The Coronavirus disease 2019 (COVID-19) is an acute respiratory disease caused by SARS coronavirus 2 (SARS-CoV-2 or COVID-19 virus). A lot of information about the COVID-19 virus, which first appeared in Wuhan, China in December last year, is already out there but let’s run through the basics. Index infections were from a seafood market in Wuhan China.
Originally China tried to cover up the outbreak and by the time China acknowledged the emergence of COVID-19, community spread of the virus had already begun in China. Due to the interconnected nature of our world especially via trans-global transportation (air travel in particular), the virus quickly spread beyond China. The World Health Organization declared it a pandemic and at present, the virus has infected more than 1.4 million people worldwide and more than 82,000 fatalities.
In Nigeria, the National Centre for Disease Control (NCDC) as of today reports 254 confirmed cases and 6 fatalities. My primary motivation for writing this article is to directly debunk assumptions that Nigerians or Blacks living in sub-Saharan Africa somehow are immune to contracting coronavirus or have anti-bodies that inhibit the development of the disease after it enters the body.
I have had the course at several forums, in discussions with academic colleagues at the American University of Nigeria Yola where I presently teach, and on Gotel Television in Yola, to advise Nigerian and other African Governments to sustain ongoing measures aimed at protecting their populations against the Coronavirus, as there exists yet no scientific proof that sub-Saharan Africans enjoy any form of immunity against the virus.
In the absence of a vaccine or effective drug, social distancing measures is the only effective public health intervention. Data from China, Singapore, Czech Republic, Taiwan, Austria, Norway and Germany have consistently shown that social distancing flattens the epidemic curve.
My submission as a researcher and molecular virologist of over 30 years, in Norwegian and Nigerian universities and research institutes, is that it will be beyond recklessness and irresponsibility to relax the present ongoing social distancing measures in the inane belief that Nigerians have some innate or acquired resistance to COVID-19 virus.
There is no evidence to support that Africans have some immunity to COVID-19. Indeed, the very risk factors for the severity of COVID-19, that is, diabetes, high blood pressure, asthma, etc. are very common in Nigeria and African communities around the world.
As already shown from the data in the USA, COVID-19 will kill much more in Nigeria because of these associated morbidities. This misinformation spreading on the internet that Africans are immune is responsible for the shocking statistics that are coming from the USA, that is, in states like Louisiana where Black Americans constitute 30% of the population, but account for 70% of the fatalities.
African American communities believed this false narrative of immunity and thought that COVID-19 is a white man disease, refused to practice social distancing and other precautionary measures and now we are witnessing the fatal consequences. I am worried that the same scenario is and will play out in Nigeria with much more devastation.
We will keep shouting, and screaming until our policymakers hear us and take decisive action. I am afraid that if nothing is done to counteract this misinformation of immunity, the consequences to our people in terms of infection, morbidity, and fatality will be of apocalyptic proportion!
The issue of resistance to malaria conferring some protection to COVID-19 is a legitimate but premature hypothesis. Reason being that an insignificant portion of individuals in malaria-endemic regions have been tested. Nigeria has tested about 4000 people representing about 0.002% of the 200 million population. You need to at least test 1% of the population, that is, two million Nigerians to start making any correlation and then test those correlations.
Why will we spend time investigating an unestablished correlation between malaria resistance and COVID-19 fatality when there is an established correlation between risk factors like diabetes, hypertension, asthma and COVID-19 severity? When time is of the essence and the difference between life and death, it is far better to spend resources including scientific investigation, public health intervention efforts on established correlations.
The malaria resistance if future data supports it can then be investigated but as of now it is not a priority in terms of risk assessment and public health. Remember, last week, Nigeria had 131 cases and 1 fatality but today (one week later), it is 234 cases and 6 fatalities, almost 80% and 500% increase in the number of infections and fatalities respectively.
Even when you eliminate under testing and reporting, the almost doubling of the infection cases and 500% increase in fatality within a week is ominous, and suggest as I have argued in my previous discussions that our reported COVID-19 cases are following the same pattern as countries in the early phase of the epidemic curve.
Nigerian infection curve is about four to five weeks behind the USA. A month ago, the USA had very few infections and fatalities prompting Trump to boast that the COVID-19 virus is contained. Today, that is, four weeks later, about 400,000 Americans are infected with 12000 fatalities. The public health message should be that all must practice social distancing and wear a mask if they have to venture outside and those with underlying illness (diabetes, hypertension, asthma, etc.) as well as the elderly (60 years and above) must stay at home. Disobeying the social distance measures exposes one to the virus with attendant morbidity and mortality. In addition, one may also be a spreader of the virus to uninfected individuals.
