We are preparing for possible surge in COVID-19 cases, says NCDC

Dr. Chikwe Ihekweazu is an epidemiologist and public health physician who is the current Director General of Nigeria Centre for Disease Control (NCDC), the agency responsible for protecting public health and safety through control and prevention of communicable diseases in Nigeria. Ihekweazu has worked in senior public health and leadership positions in several national institutes, including the National Institute for Communicable Diseases South Africa (NICD), UK’s Health Protection Agency, and Germany’s Robert Koch Institute (RKI). He has led several short-term engagements for the World Health Organisation (WHO), mainly in response to major infectious disease outbreaks around the world. He was part of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). In this interview with The Guardian, he speaks on the resurgence of COVID-19 cases in the country and the emergence of the Delta variant as well as how NCSDC is addressing the situation. CHUKWUMA MUANYA writes.

Despite the progress made so far, there have been speculations on the expected third wave of COVID-19. Is there a third wave of COVID-19 in Nigeria?
Despite significant efforts, there is still ongoing transmission of the Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) that causes COVID-19, in Nigeria and across the world. This means that until we control virus transmission, we will experience periods where there is a surge in cases, associated with various factors.

This surge in cases can be a result of the spread of variants of concern, especially where the variant is highly transmissible. Additionally, as the virus spreads when people are in contact with others, the resumption of social gatherings with poor adherence to public health and social measures will contribute to an increase in cases.

Nigeria, like other countries across the world, is at risk of a surge in COVID-19 cases. This risk is higher as more people disregard the public health and social measures in place. We still have a window of opportunity to prevent this surge, but this requires personal and collective responsibility. It is important that Nigerians recognise this risk and adhere to the known preventive measures by avoiding large gatherings, wearing a face mask properly in public settings, washing their hands regularly and adhering to interventions such as the international travel protocol. Now that we have a COVID-19 vaccine, it is important to get vaccinated to protect you and your loved ones.

The Delta variant has been reported in Lagos and Oyo states. What is the situation? Is it something we should be worried about?
It is not unusual that a virus mutates, leading to the rise in variants of concern. This further underscores the need for rapid action to control the spread of the virus.

There is evidence that the Delta variant has a higher level of transmissibility, compared to other variants of concern. This has been associated with the surge in cases in India, and an increasing number of cases in some African countries. There are still ongoing studies to understand the impact of the variant on existing vaccines and diagnostics.

Irrespective of the variant, the virus is more likely to spread when people gather without public health and social measures. We were able to detect this variant because of the genomic sequencing capacity in place in the country. However, we still need people to take personal responsibility.

We urge all Nigerians to be aware of the risks associated with this variant, and take responsibility for their health and for our country. Please continue hand washing, physical distancing, and other measures in place to prevent the spread of the virus.

Does the AstraZeneca vaccine that some three million Nigerians have received protect against the Delta variant of COVID-19?
Based on current data, people who have been vaccinated are at lower risk of COVID-19. The AstraZeneca vaccine provides protection against COVID-19 and this protection is higher, when a person has received the two doses required.

While the studies on the impact of the variant on vaccines are ongoing, we have to use all tools available to us in protecting ourselves. Vaccinated people are better protected but must continue adhering to known public health and social measures – proper use of facemasks, hand washing, physical distancing.

What is the NCDC doing to contain the situation?
The national Emergency Operations Centre led by NCDC has continued to coordinate, scale up and sustain the public health response. We have continued to monitor developments globally, provide data to guide decisions taken by the Presidential Steering Committee on travel restrictions, support states to monitor trends, sustain our risk communications among other activities.

Importantly, we have been working with the private laboratories approved for COVID-19 travel tests, to carry out genomic sequencing of COVID-19 positive cases among travelers. This is in addition to our routine genomic sequencing at the NCDC National Reference Laboratory and with the African Centre for Genomics of Infectious Diseases at Redeemers University, Ede.

To prepare for a possible surge in cases, we have ensured regular supplies to all laboratories and treatment centres for rapid detection of cases and case management, risk communications among other response activities.

The responsibility to prevent a surge in cases is not with the government alone, but requires adherence to public health and social measures by all members of the public.

What is the Federal Government and people of Nigeria expected to do to avert it?
The known public health and social measures are extremely important to prevent COVID-19 infection irrespective of the variant. This includes keeping a distance of two metres from others, washing hands, wearing masks and ensuring good ventilation. Given the evidence that the Delta variant spreads faster, it is even more important to adhere to these measures.

We appeal to business owners; religious leaders and people in authority to take responsibility by ensuring that people in their premises wear masks and adhere to physical distancing. The virus is more likely to spread when people gather and do not adhere to these measures.

