In my 31 years of medical practice, I have never seen an infection spreading on a scale like this —UCH CMD

THE Chief Medical Director of the University College Hospital (UCH), Ibadan, Professor Jesse Otegbayo, in this interview by SADE OGUNTOLA, speaks on his brush with the coronavirus disease, efforts of the premier hospital at fighting the pandemic as well as the way forward for Nigeria and, indeed the world.

You shocked the country when you announced that you tested positive for COVID-19. This was essentially because you are the head of Nigeria’s premier teaching hospital. How did you feel making such an announcement?

I announced that I was positive mainly because I had heard a lot of stories from the lay public that the whole claim of the existence of coronavirus was a hoax; that there was nothing like COVID-19; that people were making it up. I wanted the public to know that the disease is real and that no matter how highly placed you are, you can be infected and so that people could take all the necessary precautions to prevent the infection.

There was no politics about it. People have been insinuating that maybe I was given some money to proclaim that the virus is real. I have heard all sorts of things that are completely and totally incorrect.

I was attending a quarterly board meeting and one of our board members took ill and he was screened and he was positive. Because of that, the other board members who attended the board meeting with him had to be screened. Three of us were positive and we had to go on self-isolation and thank God, it turned negative afterwards. I was not shocked in any way when I had the infection, knowing that this is an infectious disease and it is one of the job hazards of any doctor or physician.

In the 90’s, I had a patient with liver cirrhosis who had hepatitis B. I mistakenly pricked myself with a needle while trying to set a line in his femoral vein. I tested immediately and I was negative, but a couple of months after, I tested positive. That makes it very clear that I infected myself through that patient. That is the job hazard for practising physicians or anybody that works within the hospital environment. So, I just took it as one of the job hazards that befell me at that point. And usually, when things like this occur, my thought is about what is next to do and I take the necessary actions afterwards.

You got over the infection very quickly. Is there a secret drug you took which fast-tracked your healing process?

Categorically, COVID-19 is a new infection and that is why it is called a novel coronavirus. Nobody has any known effective treatment. It is an infection about which not everything is understood. A lot of researches are still going on. Yes, some drugs have been tried and they were found to be effective but the same drugs were tried in other studies and they were said to be ineffective. Therefore, I will not recommend any particular drug for anybody. All I will say is that anybody that gets tested and is positive should just go to their physicians who will evaluate them and know the appropriate medications to give.

In my own case, I had been taken some medications that were supposed to boost my immune system before I contracted the infection. Immediately the first case was reported in Lagos, I knew that it would most likely spread. So, I started taking high dosages of Vitamin C.

Vitamin C does not kill the virus; it is not an antiviral but it stimulates your immune system. It has what is called antioxidant properties. When infections of organisms cause disease, they cause inflammation; they release free radicals. Vitamin C in high doses helps to mop up these free radicals and reduce the process of inflammation and that way, the body can curtail the devastation that the infection would have caused because of the boosting of the immune system. And of course, I took a lot of fluids because when you get hydrated, you are better off.

I did some steam inhalation. But that does not mean that is the recommended therapy. All these are just palliatives as far as I am concerned. And I will not recommend anything for anybody. All I will say is, see your doctor or health worker for you to know the appropriate thing to do.

As regards how I turned negative very fast, the infection is known to be more devastating in people who are 70 years and above. It is more devastating for those who have underlying medical conditions like kidney disease, heart disease, lung disease and diabetes. I did not have any of those. When the viral load was done, it was said to be on the low side. Some people come up with a high viral load and so are likely to be having symptoms of the disease.

Also, the index of the immunity of an individual with this virus, which is CT value, is always checked. Mine was said to be on the high side, meaning that my immune system was good and I did not have any underlying chronic medical condition. So, these things, I believe, contributed to my early recovery and I am not the only person to have recovered; all three of us who were infected from that board meeting have converted to negative. Of course, there have been cases of people converting to negative after four days in many other countries, including the United States and China. There is a popular footballer that tested positive but tested negative about four hours later. So, it is not something unique to me; it is just part of the biology and evolution of the virus.

The number of people with the COVID-19 infection in Africa is quite low compared to other continents. To what would you ascribe this?

What I say is just my opinion; it is not that I have done any research to support it. It could be linked to international travels. This infection started in China. The Chinese travel a lot; they have businesses in many countries, including the United States. We also travel but not as much as the Chinese do. Also, if you look at it, many of the people who have died in the US and other countries were older people. Although young people also died, the majority of them were 60 and above. At that age, your immune system would have gone down.

At an advanced age, you stand a very high risk of contracting an infection because your ability to fight an infection is reduced. That is why mortality is higher among those age groups.

Some people say Nigeria’s hot weather plays a role in limiting the spread and severity of coronavirus. Others say it is because of BCG vaccination.  What is your opinion on this?

Experts have made such postulations but they are not sure. In fact, they want to compare the pattern of the disease during winter and summer to know if its spread is the same. So, we are all waiting for their findings on this. We can then translate it to Africa, being warmer than the temperate countries. However, it is also said that the virus cannot survive above 26 degrees centigrade. That was what brought up the concept of using steam inhalation to destroy the virus in the nose and the throat. All these are just postulations, I will say.

In all your years of medical practice, did it ever occur to you that a disease would ravage the world and confound everybody as this COVID-19 is doing?

In my 31 years of medical practice, I have never seen an infection spreading on a scale like this. Even Ebola, the first one I experienced, was not like this.

In the 18th century, there were incidences of pandemics. There was a time in the US when they had the black plague. But I never imagined this because I believed that man had been able to conquer a lot of things. A lot of drugs that were not available in the past, we now have.

