Like most of his colleagues in the medical profession, Head, Department of Otorhinolaryngology, University of Abuja, Prof. Titus Ibekwe, is bothered and eager to see the ailing health sector of the country revamped. He believes that the federal and state governments need to see the COVID-19 pandemic which exposed the infrastructural deficiencies in the healthcare delivery system as a resounding wake-up call to totally rebuild the health system and make it effective and functional, and thereby be able to deliver beneficial service to the people. In this interview, Prof Ibekwe, who is the Faculty Secretary of ORLHNS (Otorhinolaryngology-Head and Neck Surgery) at the National Postgraduate Medical College of Nigeria, posits that sheer luck saved Nigeria from experiencing the worst-case scenario of the deadly COVID-19 outbreak as witnessed in some developed nations.
Several governments across the globe have eased the lockdown imposed on their citizens in the wake of COVID-19 pandemic. With the resumption of economic activities what are your thoughts with respect to the spread of the virus?
COVID-19 is very special and different from other diseases and other pandemics that the world has seen. It is a disease of nature and nurture, because you must consider two aspects of what makes a quality life. Number one is health, and the second one is the combination of the economy and livelihood which together constitute nurture. And a balance between these two must be attained. But when you look at the economy of developing countries like Nigeria and other African countries, it is very backward, and not even close to balancing the two. Our attitude towards this virus has been deliberately very poor. People are still living in denial. Even those who should know better and be the role models are openly debunking the existence and the reality of the virus. When opinion leaders refuse to accept reality, then they are going to mislead a lot of people in the process.
Now there are different dimensions to the disease that have been evolving over time. COVID-19 is a disease that is just a little over eight months old. So, not so much is known about it. But the latest now is that it can be transmitted longer distances through micro-droplets borne by air. And that even makes it more dangerous.
So the simple precautionary measures of source control through wearing masks and physical distancing are the simple ABC of controlling COVID-19. But our attitude towards this has been very, very poor. It has not been encouraging in any way. The only thing we can say is that nature has a way of protecting the weak. Nobody can really explain why we have minimal illnesses in this part of the world. Otherwise, if we juxtapose our attitude towards the control, and the efforts we are putting in, against this disease, we would have had a lot more fatality cases. But let’s not forget that it is probably because we have a case of under-reporting. Because a lot of times, people dying in the hinterlands would not be captured, but when prominent people die as a result of COVID-19, it makes the news. So, I can tell you that so many people are being cut down on a daily basis.
When you look at all these equations in every ramification, then the World Health Organisation (WHO) has every reason to project and say that the worst is yet to come as they usually say regarding Africa. But for me, it may not turn out to be as bad as earlier predicted that “there would come a time that corpses would litter the streets of Africa.” I don’t think we’ll get there, because mainly what we have here in the country appears to be a mild disease. We realize that majority of the people dying from COVID have underlining illnesses, or the susceptible ones are mainly elderly. But that is not to say that the younger ones have not been dying of COVID-19 too. So when you compare what has been happening in Europe, South America, and other developing countries, you wouldn’t say that our case is as bad as theirs. And we’ve been asking questions with no proven answer yet. And I think researchers should beam their searchlight on that. First is that we could be having cross-immunity, bearing in mind that in this part of the world, our hygiene level as well as exposure to illnesses and diseases have escalated over time. It means that to some extent we would have been bestowed with some level of immunity which would have a way of protecting against COVID-19 if we would have some virile illnesses that have some semblance with it. That is what I mean by cross-immunity.
Secondly, we talk about the issue of our environment. It’s been proven that tropical areas where you high temperature, the virus would not survive, yet we know that at 29 degrees centigrade that these viruses are inactivated. And we know that within and around Nigeria, at the equatorial belt for instance, there are places where environmental temperatures rise up to 40 degrees. Then, could this have an effect on making this virus a lot milder? We have an abundance of sunshine, so could the UV rays of the sun have an effect on the virus?
Also, we have known that over time viruses undergo transmutation, which is something that is almost like a constant in regards to viral illnesses. So could there have been some viral transmutation within our country here? We don’t know. But what we know is that the genomic sequencing of the Coronavirus-II that was done here in the country shows that we are having strain that is 99.8 percent similar to the variety of the strain of the virus they have in China. This means that the one here in Nigeria is not significantly different from the strain in China. So putting all these factors into perspective one wouldn’t know why the severity of the disease was not as expected. And one may project here that the initial WHO and UN projections may not come to pass. But the reality is that there is need and cause to worry, because our attitude and effort towards fighting the disease have not been encouraging.
Now that it is known that the Coronavirus can be airborne, what is the implication?
It means that every one of us has to be alert; we can’t afford to be complacent. We have to be more careful now than we were before bearing in mind that there is no treatment yet and there is no vaccine yet. We all depend on preventive measures, which are not so difficult to abide by. You will recall that initially, WHO thought that masks may not be necessary if you are not in an environment where you have somebody who is actively sick, but now we know that masks are important for everyone once you are outdoors, because it is now possible that the virus is airborne. Once everyone wears a mask when outside, the tendency is that you will protect yourself from picking it up and also protect the next person, so you don’t pollute the air.
How do you feel about the relationship between the government and health workers, particularly those on the front line?
The truth is that we have not invested well in our health system over the years. From the level of our preparedness with regards to our health facilities and paying attention to the health of the populace, it is very clear that what we are putting down as investment into the health sector has been very discouraging.
In 2000, African leaders met in Abuja and agreed that a minimum of 15 per cent of the annual budgets of their countries should be invested in the health sector. Nigeria has never invested up to 7.5 per cent. The best achieved so far was 6 per cent, and even this amount has dropped to only three or four per cent. How does that make you feel, given what we are passing through at this time?
These are the problems haunting us. And COVID-19 has made it very clear to us right now. I was very happy that the chairman of the Presidential Task Force on COVID-19, Boss Mustapha, at a time made a public statement on the situation. And I applaud his frankness. COVID-19 has given us a second chance to begin to do things differently. So let’s hope and pray that it serves as a wake-up call for our government to learn how to do things better and differently.
What is the way forward as our health workers continue to tackle the pandemic?
The neglect of the health sector is haunting the country, and we have also made some recommendations on it. There are things that we have to do right because these front-liners are like the geese that lay the golden eggs. They must be protected at all costs. They are like your soldiers that protect the entire country. They are like sacrificial lambs who have attempted to lay down their lives for others. During the lockdown, everybody was asked to stay indoors so that they do not contact the virus and some were given palliatives. But some people were sleeping in the hospital, taking care of the sick, and exposing themselves on a daily basis. They didn’t even know if they would live the next day. So the minimum that you’ll do for this set of people is to have a good health insurance cover.
Two, you should be able to give them that good sense of belonging so that they would know that even the future of their children is secured if anything happens to them tomorrow. They should not debate about their emoluments or even complain about their take-home pay. Other countries are multiplying their take homes in quantum to encourage them to do their work. But in our country, some states are talking about reducing their pay. Then they should be paid benefits on a daily basis because of the risk they are exposed to daily. We have to ensure that there is adequate insurance cover for them. All these are lacking here. According to the last census conducted by the Nigeria Medical Association (NMA), it was revealed that we have a ratio of one doctor to 6000 patients in Nigeria, whereas the recommended situation according to WHO is one to 600. This shows that we are falling short of expectation, so imagine the number of lives that are left at risk when we lose one health worker. The records in the public domain show that hundreds of them have been infected and have died in the fight against COVID-19.