Why Nigeria is at risk of infectious diseases outbreaks —NCDC DG

Dr. Chikwe Ihekweazu is the Director General of the Nigeria Centre for Disease Control (NCDC). In an email inteview conducted by LAOLU AFOLABI, the foremost epidemiologist and public health physician speaks on the current global distress caused by the coronavirus pandemic, ongoing efforts by Nigeria’s Federal Government in tackling the virus as well as pressing challenges.

RISING cases of COVID-19 has been attributed to rigorous testing and increasing number of molecular labs in the country. What more can the country do before we see decline in the number of cases?

We have significantly increased the number of testing laboratories for COVID-19 in Nigeria. This has enabled us to improve our detection capacity, ensure prompt isolation and management of cases to recovery. The government of Nigeria continues to invest resources to ensure that we respond effectively to this pandemic. However, we must remember that this response requires a whole of society approach. This means that every Nigerian must take responsibility for us to see a decline in the number of cases. This includes adhering to public health preventive measures such as frequent hand washing, use of face masks when in public, maintaining physical distance of at least two metres from others in public, avoiding large gatherings, etc. As the economy gradually re-opens, we urge Nigerians to strictly adhere to these measures. Some of these may not be easy, but we must pay a price for the number of cases to decline, while we await long-term solutions such as a vaccine.

 

Nigeria confirmed its first case on February 27. No major action was taken till weeks after. Do you think the figures would have been significantly lower had we taken the necessary steps earlier?

Prior to the confirmation of the first case in Nigeria, we initiated preparedness activities in the country. A COVID-19 Preparedness Group was set up by NCDC –  this group monitored and studied the trend in other countries as we prepared. Before the first case was confirmed, we had activated testing in five molecular laboratories in Nigeria. We also developed guidelines, trained health workers and began risk communications activities. These were escalated following the confirmation of the first case.

On the 28th of February, an NCDC-led multi-sectoral national EOC was activated by the Federal Ministry of Health at the highest level, to coordinate the public health response to the outbreak.

The proactive measures that were initiated ensured that we could promptly confirm the first case, carry out contact tracing and other response activities. At the early stages of the response, majority of the confirmed cases identified were returning travelers who were detected as a result of preparedness and increased surveillance.

 

Ghana says it has tested well over 100,000 samples and still hovers around 6,000 cases with less than 40 deaths. Nigeria hasn’t tested up to 50,000 and already has over 7,000 confirmed cases with more than 200 deaths. With the current trend, should Nigerians be worried about what happens when this peaks?

Countries have adopted varying strategies for COVID-19 diagnosis and for us, it is important that we get it right. Recently, we published a national testing strategy for COVID-19 with detailed information on how we will ramp-up testing for various phases of transmission by leveraging existing technology. We are thinking ahead and have plans in place to meet the demand for testing at various points of the response.

 

It’s been said that those with a huge dose of malaria parasite in them will most likely test positive for COVID-19. How would you describe such claims, especially that coronavirus is nothing but an escalated form of malaria?

The knowledge of the disease is still evolving and we have new findings nearly every day. However, currently, we know that coronavirus and malaria are caused by different organisms. Like malaria, one of the most common symptoms of COVID-19 is fever. Despite this, both diseases differ in terms of mode of transmission and presentation at the severe stage. Malaria is endemic in Nigeria, and so it is common to find people with the disease. It is very important that Nigerians are aware of these facts to reduce the risk of spread of COVID-19, and to protect their health. It is important to get a test if you feel ill, and be treated appropriately – for malaria, COVID-19 or any other disease.

 

If one considers the reality, it’s safe to assume that a significant number of the population may have been infected and probably recovered without necessarily needing medical intervention. Is there a major difference between what obtains here from other climes?

It is too early to reach such conclusions. About 80 per cent of people who get infected will show mild to moderate symptoms and can recover without medical intervention. However, the high number of fatalities recorded in Europe and other parts of the world point to the fact that this disease cannot be handled with laxity. Majority of the fatalities recorded in Nigeria are persons with existing medical conditions, so we must continue to fight this virus, to protect the vulnerable amongst us.