The body of scientific knowledge now is so much that I would have imagined that we would be able to conquer anything that would ravage the whole world like this. This, I believe, is to show the omnipotence of God. Nobody imagined this would happen and yet it has happened. Scientists and religious people had made projections of how the year would be. Nobody knew it would be like this.

So, I never imagined it because I believe that medical science had developed to a level that we should be able to tackle some of these things head-on. So, it is really novel; it is completely new.

Given your wide contacts home and abroad, how soon should the world expect a vaccine or a cure for COVID-19?

It will take somebody with prophetic anointing to be able to put a finger on the particular time a cure will come. However, there are trends that you can watch that may determine how soon the pandemic will stop. And this is hinged principally on preventing the spread of the infection in the community. If we stick to all the public health measures – the lockdown, public education and awareness creation on hand washing, use of hand sanitiser and face masks as well as isolation of who are infected – to prevent the spread, all of which Nigeria is doing now, we would see the end quicker. But if we relax the measures, we are likely to have it for quite a long time.

Some weeks ago, you called for support to increase the holding bay capacity of the UCH. Has any help come the way of the hospital?

We had to make that appeal because we have a four-bed isolation centre that was built during the Ebola period of 2013/2014. But knowing that we receive most of the critical patients in Oyo State, we felt that we have to prepare something bigger to receive them. In that light, we wanted to convert our multidrug-resistant TB building, which has been lying fallow, to ensure a bigger space to keep our patients. This is an infection we never foresaw. We did not budget for it and our finances are already overstretched. So, we had to cry out to the authorities and philanthropists to come to our aid.

What about using the hospitals’ internally generated revenue?

We cannot use the IGR because it is not enough to run the hospital. If we now add this, it will consume the IGR and other things will have to suffer. But we don’t want our clinical services and other areas of service to suffer. We had to cry out because taking care of an infection like this is very expensive.

We have to make provision for all our staff members who are on the front line. Just one Personal Protective Equipment (PPE) garment alone costs about N27,000. It is only worn once and one doctor or nurse will have to use more than one in a day.

PPE is not readily available now because many people are buying it. This is aside from the face masks and hand sanitiser that our staff members expect us to give them. And they are right because if we are sending them to the war front and we have to arm them. That was why we had to cry out to good-spirited Nigerians to help us.

The donations we have so far received amount to N6,053,000. Two major donors, the Ibadan Electricity development Distribution Company and a former finance commissioner in Oyo State, gave us N5 million and N1million, respectively. The remaining N53,000 was donated by other people. Some people gave us N1,000 each.

What is the exact amount of money the hospital needs for this project?

The letter that was written to solicit for assistance has a list of all that we need for this new ward – PPE, ventilators, beds, piped oxygen for each bed and, of course, all the protective materials like boots, gloves and masks. In fact, we need to install a CCTV camera. You cannot say a nurse should sit by the bedside of a patient forever but they can monitor so many patients at the same time from the nursing bay by merely looking at the CCTV. These are the things that we need the money for. Of course, we also need a generator as a power backup for the centre.

You will notice that the first letter I sent out did not even provide an account number, just to let people know that it is not the money we want but the materials. But some people were saying that they were going to give money. That is was why we issued another circular where we put the account details. The TSA account is for the purpose of accountability and transparency.

Do you foresee more pandemics in the future?

Yes. The reason is organisms that God has been created. No matter how primitive they look, they have what is called survival instinct or survival strategies.

Unlike organisms that have been in circulation for a while and are going extinct, such develop the capacity to resist what will make them go extinct and that is why mutation occurs. When a mutation occurs, they become wilder than they used to be and because they are now new, it will take some time before the human body develops immunity against them. At least, about 80 per cent of the population would have been affected before herd immunity is achieved and will no longer be able to affect the human race as much as possible. Again, once they see that they are being suppressed and they cannot multiply or survive, they mutate again.

This is something that will continue to come from time to time and again, there are some of these viruses that have their reservoir in animals. For instance, the coronavirus is a zoonotic infection, an infection that can be transmitted from animals to man. They live mainly in bats and it does not kill them just like Ebola was in animals, too.  When people consume raw animal flesh, drink animal blood and so on, it crosses to man. Man now transmits to another man. That is how it spreads to the entire community.

Modern-day living and international travel have made the spread of diseases easy. A disease can occur in New York today and occur tomorrow in Osogbo because of international travel.

Past experiences indicate the possibility of more pandemics as a result of different organisms occurring. What should be the way forward to ensure adequate preparedness as a nation?

Let me go back to when I was a child. Even in the remote areas of Nigeria in the 70s, there were buildings outside the villages that they used to call infectious disease hospital (IDH). I did not know what IDH meant until when I grew up. They prepared a place for infectious diseases even in the 70s. But now, we don’t have such things anymore.

I was at a teaching hospital in Frankfurt in 2000. There was a whole complex that was an IDH. It is like a hospital within a hospital. So, if any epidemic or pandemic occurs, there will be no need for a shotgun approach where you start hurrying because you already have all the things in place.

So, what we are seeing in developed countries that they are even admitting in unusual places is a kind of overflow because they are overwhelmed; they had filled their infectious disease hospitals. We need to put all these things in place, too. We should not wait until we have Ebola or Lassa fever and as soon as the epidemic goes down, we should not go back to sleep. We need to have a national plan where we designate some hospitals, because if you look at it, infectious diseases are always there, even in non-epidemic times. Such designated hospitals must be appropriately funded and equipped and maintained. These are the things I think that we should put in place. And of course, health education is very important. Some infections already have vaccines but we should ensure that childhood immunisation is enforced.

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