Low COVID-19 numbers in Nigeria: Contextual questions, facts
In 1962, when Bob Dylan wrote the song, “The answer is blowing in the wind,” he was probably not referring to the questions surrounding the novel coronavirus. The first human coronavirus had not yet been identified. To date, seven human coronaviruses have been identified. It’s almost a year since the seventh coronavirus; SARS-COV-2 entered the global stage and upended our lives. It has gregariously obtained a permanent residency visa in all the nations of the world except perhaps in a few island nations.
Curiously, despite our much advancement in human and biological warfares, we are still befuddled about how a seemingly innocuous virus can dribble and bamboozle the World Health Organization and all the super powers. The United Sates has the highest number of confirmed cases followed by India, Brazil, France and Russia. Russia is even talking about a third wave of the virus by next year’s spring. Mathematically speaking, although India ranks second on the list, we should note that it makes up one-sixth of the world population and it has a relative number of fewer deaths when compared to its population. It has 127, 104 deaths as of November 10.
The USA has the highest number of deaths with 244,449 persons. The United Kingdom ranks eighth in the ranking of countries by number of confirmed cases and is on its second lockdown as well as many European countries. The first ten countries include countries that are generally seen as having super powers. Not one African country makes the list of first ten nations with the highest number of cases. The first African country to come on the list is South Africa which comes 13th. The next African country on the list is Morocco coming as the 32nd country. Nigeria ranks 71st on the list. It has turned the gloomy predictions of the WHO about the impending coronavirus related deaths in the hundreds of thousands in Africa on its head.
Why does Africa seem to have low cases? Why are people not dying as initially predicted? Where is the second and third wave for Africa as expected? These are some of the questions that should not be allowed to blow in the wind. In Nigeria of today, wearing a mask on the street in some places is considered an anomaly. This should not be so but it is what it is. Nigerians and in fact many Nigerians believe that the virus is gone or that it was all a political hoax and never even existed. Let us factually, tease out some of the answers to these questions, to what has seemed to turn the apple cart on its head.
The virus exists. It is not a hoax and it is very much in Nigeria. I wrote lengthily about this in my article on “Conspiracy Theories Around COVID-19.” Although we are testing below the expected numbers for the size of our population, notwithstanding the number of confirmed cases in Nigeria and in Africa as a whole has been low. Why the low numbers?
There is a plethora of reasons for the low numbers. These reasons include our exposure to the sun and subsequent absorption of Vitamin D, possible antibody build up from asymptomatic infections, possible immunity from low doses of the virus enabled by mask wearing, reduced infection from childhood BCG vaccinations against tuberculosis, ubiquitous drinking of local antimalarial herbs, use of chloroquine, ingestion of vitamin rich fruits and proteinous meats and our penchant for social gatherings. Further, although Nigerians may say they do not believe the virus exists, they are still careful and do not want to fall sick because they know our health care system is very weak and hospitalized persons are never sure of recovery until they actually step out of the hospital.
However, in the developed countries where they believe their freedom is being trifled with when asked to wear masks, they do so willy nilly knowing fully well that if they do fall sick and need hospitalization their government would at least treat them first with the latest gadgets before asking them to pay.
A lot of people in the developed nations are also vegetarians. They do not eat meat or they place themselves on special diets that require little or no animal protein. They can have meatless burgers and even meatless sausages. On the long run, their bodies would lack definitive proteins required to adequately fight the virus. They often lack vitamin B 12 as well. Further, the environments of some of these super powers has been so sanitized that the human body’s immune system lacks memory cells that can fight virulent organisms that lurk in unsanitary environments. While, I’m not advocating for unsanitary conditions, I’m suggesting a myriad of ways that Africa has been able to have low numbers of cases despite our inadequate healthcare systems.
Vitamins D and C play vital roles in the suppression of SARS-COV-2 replication. Despite our melatonin rich skin, we are able to absorb abundant Vitamin D by our constant exposure to the sun. Our global neighbours in temperate regions do not have the luxury of so much Vitamin D because of their cold weather. They usually have low levels of the vitamin. There is less sun in winter and even if the sun was out, the weather would be cold and they would only venture outside wearing their coats thus covering their entire skin, preventing entry of Vitamin D.
In Nigeria and in Africa as a whole, most of our fruits are organic, produced without much of genetic engineering because our farming is still subsistence. We have been blessed with many tropical fruits that come in different seasons and are rich in Vitamin C. Even if we can’t buy from the market there could be a tree or so nearby where we can pluck fruits in season.