We also encourage Nigerians to avoid travel to countries where there is a surge in cases associated with this variant. We must do all we can to protect our country and ourselves. For international travelers to Nigeria, please adhere to the international travel protocol, including the self-isolation period and test on arrival. It is important for us to do all of these to prevent a surge in cases and its impact on lives and livelihood.

What has been the secret of the success the country has recorded so far?
It is still too early to conclude on success with the COVID-19 response. We have continued to build on lessons from previous disease outbreaks as well as the experience from other countries in response to the pandemic.

In 2020, the government of Nigeria introduced the lockdown and other measures early, compared to other countries. The Presidential Task Force on COVID-19 established by President Muhammadu Buhari and led by the Secretary to the Government of the Federation has also provided strong multi-sectoral coordination. We recognised the gaps in our response early, such as the limited number of testing laboratories, and worked hard to close these gaps.

Our health workers have continued to work extremely hard for more than a year and show exemplary commitment to service.

What have been the major challenges?
One of the biggest challenges we have faced in the response to COVID-19 is the spread of misinformation. Very early on, we introduced a communications campaign called “Take Responsibility” in Nigeria. We continue to leverage on social media, traditional media and other means available to share the right information with Nigerians. We continue to urge all Nigerians to avoid sharing unverified information. The NCDC has an active website where you can verify all information you need on COVID-19: www.covid19.ncdc.gov.ng

In terms of the overall response, we have been affected by the global shortage of vaccines, especially as wealthier countries procure large volumes of the available supplies. Despite this, we continue to explore all available mechanisms to ensure that Nigerians have access to the vaccines needed for protection.

Please throw more light on the confirmed case of Delta variant of COVID-19 detected in Lagos and Oyo states?
Yes, our team detected a confirmed case with the SARS-CoV-2 Delta variant, also known as lineage B.1.617.2. The variant was detected in a traveler to Nigeria, following the routine travel test required of all international travelers and genomic sequencing at the NCDC National Reference Laboratory in Abuja.

The Delta variant is recognised by the WHO as a variant of concern, given its increased transmissibility. The variant has been detected in over 90 countries and is expected to spread to more countries. The variant has also been linked to a surge in cases in countries where it is the dominant strain in circulation. There are ongoing studies to understand the impact of the variant on existing vaccines and therapeutics.

As part of Nigeria’s COVID-19 response, NCDC has been working with the Nigerian Institute of Medical Research (NIMR), African Centre for Genomics of Infectious Diseases (ACEGID), and other laboratories within the national network, to carry out genomic sequencing. This is to enable the detection of variants of concern and initiate response activities.

All data on variants from Nigeria have been published on GISAID, a global mechanism for sharing sequencing data. Given the global risk of spread of the Delta variant, positive samples from international travelers to Nigeria are sequenced regularly.

The government of Nigeria through the Presidential Steering Committee (PSC) has initiated several measures to reduce the risk of spread of COVID-19. They include introduction of travel restrictions from countries where there is a surge in cases associated with widespread prevalence of variants of concern. The national travel protocol which includes compulsory seven-day self-isolation and repeat test on the seventh day after arrival, are in place to reduce the risk of spread of the virus. It is very important that this is strictly adhered to, to prevent a surge in COVID-19 cases in Nigeria. The COVID-19 vaccine is safe and effective and offers protection against the disease.

Additionally, states are urged to ensure sample collection and testing for COVID-19 is accessible to the public. Public settings such as schools with accommodation facilities, workplaces and camps should utilise the approved Antigen-based Rapid Diagnostic Test (RDT) for rapid testing of their population.

Although we have seen a low number of COVID-19 cases in Nigeria in the last eight weeks, it is incredibly important that we do not forget to be careful. The surge in cases in countries across the world and Africa is an important reminder of the risk we face. Please protect yourselves and the people you love by adhering to the known public health and social measures.

How is the NCDC responding to this new COVID-19 variant?
In the last six weeks, there has been an increase in COVID-19 cases in African countries. The highly transmissible Delta variant has been detected in more countries and is likely associated with the surge in cases in these countries. Although Nigeria has recorded a decline in the number of COVID-19 cases in the last two months, the country remains at risk of a surge in cases.

The WHO estimates that the Delta variant could be 30 per cent-60 per cent more transmissible than other variants. This highlights the risk that Nigeria and countries across the world continue to face. The current decline in cases presents a window of opportunity for all Nigerians to take responsibility, to prevent a surge in COVID-19 cases.

People in places with low COVID-19 vaccination rates are among the most vulnerable populations and are likely to be infected. To reduce this risk in Nigeria, the National Presidential Steering Committee on COVID-19 has introduced travel restrictions from countries with a high number of cases and spread of variants of concern. This is one of several measures put in place.

NCDC also advised that regular temperature checks, provision of hand sanitiser and no-mask-no-entry policy even if vaccinated should continue to be widely enforced in public spaces such as shops, schools and transport service facilities.