• Fear grips experts as cases soar by 1,000 per cent in 24 days
• Testing wobbling – Ifeanyi, lab scientist
• How community transmission worsens situation – Odubanjo, National Academy of Science Executive Secretary
By Chioma Obinna
Before the first 14 days of coronavirus lockdown was imposed on March 29, 2020, Nigeria had a total of 111 confirmed cases of the virus in 12 states with one death. Nearly seven days into the second round of the lockdown, however, the cases have continued to rise.
As of 2.00am of Friday, April 17, there have been 442 confirmed coronavirus cases (nearly 300% increase) and 13 deaths in Nigeria while 152 people have recovered after contracting COVID-19.
Experts, in separate interviews, blame the situation on the shift in the transmission of coronavirus from imported cases to community based cases just as they fear confirmed cases may soar further in weeks to come.
We may reach disastrous transmission level – Ifeanyi, top lab scientist
Dr Casmier Ifeanyi, a renowned laboratory scientist and molecular biology expert, is also the National Publicity Secretary of Association of Medical Laboratory Scientists of Nigeria, AMLSN, says coronavirus has binary fusion of transmission.
Going by the number of cases and the number of recoveries and death, would you say we are winning the war against coronavirus and flattening the curve?
To have won the war, we should have contained it and not allow it slide to community transmission. Having lost the opportunities we had to halt community-driven transmission, it won’t be scientifically said that we are flattening the curve. Professor Akin Abayomi, Lagos State Commissioner for Health, had, about two weeks ago, celebrated in one of his media briefings that the curve was flattening. No; the curve is not flattening because we get all our results in retrospect. Our laboratory test results for COVID-19 testing are turned-in in arrears. The value known today is actually what it was in minimum of five days before announcement.
The lag in the turn-around time of our testing is usually what it was 3-5 days ago. Even at that, we find out that positive cases have continued to increase by the day, so no one can claim scientifically that we are flattening the curve. If we continue to get positive cases, particularly in states where we didn’t have report before like Kano that had three cases but the number jumped to about 21 in 72 hours, certainly, we are not flattening the curve.
Why have we failed to flatten the curve?
We failed to judiciously utilize the window we had to stop the pandemic from sliding into community-driven transmissions from occurring. We are beginning to record community-driven transmission which means persons who had no history of foreign travel or history of contact with foreign travel returnees are testing positive. That is an evidence of community-driven infection. COVID-19 has a binary fusion of transmission; like from 2 to 4, 4 to 8, 8 to 16 and16 to 32, etc. So, any person who is discharging the virus and is within the community can, on daily basis, be multiplying them in a doubling fashion and sometimes it becomes geometric. The worry is how did we get to this point? We did not close the borders on time. When we were supposed to close them and even when we eventually closed them, we were still playing politics with the intervention processes.
The laboratory testing process and the politics is still on, and if we continue with the politics, we may never be able to flatten the curve and if community-driven infection gets entrenched in Nigeria it will very disastrous. We need all hands to be on deck.
That is why we were taken aback by the tweets from the Minister of Health, Dr. Osagie Ehanire, in which he balkanized medical and critical care health professionals. It is unfortunate that the minister has wrongly chosen to reduce medical and critical care health professionals to doctors, nurses and pharmacists only. What he has done is alien to standard care practice; the worry is that it is coming at an odd time.
Dr. Ehanire has no justification to have introduced discrimination, dissentious disharmony, and acrimony inherent in the Federal Ministry of Health against the much needed collective effort that is required to make sure we win the war against this pandemic. President Muhammadu Buhari and Nigerians should advise the Honourable Minister of Health to rescind his amorphous pact with doctors, nurses and pharmacists. It is reprehensible and at variance with the ethos of governance leadership and direction.
As a leader, every group whose professional input is required, including the janitors that clean the places where this service is going on, is critical. That is the practice across the globe, why the politics by the Minister of Health? It is the same politicization that destroyed the Nigerian health system. He’s doing more harm than the virus if not called to order speedily.
How did the transmission shift to community spread?
The Association of Medical Laboratory Scientists of Nigeria (AMLSN) commends those doing contact tracing, it has not been easy. Mostly medical laboratory scientists are involved in the contact tracing and so we understand the enormity of the task.
