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COVID-19: Why Nigeria is discharging patients after 1 negative test

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As medical lab scientist says initial protocol was faulty

COVID-19: Why Nigeria is discharging patients after 1 negative test

By Chioma Obinna

Indications have emerged that the modification of the discharge protocol for COVID-19 patients who were admitted in isolation centres across the country may not be unconnected with a shortage of bed space as well as reagents for laboratory testing.

Last week, the Director-General of the NCDC, Dr. Chikwe Ihekweazu, had stated in Abuja during one of the daily briefings of the Presidential Task Force, PTF, on COVID-19 that COVID-19 patients were being discharged earlier than usual.

In his brief, Ihekweazu announced that the Agency had switched to discharging patients who test negative once as against the previous mandatory requirement of testing negative twice before discharge.

He said the decision was to enable the decongestion of some isolation centres. According to him,  the discharge criteria were

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changed from two tests  24 to 48 hours apart to a single negative test, claiming that the reason was that, most of the cases that tested negative also tested negative for the second time.  For him, there would be some exceptions.

But he also said: Given the pressure, we have on bed spaces especially in Lagos, Kano, and the FCT, we made a pragmatic decision to move to one negative test sufficient to discharge people.

Ihekweazu further claimed that new evidence shows that it is safe to discharge recovering COVID-19 patients even when the results are still positive.

According to him, new evidence is emerging that even when the test is still positive after that patient has been in care for a certain amount of time; it is possible and safe to discharge that patient to home isolation.

However, Good Health Weekly, gathered that Nigeria is being forced to make these changes due to a shortage of reagents and bed spaces.   For instance, in Lagos, despite the state having a good number of bed spaces, an increasing number of cases is gradually forcing the introduction of home management, according to the state Commissioner for Health, Prof Akin Abayomi.

Nigeria currently has about 3,500-bed spaces identified in isolation centres.  In Lagos, there are eight isolation centres with 547-bed spaces. Already, the state is struggling with bed spaces.

At the Gbagada Hospital, there are 118 beds; LUTH, 60; the Infectious Hospital  Yaba, 115; Onikan Stadium centre,  100;  Landmark centre,70;  Lekki centre, 45; Agidingbi centre, 34, and the First Cardiology Hospital has 5 where critically ill persons are treated.

However, with a total of 3,505 confirmed cases and only 738 discharged in Lagos state, health watchers fear that the health system may have been overwhelmed.   They also worry that the consideration of homecare may cause more harm than good.  Good Health Weekly, also report that states like Kano and the FCT are also struggling with bed space due to increasing positive cases in the areas.

The President of the Nigerian Medical Association, NMA, Dr Francis Faduyile, said Nigeria should be wary of adopting the WHO homecare management strategy as the country was already challenged in the area of housing.

The housing facilities in Nigeria make it almost impossible for someone to stay all alone in a house or in a room and this may affect home management, but it is left for the government to find the best way because certainly, it may be difficult to treat all the cases in an isolation centre due to paucity of bed spaces especially when many of them presented with mild or moderate symptoms.

Discharge criteria

Further investigation by Good Health Weekly revealed that another constraint is laboratory materials like the reagents.   Recently, the Lagos State Commissioner for Health, Prof Akin Abayomi disclosed that a COVID-19 test cost N40, 000 – N50, 000, and with the state government spending over N8 million on tests, the decision to limit the discharge criteria to one negative test may not be far-fetched.

A medical laboratory expert,  Dr. Casmier Ifeanyi faulted the process of testing for COVID-19 in Nigeria.  According to him, Nigeria failed abinition from on discharge criteria.

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Ifeanyi said for a country utilising the gold standard which is the real-time quantitative PCR, there was no need to waste the country’s resources on double testing before discharge.

He said Nigeria failed to allow Nigerian laboratory scientists to take over from start but rather allowed non-laboratory scientists to drive the entire process.

Many people who by virtue of training should not perform testing on humans took over, tests, interpret the outcome of such results as it applies to patient admittance, patient management, and patient treatment and eventual discharge.

When they were doing serial testing to determine positive and they were doing serial testing to determine discharge, they were wasting human resources, wasting exotic materials that are hard to come by the course of this pandemic.

“What we have adopted to use in Nigeria ever since the outbreak started and we commence intervention and testing of COVID in Nigeria, is the gold standard.  If you are using the gold standard it means, it is not it and it is not like it.  With real-time quantitative PCR which is the gold standard because you have taken the testing to see into the DNA of the causative agents. You are detecting the DNA of the causative agents.  So it is either the organism or the agent is there or it is not it at all.”

He said Nigeria is reviewing the criteria because the wrong persons have been giving an interpretation to the results and even to discharge patients. Ifeanyi regretted that because the NCDC was becoming resource-constrained and they are falling back in using one test to discharge patients.

“In the first place, the double testing was a waste of resources, they would have deployed the same to do more testing to identify more members of the community.

He urged the Director-General of the Nigeria Centre for Disease Control, CDC, Dr. Chikwe Ihekweazu to do more effective collaborations with the sister agency in the federal ministry of health, the Medical   Laboratory Council of Nigeria, MLSCN, to help Nigeria become top-notch in standard compliance of testing in molecular testing and interpretation as well as subsequent use in the management of the patient.

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