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Taking ownership in the management of COVID-19

By Titilola Obilade
26 May 2020   |   3:38 am
There is some truth in conforming with the norm. Many idiomatic expressions connote the conventional as the normal.

There is some truth in conforming with the norm. Many idiomatic expressions connote the conventional as the normal.

Statements like, “Don’t be an oddball,” “If you can’t beat them join them” are clear indications of affirmation when you conform to what is considered acceptable. In 2019, Nigeria marked her 59th year independence anniversary from colonial rule. By 2050, Nigeria would be the third most populous nation in the world with an estimated population of 400 million. Nigeria is a unique country with an estimated population of 200 million people. The task of managing a population like ours during a COVID-19 crisis is not for the faint-hearted. The sum of the populations of Ghana, Cameroon, Niger, Togo and Republic of Benin barely makes up half of the population of Nigeria. The population of Lagos State is the sum of the populations of Togo and Republic of Benin. Kudos to the Lagos State Government for managing the population size of at least two West African countries! In many ways Nigeria has been running on the unconventional track but in managing the COVID-19 pandemic, it has been trying to use conventional means like they do in more advanced countries. While many citizens excel in their own countries, Nigerian graduates usually excel in foreign lands that operate in more conventional ways. They graduate from the country’s unconventional system and despite all odds excel abroad. Tax-paying Nigerian citizens expect tarred roads, steady electric power, potable water, security of life and property. Sadly, this is not the case. The roads are not always motorable, generators have replaced unreliable electric power supply. If you want a steady water supply, you have to sink your own borehole. In other countries, you can get a loan at less than ten percent interest to buy a house but here, it would be close to twenty percent interest rate. After building your house, to ensure your own safety, you build a fence that imprisons you and maintain armed security in your estate.

Since the telecommunications industry is a playing field for aggressive, profit-seeking, customer-exhausting juggernauts, you will most likely own at least two or more telephone lines with different carriers to ensure your business is not hindered by poor network service. In conventional countries, when you call the emergency line, within nine minutes, the rapid response squad will be at your location. Here, if you call the helpline in an emergency and you are lucky to get a response, you might be told that there is no fuel in the police vehicle but that your monetary donation would be welcome. Our response team is gradually improving. In the pre and post independent Nigeria, we were taught that Mungo Park discovered River Niger. Any history around the River Niger before then seemed unimportant. The history around the people whose livelihoods depended on the River Niger before its exploration were ignored. The mentality that any idea or product from Nigeria is inferior to that of the developed countries should be debunked. There are great minds and ideas in Nigeria. Nigerians should stop harboring products and strategies developed in Nigeria. In countries where health systems work, when you have symptoms of COVID-19 infection, you are advised to call a helpline and the caller would be directed on the next steps to take. Similarly, when such countries are on anti-coronavirus lockdown, the citizenry are paid stipends, small and medium-sized businesses are given non-repayable loans, front-line workers are treated with gentility. These efforts serve as a cushion against the economic and mental health effects of the anti-coronavirus lockdown because the economy apart for those manufacturing face masks, nasal swabs and other health essentials is also on lockdown. Nigeria has never been transparent with the inflow and outflow of revenue. Many Nigerians expected our leaders to change overnight and waited in vain for stipends to drop into their accounts like it happened in some developed nations.

Nigeria is a unique country; unconventional in many dimensions. A democratically elected president can travel overseas for health reasons, abandoning the health systems of the country he has promised to defend, instead preferring that of a foreign land. And the citizens are not any wiser on his health status. The Prime Minister of the United Kingdom tested positive for the virus and the citizens knew when he was diagnosed, on oxygen and where he was treated. He was admitted in the same public hospital that the general public use. They also knew when he was admitted into the Intensive Care Unit and when he was discharged. He named his baby boy after two of the doctors that treated him. Going by all that I have written above, how can an unconventional country like Nigeria ask her citizens to call some sets of numbers when they have an inkling of the virus? A square peg cannot fit in a round hole. There are hundreds of locales in Nigeria where they do not have a phone reception for all the networks. Aside from the issue of phone reception, making some sets of numbers available for millions of Nigerians to call is not sustainable. The idea is a good one but we should not just assume because it’s being done overseas, it would work for us. Clearly, it’s not a feasible plan.

