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Nigeria’s COVID-19 problem is bigger than it looks and the NCDC needs to ramp up testing now

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Nigeria’s poor handling of its third index case is why 25% of the Population is likely to be infected with Coronavirus 

The first reported case of coronavirus in Nigeria was on February 27, when an Italian citizen in Lagos tested positive for the virus. Two weeks later, a Nigerian who had contact with the Italian tested positive. Then there was a lull. 

While countries in Europe were reporting over 500 positive cases daily, authorities in Nigeria insisted everything was under control. 

The Nigerian Center for Disease Control (NCDC) pointed to how the country handled the Ebola outbreak and said Nigeria could handle whatever was coming. 

The head of the NCDC, Chikwe Ihekweazu, told CNN: “Nigeria is ready. We successfully managed Ebola and we manage outbreaks all the time and are currently managing Lassa fever. We have a strong team that is used to doing this.”

His confidence has proved to be misplaced and with that has come the increase in the spread of fake news. Many ordinary Nigerians believe that black people are immune to the virus. Some think that coronavirus can not survive in the tropics. 

One extreme conspiracy theory is that coronavirus is a hoax created by the Nigerian government to steal public funds. While battling fake news, it means Nigeria is only now realising the scale of the problem. 

The scale of the problem 

As at the time of this report, the NCDC has reported 111 cases in Nigeria, with the biggest jump coming on Thursday, with 14 confirmed cases. 

According to Chikwe Ihekweazu: “We are seeing more cases of Covid 19 in Nigeria as a result of a combination of factors. We are working hard to scale up our testing capacity to bring in more people for clinical management.”

His comments show one of the reasons why Nigeria has reported small jumps in its number of cases. There isn’t enough testing being done by the NCDC.  

Credit: Business Insider

By March 22, the NCDC had tested 152 people, with less than 50 people testing positive. The latest report shows the number of people tested is up to 262 and the number of confirmed cases is over 60.

24.8% of people tested are confirmed cases. According to The Economist: “A very rough guess is that without a campaign of social distancing, between 25% and 80% of a typical population will be infected.”

For context, South Africa has tested over 15,000 people with over 900 confirmed cases. In the United Kingdom, over 104,000 have been tested, with 11,658 confirmed cases. 

Here’s another stat to keep in mind: Nigeria’s information minister, Lai Mohammed says the country is attempting to trace 4,370 people who may have had contact with coronavirus patients all over the country. 

It is daunting work and it hasn’t been made easier by the NCDC, an agency which has been criticised for their slow response time.

At the time of this report, several calls to the agency’s communications department went unanswered. 

NCDC and slow response time

Ayobami Adekojo’s faith in the NCDC was tested when his friend, who later tested positive for coronavirus returned to Nigeria. 

According to him: “When my friend came into Nigeria on Friday, March 13th, we both agreed she would take a test immediately and self isolate. 

At that point, we thought testing was going to be easy since we had been reading about how the NCDC was prepared. So when she landed, she called the numbers and they were not helpful”

He recounts how NCDC officials took his friend’s details and promised to get back to her. But there was no feedback from the agency.

“On Saturday, we heard nothing from them- they were not ready to test her to be factual. So, she started feeling mild symptoms on Saturday evening so she called me and I tried to call them immediately”

“They were disrespectful, so I called the Lagos hotlines instead and got nothing. By Saturday night when she called again, they said they would come and test her on Sunday” 

On Sunday, the NCDC officials did not show up and after calling the agency again, Ayobami took to Twitter to demand an answer. He says that at this point, his friend’s symptoms were “much worse”.

He was not ready for the pushback he received as hundreds of people insulted him and accused him of creating panic. High profile Pro-government handles accused him of shaming the government with a fake case.

“People wished the virus on myself and my family but I wasn’t too disturbed because I know I have the reach to raise the roof. I ignored the comments and when it was trending, I finally received a reply from the DMs from the NCDC”. 

Despite his persistence, the NCDC were in no hurry. “They told me that the U.K isn’t high-risk and they can’t promise a test. The Lagos helpline promised to help first thing on Monday morning. 

“By 12, I was still tweeting and they came to take her sample eventually in the evening as the tweet was still causing a storm”

At the time of this report, Ayobami says he has received messages from 7 people this morning who are symptomatic and claiming that the NCDC helpline isn’t helpful.

“They’re asking me to help escalate as I did for my friend”.

Without widespread testing, Nigeria cannot determine it’s epidemic curve. 

Plotting Nigeria’s epidemic curve

Dr. Emaediong Akpan-Ekpo, a Physician and Epidemiologist who is a former WHO/TDR Fellow on Neglected Tropical Diseases spoke to NewsWireNGR.

He believes that it is difficult to know Nigeria’s epidemic curve because of an absence of data. 

An epidemic curve is a diagram that shows the frequency of new cases over time based on the date of onset of disease. 

The shape of the curve shows the nature of the outbreak. A steeply rising curve shows that the outbreak is progressively propagating. A flat curve means the outbreak has been adequately controlled. 

According to Dr. Akpan-Ekpo: ”The only way Nigeria can get an accurate epidemic curve is case identification. Case identification depends on testing. More testing will lead to more case id and then we can begin the conversation about a true epidemic curve. 

Our epidemic curve is at best, fictional because testing is less than 20% of exposed individuals. 

“What I perceive is happening is: since the treatment centers are barely available, they’re counting on cases to “manage” their conditions since it’s self limiting in isolation pending whatever fate awaits them.”

He believes this is why Nigeria cannot measure the scale of the crisis. Despite this, the Lagos state commissioner for health, Akin Abayomi, told newsmen on Friday that the worst case scenario would see Lagos report 39,000 cases.

“Our mathematical modelling shows that the worst-case scenario is that we may see up to 39,000 cases in Lagos,” Abayomi said.

“If we add social distancing to active contact tracing, then we will be able to bend the curve further.”

Given the absence of adequate testing, the commissioner’s projections are far from the reality of the situation.

According to Dr. Akpan-Ekpo: “There are steps in investigating and managing an outbreak, and we are doing a poor job at it. We have never managed an outbreak of this scale before and the inexperience is so obvious. There’s zero political will in making resources available for case identification and treatment. The only thing we’ve managed to have so far are isolation centers which is like solving 1/10 of the outbreak problems. In my opinion, we might just be on our own.”

His sentiment may explain why foreign missions are evacuating their citizens from Nigeria. 

France and Netherlands are evacuating citizens from Nigeria

Despite a travel ban by the Federal Government, the French and Dutch governments are evacuating their citizens from Nigeria. On Thursday, the French government evacuated 260 citizens while KLM flight from Amsterdam arrived Lagos to evacuate some Dutch nationals in Nigeria.

According to the Punch newspaper, the U.K is also considering evacuating its citizens in the coming days. The UK High Commission said in a statement: “it has become more difficult to get out in case of need, we have taken the decision to reduce the number of UK (United Kingdom) staff and dependents from our High Commission.

“Our missions in both Abuja and Lagos will remain open, continuing to carry out essential work, including providing 24/7 consular assistance and support to the British nationals in Nigeria.”

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