EDITORIAL: The Urgency of Tackling Nigeria’s Second Wave of COVID-19

Over the past seven days, the number of new cases of COVID-19 has ranged between nine hundred and sixty four and just under two thousand cases per day, with more than 60 per cent of the states in the country recording sharply rising numbers of cases daily. Whereas these statistics could easily be chalked up solely to the increased testing capability and widened laboratory coverage that have enhanced the access to COVID-19 tests of communities previously unable to gain such access, unfortunately, with the rising numbers of cases, there are regrettably more frequent reports of case severity and deaths.

Facilities ear-marked for the isolation and treatment of symptomatic COVID-19 patients in need of medical care are fast running out of capacity and life-saving interventions. Medically-provided oxygen, essential for managing the growing number of patients who are out of breath, is now as scarce as fine gold. The upsurge in the daily consumption of oxygen in many of its COVID-19 treatment facilities, has forced the Lagos State government to set up its own oxygen plant to meet patients’ demand.

The country saw an exponential increase in the number of cases in the aftermath of the holiday season. This should have been anticipated and provisioned for were we the kind of country that learns lessons from other people’s experiences.

We have, however, responded to this challenge as if it were business as usual, with key cogs in the healthcare system exhibiting a mystifying lack of urgency in their response to this second wave of the pandemic.

Walk or drive along the streets of the country’s busiest cities, and you would be hard pressed to locate face masks being used by pedestrians, even in heavily populated and busy parks, markets, shops, offices, and bus stops. Aside from the daily reports released by the NCDC, one would think that the pandemic was pretty much over – at least in Nigeria.

While authorities at the federal level and in many of the states – with a few exceptions – could be said to have put some preventive protocols and regulations in place to guide the public, even if these have not been communicated or enforced well enough across the country, the rather unfortunate role of numerous opinion leaders – from the religious to the political – in sowing doubt about the existence or virulence of the disease has been quite galling.

This has inspired behaviours largely driven by ignorance and supernaturalism in the general population, which have compounded the present public health crisis pertaining to COVID-19 in Nigeria.

Whatever explains the initial low occurrence of cases, comparatively speaking, in our land, we should not push our luck too far. This yet-to-be-explained circumstance, plus the proliferation of conspiracy theories may have contributed in no small measure to limiting our success in having the populace take the threat of the pandemic seriously.

If one thing is clear, even in this second wave of the COVID-19 pandemic, it is that the mode of transmission of the virus, regardless of which variant it may be, remains largely unchanged. It is still transmitted from person-to-person through droplets from asymptomatic, pre-symptomatic and symptomatic individuals. Therefore, preventive measures such as wearing face masks correctly, physical distancing, frequent hand washing and use of sanitisers, remain unambiguously valid.

2020 was a difficult year, and the COVID-19 pandemic dismantled many of the societal norms and cultural practices that are tied to our identity as Nigerians and as Africans. Norms such as gathering in celebration and worship; and practices such as congregating closely in friendship and fellowship, have been upended. But, tragically, as at the end of the year, the pandemic had also deprived more than 1,350 Nigerian families of at least one member.

We do not need to wait for more deaths to recognise that we have a dire situation and react to it with the urgency that it requires.

First, the intensity with which the COVID-19 preventive measures were upheld during the first wave needs to be rekindled. The wearing of face masks, physical distancing and restrictions on public gatherings are now regarded as personal and collective choices, and it is not uncommon to see event centres and venues packed with traffic from throngs of event attendees. Enforcing restrictions on public gatherings and ensuring the adherence to COVID-19 preventive measures in schools and higher institutions of learning are especially essential at this time.

As such, there is the need for governments in the country to be more proactive around enforcement, with an instructive case being the COVID-19 Marshals announced by the Kano State Government to police compliance with protocols around preventing the transmission of the virus.

