Management Of COVID-19 In Nigeria: An Urgent Call For A Different Approach – Uko Nkole

The Global Coronavirus (COVID-19) Pandemic blindsided the whole world with the nature of its arrival and spread. The fact that the most advanced civilizations were not able to prevent its spread to their countries nor manage its effects bears testimony to just how unpredictable a scourge this is.

Till date, all efforts geared towards the virus have at best been crisis management and in worst instances, flailing without direction.

Nigeria, being a member of the global committee of nations, was also caught in the milieu of the effects of the pandemic. Inevitably, we registered our index COVID-19 case on the 27th of February, 2020 when an Italian National tested positive to the virus in Lagos after arrival from abroad aboard an international flight.

From February 27 till date (June 22, 2020), Nigeria has recorded a total of 20,244 cases of the Coronavirus, discharged 6,879 and lost 518 souls to the virus. A grim statistic by every ramification. It is also important to note that by June 18, 2020, Nigeria had tested 115,760 citizens placing our prevalence percentage at 17.5% of the population. Considering the population of Nigeria, this is a scary concept.

Another factor worthy of note is the high recovery rate and low death rate of the virus prevalence in Nigeria. Our numbers, though still grim, are still fair compared to what is happening in some Western countries where they are dying in the thousands everyday from Coronavirus.

At the onset of the virus, the Federal Government of Nigeria stepped in to manage the situation. The National Centre for Disease Control took centerstage as the Agency responsible for management of diseases in Nigeria. In addition, the Federal Ministry of Health also stepped in to direct proceedings while the President set up a Presidential Task Force chaired by the Secretary to the Government of the Federation, Boss Mustapha, to provide highest-level coordination on the management of the pandemic. State Governments, with Lagos State playing a critical role as the epicenter, have also taken different steps to manage the pandemic.
The coordinating Agencies and Task Force have since been providing guidelines on responses to the pandemic.

The NCDC prioritized Testing of contacts of infected persons and isolation of all positive persons. While there is yet no known certified cure for COVID-19, a combination of drugs has since been used on positive patients and we have recorded a high recovery and discharge rate in the country.

However, there has been an avoidable downside to the management of the pandemic. A lot of attention and publicity is given to the positive cases and isolation efforts but little is being done to humanize the recovery process. I posit that we have not taken full advantage of our high recovery rate from COVID.

What the concentration on contraction messaging over recovery messaging has done is that a lot of fear and myth has been built around the disease and inevitably, a stigma has been attached to it. The over-dramatisation of the isolation and quarantine process has scared people away from accepting when they have the disease and submitting to early testing and treatment.

A video is currently going viral where a young man is being bundled into a bus ostensibly by officials of the NCDC enroute an isolation facility in Ebonyi State. Reports abound of NCDC officials storming, Gestapo-style, the abode of those who test positive to whisk them to isolation centres. In Gombe State, those in isolation centres have been reported to take to the streets to protest their ‘detention’ under inhuman conditions.

It is my humble posit that the time has come for a different approach to the Coronavirus pandemic in Nigeria. We have established and we are all in agreement that the virus exists and is among us. We have taken steps to create awareness about preventive measures and ways to protect ourselves from catching it. Due to our astronomical infection rate, the time has come for more emphasis to be laid on recovering from COVID-19 rather than how not to catch it.

We have to accept the fact that the more people we test for COVID-19, the more positive results are going to come in. It is therefore surprising that after over 100 days of the outbreak of the COVID-19 pandemic in Nigeria, we are yet to have a test-centre in at least all the states of the federation.

I am proposing a situation where we have a test centre in every Federal Constituency in Nigeria at the very minimum so that test results can return faster to enable treatment and other necessary protocols to be commenced. We currently have a situation where it takes weeks and in some instances, months for Coronavirus test samples to return with a result after being transported to other states for analysis. This is both procedurally problematic and logistically unsafe.

We are also aware of the news making the rounds about a new strain of malaria which a lot of people are suffering from causing them to lose sense of taste and smell but without the other symptoms of COVID-19. Every indication points to the fact that these ailments are symptomatic of COVID-19 but because we are not testing people enough and we are not confirming results fast enough, people walk around with diverse ailments without proper diagnosis and treatment.

Added to all of this like I mentioned above, is the stigmatization of the COVID-19 situation. This is baffling and makes no sense. Health workers are treating all patients who present at hospitals as COVID-19 suspects and keeping them at arm’s length. There is also a palpable excitement and rush to label patients who present at hospitals as COVID-19 patients. Deaths within this period have attracted instant and undiagnosed labeling as COVID-19 deaths. This is shameful and unacceptable.

Before COVID-19, people were falling sick and dying. Why then is every ailment and death suddenly COVID-19 related? A young asthmatic patient was refused treatment at all hospitals she was rushed to when she came down with an asthma attack at night because it was assumed she had COVID-19. She died before help could be found. Occurrences like this abound nationwide.

I am therefore imploring the Presidential Task Force on COVID-19, the Federal Ministry of Health, the National Centre for Disease Control, CACOVID, etc to begin to concentrate effort on disease management and recovery rather than the over-emphasis on prevention and education.

We need to ramp up our testing capacity. We need to de-emphasise the isolation centre method of case-management which leads to stigmatization and ostracisation and begin to make public, the drugs that are currently being used to treat positive people so that people can access them on their own.

There may as yet be no certified cure for COVID-19 but those taken to isolation centres are given drugs to take for 14 days after which a series of tests are run until they are certified negative. We do not need to flood our isolation centres with people. Let people be aware of these drugs that are used at the isolation centres so that they can purchase them and manage the outcomes.

We need to activate all the PHC /Private health facilities in the 774 LGAs in Nigeria by urgently training and providing medical personnel to all the centres for the purpose of handling and treating ALL ill health cases as COVID 19 case while further evaluation can follow in a secondary facility on case basis.

I hasten to add that I am not promoting self-medication or self-help in the management of COVID-19. Far from it. To discourage self medication, the drugs in use for the management of COVID 19 cases should be distributed to Private/ PHCs to enable the rural populace access them free of charge. Given the fact that a lot of funds are available for the COVID-19 fight through donations from global organizations, public spirited individuals and corporate organizations, this is achievable. It is important to state here that 70% of the management drugs so far approved for trial by NAFDAC etc serves as both prophylactic and curative purposes while the others could be given based on further review by the relevant medical professionals.

We are not incapable of dealing with this problem. We have played leading roles in managing pandemics in time past within the continent. Our story with Ebola is still exemplary as even other countries are adopting our Ebola response strategy in the fight against COVID-19. We have what it takes to win this battle. We have what is needed to flatten the curve and reverse the high numbers we are clocking everyday but it is very important that we explore new strategies of tackling this challenge.

In essence, what I am advocating for is increased testing capabilities and democratization of the prophylactic and curative drug obtaining protocol. Relying on NCDC alone to certify people positive and insisting on hauling people to isolation centres will only promote a culture of stigma around the virus and lead to even more ‘sudden deaths’ due to unknown causes which can be avoided if the virus is de-stigmatised.

The current approach is simply not working fast enough to keep up with the evolution of the narrative around the virus. It has been over 100 days since we came up with the test and isolate method. The world is dynamic. The time has come for us to change approach and try something else to save our people from dying from preventable causes.

Hon. Nkole, a Town Planner, is the Member Representing Arochukwu/Ohafia Federal Constituency in the House of Representatives.