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Furore over second wave of COVID-19, access to vaccines

By Chukwuma Muanya
10 December 2020   |   4:19 am
Medical experts have provided reasons why Nigeria cannot be spared of a second wave of COVID-19 and why only less than 900,000 Nigerians have been tested for the coronavirus.

(Photo by Kola Sulaimon / AFP)

Medical experts have provided reasons why Nigeria cannot be spared of a second wave of COVID-19 and why only less than 900,000 Nigerians have been tested for the coronavirus.

They also assured that the country would have access to effective and safe COVID-19 vaccines as soon as the World Health Organisation (WHO) approves them. The experts disclosed plans by the Federal Government to deploy rapid diagnostic test kits in efforts to meet the country’s target of testing at least ten million people.

A professor of Virology, pioneer Vice-Chancellor of Redeemer’s University and Chairman of Expert Review Committee on COVID-19, Oyewale Tomori, told The Guardian: “Nigeria cannot be spared from a second wave because we have generally and almost totally abandoned the safety precautions in the false belief that COVID-19 is gone out of Nigeria. Since it arrived on February 27, it has not left. The only issue is we will never know the magnitude of the second wave because we truly never knew the size of the first. So laying our COVID-19 epidemiology on the foundation of incomplete and sometime fake data, we will never be able to tell how severe the second wave will be. Only yesterday we reported over 324 cases in one-day compare to the paltry numbers we have been reporting. Again we do not have details of dates when these samples were collected.”

What can Nigerians do to mitigate this calamity? “Do what we should done in the first place that should have prevented nearly 70,000 cases and over 1000 deaths respectively from the disease. It is just that we place minimal value on life that we regard these numbers as yardsticks of success. One unnecessary and preventable death is a stain on our health banner,” Tomori said.

Reacting to the fear of second wave of COVID-19 across the world, Chief Executive Officer (CEO)/Director General of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, told The Guardian: “The reality is that no country in the world is safe, until every country is safe. There is the risk of a ‘second wave’ and many countries have begun to experience a spike in cases. However, we are learning from these countries and introducing strategies to reduce the risk of spread of COVID-19 and loss of lives in Nigeria.

“Since the beginning of the pandemic, we have built on lessons learned to strengthen our response and be better prepared for an increase in cases. We have grown from five laboratories to about 80 public health laboratories across all 36 states and the Federal Capital Territory (FCT) Abuja. This has enabled us improve laboratory turnaround time. We have continued to communicate with the public and share key messages through mainstream and social media.”

A consultant public health physician/epidemiologist and a member of Lagos State COVID-19 Response Team, Prof. Akin Osibogun, in an interview with The Guardian, yesterday, said: “Many countries including Nigeria, are worried about a possible second wave of the COVID-19 outbreak and the best approach has been to be prepared and not let down your guards. The preventive approach of promoting facemask, social distancing, hand washing and limiting crowd events are still recommended.

“The Lagos State Biobank now has capability if conducting up to 2,000 tests per day. In addition, up to seven private laboratories have now been licensed and brought into the State network of COVID-19 labs. The capability for testing is highly enhanced in Lagos State now. Those who need to be tested can be tested in the public labs while those who want to be tested can be tested in the private labs. The COVID-19 test in the public lab is free while the test in the private labs us at a cost.”

Osibogun, who is also the immediate past Chief Medical Director (CMD) of the Lagos University Teaching Hospital (LUTH) Idi-Araba, said the Polymerase Chain Reaction (PCR) test remains the gold standard while efforts are in to determine rapid mass testing techniques that may be appropriate and reliable for the environment.
Low testing

Ihekweazu said: “So far, we have tested over 800,000 samples since the beginning of the pandemic in Nigeria. We have not reached our target-testing rate yet but have expanded testing capacity to all states in Nigeria.

“We have significantly scaled-up our national testing capacity as well as expanded the number of laboratories for COVID-19 testing from four at the beginning of the year, to 80 public and private laboratories, with at least one public health laboratory in every state of the federation. This means that public health testing is easily accessible to the public and at no cost.”

The epidemiologist, however, said some states are not testing as they should but NCDC is working with them to improve demand for and access to testing. Ihekweazu said sample collection sites have been set up in tertiary hospitals and other locations across states and NCDC continues to intensify risk communication activities to sensitise Nigerians and encourage testing. “If you have symptoms of COVID-19 such as sudden loss of sense of smell or taste, please visit a sample collection centre immediately. The list of sample collection centres can be accessed via https://covid19.ncdc.gov.ng/laboratory,” he said.

How far with testing? Is like some states have stopped testing? Tomori said: “We did not go far enough in the first place and now we have virtually abandoned testing except where it is made mandatory by sickness or travel. Many states stopped testing a very long time ago and they got billions of naira to deal with COVID-19. However, many have used the fund for unintended, illegal and dubious purposes, bulging their bottomless pockets instead of flattening the COVID-19 curve.”
Rapid test kits

Has rapid testing been approved? Ihekweazu said: “Prior to fully deploying the World Health Organisation (WHO) approved Rapid Diagnostic Tests (RDTs) for COVID-19, we have to carry out an in-country validation process and the data will be used by the regulatory authorities for approval.

