As we all probably know, the cases of COVID-19 in Nigeria have been on the increase and increasing along with the panic. Is it time to panic? Not at all! It’s only time to re-evaluate our strategy which has been generally good so far. Let me say at this point, that having COVID-19 cases in the country should not surprise us nor should it surprise any country. Unfortunately, that is one of the costs of globalisation – diseases travel as far and fast as people and goods can move around the globe. In short, it is more a matter of when, and not if, COVID-19 will arrive in any country.
Let me also say that border closures, as seen in many countries, may last a while but are impractical in the long run. Economic downturns and consequent possible civil disorders are threats to long term shutdowns. In a country like Nigeria, that is unaffordable even with armed forces that are already stretched thin with other security matters. Also, with border closure, when would we reopen? When there are no more cases globally? As long as there are cases anywhere (irrespective of the numbers) the risk still exists even if minimal. At such a time as we reopen borders, would our surveillance system still be functional enough to pick cases up or it would have gone into a sleep mode.
I write this out of some annoyance – at the panic being spread around using the mass media, social media, and any other means and, sometimes, by those who should know better! I am annoyed that every Nigerian now has become a public health expert telling the government what to do instead of listening for what they are to do. I write this to say that diseases come and go but mankind remains and will overcome. I write this to say that this would be taken care of by simply doing what we are meant to do and allowing the experts to do their job. So, as a country, what are we to do now? I have some random thoughts to share.
Stop the panic!
The biggest pandemic at the moment is not the outbreak of a virus but of fear! I talked with someone in a country with a high burden of COVID-19 and he told me how the fear is really tormenting for him and others. In fact, he says just thinking about the situation made him feel like he had the symptoms. His friends also felt the same way sometime or the other. We do not need to panic. In Nigeria, most people found to be positive for the virus have only had mild to moderate illness and have been recovering well. Even a vast majority of their contacts did not catch the disease. In Wuhan (China) where it was first reported, there was no new case today and most people have recovered/are recovering. It doesn’t even mean China has totally relaxed but they have shown that even a very bad situation can be taken care with a cool head and the right strategy.
I am upset that professionals say that people will die because we don’t have respirators or enough Intensive Care Units. What about appropriate local technology as we were taught in medical school. We should simply innovate in managing the relatively few people that will need that (you can understand my not giving any more details here). I recall how we managed a very (and I mean very) premature baby at Adeoyo Maternity Hospital Ibadan without even a functional incubator at the time! Let’s prepare vigorously…to win and not to lose.
We have conscientiously reported the deaths but have been silent about the majority who recovered. We have quickly shared stories about the doom that hit some places but not that of other places where the outbreak is being controlled. We have not shared stories of those who told us that they are just a little unwell with the virus, and told us not to be worried. Diseases often take a worse course in individuals who are fearful. Spread encouragement and not fear. Also, the media must find a balance that enables positive and factual reporting. Situations like this pandemic require some sensitivity in reporting. The stories we share must motivate people to act while maintaining a level head. It applies in almost every facet in life, including sports. A football team that is losing with four goals down throws away the chance of a comeback up when it panics.
Good public enlightenment
Curbing an epidemic is so much easier when people are effectively taught what they need to know, with attendant corresponding actions. I salute the lady who came into the country and isolated herself immediately seeing that she felt unwell and thought she might have the virus. She did so well that even her parents who picked her up from the airport and were in the same house with her for days did not catch the virus. I was excited at seeing Mr. Tonye Cole’s tweet about being on the same plane with the lady and now isolating himself as instructed by the government. Such stories are important to highlight good behaviour and to encourage other people to behave as expected/instructed, in being considerate of others. They are also testaments to the good job being done by the government and other bodies, such as the Association of Public Health Physicians of Nigeria (APHPN), which must be intensified.
Call centres needed
A worrisome dimension has been the repeated story of people not getting through to the helplines publicised. As we succeed with the public enlightenment, we must ensure that when people do as told and phone in, they must get through to someone and, that also, easily. Luckily, this is not rocket science and our telecommunications firms should be able to help. They can provide numbers and also the call centres and or even personnel to man them.
Develop clinical capacity
The disease is new and so is the required learning. However, an advantage of not being first is that we can learn from those ahead. We have learnt that ibuprofen (which people take to bring down fever) is not to be taken with this infection. We have also learnt that certain anti-hypertensive drugs are also better avoided with this infection. For sure, this is not the time to practise self-medication!
We have to prepare for the relative few who develop severe disease as these are the ones that result in death and scare the population more. By the way, I just read of a 101-year-old lady, with underlying bronchitis, that made a full recovery from COVID-19 infection. Apparently, the severely ill ones will need some form of respiratory support. Are we ready for that? All I am trying to say is that infection with COVID-19 does not have to result in death, even with severe illness, with old age, or other underlying conditions. We should research into what the Chinese and others did/are doing which apparently improved outcomes as the days went by.
We must do our part
Similar things were said in 2014 with the Ebola outbreak. We did a few things, for a while, and then went back to our old ways. We should know by now that disease outbreaks are largely caused and sustained by human behaviour. I am sure many were shocked when, with the outbreak of COVID-19, we were told to wash our hands to control the spread. Is that all? Is that not what we did with Ebola? Yes, human behaviour, including personal hygiene, is important in controlling the spread of most infectious diseases. This COVID virus needs droplets to go from person to person directly or indirectly. So, I must cover my mouth when I sneeze and or cough. I must cover my mouth with a piece or tissue (and discard properly) or, as an alternative, I can sneeze or cough into my elbow. I should not be using my soiled hands to touch surfaces (such as door handles) that others will touch too. If somehow I did touch a surface, I know what I did and should be considerate enough to wipe it with an appropriate agent. Of course, washing my hands frequently ensures that whatever droplets/viruses may be on it from sneezing/coughing or touching contaminated surfaces gets washed off soon enough.
Let me also add that social distancing is not so much about the number of the people in a gathering but about the behaviour of the people at a time like this. However, it is easier to control a smaller crowd than a bigger one. Anyway, the main principle is avoiding bodily contact with others in case anyone was infected with the virus so it doesn’t get passed on to others.
Local research
I want to end with this important element. Though we are dealing with a pandemic, we should not fold our arms and wait for China, US, UK, or whatever country, to find the cure. Some scientific postulation even says that COVID-19 is likely to stay with us from now and will be a problem from time to time. Note also that any drug found now may not be available to many poor countries until the rich countries have had more than their fair share of it.
Let’s fund local research now. Let’s also fund our own test kits and drugs since we could do the gene sequencing. Many countries can find many different drugs at the same time. Let’s now rethink the value we place on science, technology, and innovation. This is an important investment. See how all our economic projections for the year are now useless with a single disease outbreak.
In conclusion, let me say that we must remember that most people infected with this disease have mild disease and recover. We must know that public education with attendant appropriate behaviour will be our biggest weapon in this fight and others. We should not panic but know that we can overcome this too.
Oladoyin Odubanjo
Dr. M. Oladoyin Odubanjo is a public health physician