The challenges in Nigeria are mighty but the resources to overcome them are mightier. If we had the wherewithal to field calls from every nook and cranny of Nigeria, then we might be comfortable that once we place a call, our case will get acted upon. In developed nations, for decades, their health system has been tried and tested with taking emergency calls and other health-related calls. Therefore, it does not pose a challenge when they had to include calls for COVID-19 symptoms. In Nigeria, we believe that anything copied from abroad is always better than what is made in Nigeria. We need to develop Nigerian-made strategies that would work for Nigeria. This is not the time to shun Nigerian-made ideas.

We can start by decentralization of the tests and disseminate information on treatment strategies; including both the ones that work and do not work. Test kits and Personal Protective Equipment can be manufactured and validated in Nigeria. Most importantly, there’s a need to acclimatize to Nigeria’s peculiar situation in the management of the disease.

The first COVID-19 case in Nigeria was reported on the 27th of February. The airports, seaports and borders were not officially closed until more than a month after the index case. We ought to have dodged the bullet earlier than 29th of March when the airports were closed. Closing our airports around the same time line as the United Kingdom, the European Union, and the USA was not one of our best strategies. While the developed nations could prolong closing their borders, we didn’t have the luxury of machinery and wealth that they had. We cannot continue to tow the line of developed nations in the management of this disease. Although USA has the grim honour of the country with the highest number of fatalities, by the end of April, it had tested more than 6 million people. By the end of April, United Kingdom was conducting more than one million tests per day and Nigeria had tested a total of fifteen thousand samples. The fifteen thousand included all the samples tested from the moment the index case was detected. We are testing 0.000075 per capita and USA is testing 0.018 per capita. The population of USA is 328.2 million. By sheer strength of numbers in testing, USA and UK are ahead of Nigeria in the management of the disease.

These two developed nations can put out telephone numbers for persons suspected of having COVID-19 symptoms to call. They have the technology and manpower to make it work. On the other hand, Nigeria does not have efficient technology or manpower. It’s not every Nigerian adult that has a phone. And if they have one, it may not have a phone credit to call or the battery charge may be zero because of electrical power failure.

If they eventually put a call through, the steps that the caller should take are sometimes murky.

While these developed nations can manufacture their test kits and personal protective equipment, we still have to depend on donations or imports from other countries at competitive prices. With Nigeria’s population of 200 million people over a land mass of almost a million kilometres squared, land mass per capita is 0.0046. The USA land mass per capita is 0.03. It has a landmass of 9.834 million kilometres squared. Social distancing may be possible in the rural regions, but presents a daunting challenge in the urban cities. More than half of Nigeria’s population live in urban areas. Tanzania is the only African country whose land mass is close to that of Nigeria but its population is only 56.32 million; one-quarter of Nigeria’s population. Tanzania has a land mass of 945,087 kilometres squared. Tanzania can manage social distancing better.

Our open-air markets with narrow pathways struggling with moving small business vendors and unapproved stalls cannot be urgently remedied at the time we need social distancing. Similarly, many homes are overcrowded and self-isolation will be a mirage. So far, we have seen why calling help lines and social distancing are not the most feasible measures in today’s Nigeria. However, these measures are achievable in the United Kingdom and the USA. In light of this, Nigeria has to institute legitimate steps to mitigate the spread of COVID-19. We have to take ownership of our management of the disease. Presently, Nigeria cannot sustain testing at a scale that covers hundreds of thousands per day or per week. Such massive testing with contact tracing would put the spread under manageable control. We cannot wait till the virus infects and begins to replicate itself. Time is of essence. There is no World Health Organisation (WHO) approved drug for the disease. Health Education is the currency of disease prevention.

