Within 5 months, the outbreak of one infectious disease (Coronavirus) has become the most significant event in the world. This pandemic has affected economies, families and even individual lives, schedules of properly planned and seemingly unchangeable events like the Olympics have been adjusted to curtail the spread of this disease. Amazingly, this highly infectious virus which originated from Wuhan, China in December 2019 was underestimated by all hence, response to it is mostly reactive. A cluster of patients with severe respiratory illnesses was identified and using the real-time reverse transcription–polymerase chain reaction (real-time RT-PCR) and next-generation sequencing laboratory techniques, the novel coronavirus was isolated.
INFORMATION ABOUT THE VIRUS/MODE OF TRANSMISSION
Coronavirus is a family of viruses characterized by crown-like protein spikes on their surfaces when viewed with electron microscopy. They cause various mild to moderate respiratory tract infections like the common cold. Within the past two decades, three new coronaviruses have emerged causing severe illness: SARS- CoV causing Severe Acute Respiratory Syndrome in 2003, MERS- CoV causing Middle East respiratory syndrome in 2012 and SARS-CoV-2 causing COVID-19 in 2019. Coronaviruses are found in some animals which serve as reservoirs but sometimes can spillover to humans causing illness. The animal reservoir of SARS-CoV-2 is still unknown.
It is known as at today that the coronavirus is transmitted from person to person through droplets which are usually released when one coughs or sneezes. These droplets can enter directly through the eyes, nose or mouth which are the portals of entry into the body. They can also fall on surfaces or objects where the virus remains active and can be contacted by touching with the hands and then transferred into the body by touching any of the named portals of entry. The incubation period is from 1-14 days and symptoms range from fever, cough, tiredness, in mild cases to shortness of breath, pneumonia, and death in severe cases.
COVID-19 is highly infectious with the number of cases expected to be generated by one case or basic reproduction number (R0) of 2-3. Transmission can be from a patient who is symptomatic or pre-symptomatic; that is even before being symptomatic. The investigation is still ongoing about asymptomatic transmission meaning a seemingly healthy individual can be a carrier and distributor of the virus.
THE EFFECT OF COVID 19 IN NIGERIA
In preparedness of the advent of the virus, on the 22nd of February 2020, as part of a continental initiative to rapidly detect and treat Covid-19, ministers of Health of African countries including Nigeria came together to form the African taskforce for Coronavirus preparedness and response AFCOR. The Director General of the NCDC also visited China to understudy the management strategies being used in tackling the virus.
The index case of Covid-19 in Nigeria was reported on the 27th of February 2020. A 44-year-old Italian man who returned from Milan, Italy. It is believed at that time that there were temperature monitors at the airport but probably they did not identify him because he was yet asymptomatic at the time of entry at the ports and only started showing symptoms two days later. He was taken to the Isolation center in Lagos and contact tracing started. As at the time of writing this article on the 20th of April, there are already 665cases, 188 discharged and 22 deaths with 25 states having the infection and Lagos being the epicenter.
At the beginning of the outbreak in Nigeria, some interesting trends were observed. Firstly, it appeared to be a disease of the elite as the first set of persons to declare their Covid-19 status were the top government functionaries. The Chief-of-staff to the president was confirmed to be Covid-19 positive on the 24th of March 2020. Prior to this, he attended several official functions including meetings with some state governors. Hence the governors were tested and declared their statuses. A poll conducted on the 18th of March showed that 84% of Nigeria are aware of Covid-19, 26% say they are immune and 63% were concerned that they can get it
At almost the same time, a drug was approved by the FDA for compassionate use in the treatment of COVID-19. This sparked up a reaction in the public as many people ran out to purchase Chloroquine and within a few days, the reports came back of persons with chloroquine toxicity.
