‘Why biosecurity, biosafety laboratories are strategic to tackling pandemics’
Adetokunbo Fabamwo is a Professor of Obstetrics and Gynaecology at the Lagos State University College of Medicine (LASUCOM). He is currently the Chief Medical Director of the Lagos State University Teaching Hospital, (LASUTH). In this interview with PAUL ADUNWOKE, he discussed how the hospital was able to successfully tackle the Coronavirus pandemic. He said allocation to health sector in the 2021 budget should be reassessed, while every state should be encouraged to have biosecurity and biosafety laboratories in case of another outbreak.
How has LASUTH been coping since the outbreak of COVID-19?
Before Coronavirus came to Nigeria, we had warning about it from world news. We knew we were going to have it, so we started preparing. In February this year, the virus was discovered in the country. Before then, we had started educating our health workers about the virus. We were training them on infectious disease prevention and control, acquiring for them personal protective equipment (PPE), hand sanitisers and ensuring that water was running in the hospital premises. This is because we knew the virus requires frequent washing of hands.
Then the first case came, and we knew it was time to intensify our efforts. Therefore, we instituted a script screening method for all the patients coming into the hospital. We checked their temperature and oxygen saturations. The first suspected COVID-19 patient was referred to the infectious disease hospital in Yaba, Lagos. After that, we developed more sophisticated screening method, where we designed questionnaire for specific parameters, which included asking the patients such questions as: Have you travelled recently? Where are you coming from? Are you coughing? Do you have chest pains and sore throat? Have you lost the sense of smell and taste? We had a specific score, which would make the patient to be suspected of COVID-19 or not.
In between, we developed an isolation ward, where we kept suspected patients until their test results were available, and then we decide whether they are positive or not. We referred those that tested positive to Yaba, while those who tested negative were treated here in our hospital.
Then fortune smiled on us. A certain philanthropist decided to build an isolation bay for us, which will soon be commissioned. It is the first of its kind in Nigeria because it is an individualised isolation bay with 20-bed wards. Both COVID-19 negative and positive patients could be kept there without any risk of cross infection. So, when it is ready, we will be able to see and keep COVID-19 suspected patients in our facility and start to investigate. And if the result comes out positive, we know how to treat them, which is a big plus for us. We used to be under pressure to admit and treat COVID-19 patients. But we resisted the pressure because the hospital was a bit chocked, with the wards close to each other. So, if we started admitting COVID-19 patients, there would be high risk of cross infection.
Interestingly, though we were not admitting pure COVID-19 patients for treatment, about 100 of our health workers still tested positive for the virus. We equally lost a nurse to the pandemic. All along, we have been lucky in terms of positioning of our PPEs. We have been getting our PPEs from the state’s central store, and a lot of private organisations have been so generous and magnificent; they gave us donations for PPEs. We also spent our money to get PPEs.
When COVID-19 started, there was anxiety, as nobody real understood how the virus was. Our health workers insisted on maximum kitting before attending to patients. But gradually with research, publications and information coming out, we discovered that the virus is all about wearing face mask, surgical gloves and gowns, among others, as these protect health workers from contracting it. For a very long time now, we have not had cases of our health workers testing positive for the virus. What we did was to psychologically support our health workers that tested positive to the virus. We also supported them with food palliatives and other relief materials to ensure they fed well to have strong immunity to fight the virus, and we had 100 per cent recovery, aside the nurse.
Have we coped well? The answer is yes compared to other places. At the beginning of the pandemic and during the lockdown, we had to shut our clinics. On many occasions, nobody could enter the clinics. We shut them to ensure that our health workers were not exposed to the pandemic. It was after the lockdown that we started reopening gradually. Presently, all our clinics are open, and we have started undertaking selective surgeries.
One thing we have done is to strictly regulate our clinics, as we are not yet in post COVID-19, the virus is still here with us. We no longer have overcrowded clinics, but we have specific number of patients we attend to in our clinics daily to avoid overcrowd. Another preventive measure we put in place was that if a patient wants to do surgery that is not emergency, he/she would undergo COVID-19 test before the surgery, so that our surgeons will be protected from the virus.
What can the country do to win the war against COVID-19?
I do not know whether the country can win the war or not. I work for Lagos State, which is the epicentre of the virus. But Lagos State rose to the challenges, thanks to Governor Babajide Sanwo-Olu and the Commissioner of health, Prof. Akin Abayomi, who tackled the problem headlong. However, I have my fears. We have had situation where some governors denied having COVID-19 cases in their states. Some governors do not adhere to the safety guidelines of the pandemic and during the burial ceremonies of some notable personalities, the guidelines were not observed. All these present a worrisome national picture, which can make it difficult to win the war against the virus. Also, the health workers in the national space are unhappy with the Federal Government because their hazard allowances have not been paid. Therefore, the Federal Government should pay health workers the COVID-19 hazard allowance to encourage them.
