By Chioma Obinna
Over one fifth of the world’s population has been under lockdown in the global fight against coronavirus, Nigeria inclusive. According to the Director General of the World Health Organisation, WHO, Tedros Adhanom Ghebreyesus, countries need to lock down their populations and the period used to attack and prevent the spread of coronavirus.
Countries that have put their citizens on lockdown include India, Italy, United States and France, but Italy, China and El Salvador have implemented the largest and most restrictive quarantines so far. Meanwhile, WHO Chair, Global Outbreak Alert and Response Network, Dale Fisher, said countries under lockdown should look to Singapore’s actions and efforts and replicate what the country has done.
Singapore has managed to stem catastrophic outbreaks that have occurred in other countries.
As of March 31, Singapore recorded a total of 879 cases of COVID-19 and three deaths.
Fisher outlined some of the measures Singapore has taken, including isolating and quarantining cases, contact tracing, identifying and isolating those in close contact with infected patients, and practicing social distancing.
Lagos, Ogun and Abuja are under total lockdown since Tuesday (six days ago) following a broadcast by President Muhammadu Buhari. In the broadcast, the President exempted medical workers, journalists who can prove they can’t work from home and a few others from the lockdown.
Sunday Vanguard spoke to health experts on the effectiveness of the lockdown.
To them, government has failed to properly implement the exercise.
Before the lockdown on Monday night, the number of confirmed coronavirus cases in the country was 135.
But since then, the cases have skyrocketed. As of Thursday night, the figures from the Nigerian Centre for Disease Control (NCDC) were 184 confirmed cases, 20 discharged and two deaths.
Leaving out Ogun for four days was a major compromise – Ifeanyi
A renowned medical laboratory scientist, Dr Casmir Ifeanyi, who noted that lockdown was one of the six pillars recommended by WHO to contain the pandemic, said leaving Ogun State out of the lockdown for four days was a major compromise.
Ifeanyi, who is also the National Publicity Secretary, Association of Medical Laboratory Scientists of Nigeria, AMSLN, explained that WHO recommended the six pillars nations are expected to expand and train their health force, yet Nigeria was yet to deploy public health workers effectively.
“Secondly, we are to implement a system that will help us find every suspected case at the community level.
“The NCDC Director General, Dr. Chikwe Iheakweazu, said one of the reasons they recommended the lockdown was to trace well over 5, 000 suspected cases in the communities.
“If the information he gave is anything to go by, you will know that any positive person in the community has a fashion of binary of infecting members of the community.
“That simply means that he needs to get five persons to infect another five persons who will meet another five persons and you will have about 25 and the 25 will meet another 25 persons.
“The third pillar is that we need to ramp up the production capacity and availability of testing.
“We have not effectively ramped up testing. As of Wednesday, we have up to seven laboratories. I am happy that they are listening to advice that they should ramp up the capacity of federal medical centres and teaching hospitals.
“With the coming on stream of two more labs (Abakaliki and Ibadan), I am personally fulfilled that our outcry has not fallen on deaf ears but I want them to do more.
“We have more than 70 teaching hospitals in Nigeria.
“The fourth one is that countries are expected to have facilities where patients will be treated.
“The fifth is to develop a clear plan and process to trace and quarantine contacts. That is where the lockdown fits in.
“The sixth is to refocus the whole government on suppressing and controlling COVID-19.
“Of these six pillars, if you limit yourself to one, you are just scoring one over six.
Impact of lockdown
“On how effective the lockdown has been, of course the lockdown will start in Ogun on (last) Friday, so letting Ogun loose compromises all the efforts in Lagos because of the closeness.
“In fact, more than 60 per cent of what happens in Lagos comes from Ogun.
“So, leaving out Ogun for four days to commence lockdown on Friday is a major compromise on all the measures taken in Lagos.
“We also have states that are close to Abuja like Niger. Close to 40 per cent of what happens in Abuja is determined by what happens in Suleja, Niger State.
“In equal measure, close to 60 per cent of what happens in Abuja in terms of human and vehicular movements comes from Nassarawa State, specifically Mararaba, and Masaka.
“This axis is not on lockdown. It was only yesterday evening (Wednesday) that Nassarawa state government imposed some sort of curfew around Maraba and Marsaka axis.
