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‘We’re limited by global shortage of testing reagents’

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Ihekweazu

Dr. Chikwe Ihekweazu, an epidemiologist and Chief Executive Officer (CEO) of the Nigeria Centre for Disease Control (NCDC), in this exclusive interview with CHUKWUMA MUANYA, he revealed the Centre’s efforts and challenges faced in the bid to contain the spread of the novel Coronavirus (COVID-19) in Nigeria.

How much does the Federal Government spend daily on contact tracing, testing patients, maintenance of health workers, logistics and other efforts at containing COVID-19, especially in the light of the 100 newly recruited ad hoc staff?
Currently, the NCDC has deployed 15 Rapid Response Teams (RRT) to states across the country. For every new state with a confirmed case, an RRT is deployed under 24 hours. These RRTs work closely with the state Ministry of Health to follow up with contacts of confirmed cases and passengers of interests. We follow up via phone calls to over 6,000 people daily, who returned to Nigeria in the last one week or who had contact with confirmed cases. Where it is important, our teams visit contacts at their homes and provide them with handheld thermometers to monitor their temperature. These efforts cost a lot of money, time and human resource. Our goal is to strengthen our contact tracing capacity to detect cases early, stop transmission and manage the cases we have to recovery.

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Our investigation revealed that the country has low testing capacity and has tested less than 31 per cent of people that have been exposed to COVID-19. What is NCDC doing about this?
In the last three weeks, nearly 3,000 samples have been tested. Although we are limited by the global shortage of testing reagents and the complexity of the currently validated laboratory method, we are working very hard to scale up our capacity. Our focus is to test people who have symptoms of the disease, identify their contacts quickly, follow up with them and manage the cases to recovery. This is our strategy at this stage. We will continue to review this as we learn more about this virus.

Have you been able to expand NCDC’s capacity to test?
Within three weeks of the confirmation of the first COVID-19 cases in China in January this year, we set up testing capacity in five laboratories in Nigeria. At the time, Nigeria had not recorded any case. The fifth laboratory was added in February.

With the increase in cases in Nigeria in the last one week, we have included two more laboratories. Overall, there are seven laboratories with the capacity to test for COVID-19 in Nigeria and we are including a least six more laboratories in the next one month.

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At the moment, the validated method for COVID-19 diagnosis can only be carried out in molecular laboratories. A brand new molecular laboratory requires extensive financial and human resources and time. We have had to focus on building COVID-19 testing capacity in existing molecular laboratories. With new methods, such as the use of Gene-Xpert machines, we hope to continue to scale up this capacity. But with increasing demand globally for limited reagents, this could take longer than we would like.

Some virologists and professors of Medicine are calling for the deployment of rapid testing kits to solve the problem of low capacity. What is your position on this?
The virus that causes COVID-19 is a new virus that had not been seen previously. The world is moving fast to find new solutions, such as vaccines, diagnostics, therapeutics and others. However, we must keep in mind that these technologies must go through a process of validation. At the moment, there is no rapid testing kit validated for use by the World Health Organisation (WHO). This means that the current rapid test kits will produce false results. The NCDC is keeping abreast of new technologies and will access these as soon as they are approved for use.

Predictive models show that the country might have up to 665 cases by April 14. What is your take on this? ‬‬
COVID-19 is easily transmitted from one person to another, mostly through respiratory droplets. This is why we urge Nigerians to adhere to the measures put in place. Avoid all unnecessary movement and travel at this time, wash your hands with soap and running water regularly, avoid contact with sick people and if a lockdown has been instituted in your city, please adhere to this. These are difficult times, but these measures are our window of opportunity to control this outbreak.

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Ventilators, PPEs, facemasks and other medical supplies globally appear to be in short supply. But said earlier that the only shortage you have is that of ventilators. What is the situation now?
There is an increasing demand for medical equipment, laboratory reagents, personal protective equipment and other response commodities across the world. This is rising with the increase in cases in more countries. As the demand rises, the supply is affected. With leadership from the Minister of Health and Presidential Task Force (PTF), we are working very hard to ensure that we have the required supplies in our treatment centres and laboratories.

Many are worried about the wellbeing of health workers, who are at the front lines and are exposed to the virus. How can they be safeguarded?
Health workers across the world are under an incredible amount of stress at the moment, and this cannot be over-stated. In Nigeria, we have developed guidance to support health workers’ mental health at this time. We have also included a module on psychological support in the training we offer to them.

Chloroquine is being used all over the world now to treat the virus. Are you doing any clinical trials on it and what is your take on this?
Clinical trials and other processes are still ongoing to validate the use of chloroquine for COVID-19 treatment. In addition to validating the efficacy of the drug, we must also ensure there are no fatal side effects.

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Our sister agency, the National Agency for Food and Drug Administration and Control (NAFDAC), has put out a statement on the country’s strategy for this. For now, we will adhere to validated treatment protocols for the management of COVID-19 cases.

What is the best way to contain the virus?
We do not know what the best strategy is, as we are still learning about this new virus. We will continue to learn more as we respond. It is not the most ideal approach, but we must remember that during a pandemic, there is no “one size fits all” approach. What has worked in one country may not work in the other. However, we will continue to ensure that our response is driven by science and evidence.

The pandemic is straining health systems worldwide, with increasing demand on health facilities and health care workers threatening to leave some health systems that are overstretched and unable to operate effectively. What are you doing to address this?
The Federal Ministry of Health is developing a strategy to ensure the health system’s response to other challenges continues. We are working closely with sister agencies, such as the National Primary Health Care Development Agency (NPHCDA) and National Agency for the Control of AIDS (NACA) for continuity in the health sector.

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