By Gbolahan Diyaolu

SUCCINCTLY put by the late Chinua Achebe: “Things fall apart; the centre cannot hold. Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere the ceremony of innocence is lost. The best lack all conviction, while the worst are filled with passionate intensity.”

Coronavirus is here and the world will never be the same again. This is the recalibration of the world order. Let’s put it in an historical context. Every century or so, it looks like the world gets besieged with one calamity starting from the plague, through the Spanish influenza episodes and now coronavirus. What is coronavirus? These are viruses that affect the upper respiratory tracts (nose, throat and lungs).

COVID-19 is a ribonucleic acid, RNA, virus with a lipid outer surface that is easily destroyed with heat, any high alcoholic content solvents or any solvent with sodium hypochlorite as its main ingredient. COVID-19 is a novel virus that originated from bats that jumped to humans. It is very infectious with average mortality rate hovering around three per cent now. It is called COVID-19 because it was discovered in 2019.

COVID-19 is a self-limiting virus that will last, from infection to spontaneous remission, about 21 days. To date, 90 per cent of infected persons will spontaneously go into remission within 14 to 21 days. The remaining 10 per cent have varied symptoms ranging from cough, scratchy throats to more severe symptoms like low oxygen saturation (hypoxia); acute respiratory distress syndrome, ARDS; cardiac arrest, total organ failure and death.

It tends to affect more males than females, over 65 years than under. High incidence is seen in lower socio-economic individuals, probably due to more exposure to infected individuals. The increased mortality is seen more with individuals with co-morbidity with hypertension, obesity and diabetes. The virus resides predominantly in the upper respiratory tract of both asymptomatic and symptomatic patients. The transmission of the disease is by aerosol droplets from a carrier. These droplets, as currently postulated, can last on surfaces for as long as six days in some geographical areas.

Now, let us bring it home. To date, in Nigeria, majority of the infected individuals is by close contact. Very few documented cases of community acquired infection have been reported to date.  It is possible that the low number of community infection is due to our geographical location. The question now remains: is it a tropical disease? The answer is not known yet. One explanation may be the theoretical possibility that these aerosol droplets’ life expectancy is very short in the sub-Sahara region, thereby limiting the community transmission rate.

The other possible explanation is that the lockdown is effective. Nevertheless, the Nigeria Centre for Disease Control, NCDC, needs to conduct its research to determine the veracity of the above. There is a trend though,  albeit anecdotal in nature. The rate and extent of infection in places like California, Nevada, Florida, Arizona to name a few, is far less from expected cases.

So, what to do? As it is, saying that we have a fragile economy will be an understatement of the century. The continuous lock down is getting to be unsustainable, and if care is not exercised,  we may never recover. Japan just went through what is termed the lost decade, we should be prepared for the lost century without a comprehensive plan to get back our economy. In Nigeria,  we lack the business infrastructures other first world countries have.

According to statistics, less than 20 per cent of the population has N25,000 or more in their bank accounts. Over 50 per cent of our young adults are dependent on daily wages. With the above statistics, how long can we go without seeing unintended consequences? We have to ease ourselves back to circulation. We need a Nigerian solution. The proverbial wheel has been invented but we can tweak it to work for us. No more one size fits all solution.

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The principle to adopt is test, trace, isolate and treat in that order. National testing for antibodies (IgG and IgM) is a must prior to reopening the economy. This is the only test that shows real extent of exposure. This will identify all who have been exposed to the virus and thus have developed sufficient immunity to prevent reinfection. These individuals can resume work immediately. This should be performed by individual companies.

The banking industry needs to lead the way. Without the banking industry and other financial institutions going on line first, post-COVID-19 economic recovery is virtually impossible. We cannot wait for expensive machines from abroad, specifically US brands to be perfected, before we re-open our economy.

Furthermore, we are devoid of infrastructure to effectively use such machines in a cost-effective manner, to service the country at large. Such thought process is cost prohibitive. We will forever depend on the manufacturer not only for machines but test kits and solutions. It will be more prudent and cost-effective to tailor the testing to our infrastructure.

This is the time NCDC should think outside the box. We, as a nation, have to stop being intellectually lazy by always regurgitating solutions from abroad. The makers are US companies and will favour the usage of their products. This, in turn, helps their country’s economy to recover faster, help their citizenry; while our country is mired in abject poverty. Diversification is the key to a successful economy.

Ideally, we should be able to use home grown products but in the absence of that, a more cost effective alternative is next. There are cheaper 15 to 20-minute blood or serum COVID-19 test kits that are 93 per cent accurate. The usage of these test kits should be the preferred option for our country. These test kits are currently in use in South Korea,  Singapore, China and Germany. These test kits have CE certification.

If properly stored, and directions followed, they are good alternatives. As mentioned above, individuals with positive antibody test can return to work with little or no encumbrances. Negative individuals should subsequently have diagnostic test performed. All negative diagnostic individuals also can return to work safety, but should continue to maintain proper hygiene and social distances from customers. Everyone that tested positive should continue isolation and or treatment based on symptoms and return to duty after positive antibodies test.

The followings are other measures to adopt as we transition into the new normal of post COVID-19.

1. All work places including ventilation and air conditioner ducts should be disinfected properly as recommended by WHO standards.
2. The government can provide assistance to companies as warranted.
3. Treatment should be triage based.
4. All businesses should screen customers before entering the establishment.
5. All public places should be disinfected.
6. Social distances should be maintained until we all seroconvert or availability of vaccines.

It will take 12 more months to have an effective vaccine to protect all, but Nigeria cannot wait. Action is needed now to effectively transitioned into this new world order.

 Dr. Diyaolu is an Adjunct Professor of Clinical Practice at Massachusetts College of Pharmacy University.

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