act appropriately to protect ourselves. It should be noted that for every infected case, there are many others who have not been diagnosed but may well be carrying the disease.

Ninety days after our first index case was recorded on February 27, 2020, we crossed the 10,000 milestone when 10,162 cases; 3,007 discharged and 287 deaths were reported. But barely four weeks later on Saturday June 27, over 13,000 cases were added to the existing tally thereby taking the total number of cases to 24,077 out of which 14,894 were discharged and 558 patients died. By June 13 (two weeks ago), 15,181 infected cases were reported; 4,891 discharged with 399 deaths based on information available at the Nigeria Centre for Disease Control (NCDC) website.

So far, only about 127,158 samples have been tested nationwide but can you believe that 779 new cases were recorded in 22 states and Abuja in one day on Saturday June 27? This is the highest single day tally so far. Community transmission, according to the health experts, is responsible for the spike and exponential growth of reported cases. This number will definitely go through the roof by the time we expand our testing capacity. At the outbreak of the disease, Nigeria had less than four test centres for COVID-19 but by the last count, we now have 39 molecular and gene-expert labs that have the capacity to independently test for COVID-19 disease. These testing centres include the recently activated gene-expert lab in Kaduna.

Last Friday, the Lagos State Commissioner for Health, Prof Akinola Abayomi, announced that the government had approved and accredited seven private labs to test for COVID-19 from this week. By the time you add these labs in Lagos, it means the testing centres would have increased to 46 but that is still like a drop in the ocean. As the community transmission increases, the number of fatalities is also rising.

Recently, the former governor of Oyo state, Senator Abiola Ajimobi — he was 70 years old — died as a result of complications arising from COVD-19. The Chief Judge of Kogi State, Nasir Ajanah, also reportedly died of COVID-19 disease at the Gwagwalada isolation centre in Abuja. May their souls and all the other faithful departed rest in peace. Unfortunately, so many people still believe the dreaded disease is scam even with the rising number of cases. For those still living in denial, they should understand that COVID-19 is real and deadly. The federal and state governments must therefore work hard to change this perception and earn the trust of the people.

When there is lack of trust in what government does, it creates doubt and credibility challenges. This problem has been with us for a long time – governments come and go without fulfilling their “social contract” with Nigerians. Due to widespread economic challenges, people worry more about their daily survival; vanishing job opportunities; how they will pay school fees and hospital bills. In a country where treasury looters are celebrated and decorated with chieftaincy titles as well as national honours, COVID-19 will be regarded just like any other disease. Most people are also scratching their heads to figure out how donations received in respect of COVID-19 relief fund are being utlised. From all indications, the political leadership needs to do something about the inherent trust deficit in their balance sheets.

In order to tackle the coronavirus disease, we need more isolation bed spaces. From available data, Lagos State has eight isolation centres with 547 bed spaces. The breakdown is as follows: Gbagada General Hospital has 118 bed spaces; LUTH (Lagos University Teaching Hospital) has 60 bed spaces; Infectious Diseases Hospital in Yaba has 115 bed spaces; Onikan Stadium Centre has 100 bed spaces; Landmark Centre has 70 bed spaces; Lekki Centre has 45 bed spaces; Agidingbi Centre has 34 bed spaces while First Cardiology Hospital in Ikoyi owned by Dr Adeyemi Johnson has 5 bed spaces for critical care.

Now let us examine the case of LUTH in Idi Araba. It is difficult to understand why LUTH, a federal government facility, has only 60 isolation bed spaces built in conjunction with the Lagos State government. At LUTH and other teaching hospitals in the country, there are nurses, house officers, resident doctors and consultants – these are some of the brightest minds you can find in the field of medicine but they are largely under-utilised at a time coronavirus disease is spreading like wild fire. With the number of healthcare professionals at LUTH, they should be busy with at least 1,000 isolation bed spaces. In the same vein, the Federal Medical Centre at Ebute Metta in Lagos can also be upgraded to have at least 200 isolation bed spaces.

Setting up isolation centres across the country was not a bad idea but we still have massive shortage of isolation bed spaces. The “brand new” isolation centres were unable to recruit enough medical personnel and the threat of incessant strikes also compounded the problem. The Presidential Task Force (PTF) on COVID-19 headed by Boss Mustapha, secretary to the government of the federation (SGF) and the health authorities, in my view, should also have considered improving and expanding the existing capacity in government hospitals nationwide to manage COVID-19 disease. The plan would have been for each hospital to have at least 200 isolation bed spaces. Additional healthcare workers, where necessary, could have been recruited to complement those already in the employ of the government owned hospitals.