“Ordinarily, since we commenced the lockdown, those places have been loosed and activities have been on in the areas.
“The lockdown, because it is done in partial across the length and breadth of the country, is compromised and will not help the strategy to work.
“In Abuja, it was total the first day; although there was a protest, law enforcement agents were on top of their game and were quiet civil, but I learnt that in Lagos there was a sort of rascality.
“But because the lockdown came in as a fiat and was not thought through and undemocratic, it lacked the rudiments, the necessary legislative framework that will support and make it effective.
“If you violate this lockdown in France, you are made to pay a fine; if you renege on paying the fine, you are made to stay one year in prison.
“In Nigeria, it is a matter of the people versus the police. That is not how lockdowns are carried out at times like this.
“This is likened to the state of emergency. Our Constitution provides what government should do in a state of emergency but they never did that.
“It has not been very effective.
“In less than 24 hours, the Presidential Task Force reviewed the lockdown and broke it.
“They think they are being responsive but at least it should have been done three days into the lockdown.
“By so doing, you will be able to identify the flaws in the lockdown and review it and make it stronger and the process tolerable.
“They have gone around saying in four whole hours in a day, people can go out to buy foods.
“That was a major compromise because 10am to 2pm is a hub of activities, transactions across the globe.
“And that is the time you chose to relax the lockdown? My recommendation is that the Task Force should review the relaxation from 5pm to 7pm.
“The idea is that even if you have reason to stay out at that time, nightfall will force you back to your house.
“It will make the number that will come out very negligible but the number that will hit the roads between 10am and 2pm will be tremendous.
“I think our government is not thinking it through. It is only in Lagos that you have the real effect. Other states are lackadaisical; some of the states are still doing burial etc.
“The Presidential Task Force should review the timing towards dusk so that nightfall will force people to go back home.
“Since we now run the country by executive order, President Buhari should give order stipulating penalty for defaulters, the very punitive penalty for defaulters.
“If that is not put in place, we will continue to deal with levity and the worry is that what could claim 500 lives per day in France, if it hits Nigeria, will claim well over five million per day because of the non-existence health system.
“That is the worry”.
Asked why people are averse to lockdown, he answered, “In countries where you have a lockdown, what is government doing to take off the pressure from their people?
“Government is providing definite intervention and relief packages. In Nigeria, FCT, there was a show of shame when officials went to Kwali area council and say they were giving people N20, 000.
“One of the persons who collected N20, 000 meant for the poorest of the poor said he has two children in the university; the poorest of poor cannot have two children in the university.
“The second person that spoke after collecting N20, 000 told us that he is an agricultural produce merchant; so, for me, it is a window for looting that has opened up.
“There is no organised process of delivering lockdown relief. The one in Lagos, I saw it in a Bagco sac, a miserable one kilogram of rice. A family of six, what kind of relief is Lagos State government giving them?
“We hear N100 billion has been donated. If that is judiciously applied, it will be used to provide food and water and probably medicament, that is exactly why people want to go out”.
We need effective palliative measures —Aliyu, NARD President
The President, Nigerian Association of Resident Doctors, NARD, Dr. Sokomba Aliyu, who also expressed concern over reports of substantial non-compliance to lockdown in some parts of the country, argued that to have impactful exercise, effective means of implementing palliative measure must be fashioned out.
“Lockdown appears to be the only option government has to contain the spread of COVID-19 in Nigeria because our health system does not have the capacity to contain the disease should there be sustained community transmission”, Aliyu said.
“It is worrisome that there are reports of substantial non-compliance which will not augur well for the control plan”.
“As distasteful as this may sound, it is practically difficult for the over 50 per cent extremely poor Nigerians, living on the bottom rungs of the income ladder, and surviving on less than $1 a day, to sustain the compliance with the lockdown as they have to go out to get what to eat, lest they die from hunger before coronavirus gets to kill them.
“I think before the lockdown can be effectively implemented, more work needs to be done to fashion out efficient and effective means of implementing palliative measures to cushion the economic shocks that come with lockdown.”
The NARD official listed measures for the containment of the disease to include intensified awareness campaign to more Nigerians on what the disease is, the seriousness and the consequence of community transmission of the disease and synergy of all stakeholders in the fight against the outbreak.
