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Let me start by saying that during any public health crisis, public health response is purely based on science and not decisions made at the whims and caprices of leaders and public health experts. Furthermore, all public health measures have certain goal in mind that must be achieved through public health measures put in place, which is to bring the public health crisis under control. Without compliance, control will not be achieved. So it is good for people to know that the public health measures instituted by the Presidential Task Force are deeply rooted in science and only when complied with, will the Covid-19 pandemic be brought under control. For a successful control of the pandemic to be achieved everyone has a role to play, right from government across the 3 tiers to individual citizens who contribute largely to this success in every nation and Nigeria cannot be an exception.
It is important before going further, to explain in simple terms the science and the goal behind the public health measures instituted globally and in Nigeria to curb the Covid-19 pandemic. A lot has been said about ‘Epidermic Curve’ and its features (such as a steep rise, reaching peak of the epidermic, to plateau , flattening of the curve and a downward descent of the slope which I thought I should start with. An “epidemic curve” shows the frequency of new cases over time based on the date of onset of disease. The shape of the curve in relation to the incubation period for a particular disease can give clues about the source. There are three basic types of epidemic curve namely: Point source epidermic, common source epidermic and propagated epidermic. We are concerned with the propagated epidermic which the Covid-19 is, though some say it is also a mixed epidermic.
Using Nigeria as an example, we all remember the first index case in Nigeria, an Italian who flew into Lagos and travelled to Ogun State. That one index case infected people he came into contact with. The infected people who came into contact with him also infected others. So in a short time many people became infected with Covid-19. This was what happened with the rest of the index cases in Nigeria spreading the infection. So if you take this numbers of people as you detect them over time and plot a graph, the numbers will be increasing everyday and so the graph will be going up (rising or upward slope). After some time you will get the maximum number of people infected and the graph will stop rising. This is called the peak. The number of new cases will then remain relatively the same for some days, so the graph every day will have the same height. This is called plateau. When the new cases detected every day begins to reduce, the height of the graph begins to shorten (downward slope), until it comes down to zero.
With this small explanation of the epidermic curve, you can imagine, with the highly infectious nature of the Covid-19, how many people will get infected in such a small time in Nigeria bearing in mind our dense population, low literacy level, poverty and overcrowding? If a country has capacity to test large numbers, hundreds and thousands of people will be detected and many with other chronic medical conditions and old age may die. So, if these new infections are plotted in a graph, the line will rise sharply which is called a steep upward slope. And as long as people continue to move about and interact with each other, just as is the case in Nigeria, the infection will continue to spread fast infecting hundreds and thousands of people without end in a short time killing many too.
What this means, is that in Nigeria, it will take a long time to reach the peak of the epidermic, talk less of a plateau and subsequent descent. So what public health experts do that guided the PTF, is to institute measures that will reduce how fast the Covid-19 infection spread thereby reducing the number of new cases detected daily, including death. So that the graph, since it represents number of new people infected over time will not rise steeply, and the height will also be short but a bit prolonged. This is called ‘flattening the curve. This was what the lockdown in Nigeria intends to achieve with all the public health measures put in place (international travel ban, inter and intrastate lockdown, hand washing with soap and water, use of hand sanitizers, physical and social distancing, wearing of facemasks in public places, avoiding any form of gathering, testing, isolation and contact tracing etc.)
Now let me come back to the reasons why I said the whole lockdown in Nigeria has become an exercise in futility. First of all I would like to say that the PTF has done its bit by laying out clear guidelines for the control of Covid-19 infection in Nigeria, some of which were enforced through presidential directives. However, the bulk of the public health measures require the cooperation of all citizens in order to succeed. No success can be recorded in the fight against Covid-19 infection without the cooperation of the citizens. What I have observed during these 8 weeks of lockdowns is that, people only desert major streets and highways, while running life as usual within the neighborhoods across many states. People gather together without face masks or social distancing to watch football, to bury loved ones, gisting at local joints, shopping and trading in neighborhood markets. In many cities, people move about and mingle freely riding local buses and keke Napeps without hindrance. Weddings still take place and local parties in some communities and local hotels.
The most annoying aspect of the futility of this lockdown is the illegal interstate travels that still happen day and night with the connivance of the security operatives charged with the responsibility of enforcing strict interstate travel bans. Equally annoying is the behaviour of people during days of easing lockdowns given at intervals for people to shop for food items. On these days the markets and banks get jam-packed with people without observing any social or physical distancing nor wearing of facemasks. What that does is that people will during the days of lockdowns breed the virus in their neighborhoods, say Tuesday, Wednesday and then massively spread the virus across the state on Thursday during easing of the lockdown for buying of essential supplies.
People come from different parts of the state travelling long distance to trade at markets, at the end of the day, they go back into lockdown on Friday, Saturday and Sunday spreading the newly acquired infections on markets days in their community. They violate all lockdown measures in their communities and then come back to spread the virus on Monday during yet another day of easing the lockdowns. So it was a vicious circle of lockdown for 2-3 days, then spread the virus in the community and then on days of easing the lockdowns, massively spread the virus at markets, banks, shopping malls etc, or acquire new infections and transport it back to your community.
