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Adopting critical preparedness, readiness, response actions for COVID-19

By Chukwuma Muanya
21 March 2020   |   4:26 am
As part of efforts to contain the dreaded Coronavirus (COVID-19), which has continued to spread all over the world including Nigeria, the World Health Organisation...

PHOTO: Ogden City

• Debate Rages On Why Sub Saharan Africans May Have Special Protection Against Coronavirus
• Academy of Science Says Containment Of Pandemic In Country Is Possible
• Churches adopt radical changes during Holy Communion To Prevent Transmission But Measures Fail Recommended Strategies

As part of efforts to contain the dreaded Coronavirus (COVID-19), which has continued to spread all over the world including Nigeria, the World Health Organisation (WHO) has released two new technical guidance documents: Critical preparedness, readiness and response actions for COVID-19 and Risk Communication and Community Engagement (RCCE) Action Plan Guidance.

According to WHO, “all countries should increase their level of preparedness, alert and response to identify, manage and care for new cases of COVID-19. Countries should prepare to respond to different public health scenarios, recognizing that there is no one-size-fits-all approach to managing cases and outbreaks of COVID-19. Each country should assess its risk and rapidly implement the necessary measures at the appropriate scale to reduce both COVID-19 transmission and economic, public and social impacts.”

Meanwhile, indications are rife that children and people from tropical Africa may have special protection against the dreaded coronavirus (COVID-19). While a recent study has backed up the claims that the virus is less severe in children and is less likely to kill them compared to adults, there is not yet any scientific evidence supporting the latter postulation.

However, the debate is fuelled by the fact that the first Nigerian patient was cured of virus less than five days compared with Italian index case still battling with the disease 17 days after.

It will be recalled that the index case in Nigeria, a 44 Italian man, that tested positive to the virus on February 27 was just cured of the virus while the second confirmed case in the country, a 40-year-old Nigeria who tested positive on March 8, 2020 was discharged since March 13. Why?

Director General of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, told The Guardian: “The index case is clinically stable at the designated treatment facility for COVID-19, the Infectious Disease Hospital (IDH) Yaba, Lagos. An additional sample has been collected for retesting.

“The second confirmed case who was a contact of the index case, has tested negative twice consecutively, has cleared the virus and was discharged to go home on March 13, 2020.

“All other contacts of the index case completed their follow up period on Friday 13th of March 2020 and have been allowed to re-integrate into the society and resume their normal lives.”

The epidemiologist, however, insisted that there is no scientific evidence that black people have any advantage.

Ihekweazu said: “For now we cannot explain what happened. It does not mean that Africans or blacks have special protection against the virus. You cannot determine that with just one case. We need more cases and evidence to determine that. But what is available shows that the virus have affected both whites and blacks all over the world.”

The Guardian reliably gathered that in the past two days alone, two African-American NBA basketball players have tested positive for coronavirus, and several cases have turned up among native populations in both African and Caribbean countries, puncturing any theory that black people are immune to the disease. Yet the memes persist.

Meanwhile, as outbreaks of COVID-19 disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue worldwide, there is reassuring evidence that children have fewer symptoms and less severe disease. That is among the insights provided by an expert review, published yesterday, in The Pediatric Infectious Disease Journal, the official journal of The European Society for Paediatric Infectious Diseases.

According to the review by Petra Zimmerman of the University of Fribourg, Switzerland and Nigel Curtis of The University of Melbourne, Australia, like previous epidemic coronaviruses, “SARS-CoV-2 seems to cause fewer symptoms and less severe disease in children compared with adults”. They summarise available evidence on coronavirus infections in children, including COVID-19.

“There is some suggestion that children are just as likely as adults to become infected with the virus but are less likely to be unwell or develop severe symptoms,” Drs. Zimmerman and Curtis write. “However, the importance of children in transmitting the virus remains uncertain.”

Meanwhile, the Nigerian Academy of Science (NAS) has said that it is possible to contain the dreaded COVID-19 pandemic in Nigeria.

President, NAS, Prof. K. Mosto Onuoha, yesterday, commended the quick diagnosis of the imported case in Nigeria, and the subsequent response by the government institutions responsible for dealing with such matters.

Onuoha said in pursuit of her mission to help solve national problems through the instrumentality of science, the NAS has made some observations.

He said with a fatality rate of under-four per cent (in China with the highest number of cases), and given that that was the first country with an outbreak of an unknown disease, it can be deduced that the disease spreads readily but is not as fatal as it is infectious.

The NAS President said known control measures are effective. He said with the strict control measures that have been instituted in China, the number of new cases outside China now exceeds those within that nation and some countries, example Nepal and Sri Lanka, with imported cases of COVID-19, have not reported any new case, for over four weeks.

Onuoha said these show that it is possible to arrest the spread of the disease if the right steps are taken and the known measures already in place, viz. regular and proper washing of hands, screening at the ports of entry, quarantine/isolation, contact tracing, public enlightenment, use of personal protective equipment, and equipping and training of health workers are effective in containing the spread of the virus – these should be strengthened in Nigeria.

Meanwhile, scientists say people with high blood pressure and diabetes could be at higher risk of severe or fatal coronavirus symptoms because of how their medicines work.

Drugs called ACE inhibitors and angiotensin receptor blockers may change the shape of someone’s cells in a way that makes it easier for the coronavirus to infect them and cause a more severe illness.

The most prescribed versions of these in England are Ramipril, Losartan, Lisinopril and Candesartan.