Due to the contagious nature of COVID-19 disease, each hospital and isolation centre should have the capacity to handle a “Biosafety Level (BSL) Four Infectious Disease”, according to Dr Barth Ufoegbunam, chief medical director (CMD) of Grace Valley Medical Centre in Okota, Lagos and anchor of Health Matta, a weekly programme on WAP TV. Since there is still no cure or vaccine for COVID-19 disease, BSL is highly recommended to assess the risk categories of the disease. BSL is a set of bio-containment precautions required to isolate dangerous biological agents in an enclosed laboratory. The levels of containment range from the lowest biosafety level (BSL-1) to the highest level (BSL-4), according to information sourced from Wikipedia.

Private hospitals unarguably see about 70% of the population when they fall sick but they were sidelined from the treatment of COVID-19 patients. The Health Minister, Dr Osagie Ehanire, had repeatedly warned that no unaccredited private hospital should admit and treat COVID-19 cases; only First Cardiologist Hospital was given the exemption prior to now. Two additional private hospitals in Lagos have been accredited to handle coronavirus cases but they were not named by the Health Commissioner. In fact, NCDC had also issued a directive that any patient presenting COVID-19 symptoms should not visit their regular private hospitals — such patients are required to call their state NCDC hotlines and act on instructions thereof.

The Health Minister at one of their regular briefings also threatened that doctors who deliberately turned back patients from their hospitals on the suspicion that the patients may have COVID-19 disease would have their licenses withdrawn. By the way, doctors in private practice faced the dilemma of not knowing which patients presented COVID-19 symptoms. What were they supposed to do? It explained why some private hospitals in Lagos became compromised over COVID-19 – and they were forced to shut down until a de-contamination procedure was carried out.

According to Dr Ufoegbunam, a complete personal protective equipment cost between N25,000.00 and N30,000.00 and by the time a set of three units is procured for the medical doctor, nurse and lab attendant, the cost of treating a patient would be prohibitive. Can we therefore say COVID-19 is a “big man’s” disease? Surprisingly, COVID-19 symptoms are similar to the medical conditions of malaria and typhoid fever. Without the benefit of testing for COVID-19 in private hospitals, medical practitioners are expected to rely solely on having a high index of suspicion alongside their clinical judgement. This explains why private hospitals are the worst hit in terms of the number of infected health workers in Nigeria.

A good number of gene-expert test machines that were previously being used to test for tuberculosis have now been converted to test for COVID-19 infections in some government hospitals. According to Dr Chikwe Ihekweazu, Director General of NCDC, these machines will enhance testing capacity. With an expanded testing capacity, the increased number of infected cases will certainly increase but the implication is that our facilities would be overstretched.

In Lagos State which is the epicentre of the disease, we should, ideally, have at least 10,000 isolation bed spaces. As at the time of writing, the number of confirmed cases in Lagos was 10,026 with 8,370 patients on admission. Over 7,500 cases are “home based patients” because there are not enough isolation bed spaces. The exploding number of cases, it appears, is overwhelming the health authorities but our numbers are nowhere near what we have in South Africa that has tested over 1.5 million samples compared to Nigeria’s 127,158 as at last Saturday.

The biggest challenge at this time is managing home based patients because of insufficient bed spaces at the isolation centres. Prof Abayomi, the Lagos State Health Commissioner, announced about five weeks ago that guidelines would be released for “home-based” patients with “mild” COVID-19 disease. Up till now, the guidelines are still not out.

Home based COVID-19 patients, without proper guidance, will only end up spreading the disease to other family members and friends because they do not have any idea on how to treat themselves at home. The Lagos State government must maintain its good standing by being more pro-active and take responsibility in respect of home treatment of COVID-19 patients.

A case in point is the story of Anthony (not real name), a popular Nigerian singer and multi-talented entertainer – he was infected alongside two domestic staff recently. Anthony tried to self-isolate at home and treat himself but it did not work. His wife, who tested negative when her husband’s result was positive, was eventually infected. Their young daughter could not escape the virus attack – she also tested positive. Everyone in Anthony’s family is now infected by the virus.

NCDC says no one should be stigmatised because of COVID-19 disease. That’s fair enough but we must urgently confront the challenges facing us to improve our epidemiological situation. Until we are able to increase our testing capacity significantly; improve contact tracing and explain the treatment protocol for home-based patients, the community spread of COVID-19 will continue.

*Braimah is a public relations and marketing strategist based in Lagos

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