•Low tests per population; just 5,000 of Nigeria’s near-200 million tested so far
•NCDC’s lines often don’t connect; samples not taken for days
•Only symptomatic patients being tested; aggressive testing needed – Tomori
•How we define cases, by Ihekweazu, says testing capacity being increased
•It is not good enough that we are not testing as many as possible — NMA
•S-Africa carries out 75,000 tests; Ghana 37,400; Egypt 25,000 tests; Nigeria 5,000
By Sola Ogundipe, Health Editor & Chioma Obinna
LAGOS — With a rapidly growing number of confirmed COVID-19 cases across the country, experts have expressed concern over what they described as slow pace of laboratory testing, and response by the Nigerian Centre for Disease Control, NCDC.
Since the onset of the recent pandemic outbreak, some Nigerians have taken to social media to complain about not being able to get tested by the NCDC after several calls to the designated emergency numbers provided by the centre.
Among those concerned about the low testing rate in the country is the Nigerian Medical Association, NMA.
There have been allegations of cases degenerating into complications before the agency’s team shows up.
For instance, Nigeria with over 200 million people has, according to Worldometer data, tested only about 5,000 people, recording over 300 cases with 10 deaths.
In comparison, South Africa, with a population of 59.3 million, recorded more than 2,000 confirmed cases with 25 confirmed deaths, and has carried out about 75,000 tests equating 1,265 tests per million population.
Similarly, Ghana, with a population of 31 million, has recorded 408 confirmed cases and eight deaths from conducting 37,400 tests, while Egypt with population of 102 million has recorded 1,939 confirmed cases and 146 deaths after it conducted 25,000 tests, averaging 244 tests per million population.
Also from the data, Brazil, with a population of 212 million, has confirmed 21,000 cases and 1,144 deaths from 63,000 tests corresponding to 296 tests per million population; the USA with a population of 331 million, has confirmed 535,600 cases and 21, 400 deaths from 2.7 million tests corresponding to 8,200 tests per million population and Spain with a population of 46.7 million has confirmed 166,000 cases and 16,980 deaths from 355,000 tests corresponding to 7,593 tests per million population.
Many other Nigerians who shared their experiences with Vanguard, stated that even after they contacted the NCDC that they were manifesting symptoms of the virus, the agency often tells them to self-isolate.
Several Nigerians are urging the agency to extend testing to non-symptomatic persons who might also be carrying the virus but wish to be tested.
There are also numerous claims that most times, the designated telephone numbers do not connect.
A case in point is the recent complaint contained in a press statement currently being circulated on social media by St Joseph’s Hospital, Adazi-Anukwu over a patient admitted and discharged from one of its facilities, Dr Joe Nwiloh Heart Centre.
According to the hospital, despite its timely high index suspicion of the patient admitted Tuesday April 7, 2020, officials of NCDC never showed until the management, after waiting for 16 hours, decided to send a delegation to the office of the Chief Medical Director, Amaku University Teaching Hospital, Awka.
CMD’s intervention got NCDC to come
In the letter, signed by the hospital’s administrator, Jerome N. Okafor, the hospital also alleged that it took the intervention of the teaching hospital’s Chief Medical Director for NCDC to send their people to take the patient’s sample for testing and to transfer him to a government-designated isolation centre.
“The team said the result will be ready within 48 hours. After 48 hours, the medical team delegated to follow up the case began to call the NCDC office. All they could get after several phone calls is a verbal report that the index patient is positive.
“Up till now, the hospital administration has not received any official report of the result of the test. What we have today all over the media is that St. Joseph’s Hospital has a patient with COVID-19. What is the motive behind this? It is certainly not in the interest of the common people that the hospital serves nor that of the patient,” the hospital lamented.
When NCDC was not forthcoming, the patient was discharged by the hospital. This is just one of the many gaps in NCDC medical laboratory test coordination.
NCDC took 2 weeks to take samples
A relation of a patient who does not want his name in print, told Vanguard that it took NCDC two weeks to take samples from his brother’s wife, even when they told them that the woman was already manifesting the symptoms.
“It was a nightmare for all of us, hoping every day that NCDC will come. We were all worried because my brother’s wife came from the UK after a two-week conference. We called and we prayed until finally they showed up. The slow pace at which NCDC works can ruin efforts to contain this outbreak,” he stated.
Commissioner intervened before NCDC
Another returnee told Vanguard that it is was not easy for her to get NCDC team.
According to her, the first time she called the NCDC line they responded and demanded for her address which she gave. It took the intervention of a commissioner before they could come.
“I have been calling them, they never responded but the first time I called they picked and promised to come. When they did not come after one week, I was forced to call the state health commissioner. It took the commissioner’s intervention for them to come. The arrangement is not good for some Nigerians who have nobody in government.”
Low tests per population
According to its guidelines, the NCDC currently focuses testing only symptomatic and high risk individuals.
However, experts note that while these categories should be priority for testing, other categories should be included.
We’re not testing as many as possible —NMA
Reacting to this last night, president of Nigerian Medical Association, NMA, Dr. Franci Faduyile, said: Another area that they (NCDC) are not doing as expected is the testing. Our efforts to contain the disease as given by the government is this lockdown and social distancing.