 

What’s your take on Hydroxychloroquine and calls by some experts for self-medication? Don’t you think it will help reduce the number of patients on admission?

Currently, there is no known treatment for COVID-19. Self-medication is dangerous and harmful. There are ongoing trials into the efficacy of various drugs in slowing the progression of the disease. Currently, Nigeria, like several other countries, is part of the World Health Organisation (WHO) Solidarity Trials to help find an effective treatment for COVID-19. Until there is sufficient evidence for its efficacy, the use of this drug by individuals outside the healthcare settings is strongly discouraged.

 

What is the level of the collaboration between the NCDC and Federal Government with the alternative medicine practitioners in finding a cure for the virus?

The Federal Ministry of Health, as part of the Presidential Task Force on COVID-19, is exploring various options in the fight against the virus. The National Agency for Food and Drug Administration and Control (NAFDAC), an agency of the Federal Ministry of Health has also called for proposals from persons with pharmaceutical or alternative drugs. While we are supportive of local innovations, we must be guided by science and every cure must go through the required process of clinical trial to ensure that they are safe and effective for use.

 

Considering the Ibadan case where one organisation has over 60 confirmed cases of COVID-19, what, from your experience, could have gone wrong?

The virus that causes the coronavirus disease is easily spread when people gather. This can be prevented by adhering to measures such as frequent hand washing, disinfection of commonly used surfaces, maintaining at least two metres between individuals and wearing a face mask when in public. We continue to urge businesses to adhere to our guidance to protect their employees. The Oyo State government has announced measures it is taking to prevent further spread of the disease in workplace settings.

 

What is the relationship between the states and the NCDC in the management of the pandemic?

One of the roles of the NCDC according to our legal mandate is to support states in the response to disease outbreaks. We have provided this support to states during previous outbreaks of Lassa fever, monkeypox, meningitis, etc, and continue to do so now.

Given the nature of COVID-19, we have scaled up this support through supporting state-level Emergency Operations Centre (EOC), providing Personal Protective Equipment (PPEs) for health workers, sample transportation, training, deploying Rapid Response Teams and surge teams and other response activities. We have deployed over 100 members of staff to all states with confirmed cases, trained over 13,000 health workers across the country on infection prevention and control.

While the state Ministry of Health provides the primary response such as sample collection from people who meet the case definition, risk communications and other activities, the NCDC supports these efforts to protect the health of Nigerians.

 

Why is the COVID-19 test so expensive?

Currently, there is no direct cost to individuals for the COVID-19 test. The Federal Government of Nigeria has ensured that all laboratories within the national network are provided with test reagents and other supplies required for testing. While the cost of procurement reagents and consumables, human resource, logistics and other aspects of testing is high, this is provided free of charge to individuals by the government.

 

There are talks about herd immunity. How exactly do you see this working considering the peculiarities of COVID-19?

We cannot predict this now, as knowledge on COVID-19 is rapidly evolving. At the moment, there is no scientific evidence that shows infection will confer life-long immunity on those who have recovered. In the absence of a known treatment or vaccine, the best thing is to stay protected by adhering to the preventive measures recommended.

 

What do you regard as the most important lesson the country should learn from its experience with this pandemic?

We must strengthen health security in Nigeria, at national and sub-national level. We need to focus on building our laboratories, surveillance, emergency preparedness and response structures in all states so that we are better prepared for the next outbreak. This also includes investment in human resource to drive these structures. While we have leveraged on existing in-country resources for COVID-19, it is apparent that we must increase our investment in and focus on health security in Nigeria and across the world. Our tropical climate and population density leave us at risk of infectious disease outbreaks, so we must be prepared.

 

What has been the greatest challenge battling COVID-19 from your perspective?

The response to a pandemic caused by a new strain of virus is challenging for countries across the world, including Nigeria. We are having to learn while we respond, which requires flexibility based on emerging evidence and science. This has affected various aspects of the response including access to reagents and other medical supplies, as the demand exceeds supply. Notwithstanding, we are relying on our innovation and coordination structures through World Health Organisation (WHO), Africa Centre for Disease Control (CDC) and the West African Health Organisation (WAHO) to not only access supplies, but also learn from other countries.

 

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