This week, Nigeria recorded only 26 cases of coronavirus and no deaths. Also, since March 15, 2021, over 1 million vaccinations have been delivered and there have been no reports of vaccine induced immune thrombotic thrombocytopenia (blood clot).
This is against the background of a relatively normal life. Everywhere is open and COVID guidelines are obeyed to varying degrees. If you compare this to other countries particularly in the West, something does not add up.
I have no access to data to explain why Nigeria and indeed most of Africa appears to have been spared from this deadly virus so I decided to postulate and to also gather anecdotal evidence from what has been shared already.
After a teaching session at the department of Family Medicine at the Lagos University Teaching Hospital, we opened up a session to discuss this conundrum.
So why are COVID cases low and why are deaths even lower? Is there a higher power at work as many Africans believe or are there answers that we have ignored? Some of the reasons may be:
Undocumented Remedies: There are several remedies that are used on the continent that have no strong research evidence to support their efficacy. It is time for us to look into some of these solutions, tailor them for our population and export them to the rest of the world if found to be useful.
‘Agbo’- Yoruba name for herbs, is a form of traditional medicine. These concoctions come in various forms including liquid, paste, syrups and consist of a mixture of bark, leaves, stems and roots of particular plants and trees. They are administered in different ways. Agbo is affordable and easily accessible. According to the World Health Organization, 80 percent of Africans use traditional medicine for primary healthcare. The use of agbo is widespread and some believe it may have a part to play in the low COVID rates. The market is unregulated and the formulation is not standardised.
Drug treatment-for those who test positive, a combination of medication is usually prescribed including steroids, antibiotics, anti-parasitic, vitamin C,D, zinc among others. The medical community to a large extent believes that this results in reduced morbidity and mortality from COVID-19.
The Sun: There is a correlation with vitamin D levels and susceptibility of the virus to heat. While the former can be a factor as increased vitamin D levels boost immune response, the same cannot be said of the susceptibility of the virus to warmer weather. Brazil and New Zealand did not respond this way to warmer and colder weather. Cases worsened as it got warmer in Brazil and did not worsen as it got colder in New Zealand.
Younger population: The median age in Nigeria is 18 hence it is unsurprising that the population is less severely affected by COVID. This is not necessarily a positive characteristic as it reveals the decay of the health system where life expectancy is still behind the West.
Prevention practices: Lockdown and mandatory testing for all arrivals were introduced very early. Also noticed particularly in the more affluent areas very early on was strict hand washing, and mandatory mask wearing before access into any place of business. This is similar to the Ebola response. While facilities are provided in the West, in the UK for example, these were introduced later and not as closely monitored.
Poor Health System: The health system is less developed and basic infrastructure unavailable. Less than 2 million tests have been carried out in Nigeria, which has a population of approximately 200 million. There is poor access to basic healthcare, next to no electronic health records and access to data very poor. This presents a less optimistic but very important view of the story.
In conclusion, there is certainly a disparity between the poor public healthcare system and the low case numbers, morbidity and mortality from COVID-19. There is a significant amount of research needed to establish if there is merit in our undocumented remedies, however there is more work needed to improve the basic healthcare provision.
Dr. Alabi is a visiting consultant at the Department of Family Medicine Lagos University Teaching Hospital. She is a practicing GP in the United Kingdom and the clinical director of Titan Primary Care Network.