Importantly, we need to achieve a massive, intensive and sustainable health education into the nooks and crannies of the microcosms of rural and urban communities. Nigerians are resilient people and listen to their religious and community leaders. These leaders would enlighten their communities on the spread of the disease, hand washing, wearing and disposing of face-masks and social distancing. I also institute hand washing up to the elbow. When people sneeze into their elbows, they invariably touch their faces. We need to destigmatize the disease.

We need to be open about prophylaxis and treatment of COVID-19 symptoms. In this pandemic, the public should be taught to use Chloroquine, Vitamins C, D and Zinc. Vitamin C reduces the reactive oxygen in infection and modulates the cytokine response. Zinc boosts the immune system and inhibits the replication of the virus. Exposure to the sun for about 30 minutes every day should give us a healthy dose of Vitamin D. It boosts the immune system. People should be encouraged to take Vitamins C, D and Zinc from now on as a prophylaxis. They should be encouraged to take plenty of fruits. If fruits are not accessible, lemon grass boiled in water will provide Vitamin C. Excess consumption can cause sensitive teeth. These are efforts to boost the immune system should one get the virus and should be sustained throughout this period. Risks of misuse of the drugs will be avoided when the health education is effective. If the virus strikes, the infected person has a better chance at surviving when the immune system has already received a boost from the vitamins and zinc. Chloroquine has been used by Africans for decades. Apart from being an anti-malarial, it has antiviral properties. It has known side-effects but notwithstanding, it’s still being used for rheumatoid arthritis and when the wave of infection is like a tsunami, we need to take ownership. Nigeria should increase the local production of Chloroquine. The organic cure being promoted in Madagascar was made from an anti-malarial plant. Nigeria can collaborate with Madagascar on their organic cure. If one now gets a general malaise and other symptoms of the virus, they should be commenced on Chloroquine and Azithromycin.

Recently published peer-reviewed articles have shown that Chloroquine and Azithromycin when commenced early in the disease improves the prognosis. Aftermath of the virus predisposes the lungs to bacterial infection. Azithromycin destroys the bacteria. It is safer to commence this regimen immediately one has the general malaise to nip the virus in the bud before the viral load gains permanent residency in the lungs. The longer it takes before one commences treatment as can happing when calling the help lines, the lesser the effect of the drugs and the less favourable the outcome. In this pandemic, doctors have used chloroquine while monitoring heart waves and successfully treated COVID-19 patients. The dose can be modulated according to the viral load. However, if Nigerians are being taught to manage the disease like they do in conventional countries whose Human Development Index rank much higher than Nigeria’s, calling help lines, and sometimes waiting for days before help comes, it might be too late. We are under testing so we should not fool ourselves that the confirmed cases are relatively “low”. We need to take ownership of our own treatment regimen and develop what works for us. This is not the time to copy the conventional models. These models are good and commendable but are not working towards our collective benefit. We cannot continue at this pace until a vaccine or a drug is approved. The anti-coronavirus lockdown, wearing of face masks in public, social distancing, avoiding large gatherings, spending the minimum time outside your home, avoiding going out except it’s absolutely necessary are strong prevention techniques in reducing the spread of the virus.

In distinctive Nigerian style, we need to be kind to one another. We don’t have to be abundantly sufficient with an overflow before considering sharing with those in need. Health Education should be sustained with intense campaign against drug misuse, wearing and disposal of face masks. We should produce local, re-usable masks that are affordable to the masses. The supply chain should be strengthened against hoarders and price gougers. Conclusively, Nigeria needs to generate a treatment model that works for her people and take ownership of the treatment of the disease. The methods in use dictate calling help lines. We know Nigeria. Telephone connections are not always present for various reasons. We have used Chloroquine for decades despite the side effects. Prophylactically, taking Vitamins C, D and zinc will boost our immunity. Prompt and aggressive treatment of the disease within the first two days will give much better outcomes. For decades, we have treated malaria at home with chloroquine. Chloroquine should not be an anathema to us now. It is cheap and easily available. Nigeria is for all of us. Help us save Nigeria!