The health system in Nigeria has been rated very low with a lack of infrastructure and medical equipment, high brain drain of medical personnel leading to a shortage of medical professionals and specialists. The few professionals remaining did not have any point of unity especially as a rivalry between doctors and other professionals has been on. In the heat of this, however, the National Medical Association (NMA), Pharmaceutical Society of Nigeria (PSN) and National Association of Nigerian Nurses and Midwives (NANNM) found a way to come together to put out a statement in support of their members at the frontline.
This was also at the backdrop of patients hiding their travel history thereby infecting the unsuspecting health workers attending to them. The Nigerian medical association was also strongly opposed the import of Chinese doctors into the county to respond to Covid-19.
Research is also being carried out in Nigeria as the Nigeria Institute of Medical research, African Centre for Genomics of Infectious Diseases in Redeemers University, Ede and Centre for Human and Zoology Virology in Lagos University Teaching Hospital on the 6th of March successfully performed the genome sequencing of the coronavirus strain from the index case and proved it to be a match with the virus circulating in Italy and Wuhan.
The National Agency for Science and Engineering Infrastructure (NASENI) also developed a ventilator prototype that can be manufactured for use in the fight against the virus.
MANAGEMENT OF IMPACTS OF COVID IN NIGERIA
Being that there are several aspects to the Covid-19, management strategy target various aspects of the disease. These strategies are done at the individual level and at the level of the government.
- At the individual level,
- Maintaining high hygiene standards, change of habits and other preventive measures are the responsibility of each individual for instance, regular hand washing, avoid touching your face and so on.
- Self-isolation in a properly aerated room on return from a foreign trip as well as when feeling unwell
- Calling the authorities and informing them when exhibiting the symptoms of Covid 19 and giving complete medical history to help the health professionals manage the cases better.
- At the level of the government: In Nigeria, the Presidential task force is responsible for coordination of response to Covid 19. Government level management system involves:
- Surveillance & port entry screening: This consists of contact tracing for confirmed cases as well as active case finding in the community.
- Laboratory testing and subtyping.
- Risk communication and community engagement,
- Infection prevention and control
- Clinical management: This involves isolation and Individual Case Management: Each suspected case is treated symptomatically using supportive care. There is currently no specific drug or vaccine.
As part of the government response to prevent the further spread of Covid 19, there is a key Non Pharmaceutical intervention which has been implemented. This public Health social measure involves closure of borders into the country, restriction of movements, lock down of some states with high number of cases as well as curfews in some states.
This lockdown measure demands that citizens stay at home in order to reduce person to person interaction and spread. The major consequence of this is that people who cannot work from home and who earn their daily subsistence cannot work or earn leading to hunger and frustration. In Nigeria, a large proportion of the population falls into this category.
The Federal government in order to reduce this economic impact on vulnerable families and businesses has introduced several palliatives and economic stimulus packages including
- A direct cash and food distribution. As part of the food to be distributed are 70000 metric tons of grains released from the Nigerian grain reserves and bags of rice seized by the customs to be released.
- The government also issued a three-month moratorium on Marketmoni, TraderMoni, and FarmerMoni loans.
- As an economic stimulus package, they have created N50 billion credit scheme for households and small- and medium-sized enterprises, N100 billion credit support for the healthcare industry and N1trillion credit support for the manufacturing industry
- Tax measures by the Federal inland revenue service have been instituted.
- Creation of 774,000 jobs has been proposed.
- Individual states also have their packages for their citizens.
Prevention of Covid-19 like any other infectious disease involves breaking the cycle of transmission. In this case, it is the transmission from person to person that is being targeted hence it is recommended that
- We maintain Physical distance of at least 1m from people coughing or sneezing
- Cover your mouth and nose with tissue when coughing or sneezing and dispose the tissue into the bin immediately after. Cough into a bent elbow if a tissue is not immediately available.
- Wash hands regularly with soap and water and use an alcohol-based hand sanitizer, avoid touching your face with unwashed hand
- Stay at home if you feel unwell, avoid large gatherings of people
- Follow instructions issued by national and local authorities.
Also important is getting information from only verified sources and avoiding fake news.