‘’It is not good enough that we are not testing as many as possible. We are surprised that up till now, we are still having very low number of cases that have been tested, even compared to Ghana.
‘’We are far behind them and South Africa. The onus is the NCDC to ensure that we test properly and get as many as possible tested.
‘’The test cannot ruin the containment efforts because if we do not do any test and everybody stays at home, and we do not mingle, we will stop the transmission of the virus.
‘’However, it is best if we have people who have tested so that we can get those who are positive quarantined and they can be treated in a separate place.
‘’But even if they are positive and they do not mingle with other people they will not transmit the disease.
‘’While I agree that we cannot test the general populace, anybody who had contact should be tested so that we can also be able to treat these asymptomatic carriers and stop them from transmitting the virus.’’
Aggressive testing needed – Tomori
Reacting to the present state of affairs in NCDC, a renowned virologist and former President of Nigerian Academic of Science, NAS, Professor Oyewale Tomori, said a lot remained to be done to get Nigeria out of the woods.
“On COVID-19, Nigeria must get on with more aggressive testing to include all symptomatic and asymptomatic contacts of positive cases. Only then can we truly know the magnitude of the COVID-19 problem and better prepare to prevent the looming catastrophe.
“We are tied to the apron strings of foreign donors for reagents and kits. We must, with local resources, set ourselves free from this dependency and introduce approved COVID-19 tests and kits to the hundreds of labs with GeneXpert machines and facilities found all over Nigeria,” he stated.
We’re steadily increasing testing capacity – NCDC
Responding, however, the NCDC said the Federal Ministry of Health had been steadily increasing testing capacity in Nigeria.
“Testing strategies have differed across the African continent, with different approaches used to determine who to test. Many countries have been challenged in their testing capacity and the approach adopted for the COVID-19 testing has been driven by the resources and testing commodities available to the country.
“There are currently 11 laboratories in Nigeria carrying out the tests for COVID-19. The increased laboratory capacity will enable more tests to be carried out daily and in the coming weeks. Further, new molecular laboratories will be opened in Kano, Kaduna, Sokoto, Maiduguri, Jos and Port Harcourt with the capacity to diagnose COVID-19. This will help to increase the number of daily tests that can be carried out in the country.
“The testing criteria adopted by the Ministry of Health in Nigeria has been targeted and prioritised certain groups who exhibit the symptoms for COVID-19 or have a travel history. The NCDC case definition offers a standard-criteria used to classify the clinical features to determine who to test for COVID-19.”
In the views of the Director General of NCDC, Dr Chikwe Ihekweazu, there is increasing demand for medical equipment, laboratory reagents, personal protective equipment and other response commodities across the world. This is rising with the increase in cases in more countries.
“As the demand rises, supply is affected. With leadership from the Minister of Health and Presidential Task Force, we are working very hard to ensure that we have the required supplies in our treatment centres and laboratories,” he said.
How we define cases, by Ihekweazu
Commenting on the case definition, Ihekweazu said: “We have expanded our case definition to enhance the response to the disease”.
“The following criteria of people meet the current case definition for COVID-19 testing: •Anyone with a travel history outside Nigeria, who presents with a fever, cough or
breathing difficulties within 14 days of arrival;
- Anyone who has symptoms and is a contact with a confirmed case;
- Anyone with fever and either cough, difficulty in breathing or shortness of breath in an area of high COVID-19 prevalence in Nigeria with no other explanation.”
He said there is an increasing push for alternatives to the current Polymerase Chain Reaction (PCR) technique carried out in molecular laboratories to test for COVID-19, such as Rapid Diagnostic Tests (RDTs).
‘NCDC still falling short’
Also reacting, Dr Casmir Ifeanyi, a laboratory scientist with skills in molecular biology, said: “While we commend the DG of NCDC for bringing expertise to bear, he has been able to give his all since the outbreak started.
“However, I don’t think he has been able to do all that is required in the circumstance. Following all the agitation for more testing, he was able to scale up from 5 to 10 labs, the zeal with which he has used to scale up laboratories, we have what it takes to test more people than just the 5000 they have put out in their website.
“This evening, the national coordinator PTF COVID-19, said they have just tested a little above 3,000.
Give and take, that means we have not done more than 5,000 cases or about 3,000. The point we need to make is that we have the requisite human resource . Following this outbreak, the association of medical laboratory scientists sent out a call to our members who have skills and competences in diagnostic molecular biology, who has bias for PCR testing and skills and we got a total of 170 responses.
“These include skills with masters, PhD and professors in this particular skill. It also included persons who have behind the PEPFAR-assisted HIV programme in Nigeria and all the HIV interventions were running on real time PCR testing, particularly for viral load estimation. And were also made up of people who were behind the 700 GeneXpert machine for TB control programme.
“So, in-country, we have people who have the requisite experience to provide the human resource and they must discuss and the Association must also be given the caveat that if NCDC takes all the 170 to unskilled laboratories, the Association will continue to pay their allowances.
‘’It is not a cost to the NCDC, we do not know why up till now the NCDC has not acknowledged receipt of that mail. They are yet to acknowledge it, they are yet to profile these people, and we are sure it is with them.”