Secondly, there is an urgent need for an integrated communication strategy led by trusted non-state actors that should be directed at increasing the understanding of the populace. The information made available to the public should be delivered in a way that is relatable and could be easily disseminated, using local languages and media.

To avoid conflicting information or misinformation, it is vital to engage community leaders to inform and engage their communities with harmonised messages. Much of the information surrounding the pandemic has been delivered with elite and enlightened audiences in mind. Even then, in a backdrop of societal mistrust of authority, it is little wonder Nigerians appear to have ‘moved on’ from COVID-19. Prioritising the messengers and not just the message is critical, as we have seen that knowledge does not equate to trust.

The public’s mistrust of government is further entrenched by the current communication of the country’s vaccine strategy. The initial delivery of 100,000 doses has been said to be reserved for frontline health workers and ‘strategic public officials’, to be allocated in a manner that speaks more to political considerations and is quite far from the reality of the COVID-19 pandemic and the current case distribution in the country.

Government at all levels should clearly communicate the vaccine strategy in a coordinated, transparent, and accountable manner, or else risk the feeding of the public’s lack of confidence in the government.

Thirdly, this current wave of the pandemic has again brought into sharp focus the fragility of Nigeria’s primary healthcare system. With many of the COVID-19 isolation and treatment facilities shut down in the last phase of the previous wave, newly confirmed cases with access to healthcare had only their primary care providers across the public and private sector to interface with, and in a health sector plagued with an insufficient workforce due to the incessant brain drain of skilled health workers, ill-equipped facilities, and a dearth of critical equipment such as personal protective equipment (PPE), and ventilators, it comes as no surprise that the numbers of severe cases of COVID-19 are rising and the disease is taking more lives.

It is therefore imperative that primary healthcare structures are strengthened with necessary equipment and manpower, so that essential health services are provided, and early diagnoses made. Strengthening primary healthcare systems ensures a robust first line of defence against unchecked infectious disease outbreaks, with skilled and equipped frontline workers testing, tracing, treating and where necessary referring infected individuals, thus forming the backbone of the pandemic response efforts.

Carrying out effective testing and tracing in the populace once again relies on public trust and people’s confidence that the health policies, preventive measures, and health system in place exist to serve them and their communities and can and will ultimately keep them safe. In addition to sound, transparent investment, government, and the healthcare workers must ensure that the systems are people-centred to build community trust, which will drive adherence to critical infection prevention measures and acceptability of vaccines when finally available.

Lastly, the scarcity of personal protective equipment (PPE) in health facilities across the country has left many health workers exposed to infection with the virus, and given the global demand for PPE and strained global supply chains, the fact that domestic manufacturing of PPE has not been sufficiently enabled at a scale adequate to protect the nation’s frontline workers, has left a very wide gap in health security.

According to the Vice President of National Association of Resident Doctors (NARD), more than 70 per cent of health workers have been infected with COVID-19 at some point. Considering that these health workers provide care in communities where they often reside with their families, cases will continue to spread like wildfire.

It is thus evident that developing the local industry for PPE is the country’s main hope for protecting the health workers at the frontline and as importantly, these protective equipment ought to be systematically distributed, and workers trained on their effective use across primary care centres, district hospitals and teaching hospitals, thereby ensuring coverage at the three levels of healthcare in both the public and private sectors.

Nearly 90 per cent of health facilities in the country are primary healthcare providers, and private facilities provide over 30 per cent of healthcare to Nigerians. The continued exclusion of primary care and private facilities in the distribution of essential equipment is therefore most unwise.

The relentless increase in numbers of cases of COVID-19 is not a fluke but a direct consequence of the laxity with which individuals have confronted the continued pandemic. Without a strong, coordinated, strategic and people-centred response, we can only expect to see escalating numbers of avoidable fast-filled hospital bed spaces and rapidly dug-up graves because of this virus.

The good thing is there is still a small window in which to act and save the lives of thousands – if not millions – of Nigerians. We must act with a determined, deliberate, collective sense of urgency, and we must act now.