If Nigeria did as many tests as Brazil, nearly 2 million people in Africa’s most populous nation may have been infected with the virus, which is more cases than Spain, Italy and the UK combined.
When Brazil, the most populous country in Latin America, waltzed into second spot on the list of countries with the most cases of the coronavirus, it cast an uncomfortable spotlight on Nigeria where low testing rates may be masking the number of infected persons.
One of the worst-case scenarios of the virus is unfolding in Brazil, which had reported over 3 million cases and 101,857 deaths as at August 12. Between late May and mid-June, the country galloped past Spain, Italy, and the UK in overall cases and total fatalities.
With Brazilian authorities lifting quarantines despite rising cases, many health experts say it is conceivable that when Covid-19 finally recedes, the densely populated country of 210 million people, where poverty is rampant and the enforcement of safety measures like social distancing is almost impossible, will have been hit harder than any other country.
Brazil’s similarities with Nigeria suggest the latter should be just as hit by the virus as the former but for low testing, which has kept numbers artificially low in Nigeria.
Brazil’s average age of 31 years compared with Nigeria’s 18, however, suggests the latter should record fewer fatalities. By testing approximately 13.2 million people, Brazil has carried out tests for 6.3 percent of its population.
The virus cases reported in Brazil and the number of tests done mean one out of four people tested returned positive, that is a test positivity rate of 22.9 percent.
Nigeria on the other hand has tested 317,496 people, 0.15 percent of its 200 million people, and would need to test 12.6 million people to be at par with Brazil.
If Nigeria did that many tests, the number of people infected with the virus could be as much as 1.8 million, using the country’s test positivity rate.
Nigeria’s total cases of 46,867 as against the number of tests done mean one in every six people tested had the virus, which gives a test positivity rate of 14.7 percent.
If Nigeria did the 12.6 million tests required to be at par with Brazil, a test positivity rate of 14.7 percent means Nigeria would have recorded 1.9 million cases, ranking it fourth of countries with the highest cases of the virus globally, behind US, Brazil and India and ahead of Spain, Italy and the UK (932,526) combined.
That is also 38 times more than what the country is currently reporting.
“Nigeria would find many more cases if there was more testing,” Charles Robertson, the global chief economist at Renaissance Capital told BusinessDay by email.
“But Nigeria is also a young country, so many more cases will be asymptomatic and it should be less deadly,” Robertson said. The implication of many more people being infected with the virus than is reported is the greater risk it adds to the rate of spreading, making the virus deadlier.
Nigeria’s fatality rate is 2 percent, having recorded 950 deaths as at August 12. That means only 2 percent of infected Nigerians have died, which is lower than the 3.6 percent global average and Brazil’s 3.3 percent.
Nigeria’s fatality rate means the number of deaths from the virus would have been 36,000 if Nigeria tested as many people as Brazil (12.6m).
Nigeria is also the only country in the world with over 200 million people to have done below 1 million tests.
That has helped keep reported cases of the virus in Nigeria 12 times lower than the 545,476 cases reported by the continent’s virus hotspot, South Africa.
South Africa has carried out approximately 3.2 million tests despite having a population less than Nigeria’s at 55 million.
More than one million people in Africa have been infected with the coronavirus but health experts say the numbers do not give a full picture of the outbreak on the continent.
As at August 11, Africa had recorded a total of 1,061,661 cases, and more than half of these are in South Africa.
Matshidiso Moeti of the World Health Organisation said the cases were a small fraction of the global count but low testing in many African countries meant infections had been under-reported.The WHO is concerned that testing is not available at the grassroots level in Nigeria.
“The challenge is how to decentralise these tests available in states and in countries like Nigeria, where we need to get to people in the local governments,” the agency’s programme manager for emergency response for Africa, said.
Why Nigeria is not testing enough people
Nigeria currently has the capacity to test only 2,500 samples a day and just half of these are actually administered each day because of the shortage of human resources, testing kits, and laboratories, and case definition for testing that prioritises symptomatic cases and their contacts.