“Government can put in place a ready health system composed of well-motivated and protected workforce whose lives are insured, make available relevant and adequate personal protective equipment beyond the newspaper provision for early, prompt and effective response to the outbreak”, he said.
“And lastly, we must ensure realistic and effective palliatives to serve as succour to the citizens as they comply with the lockdown directive”.
The coordinated palliative measures we need – Ogbonna, NUAHP President
On his part, the National President, Nigerian Union of Allied Health Professionals, NUAHP, Dr Obinna Ogbonna, who noted that the lockdown in principle was a welcome development, said the exercise was designed to curb the spread of the virus since it is transmitted through human to human.
“People should understand that the fewer the contacts we have, the lesser the spread and, with time, it would be contained”, he said.
“It has an impact socially, economically, particularly on the poor masses, but, nationally and internationally, the lockdown has a negative ripple and vicious effect on the economy as evidenced by the drastic decrease in oil price ($20 per barrel).
“Surely, lockdown is the way to go. However, coordinated palliative measures should be put in place to reach the masses at the urban and rural enclaves. “This could have been easily achieved if we have a national database for all Nigerians. If it’s available this could be explored.
“Secondly, government could adopt Biometric Verification Number, BVN, as a tool to send cash or palliative to those who are seriously affected.
“As good as that sounds, there are many Nigerians without Biometric Verification Number.
“Again, government should increase the number of laboratories for COVID-19 testing across the country; as we speak now, none is in the North-West and North-East.
“Then more testing kits should be sourced though expensive but very necessary now.
“Incentives and motivational provisions (life insurance packages etc) should be implemented for all health workers in the frontline of this disease control. “Government was right to invoke the lockdown as enshrined in the Constitution concerning the outbreak of diseases that are pandemic in their presentation.
“With the COVID-19 law just enacted, government is doubly empowered to pronounce total lockdown if the need arises to curb further spread of this deadly disease”.
Why there is rapid rise in virus cases —Enabulele, CMA President
In his reaction, the President, Commonwealth Medical Association, Dr Osahon Enabulele, who said it was too early to assess the impact of the lockdown, stated: “The rapid rise in the number of cases shows lockdown was being explored to conduct more effective and targeted tracking and testing of affected individuals, including secondary contacts despite the impact on the socio-economic and cultural life of the people.
“But it is only a temporary measure and for the good of the country. I expect Nigerians to cooperate with government to achieve the strategic objectives of the lockdown.
Importance of lockdown
“Lockdown is not what you implement without a purpose or strategic objectives. It is really meant to be strategic and purposeful.
“It serves to create an opportunity for a more effective interruption of possible community spread, effective contact tracing, isolation and mopping up of primary cases and their secondary contacts.
“This is especially so as a lot of individuals, who recently returned from overseas trips before Nigeria’s borders and international airports were closed, and who, unfortunately, were not screened at the various points of entry into Nigeria, may have travelled around the country, interacting with various population groups, with the enhancement of community transmission of the virus. “The same applies to high profile individuals who returned from overseas trips, including a history of travel to high-risk countries, and were reported to have irresponsibly refused being screened for COVID-19 at the points of entry into Nigeria.
“However, I wish to commend the Federal Government for finally implementing this courageous containment measure, along with other announced measures.
“I also sincerely commend the efforts of some state governments, particularly the proactive responses of the Lagos State government, as well as the Federal Ministry of Health and its agencies and other contributions of non-state actors among others.
“As a matter of fact, there ought to have been a prior period of intense sensitization and preparation of Nigerians for the various possible measures that may be taken to contain the spread of the virus, including a public lockdown.
“But now that it has been imposed, I expect government at federal and state levels to actualize the various promises to cushion the pains of the people through practical and urgent implementation of the various socio-economic relief packages, while also ensuring adequate security measures are in place.
“Yes, this is commendable and a good indicator of progress. After my physical assessment visit to the Infectious Disease Hospital at Yaba, Lagos, on Thursday, March 19, 2020, I had publicly appreciated the commendable management protocol put in place at the hospital.
“I was happy with their professional management of the COVID-19 patients, despite very evident resource challenges. “So, I am not surprised. However, in addition to advising on the need to fill the resource gaps, I call on them to conduct randomized control trials to generate scientific evidence for the successes so far recorded.
“The rest of the world may have something to learn from the centre”.