By Shola Ogiundipe

The Italian national, aka the COVID-19 index case or Patient Zero, will for long be remembered whenever discussion centres on the disease which broke out late December in Wuhan City, China. The Italian, whose country is one of the worst hit by the outbreak in Europe, arrived on February 24th on a Turkish Airlines flight that had a connection in Istanbul.

After spending the night in a hotel near the airport, he went on the next day to his place of work in neighboring Ogun state, and stayed there until he developed a fever and body aches on the afternoon of February 26th.
Barely 48 hours after he stepped on Nigerian soil, the Italian’s status transformed from obscurity to VIP. For obvious reasons, in the last week, his health and welfare have been major concern of health authorities and the entire Nigerian populace.

At every opportunity, the Minister for Health, Dr. Ehanire Osagie, and Lagos State Commissioner for Health, Prof Akin Abayomi, assured Nigerians the patient was doing fine. “The index case is doing fine. We started a new treatment on him two days ago which he is responding to. He is comfortable although lonely because he is alone in the isolation room of 14 beds.”

Apart from fever and body pains, the index case was not manifesting breathing or respiratory problems when he was accosted. Experts have assured that this is an indication that he might not have been too infectious at that point, But even though he was stable, responding favourably to treatment and had not developed major complications, it was clear the Italian wasn’t going home any time soon. Prof Abayomi said he would remain under isolation and management at the Mainland General Hospital, for management until it is ascertained that he no longer secretes the virus.

“We test him every day to ascertain whether evidence of virus still exists, the moment we stop seeing the traces of the virus, we will wait for extra two to three days just to make sure everything is all right. As long as he is still excreting the virus, he is dangerous to the community. Sometimes we may think the virus is cleared and there may be a recurrence. We have to be very careful, so he will remain with us.”

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The index case was recorded in densely populated Lagos megacity and commercial hub. That was significant. There was panic initially because of the complexity and peculiar awkwardness of the former national capital, but Lagos has antecedents when it comes to handling such matters. In 2014, Lagos contributed significantly towards Nigeria stopping Ebola in its tracks within 93 days.

“I am assuring Nigerians that all measures have been taken to contain and control the spread of the coronavirus. I know the capability of Lagos State; the state has a lot of experience on Ebola so they will be able to handle the case,” the Minister of Health, Ehanire remarked.

The tracing of potential contacts began hours after the case was confirmed to prevent spread. Nigeria had been strengthening measures to ensure such outbreak was controlled and contained quickly. The Italian’s movement was tracked and a dragnet was constituted to round up the potential contacts within Lagos and Ogun state where he visited the Ewekoro community.

On the 2nd of March, it was revealed by the Lagos state government that there were gaps in the surveillance efforts. The Turkish Airline flight that brought the Italian had 149 passengers. Forty-nine of the 84 passengers resident in Lagos had been reached, but as the night of the 1st of March, 35 were unreachable due to wrong data. Phone numbers, contact addresses, and next- of- kin, among others, were false.

Abayomi worried that inability to trace the passengers was a potential risk to the general public. “This is worrisome to us but we are trying everything possible to trace them. We are in touch with immigration in case they want to renew their visa. We also have what we called an emergency operation centre where we meet every day at Yaba. The Lagos emergency team comprises agencies working tirelessly to ensure there are no gaps from supply to case management, to epidemiology, surveillance.

“You may not know that you have contact with coronavirus patient because most people on that flight did not know. The sooner we find you the better for you and for everybody else. So its civic responsibility to fill your information correctly.

“If you develop the symptom we can treat it early, and at the same time minimize your exposure to other people. One person now who has filled wrong information but develops the virus may be the source of an outbreak in Lagos. So it’s not a joke, it’s a serious matter.

The 35 unreachable passengers on board the Turkish airline could make that potential threat to containment efforts a reality. Three people that earlier exhibited suspicious symptoms tested negative to the virus. One, a Chinese national who arrived Lagos on Tuesday aboard an Ethiopian Airline and suspected for COVID-19, tested negative for the disease the following day. Samples collected from the patient were taken to the Lagos State Bio-security Level 3 laboratory within the premises of the Mainland Hospital, Yaba, and the test was carried out there.

A lady from Ewekoro suspected to have the virus also tested negative. Another three were isolated on Thursday. They included a Nigerian who travelled from France. Two others in the containment facility in Yaba were from England and China. All three tested negative and are discharged.

Tough challenges are not new to Nigeria. In 2014, during the West African Ebola Virus Disease, Nigeria effectively contained the disease and stopped it completely within 93 days, recording an impressively low number of deaths in the process. To say it is prepared for the index case would not be an untruth.

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The federal government activated a multi-sectoral Coronavirus Preparedness Group under the leadership of the Nigeria Centre for Disease Control, NCDC, to work closely with Lagos state. There are five labs nationwide with capacity to test for the virus and Lagos has an established isolation facility that is being expanded even as other states are rolling out theirs.

Nigeria is banking on utilizing the same rapid detection and effective containment strategy it used against Ebola. This might just be the ace in the pack for Africa’s most populous country.

Speed is so important in diagnostics because it allows isolation of the people that are positive and keeping them and monitor them for at least two weeks. If not picked up early, they mingle in the population transmitting the virus.

But does it have ability to continuously detect quickly, and afterwards, capacity to contain the virus?. Nigeria was able to detect the virus quickly with the index case, but in the days after, the containment strategy has not really been tested because no other positive cases were detected.

The Director-General of the Nigeria Centre for Diseases Control, NCDC, Dr Chikwe Ihekweazu, believes that Nigeria’s biggest area of vulnerability lies within the health system which may be easily overwhelmed in the event of established circulation of the virus by contacts of the index case. The nation’s ability to provide clinical care is suspect.

“That’s what I worry about the most,” Ihekweazu stated. If you think about the numbers of people infected and the proportion of those who end up being severe – even though the proportion is fairly small, based on data out of China – the absolute numbers will be fairly significant if transmission really gets a foothold in a context like Nigeria.”

Ihekweazu noted that Nigeria’s best bet is to really focus on early detection and to ensure that there is the capability to maintain and contain the transmission to a limited number of cases.

“If there is widespread, established transmission in Nigeria, the biggest risk will be in our ability to provide clinical care. That includes ventilators and oxygen therapy to a large number of patients, and that’s what I worry about the most. So we really have to focus on the hardcore public health and prevention of early detection and early response in order to limit transmission,” he remarked.

Vanguard Nigeria News