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Coronavirus: Nigeria’s fate hangs on decisive leadership, personal responsibility

Without decisive leadership and personal responsibility, the spread of coronavirus in Nigeria could reach unprecedented levels that will overwhelm the country’s grossly inadequate medical facilities.

With an estimated 100,000 hospital beds to a population of 190 million people and less than 50,000 doctors, if expanded mass testing reveals the coronavirus has spread far beyond the cases already identified, experts fear the country could fare worse than developed countries that have seen their facilities stretched.

Nigeria could be facing no more than three imminent deaths and 187 infections by April 22, or a grimmer scenario with almost 130,000 imminent deaths, according to a recent study by Lanre Akinbo, managing director, Wizer Advisory Limited, that suggests the best path for the country based on mathematical projections.

There are 135 confirmed cases of coronavirus infections in Nigeria as at 3pm on Tuesday, with eight recoveries and two deaths recorded.

Under a business-as-usual scenario, by April 23 infections would be at 2.32 million, with 73 already dead and 129,857 facing imminent death while around 195 million people will be at risk, according to the study.
“Assuming a 5.6 percent mortality rate, we should expect about 73 deaths by that date. However, the bigger challenge is the ≈130,000 ‘destined deaths’ (death of infected people that would not have occurred by 23 April, because death occurs about three weeks after infection),” the report said.

According to Carter Mecher, a public health adviser who worked with the Obama and Bush administrations in the US, quoted by New York Times, “By the time you have a death in the community, you have a lot of cases already. It is giving you insight into where the epidemic was, not where it is, when you have something fast moving.”

But the aggressive fight against COVID-19, through social distancing and similar measures, would reduce infections to 1,763 with 26 deaths and 99 imminent deaths while 197 million would be at risk.

The study projects, on the other hand, that by April 22, 20 percent contact reduction would reduce infection to 246,905 with 36 deaths and 13,827 looming deaths. 50 percent contact reduction would reduce infection to 6,029 with 11 deaths and 338 imminent deaths, while 75 percent contact reduction would slow infection to just 187 with three deaths and 10 imminent deaths.

The study noted, by factoring total hospital bed capacity at an estimated 100,000, that if the baseline scenario unfolds, the country’s healthcare system would reach a tipping point before the end of April 2020.
“If we assume a hospitalisation rate of just 10 percent arising from COVID-19 infections, the number of sick people will exceed the number of hospital beds by over 130 percent!” it said.

In order to avoid these stark scenarios, the study noted the need to aggressively reduce contacts while maintaining social order. It emphasised the need to restrict all non-essential activities nationwide – private companies, schools, sports, civil service, real-estate construction, financial services, etc – for one month.
Nigeria has already enacted a lockdown of Lagos and Abuja, which took effect 11pm on Monday, with Ogun State set to go on lockdown on Friday.

While these “stay-at-home” measures have been noted to be effective at slowing the rate of spread of COVID-19, Akinbo noted in the study that social order could easily break down if people are deprived of their means of daily livelihood, dilemma governments in developing economies now face amid the pandemic.

In India, the poor are not complying with social-distancing policies because they have to feed.
“Do not shut open markets for basic necessities. There are no significant social safety nets, so people will starve,” he warned. “Looting and mayhem may ensue.”

Rather, Akinbo advised that governments should minimise infection risks in open markets through twice-daily disinfections, provision of free face masks and sanitisers, regular liaison with market leaders for aggressive enlightenment campaigns, and so on.

He also advised government to mobilise all military and security formations nationwide in readiness for large-scale logistics operations at short notice; for the movement of supplies and construction of temporary isolation tents. He said setting up simple, make-shift hand-sanitising stands at bus-stops and open markets is a way to go.

Nigeria must also take an inventory of healthcare workers, hospital beds, ventilators, diagnostic kits, personal protective equipment and treatment supplies, and plan to do the best with what it has. The country should as well use all the international clout possible to tap into donor agencies, multilateral organisations and foreign governments for in-kind donations of supplies (cash donations is not a priority at this time).

“We must be able to contain the virus from spreading otherwise it can be very catastrophic if we have to treat it,” said Francis Faduyile, president, Nigeria Medical Association (NMA), in a phone interview with BusinessDay.

“The virus has no leg, therefore cannot move. When you stop people from moving, the virus stops moving and once it cannot move, it will wear out and be unable to cause new infections,” Faduyile said.
He further explained that if those already infected are treated, the virus would be eliminated, emphasising the need to restrict movement.


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