COVID-19: How understaffing, shortage of PPEs, weak insurance scheme expose health workers to fatal hazards

As the wave of the COVID-19 pandemic continues across Nigeria, health workers involved in fighting the pandemic have continued to be victims of the same virus they were trained to curb. With experts’ viewpoints and statistical analysis, IMOLEAYO OYEDEYI explains why their infection and fatality rates may worsen in the days to come.

Before becoming the first doctor to have died of COVID-19 complications, the late Dr. Aliyu Yakubu owned and ran the popular Daura Surgery and Maternity Hospital in Sabon Gari along Zango road in Katsina State for over 40 years.

The 60-year-old medical practitioner who hailed from Kogi State died 74 hours after returning to Daura from Lagos, at the Nigeria Air force Reference Hospital in the town. Having taken his samples, the Nigeria Centre for Disease Control (NCDC) later confirmed that the famous physician had died of COVID-19. Since then, his death has continued to generate massive tension and apprehension in the state owing to the three days he had spent in the town before being hospitalised. His wife and children all tested positive to the virus days later and they have since been isolated at the Federal Medical Centre, Katsina, for treatment.

Four days after Yakubu passed on, another medical doctor died in Lagos. Unlike Yakubu’s case, the late Dr. Emeka Chugbo contracted the virus while unknowingly treating an infected patient at a private facility in Lagos. Having exhibited severe symptoms, the doctor, who already had a history of asthma, was rushed to the Lagos University Teaching Hospital (LUTH) at Idi-Araba where he died two days after on Wednesday, April 8. The confirmed case Dr Chugbo was treating died at his facility on April 4 and was the second death case in Lagos State. According to reports, the late Chugbo was a former senior resident of Obstetrics and Gynaecology in LUTH before leaving to set up his private practice in the state.

Since the demise of these two doctors, the country has continued to witness a steady rise in the infection and fatality rate of the nation’s health workers as a result of COVID-19. On Thursday, April 30, the Minister of Health, Dr. Osagie Ehanire, said “latest figures we have show that there are about 113 people in the health sector that have been infected with COVID-19. Although they are not all public health workers, there are good numbers from private hospitals.”

He noted that 113 represent six percent of the total number of confirmed cases in the country.

However, there are indications that the number of infected medical practitioners may have soared as at least 17 private hospitals in Lagos have admitted that their staffs have been exposed to the infection while attending to infected patients. On Saturday, May 1, the deputy governor and chairman of the response team for the prevention and control of the spread of COVID-19 in Borno State, Usman Umar Kadafur, said sixteen health workers were among the 69 persons infected in the state.

Similarly, on Monday, May 4, the Katsina State governor, Aminu Bello Masari, also confirmed that 14 medical staff are among the 37 new patients who recently tested positive for COVID-19 in the state.  The governor said four out of the 14 were from private hospitals. On the same day, the chairman of the doctors’ association in Lagos under the auspices of the Medical Guild, Dr. Oluwajimi Sodipo, told a press conference that 16 of its members have tested positive.

Also, in Sokoto State, no fewer than 12 health workers have tested positive. The state commissioner for health, Dr. Mohammed Ali Inname, who disclosed this, said the infected medical workers are part of the 19 confirmed cases in the state. According to the President of the Nigeria Medical Association (NMA), Dr. Adedayo Faduyile, no fewer than fifteen doctors have tested positive to the virus in Kano State.