Some states do not provide workers with PPEs. We had a situation in a state, where at the arrival of a COVID-19 suspected patient, all the health workers ran away and went into hiding, because there was no PPE. Health workers embarked on a strike, where they articulated all the problems. Therefore, for the virus to be tackled nationally, the minister of health and state health commissioners must sit down to work out strategy to have biosecurity and biosafety laboratory like that of Lagos State. Each state should be encouraged, because even after the virus goes, there are predictions that there might be other epidemics. So, Nigeria as a whole and states must be ready all the time.
The good luck Lagos had was that we developed structures to deal with Ebola, and after that pandemic, we did not collapse the structures. We had foresight and felt there could be another pandemic after Ebola. We upgraded the structures and kept them, so that when COVID-19 came, it was very ease for us to contain it, by setting up various taskforce, among others. Governor Sanwo-Olu was the Grand Commander in the fight against COVID-19 pandemic.
I would say the COVID-19 Task Force team is doing well because of their daily briefings and talks. Whether that translated into action or not, I do not know, as there are complaints here and there. I would also say that our response in shutting our airports was very slow, because we had the first case through there. If we had closed our airports earlier before the knowledge and existence of the virus in the country, we would not have been where we are today.
What lesson should Nigeria take away from the Coronavirus pandemic, going forward?
Every country has learnt a lesson from the experience arising from the pandemic. The outbreak has helped countries to identify weaknesses and gaps in their health systems and then upgrade and bridge the gaps. As a country, the COVID-19 experience has clearly shown that our health system is very poor. And though we were aware of this before the pandemic, it was brought home to us more vividly. We simply do not have the medical capacity to battle a pandemic. Therefore, we should learn from experience. As I speak, the 2021 budget allocation to health sector should be sent back for reassessment because states should be encouraged to have biosecurity and biosafety laboratories in readiness for another pandemic, even when this virus goes finally. I am sure the biosecurity and biosafety laboratories are not included in the approved 2021 budget. So, they should go back and add it.
Government should quickly accelerate training of some health workers because we do not have enough health experts in area of biosecurity and biosafety laboratories. We should quickly go back to the basics and look at our primary healthcare facilities and ensure we upgrade them.
In Lagos State, future constructions of health facilities are being constructed to adopt quick conversion into isolation centres, in case of pandemic. This is futuristic thinking, and the Federal Government can learn from it. During the peak of the pandemic, we had a webinar where we invited a health physician from the United Kingdom, and he told us that within four weeks, UK was able to build 1000-bed Isolation centres. Would Nigeria be able to do this?
I do not know, but that is what our wealth should be spent on. We have to think critically, strategically, deliberately and intentionally, if we want to make progress.
What are the hospital’s plans for post-COVID-19?
We have already started planning towards post COVID-19, because we know that a lot of things would not return to normal again. People are now saying we are in a new normal. We did many things at the peak of the pandemic, which we are still practising. For instance, having telephone appointments with patients and regulating the number of patients we see daily. We give our patients staggered appointments to reduce over-crowding and number of waiting hours. The less number of waiting hours a patient has to see a doctor, the better for the patient. We regulated our management meetings, and opted for virtual meetings and discussions. I believe that globally, people are going to maintain virtual meetings and discussions.
We have plans for COVID-19 palliative testing centres, which are at an advanced stage, involving public private partnership (PPP) venture that will make testing faster to reduce overcrowding.
There is the good news in Nigeria and abroad about the cheap rapid testing. The World Health Organisation (WHO) has just approved rapid COVID-19 testing that would not cost more than $5, which is about N250. That will be fantastic, especially for us. This means that during post COVID-19 era, it will be very convenient to quickly test a suspected COVID-19 patient and go ahead with treatment.
How do you plan to improve bed-capacity to avoid patients being treated on the floor?
Our hospital is very popular. Everybody wants to come to LASUTH. We do not mind and we love treating as many patients as possible. The government is spending huge amounts paying health experts’ wages. Currently, LASUTH has about 150 health experts— surgical and medical, neurosurgeons, cardiologists and nephrologists, among others. We are here to manage critical and advanced cases. However, over the years, our bed capacity has not increased. Sometime in the past, we did not have enough bed space, which is a big problem because we were forced to ask some patients to go elsewhere. We have passed the era of treating patients on the floor; that will never happen again. But the good news is that we are looking forward to an expansion of our hospital. A former Lagos State deputy governor provided over 200-bed wards to be constructed in LASUTH, and the plan has reached advanced stage. If we have additional 200 beds, most of our problems are solved.
What challenges did the hospital face when battling COVID-19?
Some patients deceived us. Despite the fact that we developed questioner, some patients with travelling history lied to us. Patients who had fever took paracetamol before coming to see us, so that their temperature would be normal. So, we unknowingly admitted patients that were COVID-19 positive, which resulted in some of our health workers coming down with the virus. It is still a challenge, but it might not be serious currently, as this happened at the peak of the pandemic.
The other challenge, which we overcame, was that health workers were scared of treating patients, if they were not fully kitted. But we trained them and got additional information that workers did not need to be fully kitted; maybe for Ebola, but certainly not for COVID-19. All that a health worker need is to wear wraparound gown and go ahead and treat patients. Some weeks ago, a multinational company came and donated a huge amount to enable us acquire PPEs. We are thankful to them for the kind gesture.