Advances in environmental hygiene also means that the BCG vaccine, is not mandatorily given in their environments. The BCG vaccine is usually given at birth to protect against tuberculosis, an airborne infection carried in a droplet nucleus. Vaccination with BCG is compulsorily given in every African country. Ideally, it should be given. Before the coronavirus, several observational studies showed a decrease in child mortality amongst those who were immunized with the BCG vaccine. In case you’re wondering if you were given BCG at birth you might see a small scar on your left upper arm. The vaccine is usually given intradermally on the left upper arm.
Our unhygienic environment exposes us to different pathogens some of which are respiratory ranging from viruses to bacteria. Over time, this seemingly unhygienic exposure to pathogens have actually helped to build up our immunity to different diseases including some viruses. If you’ve lived in Nigeria from childhood or for the most part and you’ve spent time in an outdoor environment, you would have been exposed to more than a few pathogens that your body would eliminate even without you knowing. Sometimes, you may have a slight cough and fever and unknowingly think it’s nothing when in actual fact, it’s your immune system fighting any of these unknown pathogens. When a pathogen like coronavirus enters the system, it’s possible for a combination of these reasons to eliminate, reduce or mitigate the overall effects of the coronavirus infection depending on the health status of your immune system.
People in the developed countries live where there’s improved housing, improved air quality, and much lower exposure to organisms causing respiratory infections. They even have a yearly immunization against the flu thus preventing a natural development against the flu. Some people especially the elderly and those with weakened immune systems might benefit from this flu shot. Some of these organisms like gram negative bacteria over time produce antiviral proteins that can help fight the novel coronavirus. It’s also possible that exposure to other human forms of the corona virus from our unsanitary environments have primed our immune systems to fight the novel coronavirus.
Let me give a case in point, how many Nigerian children living in Nigeria are allergic to groundnuts? I’m not talking about breaking out in pimples. I mean an allergic reaction that can make the body go into an anaphylactic shock. However, overseas, in developed countries, we see Africans whose environment has changed from Africa coming up with allergies to groundnut also known as peanut. Why? It’s because their present environment has been so sanitized, they have not allowed priming of their immune system to general microbes in the air that will have trained their immune system in fighting the allergies. It is in this same vein that our global neighbours in the developed world and rich nations are not able to adequately fight off the virus.
Another aspect we should not overlook is the mutation and infectivity of the virus. It is also possible that the strain of the virus in Nigeria and in Africa for the most part has mutated to a less infectious one that is now endemic in Africa just like malaria. I’m not saying we should practice unsafe hygiene. No! I’m laying down a compendium of several factors that interplay in the resultant low numbers we are getting. We do not yet know the social class or the immune state of those that are having the virus in Nigeria. Other reasons we must consider amongst those who do get infected in Nigeria is the dose of exposure to the virus because we know that a social distance of 1.5 meters does not prevent the virus from getting to the person. It only reduces the viral load that would get to the person. You will actually need a distance of 8 meters from an infected person to prevent the virus from getting to you. Further, when we wear our masks, it does not prevent the virus from getting to us, it merely reduces the viral load allowing our immune system to tackle the virus in tolerable doses.
As I laid down in my articles on “When Chloroquine became an Anathema,” and “Masked Faces; The New Normal and COVID-19” the viral load one gets depends on a number of factors; the type of mask being worn, the ventilation or non-ventilation of the environment, the amount of time spent in that environment, the loudness of the person speaking and the distance between the two speakers. In an open space where air is circulating, like in a park, there’s less chance of spread provided people are well spaced apart and it’s not crowded. The virus is less likely to travel far from someone speaking softly, than from someone singing, shouting, laughing, sneezing or coughing. These human activities are not always under our control. Spending up to fifteen minutes with an infected person in close range will increase the chance of getting infected. We are social human beings and require touches like hugging and shaking of hands but in this present era we must exercise caution. Extreme lockdown can actually lead to mental health breakdown.
Finally, the NCDC has also gotten a better grasp of the management of the disease and this helps to keep the numbers down. Regardless of the reasons for the low numbers, we should maintain our social distancing, wearing of masks and washing of our hands.
Obilade, a medical doctor and an Associate Professor of Public Health, wrote from Abuja.