“So far, we have used these RDTs for our National Youth Service Corps (NYSC) members and officials. Through the strong collaboration between NCDC and NYSC, we have been able to screen prior to camp entry and detect some positive cases. This is one of the measures we are taking to prevent an outbreak within camps.”

The epidemiologist said the early results from this validation are promising and will guide the expansion of the use of RDTs in Nigeria, in the coming weeks.

Has rapid testing been approved? Tomori said: “Yes, some kits have been approved but there are hundreds of unapproved kits flooding our markets yielding false negative results and compounding and further beclouding our already and highly under reported COVID-19 burden.”

Fear of resurgence of endemic diseases
It is feared that other endemic diseases, which peaks during this period may overwhelm Nigeria due to special focus on COVID-19. What is being done to prevent this looming calamity? Ihekweazu said: “The pandemic has over-stretched health systems across the world. We will continue to strengthen our capacity to respond to the COVID-19 pandemic, but also other disease outbreaks. We are recording outbreaks of yellow fever in states. We have begun to record an increase in Lassa fever cases, which happens during this time of the year among others.

“We have continued to strengthen our laboratory testing, surveillance, risk communication and other response capacity. However, the responsibility does not lie with government alone. We urge Nigerians to adhere to preventive measures for infectious diseases – whether Lassa fever or COVID-19. Many cases and deaths can be avoided, by adherence to these measures.”

Tomori said: “The Lassa fever and Yellow fever calamities have already loomed and will continue to escalate into 2021. I know YF mass campaigns are ongoing in some states, but as usual this is MAD- Medicine After Death- and we cannot even be mad using our own resources, we are depending to a huge extent on external support and donors. As for Lassa fever we are likely to report more cases in 2021 than we did in 2020. In 2018 we confirmed 633 cases and 161 deaths of Lassa fever. In 2019, we confirmed, 833 cases and 174 deaths. As of week 48 in 2020 we have already confirmed 1154 cases and 239 deaths. You can see that Lassa fever harvest becomes more bountiful from year to year, so expect more cases and more deaths in 2021 with COVID-19 having taken over to worsen our already deplorable healthcare.

“Sometimes I hear government agencies congratulate themselves that the country is doing well by reporting more cases every year due to increased awareness. Government is not set up to annually tally up the number of deaths from a disease, but to prevent and reduce the number of deaths. So what is being done about these calamities? We will do as we have always done, pat ourselves on the back for detecting more cases and blame other failures on poor COVID-19!”

Access to COVID-19 vaccine
People in United Kingdom (U.K.), United States (U.S.), Canada, France and six other countries will start getting vaccinated against COVID-19 next week and there are fears Nigeria may not get access to the vaccines earlier than April 2021 due funding shortfall. What is the situation now and what is FG doing about this? “Yes indeed, Nigeria will get the COVID-19 vaccine crumbs and left overs after the people living in countries run by caring leaders who are accountable to their people, have received their doses,” Tomori said.

Reacting to the fear that Nigeria may miss out on access to COVID-19 vaccine, Osibogun said: “A couple of vaccines have now been established with effectiveness ranging from 75 per cent to 100 per cent and with their roll out, Nigeria will not be left out. The FGN is interested and the Presidential Task Force on COVID19 has it on agenda. International organisations including the WHO and the Global Alliance for Vaccine Initiatives are all committed to ensuring that low income countries are not left out.”

Advice against travelling during Yuletide
Last week Nigerians were advised against traveling during Yuletide to curtail spread. How do you intend to enforce this? Ihekweazu said: “It is important to note that not every measure requires enforcement by government. Several institutions have a role to play in ensuring adherence to preventive measures- business owners, religious leaders, traditional rulers, and school heads among others.

For example, business owners can introduce measures to ensure that people visiting their stores have their masks on throughout to protect other customers and staff.

“We ask Nigerians to please take responsibility and adhere to measures in place, which are introduced to protect us all. We will continue to provide public health advice based on the evolving situation and with several other considerations.”

Osibogun advised against travelling for Yuletide is essentially an advise against crowd events and it is a reasonable advise.

Tomori said: “How do you enforce anything in Nigeria? Well, it is not solely a Nigerian problem. Americans refused to stay home for their Thanksgiving holidays and I am sure that many will travel over the Christmas and new year holiday period. So we are no different. We need to personalise the appeal. Let people know that the advice is not to retain the government in power but to keep the individuals alive.”

Solutions
Ihekweazu said the introduction of the travel protocol that requires negative COVID-19 pre-boarding and seven days post-arrival is another important strategy to minimise the risk of infection in Nigeria. “We have also provided guidelines for safe reopening of schools, businesses, religious settings among others,” he said.

The NCDC boss added: “We will continue improving the work we do, but our success is really dependent on collective responsibility by all Nigerians. The virus is still with us so we cannot go back to business as usual. Please wear a face mask in public settings, avoid large gatherings especially where public health and safety measures are not adhered to, maintain physical distance of at least two metres from the next person and wash your hands regularly with soap and running water.”