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Decline in new COVID-19 cases not end of pandemic, NCDC warns

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Ihekweazu

• Majority Of Patients Between Ages 31 And 40
The Nigeria Centre for Disease Control (NCDC) has warned that the recent decline in number of cases and deaths from COVID-19 does not translate to end of the pandemic.

Director General of NCDC and a Consultant Epidemiologist, Dr. Chikwe Ihekweazu, said the low Case Fatality Ratio (CFR) or rather death rate of COVID-19 patients in Nigeria is because majority of those infected in the country are between the ages of 31 and 40.

Ihekweazu said experience has shown gaps in legislation for health security in Nigeria, explaining that Nigeria is not part of global destination for clinical trials of progressive vaccines, like South Africa and Egypt.

He stressed that contrary to some reports that hydroxychloroquine is not recommended for the treatment of COVID-19, the Centre has not dropped the age-old drug, but rather advises the use only in clinical trials, saying COVID-19 has provided opportunity for the rapid scaling up of public health laboratory, emergency preparedness and response capacity.

The NCDC boss said a combination of public health and social measures can only provide 100 per cent effectiveness in the control of the spread of the pandemic with the compliance of Nigerians.

Asked if the pandemic is now under control in Nigeria, Ihekweazu told The Guardian: “The COVID-19 pandemic is caused by a virus that had never been identified in humans prior to December last year. This means that we are really starting from ground zero to understand the virus and its characteristics, mode of spread, preventive measures, etc.

“In the absence of a vaccine, the world is at risk of continuous transmission. For now, we have to depend on a combination of public health and social measures that do not provide 100 per cent effectiveness. The success of these measures does not only depend on the effectiveness of the measures themselves, but on compliance by the people.

“Scientists across the world, including in Nigeria, are working very hard to ensure that we have a better understanding of how to control this pandemic as quickly as possible. It is not an easy task and requires patience as we go through systematic scientific processes. But irrespective of the success of science in developing a vaccine, ultimate control will depend on the behaviour of people.”

Ihekweazu reiterated: “It is still too early to interpret a decline in new cases as flattening the curve. We are learning from countries in Europe and other parts of the world that a decline in new cases does not translate to being at the end of the pandemic.

“In most of these countries, they have begun to record an increase in cases again. In other cases, the virus has continued to spread, but not exponentially. We are proud of the leadership of the Lagos State Government in responding to this outbreak, but will not relent in our response activities.

“Although Lagos State is the epicentre of the outbreak in Nigeria, various states are at different phases of the outbreak. In some states, we are recording an increase in cases. We are only as strong as our weakest link and will continue to maintain momentum in the response, despite the decline in the number of new cases recorded.”

Asked what NCDC, Lagos State and indeed the country have done well to achieve the decline, the epidemiologist said: “The Lagos State Government has shown very strong leadership in the response. We supported the state in activating testing capacity in four public health laboratories, including NCDC’s Central Public Health Laboratory. The State Government has also approved the inclusion of seven private sector laboratories to support testing.

“In addition, we worked with the World Health Organisation (WHO) to support Lagos State in establishing sample collection centres in priority Local Government Area (LGAs) to enable increased demand and access to testing. These efforts have really helped us scale-up testing in the state.

“Also, the state has promoted public health and social measures, including the enforcement of use of facemasks, closure of large gatherings, etc. An NCDC Rapid Response Team has been supporting the Lagos State Ministry of Health since the beginning of the response. We will continue to sustain these efforts, so that we do not lose the gains that we have made so far. The ultimate control of this outbreak will depend on the behaviour of people.”

On efforts to sustain the tempo, the NCDC DG said: “A major priority for us in the coming months, is to support states to develop a sustainable approach to the COVID-19 response. This means increased ownership at state level. We have provided guidance to states to set up sample collection centres in secondary and tertiary hospitals.”

“In addition, we have published guidelines to help states prioritise testing needs. In the last one month, we have provided funding to about 20 states through the World Bank supported Regional Disease Surveillance Systems Enhancement (REDISSE) Project grant. We hope to complete the disbursement of funding to all states by the end of this month.

“This funding is to help states implement their incident action plans with activities to improve the current response and build sustainable structures. Every other week, I hold a meeting with all state epidemiologists, where we discuss the response, share lessons learned and possible solutions to challenges. We remain in touch with the State EOCs on a daily basis to ensure that they receive required guidance and support to continue this critical response.”

Regarding talk of a second wave of the virus by next month and if it is applicable in Nigeria, Ihekweazu said: “The possibility of a ‘second wave’ is based on different modeling activities and are projections of what may happen. At the moment, we do not know for certain that this will happen or not.

“However, the re-opening of society means that more people will come in contact with each other, which is how the virus spreads. This is why we have provided guidelines and measures, such as physical distancing, compulsory use of facemasks in public settings, limited the number of people that can meet, etc. It is very important that Nigerians adhere to these measures, so that we can protect each other.

“Our health systems are stretched and we must take responsibility as individuals to reduce the risk of spread of the virus.”

He explained that there are various reasons the case fatality ratio in Nigeria differs from countries across the world. “In some countries, the majority of people infected are those above 60 years, who are vulnerable and have co-morbidities. The data so far has shown that people who are above 60 years and have other illnesses are more likely to have severe cases of COVID-19 and die.

“In Nigeria, the majority of people infected are between 31 and 40. Despite this, we urge all Nigerians to continue to adhere to all our advice, as the virus can affect anyone, even though there are more deaths in people above 60.”

On why Nigeria not part of the global destination for clinical trials of some of the progressive vaccines, the NCDC boss said: “During pandemics and outbreaks, clinical trials and related activities usually begin in sites with existing capacity. This is what countries like South Africa and Egypt have been able to build and sustain before the COVID-19 pandemic.

“While the coordination of clinical trials is not a primary responsibility of NCDC, we are fully committed to supporting opportunities that may arise.

“The Africa Centres for Disease Control has recently established a Consortium for COVID-19 Vaccine Trial (CONCVACT) to coordinate and support countries in Africa to partake in vaccine clinical trials. The government of Nigeria has expressed willingness to be part of this initiative, as it will allow us to contribute to research and development.

“However, safety remains our utmost priority and we will follow all required scientific processes, whether as part of clinical trials or approved use.”


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