Dr. Sani Aliyu, is the National Coordinator, Presidential Task Force (PTF) on COVID-19. In a telephone conversation with radio station, he highlighted efforts being made to contain community transmission of dreaded coronavirus in Nigeria.
From Fred Ezeh, Abuja
Please remind Nigerians of the mandate of the PTF
It is a taskforce inaugurated by President Muhammadu Buhari to coordinate the multisectoral response to the dreaded coronavirus pandemic in Nigeria. The President, in his wisdom, thought it wise to put together this team of dedicated Nigerians long before the pandemic got to this point and that is why PTF is made up of members from relevant agencies involved in the fight against the COVID-19 pandemic in our country. So far, we are working closely with every body to achieve that task.
But is the PTF impressed with the behaviours of Nigerians since the ease of lockdown?
We are not totally impressed because, initially, people never complied with the guidelines as highlighted before the ease of the lockdown for whatever reason. But with several appeals and increased sensitization, we observed significant improvement in the use of face mask as against mass gatherings, social distancing and other personal hygienic measures as enlisted by the PTF in collaboration with the Nigeria Centre for Disease Control (NCDC)
Surprisingly, figures of confirmed cases seem to be on daily increase since the lockdown was lifted. Is there any sort of relationship between the ease of the lockdown and spike in the number of cases?
It’s really too early to see the impact of relaxing the lockdown because the incubation period for the disease is between two to 14 days. For instance, if one was to catch COVID-19 today, it will take 5 to 7 days later, on the average, to manifest. It could also take as much as 14 days in some cases. So, most of the new cases being recorded recently were contracted long before the lockdown or a day or two into the lockdown. We are few days in the post total lockdown. So, we are yet to see the true impact of lifting the lockdown. In addition to that, we have also increased our testing capacity.
Sometimes last week, we tested 2,500 samples in a single day. That’s impressive. It’s noteworthy that the more you test, the more you find positive cases. On average, 15 percent of total test we do return positive. Also, there are other reasons why the number of cases are going up. But whatever the case maybe, the true impact of the lockdown will be seen in a week or two when cases in incubation stages start manifesting symptoms.
The Nigerian Medical Association (NMA), as well as other bodies were against the lifting of the lockdown. They said it was premature. Why did you go ahead to recommend that to the President?
Nigerians must know that countries of the world have been struggling with taking similar decision as to when is the best time to ease the lockdown. Our decisions, so far, have been based on scientific evidences and close observations, and also working with other professional colleagues across the world. In Nigeria, academic and professional colleagues have also been involved in decision making so far.
The important thing is complying with the guidelines established by the PTF, notably, the use of face mask, social distancing, no mass gatherings, staying at home, self and environmental hygiene, amongst others. If Nigerians abide by all these measures, then the impact of COVID-19 in Nigeria will be similar to that of complete lockdown of the country.
Many Nigerians have criticized our poor testing capacity when compared to other countries in Africa. Are you worried?
Actually, the better the yeild, the more cost effective. Don’t forget that these test are expensive and there’s a huge competition for the reagents that are used to conduct these tests. We believe that It’s much better to do 100 tests and get 10 positive than to do a thousand tests and get same 10 positive. It’s not a case of massive, wide, disseminated testing in a community but a case of trying to pick out those that are more likely to have the illness, removing them from the community to avoid local transmission of the virus. We must commend NCDC because they have up their game in the last few weeks. They have added quite a number of molecular laboratories to the network. Few weeks ago, we had only five laboratories but fast forward today, we have over 20 laboratories in the network with more coming.
Two months ago, we had no laboratory for COVID-19 testing. Yes, there are challenges in getting the samples and other small hiccups but we are making significant progress within few weeks. For instance, in Kano, we have three laboratories for COVID-19 testing unlike some weeks ago that the only lab they had was contaminated and had to be closed temporarily, thus forcing us to transport samples to Abuja for testing. As we speak, we have gone above the expected threshold for testing. Our challenge now is to convince the people to submit themselves for testing. Many are becoming afraid because of the stigma associated with being positive for COVID-19.
Nevertheless, we are making steady progress. So far, we have tested more than 25,000 samples even though many people may say it’s much low compare to the size of our population. But we are making good and steady progress in that regard. We will continue to encourage and push to ensure that anyone with symptoms consistent for COVID-19 get tested and contacts traced for same purpose.
Nigerians must also understand that it’s easier to open a biochemistry laboratory than to open a molecular laboratory. Among other things, it requires high level of biosafety so that people don’t get infected. However, we are working on our Gene-Xpert machines across Nigeria and its cartridges. By the time we complete that next week or so, hopefully, all the states of the federation will have some sort of capacity for COVID-19 testing.
Can you confirm if it’s true or otherwise that the mysterious deaths in some states in the north are related to COVID-19?
I can’t give you precise answers to that questions. What I can confirm to you that we are closely working with the states government involved to get to the root of the problem. In Kano, for instance, it’s a joint investigation with its officials.
The PTF don’t have final result of the investigation yet. So, I can’t confirm to you if the deaths were due to COVID-19 or not. In Jigawa state, the officials have completed their investigation but I don’t have their mandate to speak on that. It has to come from the state government. One of shocking things we noticed, in addition to COVID-19, especially in Kano, was that people are struggling to access quality health care services.
