COVID-19: Cost of treatment above N100, 000 per patient as cases climb to 4, 000

• Patients Treated With Cocktail Of Drugs Plus Prescription Antiviral
• Treatment Largely Based On Symptoms
• Nigeria Considering Home Treatment
• 44 million Africans May Get Infected In First Year Of Pandemic
• Remdesivir Not Readily Available

As the country’s Coronavirus Disease (COVID-19) cases crossed the 4, 000 mark yesterday, concerns are mounting about the over-burdened treatment centres, lack of bed space, rising cost of treatment, and the increasing death rate, which has become a major concern for both the government and Nigerians.

The World Health Organisation (WHO), yesterday, also said 29 million to 44 million Africans may get infected with COVID-19 in the first year of the pandemic if containment measures fail, according to a study.

The WHO Regional Office for Africa in Brazzaville, Congo, which made the disclosure in a statement posted on its website, also said the study revealed that 83, 000 to 190, 000 people in Africa could die of COVID-19 in the first year of the pandemic. “The research, which is based on prediction modelling, looks at 47 countries in the WHO African Region with a total population of one billion.

Only recently, the Federal Government disclosed that it has started using Remdesivir- an anti-retroviral drug approved for emergency treatment of COVID-19 cases in the United States. With this revelation, many are beginning to heave a sigh of relief that the rising death toll from the virus may finally abate.

However, investigation by The Guardian revealed that this drug is not yet approved or adopted as a treatment protocol for COVID-19 in the country. The Minister of Health, Dr. Osagie Ehanire, while briefing members of the House of Representatives, recently said: “We have been using that (Remdesivir). “So, we have tried the antiretroviral drug to see what effect it has.”

Ehanire, who explained that the drug originally developed as a potential treatment for Ebola, is one of the options, which the country has adopted in treating COVID-19 patients, added that no herbal medicine has so far been approved for the treatment of the scourge.

While The Guardian reliably learnt that over 100 patients recovered after being treated with the anti-retroviral drug, some health workers at some of the treatment centres, who spoke on ground of anonymity said Remdesivir is not yet adopted, or used in treatment.

ONE issue that has continued to remain contentious in COVID-19 has been the cost of treatment per patient. Presently, the country’s health authorities are yet to come up with an official COVID-19 cost estimate per person.

However, analysts believe the cost of treatment in Nigeria would be around 15 percent of treatment cost in the United States. In the United States, a number of health spending reports were released in March 2020 from Kaiser Health Foundation, as well as, FAIR Health, Inc.These reports estimated the cost range of treating a single COVID-19 patient requiring hospitalisation to be within $5,000 to $88, 000 per person, depending on severity and duration of hospital stay

This 15 percent estimate will mean an average cash outlay of $750 to $13, 000 (or N270, 000 to N4.7million per person depending on the duration of hospital stay i.e. six-day stay or 23-day intensive care hospitalisation). This multiplied by 200 positive cases could mean N54m to N940m0 just for Lagos alone. This, of course, excludes economic impact.

Also, ExpatAssure (a health insurance broker for expatriates) estimates an average healthcare cost of $275 for a single night in a Nigerian hospital with an additional $110 average cost for consultation (i.e. likely cash outlay for 6 days is $1,650 or N594, 000). So for 200 patients in Lagos could mean N118m for a six-day stay.

Painting a clearer picture of the cost of treatment, a consultant public health physician/epidemiologist at LUTH, Dr. Olufela Oridota said: “The cost of a test is about $30 and not less than $20. You need to test a person at least three times before he/she is discharged because after the first positive test, two tests with negative results must be obtained before a patient is discharged. However, some people are tested more than 10 times like the Italian index case, who was tested several times. Some people can test negative, but their second test can come out positive when all that is needed before anyone is discharged is two negative results. This (test) is only one aspect of the cost.

“They do not pay for accommodation. If you look at a facility like LUTH, you can calculate how much it would cost for someone to be on admission for a week or two. That is another line of cost, but they are treated for free. The PPEs that they are going to put on including, facemasks to protect themselves, PPEs for the health worker are also factored in, and they are all provided by the government. And these are not the ordinary ones being used out there. In addition to these, the drugs are not specific, but any drug that needs to be administered is provided free of charge.

“Additionally, if you look at admission fees depending on the hospital, it could be up to N25, OOO or N50, 000. Add that to the cost of test – average of five tests per patient that is about $100 to $150. Then the PPEs, which are used for a day and discarded, including the overall, which are all imported. Also, if a patient needs to be on ventilator or ICU, the cost of using it in a day is enormous. So, if one looks at it on the average, it may not be less than N100, 000 to treat a COVID-19 patient conservatively.