They are given to treat diabetes or high blood pressure and around 10 per cent of people in the UK – some 6.6 million – are estimated to take them regularly.

A paper published in prestigious British medical journal The Lancet Respiratory Medicine studied how the coronavirus latches on to people’s cells to infect them.

But a doctor has warned that patients who take the medicines must not stop doing so – they should speak to their doctor if they have concerns.

Scientists say the research does not prove a link between the medications and severe COVID-19, but that a potential connection should be studied more closely.

Other risk factors for severe or deadly coronavirus infection include age – over-80s are most likely to die – and heart disease. People with weak immune systems, such as cancer patients, or those with long-term lung conditions are also at higher risk but are by no means guaranteed to get seriously ill.

Onuorah, however, said Nigerians should guard against panic. “With outbreaks of new, or relatively unknown diseases, it is important to guard against the spread of rumours and scientifically unfounded stories, including those of cures and of preventive measures. Some of these include the claim that chloroquine is a drug of choice for treating COVID-19, and the use of alcoholic drinks to wash hands to prevent the infection,” Onuoha said.

He said recommended effective measures are the regular washing of hands with soap and water (the use of sanitizers being only an alternative where this is not readily available) and keeping a safe distance from someone coughing or sneezing (face masks are more effectively used by the person who is sick and not the healthy). Onuoha said with the spread of the disease to 113 countries, it is imperative that screening at our ports of entry must be stringent and more comprehensive.

While commending the government on the steps taken so far to contain the spread of the disease to and within Nigeria, Onuoha urged for transparency, strengthening of evidence-informed containment measures, and the need to engage local experts in ensuring that Nigeria is spared the socio-economic disruption that an uncontrolled outbreak could unleash on our nation.

He said the Academy would also like the general public to know that the containment of COVID-19 will require the cooperation of everyone with the government authorities at all levels (Federal, State, and LGAs).

Onuoha said individuals have a most important role to play by complying with official guidelines and directives put in place by the government to control the disease and such cooperation will facilitate effective surveillance, as well as early detection and treatment of cases.

Meanwhile, Minister of Health, Osagie Emmanuel Ehanire, told journalists that the Federal Government is upgrading facilities especially in the emergency wards and isolation centres in the teaching hospitals located in Lagos, Kano, Port Harcourt, Ogun, and Enugu because they are the major ports of entry for international passengers.

Ehanire said he has met with Chief Executives of all the teaching hospitals in the country and they are preparing for a worst-case scenario where even tents will be provided in these locations to carter for over flow of patients.

Ihekweazu said what the NCDC encourages now is social distancing and optimal hygiene.

Also, some churches have adopted radical changes especially during Holy Communion to prevent transmission although the measures fail recommended strategies.

The leadership of the Church of Nigeria Anglican Communion has discouraged handshakes during services and the use of few cups to serve the Holy Communion wine to hundreds of people.

The measures took effect yesterday, Sunday in some churches. At St Paul’s Anglican Church Oke-Afa, Isolo, Lagos, the Vicar announced against handshakes and unlike the previous Sunday’s, the Holy Communion wine was served with smaller but re-useable cups.

Also, the NCDC has insisted that there is no cure for COVID-19. Ihekweazu criticized cure claims for coronavirus. “How can people claim to have cure for a disease they have not seen before? This virus was just identified this year. How can people say they had discovered a cure in 2015?”

Indeed, misinformation about COVID-19 is spreading online, including many fake cures or treatments for the disease. At least seven companies have been warned by the United States Food and Drug Administration (FDA) for fraudulent products to treat COVID-19. The products cited in these warning letters include teas, essential oils, tinctures, and colloidal silver.

As anxiety over the potential spread of the novel coronavirus has increased, so have the fake treatments and cures for COVID-19, the disease the virus causes.

This prompted FDA and Federal Trade Commission (FTC) to send warning letters this week to seven companies for selling “fraudulent COVID-19 products” that claim to prevent or treat the disease.

The products cited in these warning letters include teas, essential oils, tinctures, and colloidal silver. The FDA stated, “There are currently no vaccines or drugs approved to treat or prevent COVID-19.”

The FDA approval process requires companies to show that their products not only work the way they say they do, but also that they are safe. This involves backing up their claims with well-designed scientific studies.

None of the companies warned by the FDA have gone through this process.

Meanwhile, despite the admission by the British National Health Service (NHS) that they do not have enough ventilators to tackle coronavirus, Ehanire told The Guardian yesterday: “We have ventilators in nearly all hospitals. But only few coronavirus cases need ventilators mostly the two cases treated in Nigeria did not need one.

“No one anywhere knows whether ventilators are ‘enough’ since you cannot know how an outbreak runs.

“We have prepared so flexibly as to move ventilators to where they are needed fast.”

According to the World Health Organization (WHO), the course of 15 percent of coronavirus-infected patients is so severe that an additional supply of oxygen is necessary.

A former NHS official said it is ‘unforgivable’ that not enough are available and the UK faces a huge challenge getting more.

Engineers have already been asked to draw up plans to quickly produce more ventilators in the country, amid concerns that critical care facilities will come under intense pressure as the COVID-19 crisis intensifies. Negotiations are also taking place with private health firms about access to their hospital beds.

Health Secretary Matt Hancock said the thing the NHS “needs more than anything else” is ventilators – which he admitted are “complicated’ to create – and the government has been buying as many as possible, while producing more too. He said he could not make guarantees that everyone who requires a ventilator will get one, saying: “We don’t make guarantees in healthcare.”