Nigerians await change of tactics as inefficiency, high costs keep COVID-19 testing out of reach

Nigerians are expecting a change of tactics in the management of COVID-19 testing as government run laboratories have increasingly failed people especially in dire straits and costly rate at private labs keep testing out of the reach of many.

Amid a deadlier second wave that the contagion rate is quicker and sending more people into hospital wards, access to testing is dangerously narrowed, hardly catching up with spiralling infection.

The government has maintained its first wave approach of restricting free testing to symptomatic people and those with confirmed contact with positive cases, which health experts consider a disservice to the current situation at hand.

With the intention to free public facilities from overburdening, asymptomatic people and those seeking the test for non-medical purpose such as travelling were restricted to private laboratories that charge N50, 400 ($132), one of the highest fee for COVID-19 test in Africa.

Nigerians pay 59 per cent higher for COVID-19 test than peers in South Africa; 43 percent more than what is paid in Senegal; 24 percent above Kenya and Ghana; and 75 percent higher than India’s.

Unfortunately as the second wave rages with roughly 7000 cases confirmed so far in 2021, many asymptomatic people who potentially act as super spreaders aren’t getting tested on largely on high cost of testing, while some critically ill ones who the public labs are meant to save have been forced to turn to private labs to avoid dying on queue.

Some medical facilities in major cities of Lagos, FCT and Kaduna are getting overwhelmed, with patients competing for ambulance services, oxygen supply and ventilators already short in supply.

Richard Ajayi, board chairman, Synlab Nigeria, one of the approved private laboratories argues that government should be providing testing for everybody in the face of an escalating public health crisis.

But “I think we are dealing with a significant resource challenge. The amount of test is clearly limited and the Private sector should be there for succour. It is not an ideal situation but I think government is trying to make the best of a bad situation,” Ajayi told BusinessDay.

He stressed with the lack of facilities to isolate, the government must do better to ensure that sick people at least gain access to testing and treatment.

“We need to be careful of how we select those at risk which is the people with significant comorbidity,” he added.

Chris Bode, chief medical director (CMD) at Lagos University Teaching Hospital (LUTH) raised an alarm over seeing an upsurge in the rate of people treating malaria instead of going for the COVID-19 test, recently in a statement.

At the private facilities end, Ngozi Onyia, the managing director and founder, Paelon Memorial Hospital who described the second wave as a Tsunami said patients are both unable and unwilling to pay for treatment, despite requiring it.

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“My phones have been ringing off the hook, with patients crowding in and around our holding bay for Covid 19 positive patients, making tough calls. Who to take into the treatment centre, and who to put on one of our four ventilators are ethical decisions I’ve never had to make in over 38 years,” she said in a LinkedIn post.

As of late December, sources familiar with Nigeria’s first licensed private hospital to treat COVID-19, First Cardiology told BusinessDay that the hospital capacity was being overstretched.

Hotels such as Sheraton Ikeja have been stepping into the role of isolation centres for well-heeled Nigerians and expatriates, following increased importation the pandemic by inbound travellers.

Nigeria has tested slightly over 1 million people, who constitute less than 1 percent of its population estimated at 206 million by World Bank.

Although coming from a history of five polymerase chain reaction and GeneXpert laboratories to 71 across the country, the country expanded its capacity for testing but shortage still persist.

The Largest African country by population and economy is 9th on Africa’s testing list, as South Africa leads with a total of 6.8 million tests, Morocco with 4.5 million, and Ethiopia 1.8 million.

Lagos, the economic capital home to over 20 million people has run 230,000, 45 per cent of which the private laboratories account for despite coming late to the testing party.

No respite yet

Nigerians shouldn’t expect any respite from the private laboratories on the issue of cost. Here is why.

According to BusinessDay source at one of the private laboratories in Lekki, the cost of running a laboratories from importation of reagents under high exchange rate to purchase of protective gears and rising electricity cost among others impacts the final cost of service.

With the resurgence of the pandemic, the laboratories in December saw 45 percent positivity rate from 300 samples tested in a day.

“We make use of reagents that has to be brought in from Korea. When we buy from Korea, we pay legal fees including freight, custom duty, NAFDAC registration fee. Across the entire supply chain, you are parting with money all along. By the time you do this across the entire value chain and somebody is telling you to test for N5, 000 or N10, 000? It’s not feasible,” he told BusinessDay.

“Is it okay to do business and make a loss? We don’t even go for home collection without a complete new set of PPE that cost 10,500 per person,”

Certainly, Nigeria needs to decentralise and increase the testing centres and get them closer to the people, Oyewale Tomori, professor of virology and former vice-chancellor of Redeemer’s University said in an interview with BusinessDay.

“But that is not enough. The labs must be provided with adequate test kits to meet the demand and these labs should operate 24 hours with well compensated lab workforce working in shifts. Through these steps we can reduce the turnaround time for lab tests,” he said.