Oridota, who added that most patients would never be able to pay for some of the materials used in their treatment (which were donated) because they are very expensive. Before now, many patients were having issues paying even their admission fee.

“Also, an ambulance picks these patients from their houses and they do not pay for that. If they were due for psychological support, social workers and expert psychiatrists would be brought in, and their families may also be in need of psycho-social support too. As these patients are being treated, their husbands/wives, children and their contacts are being tested and at the same cost of between $20 to $30. And none of these people would pay for the tests, which are part of the indirect cost to a patient. In the case of the Italian, the country’s index case, he had about 100 contacts. You can now see that the cost of treating one patient is enormous.”

PRESENTLY, treatment of COVID-19 patients is based on symptoms, and this is the standard protocol observed in all treatment centres nationwide. According to the National Guideline for Clinical Management of COVID-19 patients published by the Nigeria Centre for Disease Control (NCDC) May 2020, patients are treated based on severity of the cases. Mild or severe cases are admitted and treated at wards, while critical cases are admitted to ICUs.

The treatment protocol includes, ensuring that the patients are oxygenated, applying conservative fluid therapy, checking vital signs every four hours, addressing for severity of cases, using broad spectrum antibiotics, or anti-viral depending on symptoms.
   
Until now, the cocktail of drugs and the cost of treating COVID-19 patient in the country were shrouded in secrecy. In fact, earlier reports suggested that patients were administered Vitamin C, Paracetamol tablets and anti-viral drugs, while others suggested that some isolation centres were using some experimental drugs.
   
However, a consultant public health physician and former Chief Medical Director of the Lagos University Teaching Hospital (LUTH) Idi-Araba, Prof. Akin Osibogun, who has been in the thick of treating patients at isolation centres in Lagos, told The Guardian: “The aim of this stage of control strategy is the early detection and treatment of all cases. If cases are reported or are detected early and treatment commences right away, the chances of complications developing are reduced, and patients have greater chances of good recovery. The isolation of detected cases also reduces the chances of further transmission, while the current treatment process is that cases that display sufficient symptoms, or have been in close contact with confirmed cases are eligible for testing, and if their results come out positive, they need to be isolated and treated as determined under the Case Management Protocol.
   
Commenting on the drugs, he said: “The cocktail of drugs include a prescription anti-viral drug that can only be authorised by a licensed medical doctor, in addition to other supportive therapies, and I cannot say what the cost per patient’s treatment has been, but can only say that the Lagos State Governor, Babajide Sanwo-Olu has left no stone unturned in seeing that patients receive the best possible treatment under. 

Corroborating the treatment process during a presentation in Ondo State, an Infection, Prevention and Control expert, who is part of the Rapid Response Team for COVID-19 in the state, Dr. Chuks Agbejegah, said: “The approved treatment protocol is to treat based on symptoms. If the patient has body pains, we give them Paracetamol or other pain relievers. If they are down with cough, we give them antibiotics like Augmentin, or Erithromycin. For asymptomatic positive patients, we give them things to boost their immunity, including Vitamin C and Zinc. For those with underlying illness or complications, we let them continue their medication while we take care of any symptoms.”

On the use of Remdemsivir he said: “We have not seen the management protocol that says the drug is approved, neither have we seen the drug.” However, in order to stem the rising COVID-19-related deaths, experts insist that the country must look beyond Remdesivir for treatment.

Shedding light on the possibility of home treatment of COVID-19 patients, which is now being considered, after the Federal Government complained that treatment centres were gradually getting overwhelmed with patients, while lack of bed space is also becoming an issue of concern, Dr. Agbejegah said: “This came up at the last case management review meeting, which held last Thursday via teleconference. The home treatment will not be for every patient. Some of the criteria for the home treatment is if the person is positive, but has no underlying issue, or if he/she is asymptomatic, and less than 50 years of age and has a good accommodation, not living in the ‘face-me-I-face-you’ kind of accommodation.”

A public health physician and Director of Cantabridge Health Consult, Dr. Olalekan Makinde, said Remdesivir is likely not available yet in Nigeria. “We have to consider the cost and availability of the drug. It is time we start producing our own drugs and stop ‘follow follow’. It is time government encourages local productions. Although am a doctor, am not against herbal medicine. But we need to research and find out what works”, he said.

Meanwhile, a virologist, Prof. Oyewole Tomori, while commenting on the clamour by Nigerians for herbal remedy, said there was nothing wrong with herbal remedy but added, “we need to go through the proper procedure. We should start with animal experimentation before human experimentation. The human stage is likely the fifth stage. I do not approve of using any body as a guinea pig.”