While speaking on Saturday, April 23 on national television, the Lagos State Commissioner of Health, Professor Akin Abayomi said: “chances of health workers contracting the virus are exceedingly higher than any other person’s chances in the country.” In a similar vein, former President of the Nigerian Association of Resident Doctors, University College Hospital, Ibadan, Dr. Olusegun Olaopa, told Aljazeera that, “health workers in the country face challenging working conditions with no life insurance, inadequate pay and constant burnouts,” adding that, “the pandemic has put more pressure on an already overwhelmed health workforce struggling with low morale.”But in what could be seen as a response to the clarion call on safety of the health workers, the Chairman of the Presidential Task Force (PTF) on COVID-19 and Secretary to the Government of the Federation, Mr. Boss Mustapha, said the Federal Government has reached an agreement with the insurance sector to offer life insurance to 5,000 health workers in the tune of N112.5 million, while the Minister of State for Health, Dr. Olorunnimbe Mamora, added that, “A special COVID-19 hazard and inducement allowance of 50 percent of Consolidated Basic Salary will also be paid to all health workers in Nigerian Teaching Hospitals, Federal Medical Centres (FMCs) and designated COVID-19 centres for the first three months.”

From the minister’s statement, nothing seems to be set aside for the teeming health workers at the various private clinics and hospitals in the country, who according to Faduyile, have the biggest risks of contagion.

Health workers at non-isolation facilities are at higher risk of infection—NMA

Speaking with the Nigerian Tribune, the NMA president said: “It has been discovered that 65 to 70 percent of patients often patronise the private hospitals. So it is not out of place that you have seen that most of the areas where the virus has been contracted have been at the level of the private hospitals as well as other public centres where ordinary Nigerians seek for their health issues.”

Faduyile said the continued infection and fatalities of health workers has necessitated the need to define who the true frontline workers are. He stressed that contrary to the claims by the government, “every health worker in the country wherever he or she may be has a high chances of contracting the virus,” adding that, “in fact, the health practitioners with very high chances are those not working at the various isolation and treatment centres designed for the coronavirus patients.

“The Personal Protective Equipment (PPE) is majorly in short supply. More so, there are a lot of pressures on the health workers to ensure that they continue treating everybody that comes their way not minding that every single patient today is potentially COVID-19 positive.

“Take for example, a situation whereby someone that just had a road accident and fractured his leg was taken to a hospital. A doctor attended to him trying to help realign the fracture with a POP. And at the end of the day, you will just realise that while the doctor was treating a broken part, the patient may be COVID-19 positive. These are the risks that every health worker faces now. And it calls for high index of suspicion on the part of the health workers and the need to fully protect them on the part of the government and managements of the various hospitals in the country.”

When asked whether the country won’t likely witness a rise in the cases of infection and fatalities of the health workers if the status quo remains the same, Dr. Faduyile said: “Yes, that is what is staging up as it is now. And that is why we have come up with an initiative to save our private health practitioners by ensuring that they get enough PPEs. We also plan to do some further training for them especially on how to protect themselves in these challenging times

“On our part at NMA, we are not too happy because the issue of testing which supposed to go hand-in-hand with the lockdown has been largely abysmal. The governments have not been doing well at all in terms of testing. For example, Ghana, a country with a smaller population has tested 55,000; South Africa has tested 160,000; even Kenya despite being very small has tested 18,000. Yet, we have been able to test only about 10,000. The implication is that we may actually not know the correct incident rate because we have not done enough testing.

“We have advised the government that the molecular testing they are doing which is very expensive should be supported with the rapid testing. Although it may not be the best, at least, it will make the process faster and we will not be having the large number of people thronging the molecular testing centres. The government initially got it all wrong when they said people should stay at home till they see symptoms before coming for testing. What that means is that until you have symptoms you will continue to infect others. The government should just find a way to do mass testing.”

Corroborating Faduyile’s viewpoints, the President of NANNM, Adeniji Abdulrafiu told the Nigerian Tribune that: “The governments were initially slow in spreading the testing channels. It is now they are [improving]. Meanwhile, we need more testing centres and preparedness in terms of responding to viral ailments like this. Our policy and regulation of the detection, treatment and rehabilitation of the early victims was somehow shaky and that’s why we found ourselves in the mess we are in.”

Speaking on the factors contributing to the infection of health workers to the spread of coronavirus, Abdulrafiu said: “One factor that keeps increasing the infection of our members is the immoral, undisciplined and insincere nature of some people in this country. They know that they have tested positive to the virus and they will still be moving from one hospital to the other changing symptoms.