How it shifted? It shifted because of our attitude to data and information sharing. We failed to nip it in the bud until they had passed on the infection to our community, but, be that as it may, we can go on to evolve and implement other public health strategies that will help us deal with the issues of community-driven transmission. Those states that are claiming that they don’t have cases up until now, we can do active surveillance in those states.
There are public health strategies we can use in those states to make sure this virus does not spread there. But where it is already thriving, there are also things we can do. Like what the governor of Cross River State is doing. That is very commendable. He is dealing with things that ensure there is no community based transmission in his state; other governors should take a cue from what he has done.
How adequate are NCDC’s laboratory testing centres?
I want to applaud Dr Chikwe Iheakweazu, he has shown leadership and competence. He has been able to yield to the cry of medical laboratory scientists. When we started the war against COVID-19, we had only five labs, today we have up to 12 labs. But we are saying he should increase the number of laboratories in the South. He should build more centres in the South-East. There is one in Ebonyi, that is fine, but it is inadequate to serve the entire zone. In the South-South, we have one in Irrua and it cannot serve the entire South-South states.
We need to activate a lab or two in the South-South urgently. For NCDC to claim that they can test 1,500 daily, that is possible, but it is not currently happening. We can make that happen through aggressive sampling procedure.
What we need to do now is to train more medical laboratory scientists and deploy them to do sampling. I am happy to hear that NCDC said vehicles are available. So if we train medical laboratory scientists for sampling purposes, with some epidemiologists and they are deployed using these vehicles, the laboratories we have now will be amply filled with samples. That will really help us define the disease burden, particularly relating to community transmission.
The idea of testing for everyone is mission impossible. No country in the world has tested everyone, but every country has promoted massive testing. That is to say you are supposed to redefine your criteria. You are also supposed to come up with a protocol that makes test accessible to people when they want it. We must promote willingness to be tested. What has made our testing protocol biased is because we have limited it to those who have symptoms; we have to urgently review our criteria for testing so that more people can be tested.
And asymptomatic people can be identified. The danger and the real fuel for community transmission are the asymptomatic persons. They drive it because they share the infection without symptoms so you have no form of suspicion. Again, we need to up our game on hand hygiene. There is a lot of information out there being promoted aggressively, but the materials that will help promote hand hygiene, we may begin to consider the distribution of such materials.
The resources to test everyone are scarce and limited whereas the demand across the globe is high and the producers are no longer producing at optimal capacity now. It is making it very difficult to test everyone, but we can test more persons, particularly those who are willing to be tested and people who are asymptomatic.
Just like we did with the NAIS programme when we moved from house to house and people were tested, we can adopt the NAIS template to drive the issue of sampling and scaling up testing without literally insisting that every Nigerian be tested because we may not be able to afford to test 200 million people.
How close are we to getting a vaccine?
We are close to getting a vaccine but there is no short cut to the process of getting a vaccine. It will go through due process. I say it is close because the first human clinical trial for COVID-19 vaccine started about a week ago in some countries. There is none going on in Nigeria currently. Nigeria is import dependent. All the vaccines we use in the country are imported and that was not the case before. In the medical compound in Yaba, Lagos, we had a vaccine division. Vaccines were being produced there then, particularly yellow fever vaccine. WHO prequalified Nigeria to produce yellow fever vaccine that was used to combat yellow fever in the whole of West Africa. That laboratory was driven by medical lab scientists; some of them are still alive today. We have enough human resources to drive vaccine production but what has kept that from happening is politics. There is no political will on the part of government and there is politics of physician too.
Today, the vaccine laboratory is in comatose. I expect that President Muhammadu Buhari, who has done so well against COVID-19, to come up with a government policy driven by the Central Bank of Nigeria to fund vaccine production beyond COVID-19 on all the diseases bedevilling our people. We import all the vaccines we use for the routine vaccination of our children. We import all the vaccines we use for meningitis and yellow fever.
But before coronavirus vaccines come, we must take the responsibility and maintain hand hygiene. I know that social distancing has become a bit controversial but hand hygiene is what we can do without controversy.