Prof. Oyewale Tomori is the immediate past President of the Nigerian Academy of Science with experience in virology, disease prevention and control. Oyewale who is also chairman of National Laboratory Technical Working Group (NLTWG) and one time virologist for the World Health Organization (WHO)’s Africa Region, in this interview, gives reasons Nigeria is experiencing increasing COVID-19 cases, what the presidential task force should do, the need to increase laboratory testing of contacts and other measures to end the disease in the country.
Nigeria’s COVID-19 cases continue to rise by the day, what do you think is responsible?
The increasing number of cases is expected and a natural follow up to our late start in instituting appropriate preventive measures. The COVID-19 disease started in the last months of 2019 in China, and we naturally assumed that the cases would be imported from China, given the large number of Nigerians who regularly make business trips to China.
For the first two months of what soon became a pandemic, we did not detect a single case and we were almost beginning to think that we were immune to the disease, an idea buoyed by the non-report of cases in sub-Saharan Africa.
Then wham! An Italian visitor arrived Nigeria on 24th February 2020 and became our first COVID-19 case on the 27th February while in Ogun State. On that day, we should have SEALED and CLOSED ALL our borders to all travelers from COVID-19 affected countries.
But no, we waited until 23rd March, almost a month later and by which time we had at least 40 cases. Wiser and more proactive countries like Kenya and Ghana closed their borders when COVID-19 cases were three and six respectively. A country that demonstrated a lower level of care and wisdom than Nigeria was South Africa. It waited until it had reached over 400 cases before it finally closed its borders and shut down the nation. Too late, like Nigeria.
What is your assessment of the country’s response to the outbreak so far?
The response as currently conducted is barely acceptable, especially regarding compliance by the public. However, as earlier indicated, initial preventive efforts, especially at our ports of entry were shaky and limited to Lagos State and Abuja.
The Presidential Task Force was inaugurated on March 17, (a week after it was set up by the president and 20 days after we had reported two more cases in addition to the index case). The first outing of the task force rightly decided to, amongst other things, restrict entry into Nigeria for travellers from 13 high incidence countries with over 1,000 domestic cases when WHO dashboard listed an additional four countries- Austria, Belgium Sweden and Denmark – with more than 1,000 domestic cases. Unfortunately, the coronavirus pandemic was ticking much faster than our Task Force is ticking.
In the initial stages of our national prevention and control efforts, the states were pretty much left on their own, deciding what to close and what to half open.
Our Presidential Task Force took too long to spring to action and has not been detailed or thorough enough in its declarations. Finally, our president himself spoke to us on 29th March more than a month after we reported the first case. Some people say he only spoke after his Chief of Staff had contracted the disease and disseminated it to other top government officials.
This raised public feeling and perception that some Nigerian lives are more precious than others. A presidential staff had earlier said that our president does not like cheap publicity. I assume he was comparing our president to other such cheap publicity seeking presidents like Ghana’s Nana, South Africa’s Cyril, and Kenya’s Uhuru, who all came out to address their people.
We the citizens have not demonstrated enough commitment to our own health security through inadequate compliance with basic COVID-19 preventive directives and guidelines. Compliance with these guidelines will make a difference between getting COVID-19 or not, and between life and death.
When the World Health Organisation (WHO) says wash hands with soap and water, it assumes the availability of water, and when WHO says keep yourself in self-isolation, it obviously isnot talking about people who livein self-contained apartments. How do you self-isolate in the slums of Ajegunle? How do you “social distance” in the Mpape hills and wash hands with the running water in Kpaduma area of Abuja?
What is your advice to the government on tackling the disease?
It is not enough to lock down the country without considering the survival of the ordinary citizens, many of whom must work on a daily basis for the food he or she will eat. Government must consider what to do for such a group that makes up to about 50% of the population.
The looming hardship on the trail of the lockdown will not only bring hunger to the front burner of pain and agony of the average citizen, but it will also have deleterious effects on his health and wellbeing.
The health security of the citizen will be so compromised by this lockdown, making one to suggest that our leaders should spend their security votes to secure the health and wellbeing of the citizens during the lockdown.
The lockdown will definitely have adverse effects on the social and economic wellbeing of the general population, especially those who must work on a daily basis for their livelihood. There should be a relief package for such groups of Nigerians
Is there anything more important than the health and economic security of the average citizen, and by extrapolation…the nation? Now is time to release those security votes to save the lives of the citizens that will be mortally affected by the lockdown. Yes, reducing the price of a litre of petrol goes some way to alleviate the economic hardship, but such measures rarely trickle down to the stomach of Mr. Average Citizen.
What can the public do to curb spread?
There are standard safety and preventive guidelines that the public must comply with and regard as a matter of life or death. Wash hands with soap and water as often as possible, maintain the social distance, when you cough or sneeze cover your mouth and generally, maintain a high level of hygiene and cleanliness etc.
As a virologist, what is your view on the cure or quick recovery for positive patients? Chloroquine for instance has been on the front burner of public discourse?
So far, there is no proven cure for the disease. In the famous words of Dr Fauci, Director US National Institutes of Health, these cure claims are anecdotal. All the doctors can do now is to take care of the patients according to the symptoms shown.
What do you think of the testing procedure for COVID-19 in the country?
Could be better, the NCDC is doing the best it can with available resources. The WHO says test, test and test; and in our style we will ask; How many times did WHO say we should test? The answer is three times.
Our NCDC is stopping at test only, that is only one third of what WHO suggests. Why? because there are not enough testing centres, nor do we have enough testing kits and reagents. Now the NCDC is expanding the number of testing centres to ensure that all states of the country have easy and direct access to a testing enter.
Fortunately, there are existing centres funded by foreign partners and spread all over the country. These centres can be repurposed for COVID-19 testing. There are no less than 300 of these centres, not to mention the centres that were established for avian influenza diagnostic sites in Ibadan, Vom, Kaduna and many other parts of the country.
We have all it takes, but we will not take all we have to test, test and test as needed and as suggested by the WHO.
Do you have any advice on the isolation centres?
Make the isolation centres conducive for proper care of patients by providing the resources for effective treatment and care of the patients. Health workers must be provided with the resources and facilities needed to prevent transmission of disease from patient to health workers.
What is your advice for medical experts?
Medical experts, including all those involved with prevention and control of diseases, need to follow the set guidelines provided for preventing infection; doctors, nurses and other hospital workers should ensure the proper use of personal protective equipment, gloves face mask, etc. Other health workers likely to come in contact with COVID-19 infected persons should also take appropriate precautions- washing hands, maintaining social distancing etc and laboratory personnel must take extra care in handling infected samples.
What lessons do you think Nigeria can learn from the COVID-19 outbreak, especially from countries that have effectively handled it?
We need to increase laboratory testing of contacts of positive COVID-19 cases. By rigorous testing, we are able to detect the magnitude of the epidemic and better plan the control measures. Not knowing who is positive is like attempting to control diseases blindly, and thus likely to be regularly surprised as cases pop up in unexpected cases
What is your advice for the Presidential Task Force on COVID-19?
The task force should be more proactive and provide regular daily briefings, with more details of the where, when and how the cases occurred. It is not enough to tell someone that a patient visited Kaduna or Calabar.
We should be told where the person stayed, and the period of the stay. In this way the community is better able to assist health workers involved with contact tracing. If I know that a positive case stayed in the same hotel with me at a particular time, then I am more likely to request for a test.
I especially would like to thank all those who have donatedin support of the efforts to control COVID-19. An appreciable amount of the funds should be made available to procure adequate testing kits and reagents for all the testing centres and arrangement should be made to ensure that the laboratories offer 24/7 services to the nation.