Doris Obinna
As the novel coronavirus disease (COVID-19) spreads across the globe, experts advised that it is important that one practices respiratory etiquette. COVID-19 spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes.
A public health physician, Dr Oladapo Asiyanbi, told Daily Sun: “It is becoming clearer that spread of Covid-19 by people who are asymptomatic or mildly symptomatic may be responsible for more transmission than previously thought; making control of the virus more difficult.”
He said to contain its wild and wide spread, there are measures that must be taken, especially by government: “Firstly, the defensive approach should be applied. It is the primary prevention where the movement of people are restricted including, staying indoors, less contact; banks, market, offices and others are shut. These measures reduce the channels of person-to-person contact, persons-to-surface and back to contacts.
“If all these are reduced, you are taking a defensive approach to reducing transmission. This approach reduces the risk of contact of coming together. After a time, the rate of increase in cases will start reducing, which is called the lower tracking the curve. This is what the defensive approach will do.
“Secondly, the fact that you already have this case, what do you do? This is where the offensive approach comes in. This approach is the secondary prevention, whereby, if tests are carried out, then there is the likelihood of many people who may be positive and are not showing signs.
“But because we do not have all the resources in the world, we can only test those who are symptomatic for now. If we get more testing done, then we should be able to know how many cases we are battling.
Now with this, knowing how many cases you have, which gives you a truer picture, then you know how many more people to train to treat, the number of hospitals to get to, how many more health workers to drugs, materials and other things that go with treatment of the virus can do.
“It gives the society a bigger picture of the reality as well as help increase the number of testing done as against the 120 test done per day. What this means is that it gives the citizen confidence that the disease is being managed tactically.”
Asiyanbi noted that Nigeria is reacting appropriately: “We can still do more, and it comes with a price. Also, if those in authorities are more aggressive on social distancing, which people call total lockdown, economically, we would bleed heavily. United Kingdom is veering into full lockdown and India of about 1.2billion people has gone into lockdown, so you can imagine what that would cause in the economy.
“In Nigeria and in an economy where people live from day to day and week to week, they will not be able to survive this because about 70 to 80 per cent of our small businesses are daily businesses, surviving won’t be easy. And because there is no good database, it will be difficult for government to plan and compensate them.
“If the government is going to compensate anybody, then it is going to be the organised private sector and is not less than five per cent of the working population. That should tell us that we really need to know how many we are in a situation like this. But all in all, if people are obedient and keep to these simple health advices like social distancing, elbow or the Indian way of greetings, it will go a long way to help prevent the spread.”
He said government needs to take some hard decisions of what comes first; health or wealth: “We need healthy people to create the wealth and we need some form of wealth to make a good health. We have to do a very beautiful social magic by pouring a lot of wealth into health while hoping that actions taken to maintain health would yield results as it did for the Chinese.
“The government should ramp up resources in health to combat what we have now as well as implement and as much as enforce social distancing. However, we cannot afford to intermingle because of our social wellbeing.
“There is a huge price to pay for not adhering to social distancing early enough. If we ignore it, it will get to a point where most of our workforce or health workers who are at risk get ill. The higher the number of cases, the higher the number of workforce and chances of becoming fatigue and then there will be nobody to create to wealth.
“Also, note that the country has a challenge of number of doctors and nurses to patients’ ratio, you can imagine when ten more becomes a victim, and then you are making the ratio worst. The earlier the people cooperate with social distancing the better for all.” The Deputy Incident Manager, Nigeria Coronavirus Emergency Operation (NCEO), Lagos, Aderinola Olaolu, insisted that for COVID-19, the country had the time to prepare: “Before COVID-19 arrived in the country, we ensured information went around to Nigerians, especially on personal hygiene and cough etiquette, for more than a month. We have shared case definition with health workers and have a network of state and public health emergency network centres around the country so that we can coordinate information.
“We have skilled manpower that can do contact tracing. Now, we have five testing laboratories that have helped in shortening our response time for detection. Over the past decade, a number of inter-country and regional collaborations were established with the goal of ensuring shared capabilities.”
He stated that it was as a result of the 2014 Ebola epidemic that Nigeria realised the need for a public-health institute to combat infectious disease. This culminated in Nigeria Centre for Disease Control (NCDC) being signed into law in 2018, which gave the centre the legal backing to perform its functions:
“We have been improving on the structure we had during the Ebola outbreak to ensure that the incidence management system we used to respond rapidly to public health emergencies is not just at the national level but also at the state level. We have been training personnel and rapid response teams exist throughout the states.
“We are moving from paper to digital. We now have capacity to test for diseases that we didn’t have before. We now have a network of laboratories. People are more enlightened. We have social media to pass messages across to people. There is much trust in the government now, and we expect people to take their health more seriously.”
President, Nigerian Infectious Disease Society (NIDS), Prof Dimie Ogoina, stated that although the national response to the outbreak is being proactively spearheaded by the NCDC and Lagos State, most states of the federation are not adequately prepared to respond to the outbreak:
“The poor preparedness of most states is evident by the lack, or poor state of isolation facilities, limited clinical competencies and self-confidence by healthcare workers to manage active cases of COVID-19 and lack of required equipment such as functional ventilators in most designated COVID-19 treatment centres.
“Collaboration and partnership with relevant medical experts in the field of medicine will enable development of therapeutics that is science based, ethics, locally applicable and locally sourced. The public should strictly comply with social distancing and other protective measures. Lockdown of cities may be considered in places where unregulated community transmission is on going.
“However, authorities ought to provide some social support for their citizens since the daily bread of many is dependent on movement. Hospitals and isolation facilities must ramp up their level of preparedness and develop measures to address surge of cases. Healthcare workers should acquire and deepen their skills on infection prevention and management of COVID-19 cases.
“They must all be prepared to respond irrespective of their profession or discipline.
The general public must eschew fear, panic and misinformation. Everyone should seek for information from reliable sources. Government should use digital technology in enforcement of self isolation and contact tracing.”
“As a matter of urgency, the Federal Government in conjunction with state governments, should establish at least one functional and appropriately equipped isolation facility in every state. The FGN and state governments in conjunction with the NCDC must urgently identify all healthcare workers that would be involved in the COVID-19 response in each state.
“Such frontline healthcare workers should undergo training on various aspects of the public health response to the outbreak, including case management using standardized guidelines.”
He further recommended mandatory testing and quarantine of every traveller returning from countries with community transmission of COVID-19, including Nigerians:
“This will enable early detection of cases, prompt contact tracing and rapid isolation and treatment of confirmed cases. The government should also anticipate and proactively address the unintended consequences of the travel ban, including potential disruptions of the socioeconomic lives of the populace.”