WHAT IF CORONA VIRUS COMES ?

N. Mcginger Ibeneme MBBS
20/03/2020


Today on BBC live I asserted to the interviewer that the only option available to Nigeria concerning Corona Virus epidemic is to prevent it from happening at all in the first instance.

She was asking about our level of preparedness and the ability to contain it siting  the experience from Ebola .
Corona Virus has become a pandemic affecting 184 countries and territories,and 1 international conveyance ,beating Ebola and SARS.

The Ebola Epidemic of 2014 affected about 6 countries by 2016 that WHO announced it’s end with total reported cases of 28,637 and 11,315 deaths over 21 months, whereas the 2003 -2004 SARS outbreaks affected about 2 dozen countries with about 8000 reported cases and 800 deaths .

On the other hand between December that it was first reported and today being 20th March 2020, COVID 19 has affected 272,056 persons with 11,300 deaths and 90,616 recoveries, across 184 countries and territories plus 1 cruise ship . No doubt COVID 19 is a much bigger  public health terror both in rate of spread , disease burden and virulence .

Nigeria successfully contained Ebola in 2014 due to a number of factors ;
1. It first presented in a less crowded private hospital, at the time Nigerian doctors in state owned centers were on strike , could they have been around the choice destination for the index patient may have differed . Most public hospitals are overcrowded, waiting time longer and being that Sawyer was a diplomat with connection, he may have played the VIP card and freed himself.

2. Lagos State has above par public health structure and IDH Yaba was immediately available for isolation .

3. Most importantly the NCDC already has a fairly well established surveillance system and personnel . Over the years they partnered with CDC to establish the FELTIP training for field epidemiologists and have had many graduates at the time . WHO and MSF have strong presence in the country and quickly provided the first line manpower needed to provide clinical assistance for cases .

Add these to the role played by the heroic Dr Stella Adadevoh who made the golden diagnosis and also withstood the pressure to let off the index case thereby limiting his contacts. She died alongside Nurse Ejelonu Justina who worked with her .

The level of contact needed for the spread of COVID 19 is much lesser than that of Ebola which needed contact with body floods where as COVID is nasal droplets which can actually be aerosolized . Multiple infestation could therefore quickly occur from single exposure .
This also explains while much more number of persons are affected here .

If Nigeria has an epidemic with 100s Of cases as seen in many other countries , the already fragile healthcare infrastructure would easily be overstretched in a matter of days resulting in higher numbers of infections and of course deaths .
The mortality would also be very high being that the equipments needed for managing acute respiratory symptoms which cause most deaths in COVID 19 is practically unavailable in most states . For instance we may not have up to 50 of those in the whole of South East . Imagine having 100 cases of such in a day ! Italy with its comparatively more advanced healthcare has registered 100s Of deaths in a single night. Power supply remains a major problem here too. The equipments need power to function. The personnel in PPE need to have some cooling to be able to cope with the discomfort of the coverall dressing made worse by the very hot weather .
A piece of the PPE costs as high as 3000 naira , each visit needs about 4 personnel , multiply by say 3-7 visits per day . If you run 20 centers in a state you would be consuming equipments running into thousands . Most states would be bankrupted by this cost . With the dwindling oil prices the federal government would sooner or later run out of cash .
More so international trade is at a lull right now due to the global pandemic .
International aid may not also be available as most countries who would have provided such, both personnel and materials are already battling with the same issue at home themselves.

Here also , overcrowding has remained a major challenge in most cities . For instance in Lagos , the public transportation is a total chaos .

We do not have food banks to carter for our people in the event of a lock down . We do not have canned food for the people to stock pile ,as most of our foods are gotten fresh from the markets daily . The resources to stock pile is also not mostly available.

Currently in Nigeria, Physician to patient ratio is a fraction, less 1:1000. In the face of a huge epidemics most of the personnel would be deployed towards its containment, leaving out the other healthcare challenges which are also huge . Who carters to sick children? Obstetrics emergencies ? And other medical issues when most hands transfer to caring for COVID? The effect would be that many more people would die from non COVID disease causes at the end .

The point remains that the only plausible option here is to avoid this epidemics totally.
What can we do ? It may already be too late considering the numbers of new cases in the last couple of days . However it has not yet put a strain on the available trained manpower especially the field epidemiologists. While they labour to track down all extant cases , the government needs to do much more , quickly and decisively to stop any further progression;

1. Travel restrictions

2. Establishments of more centers for isolation

3. Adequate testing facilities strategically sited

4. Rapid training of personnel

5. Sustained awareness

6. Closing down of nonessential crowding like school, religious centers , malls , larger markets , rallies and events etc

7. Proper incentives for personnel

8. Food distribution planning

Etc

“Voom is still better than statement “

N. Mcginger Ibeneme MBBS
Enugu, Nigeria

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