This completely negates the very essence of the lockdown since its beginning in Nigeria nearly 8 weeks ago. On Wednesday this, we went to Ahmadu Bello University Teaching Hospital, Zaria to donate 100 hospital beds and mattresses by a Foundation. While driving down from Abuja to Zaria, the highway from Abuja to Kaduna right through to Zaria, looked just like normal times, busy with commercial vehicles and trailers, commuting travelers going for Sallah breaks as if there is no interstate lockdown. The expressway was extremely busy with lots of traffics and hold ups. All the check points had full compliments of security operatives who get tips and allow everyone to pass ultimately. I simply pitied Gov. Nasir El’rufai of Kaduna State.
With such behaviours of the citizens, I truly wonder the value of this lockdown in Nigeria. The aim of the PTF, to achieve significant reduction in the spread of the Covid-19 infections in Nigeria is defeated. Not because of the failure of the PTF, but because of the lack of cooperation of the citizens. Relating it to the epidermic curve, we may not have seen the steep upward slope because of the limited testing capacity in the country and not because the infection is not spreading fast. We may not be near the peak of the curve because people are not complying. The curve will certainly not flatten in the near future because the public health measures put in place are not strictly adhered to by people.
Nigeria has so far only tested 40,043 people out of a projected population of 205,528,166 with 7,016 people that tested positive (worldometer-5/22/20202). With the number of almajiri’s testing positive, who represent the lower ebb of the society, it goes a long way to tell you that community transmission has taken deep root in Nigeria. With the number of people tested, standing at 40,000 plus out of over 200Million people since February 27th, one cannot get an accurate picture of the epidermic curve. Some states that I know of, have exhausted their isolation centre capacity, and have thus resorted to home management of Covid-19 patients whose number runs over 500 hundred. The possibility of these patients complying with strict self isolation guidelines is everyone’s guess coupled with the potential for continuous community spread of infection.
Countries that have adopted total lockdowns including Nigeria did so knowing fully well that they will incur massive economic loss and a certain recession, but will gain in bringing the Covid-19 pandemic under control as quickly as possible. So people sacrificed and endured all the hardships to make gains health wise (Trading economy for health). In other words it was the ultimate goal of the public health measures, which is to achieve Covid-19 control that gave nations and people the courage and zeal including frontline health workers to make all the sacrifices needed to succeed including social and economic ones.
However, from my own point of view, the double jeopardy in Nigeria is that the country and the people have recorded massive economic loss to the point of recession due to Covid-19 during these weeks of lockdowns, and at the same time have not achieved the desired goal of the lockdown, which is to flatten the curve and achieve control. Lagos, Ogun and Abuja lockdowns have been eased, not because the targets of the lockdowns have been achieved but because of the country’s economic downturn with a possibility of getting bankrupt coupled with the massive pressure from the business community and citizens who are hungry and jobless. This leaves one wondering, if the lockdown should have been declared in the first instance since it could not be sustained until its purpose has been achieved.
Globally, countries ease lockdowns, based on science and data, one of which is a consistent 14 days of decreased number of daily new infections (called downward slope of the epidermic curve). But in Nigeria, we have seen rise in the number of new infections before the partially lifting of the lockdown and even afterwards. To make matters worse, about 5 states have gone against the PTF guidelines to open up their states ranging from partial to total lifting of the lockdown.
One other major concern is that, our lackadaisical attitude during this lockdown is viewed not only locally, but globally during this era of globalization and social media. The world is watching and watching keenly. The repercussions will come when countries who have achieved controls opened up their economy, Nigeria might end up been blacklisted and banned from international travels and entry to many countries for a longtime because of our poor attitudes to public health measures and failure to achieve control in good time. Lagging behind the world in achieving Covid-19 pandemic control will certainly cost Nigeria in the international community. It will only take few flights from Nigeria with Covid-19 infected passengers to plunge countries that had hitherto achieved control to descend into a fresh wave of infection with Covid-19. What I called ‘Reversed Pandemic’
One thing that is going well for our country, a blessing in disguise, is that luckily enough for us, the Covid-19 infection has been running a mild course in Nigeria, with relatively less deaths compared to Wuhan, China, USA and European Countries. We have not seen video clips of people falling and dying suddenly in bus stops, shopping malls, hospitals and communities just like the ones circulating in social media in the beginning of the pandemic in Chine and other nations. This gives credence to the assumption that Covid-19 is not as deadly as in other nations. Majority of the cases are asymptomatic and those in isolation centers have had mild to moderate infection which made some of them records videos that went viral denying their positive status.
My recommendation is that, the PTF, the President and the State Governors should consider lifting the lockdowns across the 36 states of the federation including FCT. The government should increase testing centres across the country and scale up testing, intensify risk communication, strengthen infection prevention control measures, massive training and retraining, pooling and deploying of medical expertise across the country, enforce compulsory use of facemasks while encouraging social and physical distancing, isolation of symptomatic positive patients, contact tracing, implement a robust home management practice for asymptomatic positive patients to free up spaces in existing limited isolation centres, , deploy resources to scale up isolation, treatment centres and quickly build the capacity of our hospitals and the health sector in general.
The executives should review the 2020 budget to inject capital into viable economic sectors to jumpstart the economy including bailouts and pass it to the National Assembly for speedy passage. A new post pandemic economic recovery and growth blueprint should be quickly developed and implemented to get the economy running. Agriculture should be among the key sectors; otherwise we will not have a harvest to feed people in years to come.
The ideas are endless and Nigeria is blessed with people of great ideas and gifted talents. It’s time for an honest review of the global response to give way to an indigenous homegrown Covid-19 response.
My thoughts!
