Scandalous scarcity of isolation centres and tools

It is increasingly embarrassing that leaders at all levels in Nigeria are not yet prepared to face the implications of the COVID-19 that has taken the world by storm. It is also becoming scandalous by the day that even the capital of the federation and most of the 36 states of the federation are not yet ready with basic tools, notably test kits and isolation centres needed to manage the deadly virus. For instance, inquiries have shown that only 169 ventilators are available in 16 states of the federation even as 10,000 are required nationwide. What is worse, a top official in the office of the president confirmed in a statement that he would require further treatment in Lagos, a state in the federation. This development speaks volumes about monumental unpreparedness even in the nation’s capital, Abuja.

COVID-19 is a disease caused by a new strain of coronavirus that has not been previously identified in human. It was first reported to World Health Organisation (WHO) on December 31, 2019 in Wuhan, China.

In Nigeria, the first confirmed case of the pandemic was announced on February 27, 2020, when an Italian citizen in Lagos tested positive for the virus. And on March 9, 2020, a second case of the virus was reported in Ewekoro, Ogun State and it was a Nigerian citizen who had contact with the Italian citizen.

As a result of the index case, on January 28, 2020, the Federal Government of Nigeria (FGN) assured citizens of its readiness to strengthen surveillance at five international airports (Enugu, Lagos, Rivers, Kano and FCT) in the country to prevent the spread of the deadly virus. Similarly, on the same day, the Nigeria Centre for Disease Control (NCDC) announced that it had already set up a coronavirus group and was ready to activate its incident system if any case emerged in Nigeria, which it did.

In terms of prevention, the NCDC public health advisory and sensitisation campaigns to encourage personal hygiene, including hand washing with running water; and the need to practice social distancing are ongoing.

Again, the government at all levels have issued a stay-at-home order and restricted movement. The FGN also placed travel restrictions to keep potential carriers of the virus from high-risk countries away from Nigeria. On March 23, the Borno State governor imposed a four-week ban on visitors to all IDP camps in the state. Different states including Lagos have announced measures to contain the mysterious scourge. The president finally locked down Lagos, Abuja and Ogun from Tuesday.

Notwithstanding, the cases of Covid-19 have been on the rise in Nigeria. The latest NCDC, Sitrep as at April 1, 2020, shows that since Covid-19 reared its ugly head into the country, a total of 151 confirmed cases had been reported from 11 states and the FCT. The actual number of cases is most likely higher, due to limited testing.

Available evidence suggests that the isolation centres and tools needed for combating Covid-19 and other diseases in Nigeria are grossly deficient. Currently, there are only five testing laboratories in the country (Lagos 2; Abuja, 1; Edo, 1; and Osun, 1). However, the NCDC has expanded the number of laboratories to six with the inclusion of the Virology Laboratory of University College Hospital, Ibadan; and has proposed setting up another testing laboratory at Abakaliki to ramp up the Covid-19 testing capacity in Nigeria.

Similarly, at the onset of COVID-19, the first three cases in the FCT were taken to the University of Abuja Teaching Hospital (UATH), Gwagwalada; while the seven cases in Lagos were taken to the Infectious Disease Hospital (IDH), Yaba.

With the rise in the number of confirmed cases, these facilities are definitely too little for a population of 200 million. So, to bridge the gap in isolation centres and tools, there was a report that Nigeria had designated 17 military hospitals, 37 National Youth Service Corp camps as COVID-19 isolation centres. Besides, there was another report that some schools, stadia were being prepared as Emergency Isolation Centres (EICs) for Coronavirus cases.

Again, the FGN approved N10 billion grant (about $27 million) to fight the spread of coronavirus. The money will be released to Lagos State, which has the highest number of coronavirus cases in the country. The grant is meant to increase the capacity of Lagos State to control and contain the outbreak, while also supporting other states with capacity-building. Furthermore, the president reportedly approved N5 billion (about $13 million) special intervention fund to NCDC to equip, expand and provide personnel to its facilities and laboratories across the country.

In addition, the coalition against COVID-19 has intervened to scale up the level of Nigeria’s emergency preparedness. The coalition consists of wealthy Nigerians and the organised private sector, including banks. They have donated billions of Naira to help fund medical centres and provide essential materials necessary to curtail the spread of COVID-19 in the country. While wealthy Nigerians including Femi Otedola, Abdulsamad Rabiu, Herbert Wigwe, Segun Agbaje and Aliko Dangote, Africa’s richest man, all contributed N1 billion (about $2.7 million) each; United Bank for Africa (UBA) announced a donation of N5 billion (about $13 million); and Max Air donated $200,000 to support the government in curtailing the pandemic. The donations are to provide beds for isolation centres, intensive care unit facilities and direct access to medical advice to citizens.

As an individual, the former President Olusegun Obasanjo donated a 32-bed facility at Ota, Ogun State while the ministers donated half of their March salaries. It is also on record that federal legislators have pledged parts of their salaries for the same cause. The roll call of international donors include global fund, $33 million; Chinese firm, Huawei, $100 million, Jack Ma, 20000 pieces of Covid-19 testing kits among others.

These donations in cash and kind have brought a glimmer of hope as the interventions are strengthening the capacity of the health sector to cope in terms of supporting the provision of more isolation centres and tools.

Notwithstanding, with COVID-19 cases on the rise and the non-disclosure of the total number tested, Nigeria can never be over-prepared. Furthermore, our health system may be overwhelmed if more people get infected with Coronavirus as predicted by experts, who hinged it on government delay in taking proactive steps.

Even countries with highly developed healthcare systems responding to the virus, have recorded shortages of ventilators to help patients breathe and medics care for the sick, for instance.

Therefore, Nigeria with a population of about 200 million and poor doctor patient ratio, should scale up prevention and build excess capacity in case there is a massive increase in the number of people infected; so that it will simply activate.

Specifically, the number of isolation centres and tools available for response is still scandalously inadequate, hence, designated isolation facilities across the country should be quickly resourced to treat and support patients and healthcare workers respectively.

Meanwhile, Nigeria should also improve on surveillance/contact tracing and procure more testing kits. There should be at least a testing centre in every state; more emergency operating centres (EOCs) and isolation centres. This can be achieved through inter-agency collaboration. The laboratories of universities and research institutes can be upgraded and strengthened for research, teaching and testing. Also, there should be massive investment in the physical structures in the tertiary institutions.

These do not discount the provision of potable water and electricity, because research cannot be done in the absence of basic amenities. The services should also be available to those in low-income densely neighbourhoods and internally displaced people’s camps, to reduce their vulnerability.

Government at all levels must take combating Covid-19 seriously and sustain public enlightenment through traditional as well as social media on measures to prevent and contain it. Sensitisation activities apart from focusing on personal hygiene, hand washing, social distancing and staying indoors as we noted the other day here should also focus on non-stigmatisation of COVID-19 patients.  Besides, disinfection and fumigation of public places and communities with non-toxic sprays should be continuous and widespread. That public health action will mitigate community-to-community transmission and reduce the number that will get to the hospitals. In the main, donations and grants should be judiciously used while spending should be tracked to ensure that the funds do not end up in private pockets.