While testing is free in state-owned laboratories, there are few of these facilities and they are in major cities. This often means that health officials sometimes have to transfer samples to other states to confirm results due to a shortage of test kits.
Chike Ihekweazu, director, Nigerian Centre for Disease Control, acknowledged the slow turnaround time for testing and said the response was partly due to the challenge the country faced initially trying to repurpose its laboratories to test for the virus.
Ihekwaezu said South Africa in contrast, with the highest numbers of testing on the continent and the highest numbers of cases, was able to easily do this.
Despite the yawning gap in testing, Nigeria is reporting lower cases of the virus, a development critics take a dim view of. Lagos, the epicentre of the virus in Nigeria, with 15,957 cases, recently closed health centres specifically created to treat COVID patients.
Last week, the state’s governor, Babajide Sanwo-Olu, announced that worship centres could accommodate half their capacity during services and restaurants were back in business, citing a steady decline in cases.
There are concerns that people there are self-managing their symptoms at home. Lagos has tested 66,431 samples so far, a fraction of its 20 million residents. Another barrier to testing is cost, according to Mobihealth International CEO, Funmi Adewara, who was interviewed by the CNN.
Adewara’s organisation is among those assisting laboratories with Covid-19 test sample collection.
Private facilities charge $132 for tests in addition to the cost of processing the tests. The fee, she says, is prohibitive for a majority of Nigerians without health insurance, especially as many have been hit by the economic impact of Nigeria’s five-week lockdown to tackle the pandemic.
“How many people have that kind of money to pay for this test?” Adewara said.
She added that Nigeria’s testing model excludes asymptomatic carriers, a critical data point that could give health officials a clearer insight into the outbreak in the country.
“We haven’t tested enough to the point that we have data to interpret the pattern of infections if we’re only testing those with symptoms, but the good thing is that the mortality rate seems low going by official figures,” Adewara told CNN.
Why Brazil is so similar to Nigeria
The large population of both countries makes it almost impossible to enforce strict compliance with safety measures from social distancing to wearing face masks and washing hands regularly.
High rate of poverty and lack of access to basic amenities like clean water in both countries also means several people cannot afford face masks and other protective gear, and cannot wash hands regularly.
In the densely packed favelas (slums) threaded through Brazilian cities, social distancing is not feasible and not working means not eating, especially with the cash-strapped state unable to provide enough support. This sounds all too familiar for Nigerians.
The densely populated commercial capital of Lagos also makes it hard to maintain social distancing.
Nigerians who do not own cars are in the majority in a country where 87 million people are in extreme poverty and live under $1.90 per day. That means the majority are still crammed up in commercial buses when moving around.
Not commuting to their places of work despite the risk they are exposed to also means not eating for many Nigerians.
Like Brazil, strict lockdown measures had to be eased after it became clearer that the longer they stayed the more they threatened the economy and the livelihoods of Nigerians who feed from daily wages.
The face mask wearing culture is also waning in Nigeria, as is the case in Brazil. Some people dump it in their pockets until they are mandated to wear it to enter into a banking hall or a shopping store.
Others wear it wrongly by pulling it down to their necks, which defeats the purpose of covering their noses and mouths, while some repeat non-reusable surgical masks that look like they have been worn for weeks.
Many Brazilians also do not wear masks even in the Northeast where cases are most rampant.
Like in Brazil, social distancing is also difficult to comply with for Nigerians who live in slums and have to share bathrooms and kitchens with as many as 10 people.
Then there is the challenge of people who do not believe the virus is in Nigeria. These people go about their businesses without restraint and not minding safety measures from the virus.
These factors are the same ones that have made Brazil a perfect host of the virus. Poverty is certainly also part of the picture in Brazil, like Nigeria. Almost 55 million Brazilians live in extreme poverty or below $1.90 a day.
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