The Covid-19 pandemic caught the entire world unprepared, not just Nigeria. The unpreparedness is not because nations did not receive early warnings but because those warnings were ignored by bureaucrats. The bureaucrats and policy makers thought that the probability of such an event occurring is very low.
In a layman’s term Risk is probability multiplied by the consequence. Thus, a low probability event will have a high risk when the magnitude of the consequence is extremely high. For instance, the probability of a nuclear explosion may be low but the risk is still very high because of the magnitude of the consequences, i.e., millions of people will die if it happens.
The same scenario plays out with pandemics. Thus, without question the zoonotic spillover of emerging/re-emerging pathogens from the wild should have been assigned the highest level of risk and proactive measures taken to prevent, detect, mitigate and respond. Pandemics are not just a public health concern but have immense biosecurity implications.
Thus, our country Nigeria should be deeply concerned about the health and biosecurity implications of the emergence or reemergence of pathogens. Proactive research through identification and characterization of potential pathogens before they emerge or reemerge to cause deadly infections in humans and animals is the holy grail of pathogen discovery, public health intervention, and robust biosecurity preparedness. We can only prevent, detect, mitigate and respond effectively to pathogens if we are proactive in the following ways: (a) Nigeria should establish centers of excellence on pathogen hunting.
These proposed centers should hunt for potential pathogens in the wild before they emerge, predict the potential timeline for the emergence and put in place a robust evidence-based system for response. Only by this will have the capacity for pathogen diagnostics, simulation and surveillance, as well as vaccine development and therapeutics. The pathogen hunting centers can be modeled in the way of the USAID funded PREDICT program. But this time, the proposed Nigerian PREDICT should do the scientific work and not outsource the core scientific investigation to foreign reference national laboratories in the name of quasi collaboration.
Collaboration in science is welcomed but it should not be one-sided, that is, where African scientists are mere sample collectors while the sophisticated scientific work is ferried to foreign laboratories in the USA and Europe. We must build our capacities here in Nigeria and genuine collaboration must support capacity building, skill and competence transfer.
(b) The government and private sectors should as a matter of national urgency invest heavily in STEM, particularly in the areas of genomics, molecular biology, bioinformatics, robotics, and artificial intelligence. These are the disciplines of the present and the future. They are at the core of creativity and innovation for the future, without which Nigeria cannot address the healthcare and ecosystem problems of now and the future. Young people should be incentivized to pursue careers in functional genomics, genetic engineering, systems biology, and artificial intelligence.
Many programs in our Universities and research institutes are outdated and will not equip our young ones with the skill set to discover new vaccines, cure genetic diseases, find alternative and green sources of energy, etc. Our medical schools are minting out doctors that are not equipped to address pandemics or integrated health problems. The curriculum in our medical schools should be modeled to problem-solving instead of memorization and regurgitation of obsolete information. Medical schools should emphasize molecular and translational medicine. If we develop and nurture competence in these areas and more, we can innovate or manufacture ourselves out of any problem.
Our 100% dependence on oil is a clear indictment of our poverty of scientific innovation as well as crippling inertia to technological advancement. COVID-19, oil dependency, etc.
can be solved if as a nation, our governments create the enabling environment to support research and innovation. I will propose that Nigeria should create a National Research Council whose mandate will be to massively fund STEM research in the core areas earlier mentioned, and provide the structural framework to translate research into innovation! Nigerian academics can apply for funding for innovative projects and fund will be awarded to deserving recipients after rigorous external peer-review.
All these suggestions will only work if the “Nigerian factor” is removed, that is, competence and skills must take precedence over any other consideration. How can a professor who has never extracted nucleic acid or even run a basic DNA gel lead a laboratory or agency whose mandate is molecular diagnostics or epidemiology?
The lack of investment in education, health, science and technology have irreparably crippled our ability and capacity to respond effectively to the covid-19 pandemic. It is my hope that this pandemic is a water-shed moment that awakens us to the realization that we can only compete if we innovate and create. No country or people will help us except ourselves.
Professor Malachy Okeke held senior research and teaching positions in Norway, and was Senior Scientist, Molecular Inflammation Research Group, UiT The Arctic University of Norway, before joining American University of Nigeria, in 2018.