Abdallah, an Abuja resident, said he was contacted by health officials after his colleague had died from an unknown illness, which was later confirmed to be Covid-19. Having heard about how deadly the new disease could be, Abdallah promptly made himself available for enquiries and testing. His test result came back positive and he was immediately isolated for further treatment.
Contact tracing is no doubt crucial for COVID-19 containment, but while some cases like Abdallah are cooperative and make the job for tracers a lot easier, several others literally block themselves out from being reached and have made this critical process almost impossible to carry out in the country.
Ramatu Abdu-Aguye, head, contact tracing team, said a contact suspected to have Covid-19 had told her at one time, “Stop calling me to ask me about my temperature or where I have been.” The contact had hung up thereafter.
Just like Covid-19, Nigeria had battled the deadly Ebola Virus Disease in October 2014 and successfully contained it after 17 weeks of the outbreak. Several experts including the response team said contact tracing was central to the success of the response. Nigeria was declared Ebola-free on 21st October 2014. A total of 899 contacts were successfully traced, of which 20 cases were confirmed with eight deaths, during the Ebola pandemic.
Since the outbreak of Covid-19 in Nigeria, Lagos State says it has traced 1.5 million contacts, the NCDC says 25,000 contacts have been line-listed in the country three months into the outbreak, with 96 percent of them followed up by states. To boost contact tracing, NCDC began house to house follow-up of contacts in FCT and Lagos, which are hotspot states.
But health authorities say contact tracing – though critical – has been one of the most challenging tasks. The practice is one that requires the skills of a detective and a therapist to get an honest response from people. For every confirmed case, intense tracking of their contacts is carried out to promptly detect, isolate, and treat contacts who may be infected. Each infected person could have over 30 contacts, health officials noted.
The ultimate goal of contact tracing is to halt the spread of the virus. The process ensures early detection and isolation of infected persons.
Abdu-Aguye further explained that contact tracing was much easier earlier during the ebola outbreak because the contacts traced were returnees who were mostly elites until the virus entered community transmission and the ordinary Nigerian started contracting the virus.
“Contact tracing begins with cases first, the initial cases were elites, and they were enlightened, once they know it’s to follow up, there was cooperation. They made it easy, they knew the virus was new, they gave us information, responded to our calls, visits, and followed the guide on self-isolation.
“But, as community transmission went on, contact tracing became tricky. The ordinary man feels he hasn’t traveled and should not have the virus. People drop calls on you, they are not willing to corporate. During the lockdown made it difficult, Nigerians were not willing to, they will tell you they are hungry and hope you’ll give them palliatives instead. This makes it more difficult and challenging,” she said.
Abdu-Aguye decried that some Nigerians deliberately withhold information or deny being in contact with an infected person, while some others are still in doubt that the virus exists. “An infected person says they have come in contact with certain persons when you call them, they deny ever knowing or coming in contact with such a person.
“There is a lot of political sentiment, denial and negative publicity, some people think contact tracers are paid by the number of contacts they trace, She added
She further revealed that stigmatization of infected persons or their contacts made the process also difficult. She said some contacts declined visits from contact tracers because they don’t want to be seen with health officials by their neighbours for fear of being stigmatised.
“Contact tracing and monitoring are one of the most important yet labor-intensive aspects of our response to COVID-19 in Nigeria.
“The number of contacts continues to increase as we record more cases which increases pressure on our health workforce”, Chinwe Ochu, Head of Prevention Programme and Knowledge Management at the Nigeria Centre for Disease Control told BusinessDay.
Chikwe Ihekweazu Director-General Nigeria Centre for Disease Control NCDC had also lamented that stigmatization was significantly affecting the war against the pandemic as it had driven several contacts into hiding instead of coming out for tests or treatment.
The head contact tracing team, however, noted that success has been recorded despite the challenges. According to her, some contacts, were willing to cooperate, because they understood the virus. This, she said helped in the early detection and diagnoses of some cases.
The Director-General NCDC, said Nigeria in tackling the challenges of contact tracing among others, Nigeria is drawing so many lessons from the Ebola outbreak. He said particularly surveillance, monitoring and case finding
Ihekweazu said one of the key lessons learned was the need to build systems in ‘peacetime’ that can be used during outbreaks. He said the Ebola outbreak prompted Nigerian government to invest in the establishment of National Public Health Institutes, such as the NCDC. According to too him, the capacity for outbreak response is better streamlined with a clear coordination platform.
“In December 2019, we completed the training of rapid response teams in all states in Nigeria. All 36 states have a team ready to be deployed in the event of an outbreak. Over the last three years, we have strengthened capacity at our National Reference Laboratory to provide molecular diagnosis for all epidemic-prone diseases and highly infectious pathogens such as the Ebola virus.
“Overall, we continue to build strong systems that will enable the prevention, early detection, and prompt response to infectious disease outbreaks.
The NCDC boss also noted that the ebola taught Nigeria to strengthen risk communications capacity to ensure members of the public are equipped with the right information. One setback during the Ebola outbreak was a prank urging Nigerians to drink excessive amounts of saltwater to avoid contracting the virus. The hoax spread like wildfire for several days and resulted in the death of two people and at least 20 people were hospitalized.
Ihekweazu further noted that data manually gathered during the Ebola, which made the process tedious, but said this response has made is the efficiency of electronic data gathering systems for efficient response.
The Head of Prevention Programme and Knowledge Management said NCDC deployed software called Surveillance Outbreak Response Management and Analysis System (SORMAS) for real-time case-based surveillance from health facilities to LGAs to states and to NCDC, to facilitate case finding of COVID-19.
Experts however advised that contact tracing though critical is but not enough to get the pandemic under control.
Matshidiso Moeti, Regional Director of the World Health Organization Regional Office for Africa obviously agrees that past outbreaks, like Ebola, have equipped Africa, including Nigeria on the best to tackle the Covid-19 pandemic.
“African countries are used to dealing with outbreaks and epidemics, so they are used to having to ramp up a response,” she said during a recent conversation on BBC.
Patrick Dakum, CEO of the Institute of Human Virology Nigeria, said testing isolation and treatment is just as important.