A lot of hospitals in Kano, suddenly, closed for one reason or the other. So, it was difficult for patients with different ailments other than COVID-19 to access medical services. That, perhaps, also contributed to the deaths we saw in Kano. In Nigeria today, if you have a fever, it’s more likely to be malaria and not COVID-19, and that’s why it’s more crucial for those closed health care facilities to reopen so that people can access health care services. When that is done, health care workers should be provided with adequate Personal Protective Equipments (PPEs) to help them work properly without contracting disease from patients. We must be aware that majority of illnesses in Nigeria would not be COVID-19 and the patients deserve quality health care services.
What level of cooperation are you getting from state governors?
We have impressive and harmonious relationships with them. In fact, we have a representative of the Nigeria Governors’ Forum amongst us through whom we reach them and present our case and requests if the need arises. The state governors have key responsibility to ensure that comfortable isolation and treatment centres are available. They are also to ensure that workers are well trained and, most importantly, engage with religious, community and traditional leaders in the sensitization and enlightenment of the public. Unfortunately, a lot of states are making slow progress in providing isolation centres. But we would continue to push and make suggestions where necessary. But at the moment, we relate with the governors, virtually, on a weekly basis to ensure that they are doing the right things. We will continue to work together to achieve the common goal of containing the coronavirus pandemic in Nigeria.
President Muhammadu Buhari has ordered for Madagascar herbal drug for test in Nigeria. Are you comfortable with that and envisage a way out soon?
You must know that when it comes to medicine, be it vaccine or whatever, it cannot just be administered on people immediately, and that was why the President directed that whatever drug is being considered should pass through intensive thorough checks by relevant Nigerian organizations to ascertain its efficacy and possible side effects, considering the uniqueness of our people and environment. In simple term, we cannot administer any drug claimed to be effective on COVID-19 without it passing through clinical tests and validation.
When do you project the end to this pandemic ?
World Health Organization (WHO) declared coronavirus a pandemic some months ago because it had spread exponentially across the world. In fighting pandemic, the concerns is the measures that would ‘flatten the curve’. Clearly, we are at the exponential phase of the pandemic at the moment. The interventions we put in place is just to slow down the spread which we are currently seeing. For instance, when we had complete lockdown, usually, we expect the figures of cases to double in four to five days if we are not doing anything, but we were doubling at 10 days. It’s an indication that we are making progress particularly in slowing down the spread. But whatever measures you put in place, be it total or partial lockdown, the goal is to ensure a significant drop in the community transmission of the dreaded coronavirus pandemic and making sure that the health system is not overwhelmed.
The pandemic cannot be stopped abruptly. So, it’s expected that we would continue to record cases in the coming weeks even as we ramp up test. So, I can’t predict when the pandemic will be contained because it’s a global challenge that will be tackled through the cooperation of global community.
Will you consider partnering with Senegal on testing using their success story
We have plans to do that. However, there are loads of test kits that are available for use but they are yet to be validated by WHO particularly the blood test kits which is unreliable. Currently, we use real-time Polymerase Chain Reaction (PCR) machines to conduct these tests which are more reliable and accurate. Senegalese are promoting test kits that are still under observation. Howbeit, I must confess to you that we are working extremely hard to improve our testing capacity, and in coming weeks, more molecular laboratories would be activated.
Why is Federal Government reluctant to try some local herbal drugs in the treatment of COVID-19?
As I said earlier, any drug being introduced or recommended for the treatment of COVID-19 or any other ailment must pass through thorough and strict clinical trials and other checks for it to be validated. There are ongoing studies we are doing, in addition to solidarity trial which WHO is leading which is looking at combination of various drugs for COVID-19 infection. However, anyone with drug for COVID-19 must pass through well-established processes for registration and usage. At the moment, there is no validated drug for treatment of COVID-19, and that is why we insist on prevention which can only be achieved by following the advisories highlighted by the experts. If one, unfortunately, catches the virus, either of two things will happen. If the immune system is strong enough, the patient will overcome it and that happens to about 80 percent of the patients.
But If the immune system is weak, the patient will be unable to overcome the infection, the virus will damage the lungs leading to respiratory failure and possible death. At the moment, our mortality rate is about three percent. If you are elderly, diabetic, obsessed, the likelihood of your immune system getting on top of COVID-19 is less, and that’s why we asked people to protect themselves against the disease, because the options are very limited when someone contract the disease. Evidence on the hydroxyl-chloroquine is very weak and a lot of countries have stopped using it because it has high toxicity. The only drug that is showing promise, at the moment, is an antiviral drug that was used to fight Ebola. At the moment, there are clinical trials going on on that.
There are vaccines that are undergoing trails in the UK and US. In simple terms, the best way to overcome pandemic is not to get infected and make sure that the spread stops. We are expecting the vaccine by the end of the year, hopefully, which will help to fight the virus.
PTF had asked states convert unused buildings into isolation centres. People have argued that it would enhance community transmission. Do you agree with that?
At the moment, we have hot spots and kano is one of the hot spots now. For instance, 80 percent of new infections come from Kano state and eight local governments in the state seem to bear the burden, just the way the case is in Lagos. If you have high number of cases in a particular area, it’s wise that we move people out of that area to avoid community transmission. At the moment, some states are reporting up to 100 cases per day and each case has to be isolated for 14 days or more. You have to provide them with food, drugs and decent accommodation.
Undoubtedly, we are fast running out of bed spaces. Initially, we advised states government to make available, at least, 300 bed spaces for isolation purposes but that has not been achieved in many states. But the fastest and cost effective way to succeed is to ensure that those that does not require hospital care, most often, 80 percent of the cases, are kept away from the community to avoid local transmission. We had suggested schools, hotels and other facilities to be converted to isolation centres. It’s practically impossible to get 1,000 bed spaces in hospitals because other patients would need medical attention and we can’t deny them that service or else, we would be in serious trouble.