COVID-19: ‘Epicentre likely to move to another state as more sectors reopen for business’
Dr. Chikwe Ihekweazu, an epidemiologist and Director General/Chief Executive Officer (CEO) of the Nigeria Centre for Disease Control (NCDC), in this interview with CHUKWUMA MUANYA, cautioned that the resumption of international travels, re-opening of schools, churches and social gatherings are likely to lead to an increase in cases of COVID-19, but added that the Centre has developed guidelines for safe reopening of various sectors to reduce the risk of spike in cases.
Even with the decline in new cases of COVID-19, is it safe for schools and other businesses to resume/reopen?
There are various predictions to show that this pandemic will be with us for at least a year more before a safe and effective vaccine is available for population-wide use. This means that we have to rely on public health and safety measures to reduce the risk of spread of the disease.
We have learned a lot from our response in the last seven months and we are not where we were in February when the first case was recorded. We have more laboratories to quickly test people, many states have expanded their case management capacity and introduced home care and we have a strong surveillance and contact-tracing system in place. All these will make a difference in the event of another drastic increase in cases as we reopen schools, international flights and other activities.
Importantly, every Nigerian must take responsibility. There is evidence that measures like hand washing, physical distancing, wearing of facemasks and others we have introduced can reduce the risk of infection.
The NCDC has worked with the Federal Ministry of Education, Presidential Task Force (PTF) on COVID-19 and other relevant institutions to develop guidelines for safe reopening of schools, businesses, international flights and others.
It is believed that the fewer number of cases being recorded daily is because the country is not doing enough tests and not because the rate of infection is going down. What is the true pictures?
Last month, a total of 119,825 tests were conducted, representing a 42 per cent increase in the cumulative total tests conducted since the start of the outbreak. That means 42 per cent of all tests conducted during the outbreak were conducted in the month of August alone.
We have rapidly scaled up our testing capacity and now have laboratories in all states, except two- Niger and Kebbi- but we are working with them to activate testing before the end of this month.
It is still too early for us to reach conclusions on the decline in number of new confirmed cases. For now, we are working with all states to increase demand for and access to testing. We will continue testing more people and responding accordingly.
Some say Lagos State may have flattened the curve of infection. How true is this and what are the implications?
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 World Health Organisation (WHO) to support the state in establishing sample collection centres in priority councils to enable increased demand and access to testing and these 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 state Ministry of Health since the beginning of the response.
The epicentre of the outbreak is likely to move to another state, but we will continue to sustain our response efforts in Lagos, so that we do not lose the gains that we have made so far.
There has been this argument on which of facemasks and face-shields is more effective. What is your position?
The ultimate control of this outbreak will depend on the behaviour of people. There are no published studies on the effectiveness of face shields against COVID-19 in non-healthcare settings. However there is sufficient evidence to show that facemasks are very important in helping to limit the spread of COVID-19. For effective protection, face shields should be used in combination with an appropriate facemask.
Another issue is that of herd immunity. It is believed that most Nigerians may have been exposed to the virus and the herd immunity in cities like Lagos and Abuja is high. How true could this be?
The concept of herd immunity varies from disease to disease. We still do not have enough scientific evidence to conclude on how long immunity actually lasts once a person has recovered from COVID-19. One way we can understand the level of immunity currently in our population is through an antibody sero-survey.
Nigeria is working with Africa-CDC to plan for the implementation of an antibody study. This means that antibody tests will be carried out to estimate the number of people who may have had the virus, but were asymptomatic and did not present for testing or treatment. This will be done within the framework of a research study, meaning a target group will be tested.
It is important to note that the antibody tests will not be used primarily for public health diagnosis until we have a validated test for this purpose. Without this, we cannot reach any conclusions on the extent of immunity to COVID-19 in Nigeria.
Contrary to your position that choroquine can only be used in clinical trials, the Director General of the National Agency for Food and Drug Administration and Control (NAFDAC) last week said it could actually be used to prevent COVID-19 in early stage. Has anything changed regarding your position on chloroquine?
We are very grateful for the leadership of our sister-agency, NAFDAC, in the conduct of clinical trials for COVID-19. Currently, our case management guidelines advise that Chloroquine and hydroxychloroquine are only used in the context of clinical trials.
The results from these clinical trials and other scientific processes will determine if these will be used as part of treatment modalities for COVID-19 in Nigeria.
How far with COVID-19 vaccine? Is Nigeria involved in any, especially the Russian vaccine?