“Another one is that some sincere patients are asymptomatic. And this makes it worse because these people don’t know that they are carrying this virus. Our members often come in contact with them on daily basis and this is part of the reasons for their growing infection.”

Why our members must be protected by good healthcare policies—NANNM chair

The NANNM chair further advised the government to adopt good healthcare policies that will inculcate the welfare of the workers. “They should also put in place good insurance, remuneration and protection mechanisms and ensure that there is an enforcement of public health law on hygiene, washing of hands and using of sanitisers regularly. Social distancing should also be observed because any measure without it will still leave many people in danger,” he added.

Speaking on the pre-existing conditions that patients can have that will make them vulnerable to the coronavirus, the immediate past president of the Laboratory Scientists Association of Nigeria and the current Registrar, West African Post Graduate College of Medical Laboratory Science, Dr. Godswill Okara, said: “Generally, if one has diabetes, hypertension and any other health condition that affects the organs especially the liver, it is reasonable that the person’s condition will be worsened with COVID-19 because his or her immune system would have been compromised.”

He said to guard against the virus, Nigerians generally, especially those that have pre-existing medical conditions, should be taking food and supplements rich in Vitamin D which he said as an anti-oxidant would empower the body’s immune system to fight against viral infections.

Nigeria is rising up to these challenges—CMD LUTH

While reacting to the present handicap suffered by the health workers in the face of the pandemic, the Chief Medical Director, Lagos University Teaching Hospital (LUTH), Idi Araba, Professor Chris Bode, in an interaction with the Nigerian Tribune described the COVID-19 pandemic as a war with an invisible enemy.

According to him, “If you send 200,000 soldiers to war, you don’t need to start telling them to avoid getting shot or dying? No! They know it is part of the risk of their work and that is exactly what we are talking about.

“In LUTH, we have treated more than 200 COVID-19 patients; no member of staff has caught that disease from our patients. But at the same time, we have almost 14 members of staff who went about in society and caught the disease without knowing that they have come across it.

“They had come in contact with somebody that is asymptomatic. That is the pathetic situation. What I do every day is to praise those who are doing this gallant work, encourage them and promise them that the government will not back away from them. You don’t send soldiers to war, without backing them up. Nigeria is rising up to these challenges; they can always do more.”

We need equal distribution of PPEs, face masks—MD FMC, Abeokuta

For the Medical Director, Federal Medical Centre, Abeokuta, Professor Adewale Musa-Olomu, the provision of adequate world-recognised PPEs rather than the use of improvised PPEs is central to reducing these cases.

Equal distribution of Personal Protective Equipments, masks and other materials for infection control to all government tertiary hospitals to fight the infection and increase in number of isolation centres for treatment, Prof Musa-Olomu said will further reduce exposure of health workers and the general public at large to coronavirus.

According to him, while those coming in direct contact with patients may be provided PPEs, others such as hospital administrators, accountants and drivers, because they have a lower risk in the hospital setting, should at least be provided a surgical mask to keep them from the virus.

Much more than ever, he said regular medical checkup and training and retraining of health workers should be paramount as the COVID-19 pandemic ravages on.

“They need to upgrade their training; some of them are not properly trained on how to handle even a PPE. All they have is the knowledge gained from the books and briefs of organisations like WHO,” he added.

We must prioritise training and re-training of health workers—Professor Otegbayo

Adding his voice, the Chief Medical Director, University College Hospital (UCH), Ibadan, Professor Jesse Otegbayo said the COVID-19 pandemic is a health war, with collateral damage in the health workforce.

Minimising deaths from the infection among health workers, Professor Otegbayo said would require prioritising training and re-training of health workers on Infection Prevention and Control (IPC) and establishment of a task force to enforce proper use of the provided personal protective gears.

“PPE is a scarce commodity; its price has skyrocketed because the whole world is making use of it at the same time. That is why one has to be ingenious these days. At UCH, for instance, we are sewing our own customised facemasks, which we have never done before,” he said.

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