Disregard for social distancing, hand washing & respiratory hygiene major challenges
By Sola Ogundipe & Chioma Obinna
The exponential increase of COVID-19 cases in Lagos state is inevitable as Nigeria is now firmly in the community transmission stage of the coronavirus infection.
The steady rise in the number of confirmed COVID-19 cases in Lagos state shows that it remains the epicentre for a number of reasons.
Based on the comparatively large population, congestion and intricate land mass of Lagos, enforcement of the set of interventions put in place by the Federal government to ease the lockdown has remained a major challenge.
With an estimated population of about 21 million, the control of human activity in Lagos is daunting. Experts say human activity remains a major mobility through which COVID-19 is spread across boundaries.
Lagos has recorded more than 7,000 confirmed cases which is about 45 percent of the nation’s total. Available statistics showed that in just six days (8th-13th June), a total of 1,268 confirmed cases were recorded.
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According to the figures from the Nigerian Centre for Disease Control, NCDC, released on the 27th of May and 29th May, Lagos recorded a spike of 256 cases and 254 cases respectively. On the 30th of May and 11th of June, 378 and 345 cases were recorded respectively
The COVID-19 situation report for 13th of June released by the NCDC also showed there were 501 new confirmed cases out of which Lagos recorded 195 (38.9 per cent) of the total cases recorded in the country.
Cumulatively, Lagos recorded 7,035 confirmed cases put at 44.86 percent of the overall national total of 15,682 cases.
With 82 deaths (21.7 per cent) of the total fatalities recorded as of 13th of June, Lagos with 5,816 active cases (57.16 percent), had 1,137 (22.3 percent) patients that had recovered and were discharged.
Sadly, despite this exponential rise in the number of cases, Lagosians have thrown caution to the wind. Many do not believe that the disease exists and a common parlance among residents is that COVID-19 is a ‘scam’.
The fact that a significant number of residents in Lagos are not complying with the protocol for easing the lockdown has remained a challenge. There is no regard for the guidelines developed by the NCDC, to stop the spread of the virus across the country. Health watchers fear that the disregard for the guidelines is fueling the spread.
Findings by Good Health Weekly show that a significant number of the residents of Lagos are poor and live in the slums and informal settlements where the practice of self-isolation is an impossible task.
The treatment of infectious diseases is challenged by general lack of access to standard hospitals, healthcare services and other basic amenities such as potable water, toilets and sanitation facilities poses vulnerability of the residents to the worst of health crises.
The prescribed hand washing protocol is difficult to maintain as a result of the scarcity of water.
The fragile healthcare system in the state is reflected by the quality of the primary and secondary healthcare centres which lack the capacity to provide the level of essential health-care services required to effectively tackle the pandemic.
The protocol of keeping a safe distance in accordance with the protocol
As part of the response, the state government began a house-to-house search to identify suspected cases. the exercise, tagged the Community Active Case Search which ran in phases across the 20 Local Government Areas in the state.
As of the 5th of June, 2020, Lagos had carried out over 22, 000 COVID-19 tests. Even as the State ramps up testing capacity and more confirmed cases are emerging which, according to the state Commissioner for Health, Prof Akin Abayomi, is a reflection of the fact that COVID-19 is spreading within the community at a rate that is more than it can be managed.
Lagos now has capacity to perform 1,000 tests daily even as plans are afoot to raise the capacity to 2,000 – 3,000 per day.
“Lagos State has paid for over 20,000 extraction kits and has placed an order for another 20,000 in its bid to test at least 120,000 in the next 60 days.
“If we carry on with the rate of positive testing that we are obtaining, we’re going to run out of isolation beds in our established isolation facilities.
“Therefore, we are projecting. If we keep getting 150, 200 positives every day, in another two or three weeks, even though we’re opening new isolation centres all the time, in time, we’re going to run out of beds,” Abayomi declared.
In terms of testing capacity, Lagos is ahead of other states in the country, but with eight functional isolation centres, and a total installed capacity of 607 beds, health watchers say the State does not have enough bed capacity to cater for the spike in number of COVID-19 patients.
Three of the isolation centres are located at existing hospitals namely the Lagos University Teaching Hospital, LUTH with 120 beds; the Infectious Disease Hospital, IDH, Yaba (115) and Gbagada General Hospital (118). Others are the Mobolaji Johnson Centre, Onikan (100); Landmark Centre (70): Lekki Centre (45); Agidingbi Centre (34) and First Cardiology (5). The sate is also setting up centres in Badagry and Epe.
Investigations by Good Health Weekly revealed that all the isolation centres are currently operating at full capacity. However, as a stop-gap, the state has initiated home-based care for managing mild and asymptomatic patients to address the projected rise in number of cases.
Lagos has three molecular laboratories that have been designated as COVID-19 test centres. They are located at the Virology Laboratory of the LUTH, the Infectious Disease Hospital, IDH, Yaba, and the Nigeria Institute of Medical Research, NIMR, also in Yaba. In addition, there are 20 sample collection centres located in each of the 20 LGAs.
Compliance with the use of facemasks is less than optimal. From the markets, restaurants, supermarkets, motor parks, banks and other public places, the situation is the same. You find a cluster of people without a face mask and no regard for social distancing.
The State government is also not enforcing the policy on use of facemasks. During the lockdown in April, the State government announced plans to distribute one million branded facemasks but the masks many residents said they did not receive the masks.
Investigation revealed that many Lagosians are still carrying on as they did pre-COVID-19.
For instance, the adoption of hand hygiene through hand washing with soap and running water is still a hard sell.
In most shops, markets and other public places, hand washing their hands. Also, the market leaders are not enforcing the hand washing policy. Good Health Weekly also observed like before, the markets are still overcrowded without any signs of social distancing.
The situation is not different at the various banks even though security officials try to maintain some level of social distancing. But in most places, the large number of people is overwhelming.
The nonchalant attitude of members of the Nigerian Union of Road Transport Workers, NURTW, particularly, Commercial bus operators.
Findings show that despite the policy of maintaining social distancing in the commercial buses, many operators are not complying with the state policy.
The buses are still carrying the same number of passengers.
Commercial minibuses stipulated to carry seven passengers are still carrying 14 passengers. In most motor parks no provision for hand washing or hand sanitisers were made available as prescribed by the NCDC.
Worse still, no form of enforcement of the guidelines is in place in Lagos presently.
A medical laboratory expert, Dr. Casmir Ifeanyi, noted that health professionals are not as worried by the increase in a number of cases as the compliance rate with the protocol.
“We are worried about the compliance rate with non-pharmaceutical interventions of the use of nose masks to enforce respiratory protocol. What is the compliance rate for hand hygiene, and the use of hand sanitisers intermittently? What also is the physical distancing in gatherings?”
Ifeanyi also wondered if there was still compliance with the policy of a maximum of 20 persons in a gathering or to the second phase of the lockdown which stipulates that offices should not exceed 75 per cent of capacity.