A major priority for us is developing a strategy to access a vaccine when it is available, given that we do not currently have all the capacities required to develop our own in Nigeria. These efforts are led by the Federal Ministry of Health and our sister agency, National Primary Health Care Development Agency (NPHCDA).
We are working closely with our partners at WHO, Coalition for Epidemic Preparedness Innovations (CEPI) and GAVI, through the COVAX structure that has been set up for countries to access vaccines in an equitable manner.
GAVI (officially Gavi, the Vaccine Alliance) is a public–private global health partnership with the goal of increasing access to immunisation in poor countries. COVAX is one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, which was launched in April by the WHO.
We are also monitoring vaccine research and development across the world to ensure that Nigeria is not left behind. Importantly, we are generating and contributing to scientific evidence that will enable vaccine development, such as genetic sequencing. The limited capacity to develop vaccines in Nigeria is a deficit that has become very apparent to us and we are determined to do something about it, moving forward.
It seems we have forgotten Lassa Fever. Does it mean that nobody is dying of the disease any more?
Despite the pandemic, we have continued to monitor and respond to cases of other endemic diseases in Nigeria, including Lassa Fever. We continue to publish our weekly situation reports for Lassa Fever and weekly epidemiological report for other endemic diseases.
We have continued to record cases and deaths from Lassa Fever, but this is below outbreak level. We are in a better place in managing Lassa Fever cases, as we have recorded a decline in the number of people that have died from the diseases in the last three years.
Despite this, we continue to work with our colleagues in states to ensure the prevention, detection and response to other diseases continues, despite the COVID-19 outbreak.
You have in recent times shown lots of concerns about growing misinformation on COVID-19. What are you doing about it?
One of the biggest challenges we have faced in the response to COVID-19 is the spread of misinformation, which could be linked to the fact that COVID-19 is caused by a virus that had not been detected in the world before December last year and we had to learn ways to prevent the disease while it was spreading, how to manage the virus, etc. Unfortunately, this was also a disadvantage, as several rumours and wrong information were spread.
Very early on, we introduced a communications campaign called ‘Take Responsibility’ in Nigeria. We continued to leverage on social media, traditional media and other means available to share the right information with Nigerians. We are grateful to our partners, such as telcos that have enabled us send SMS to all Nigerians every week since May, with correct information.
We have also build strong partnerships with television houses, radio, newspapers and others to share information and developed innovative methods, such as using cartoons and translating our messages to local languages to share the right information.
We continue to urge all Nigerians to avoid sharing unverified information. We have an active website where you can verify all information you need on COVID-19: www.covid19.ncdc.gov.ng
Is it true that some states are now closing their isolation centres and converting them for treatment of other ailments?
The different states in Nigeria are at different phases of the outbreak. Some, such as Plateau, are recording an increase in new cases, while others, like Lagos, are recording a decline in cases.
At the beginning of the pandemic, some temporary structures were established in the event that the main treatment centres were overwhelmed. Some of these temporary structures are not in use, given the low number of new cases confirmed.
Notwithstanding, we have advised all states to ensure they have the minimum required capacity to manage cases, and alternatives in the event of a rapid increase in cases.
Would there be a second wave of COVID-19 in Nigeria, as predicted in Europe?
Firstly, the idea about a first or second wave is based on the assumption by some people that COVID-19 is similar to influenza or common cold, where there is seasonal variation. At the moment, we do not have sufficient evidence to show that COVID-19 follows any seasonal pattern. This means we must not think about the pandemic in different waves, but as a disease that will be with us for a while.
There will be spike of cases for various reasons. As the virus spreads when people are in contact with others, the resumption of international travel, reopening of schools, churches and social gatherings are likely to contribute to an increase in cases.
This is why we have developed guidelines for safe reopening of various sectors. It is very important that these are adhered to, to reduce the risk of spike in cases.
More studies and even the WHO have admitted that Nigeria and indeed Africa has been spared on COVID-19, compared to other continents. Could this be true?
Globally, the epicentre has moved from China at the beginning of the pandemic to Europe and is currently South Asia. Nigeria and other countries in Africa recorded their first cluster of cases over a month after most of these countries did. We introduced the lockdown and other measures early, compared to other countries.
In Nigeria, we have also had strong political support and coordination of the multi-sectoral response through the Presidential Task Force (PTF) on COVID-19, led by the Secretary to the Government of the Federation (SGF).
While are proud of the efforts to keep the numbers lower in Nigeria, compared to most countries in the global south, we are not reaching conclusions yet, as we will continue to strengthen our response capacity.
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