Struggling to scale COVID-19 tests, Nigeria considers antibodies diagnosis in general population

As Nigeria struggles to ramp up the number of COVID-19 tests, the country is now considering doing serological diagnosis within its general population to determine the total number of people infected with the virus.

Nigeria sits among countries with the least number of standard coronavirus tests conducted worldwide. As of April 30, 2020, Nigeria has only carried out 12,828 reverse transcription polymerase chain reaction (RT-PCR) tests, which translates to 62 tests in every 1 million Nigerians.

RT-PCR is the standard coronavirus test. It usually involves the use of a sterile swab inserted to the back of a person’s nasal passage and throat to absorb secretions, which are then tested for the presence of SARS-CoV2 in a molecular laboratory. Nigeria has 15 molecular laboratories with an aggregate capacity to undertake 2,500 tests per day, President Muhammadu Buhari claimed.

However, last Sunday the director of Nigeria Centre for Disease Control (NCDC), Chikwe Ihekweazu, confessed that the country was in desperate need of test kits and gave specifications and preferred manufacturers

“We’re desperately looking for more RNA (Ribonucleic Acid) extraction kits as we expand #COVID19 testing. Product: Total viral RNA extraction kits (preferably spin column and with a lysis buffer). Manufacturers: Qiagen, ThermoFischer, SeeGene, Inqaba, LifeRiver etc,” he wrote on Twitter.

Though the NCDC announced an “ambitious” plan to test two million people in the coming months, it, however, admitted that the financial implication of this plan was going to be enormous.

Serological Diagnosis

Thus, in order to determine the extent of the spread of the virus in the country, the Nigerian Institute of Medical Research (NIMR) in conjunction with the University College in London, said it planned to do a serological survey across Nigeria.

“We are working with some of our colleagues in the PTF to do serological study,” Babatunde Salako, the director-general of the NIMR, told PREMIUM TIMES during a telephone chat.

“This study will look at the community and the development of antibodies against COVID-19 in the community so that we can determine how widespread the infection has been, how many people have come in contact with that virus since we are not testing anybody. That is the only test that can show us how widely spread is the disease within a particular community.”

“The one that we want to do is to assess in the general population how many people have such antibodies. That then means we would be able to project how many people within the population had come in contact with the virus.

“A large majority of the virus people(carriers) are asymptomatic, so they don’t know if they have the disease. Naturally, they develop antibodies, their bodies fight the virus and kill the virus because of the antibodies, and they can get well, and they don’t know,” he added.

Mr Salako, a professor, explained that because serological tests involved the use of conventional test equipment, it does not have the financial burden of the difficult-to-come-by test kits needed for RT-PCR tests.

“What we are using is the gold standard for testing. In serological tests, you just take blood from the patient. You don’t need that kind of serious equipment (used in RT-PCR tests),” he said.

However, Mr Salako said despite the lower cost implications of serological tests, the plan might not take off if funds were not immediately earmarked for it. The professor said he was concerned that researches into possible understanding and remedies are not getting enough attention in the country.

He, however, said he was hopeful that in the coming days the Nigerian government and private institutions supporting efforts at controlling the spread of the disease would make funds available to support research endeavours.

“Everybody both public and private are much more concern about case detection and case management and control of the disease than research. Whereas research is very key to the control and to the treatment of the disease. We are not seeing any clear-cut budget for research from the government.

“No special fund for that now but I must quickly say, I am part of a meeting with the Federal Ministry of Health and we have recently been asked to put together our action plans and I imagine that through that action plan, they might be planning to give fund for research,” he said.

WHO preaches caution

While serological tests may help countries such as Nigeria understand the spread of the virus in their population, the World Health Organisation (WHO) in a brief released on April 24, 2020, warned that it should not be used as the basis for an “immunity passport” explaining that there is not enough evidence that people with antibodies are protected from being re-infected.

“WHO continues to review the evidence on antibody responses to SARS-CoV-2 infection.2-17 Most of these studies show that people who have recovered from infection have antibodies to the virus. However, some of these people have very low levels of neutralizing antibodies in their blood,4 suggesting that cellular immunity may also be critical for recovery. As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans,” the brief read.

“People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may, therefore, increase the risks of continued transmission. As new evidence becomes available, WHO will update this scientific brief,” the brief added.

Apart from NIMR’s planned serological test, scientists around the country are working on several responses to the outbreak of the coronavirus pandemic.

These responses include the development of a rapid diagnostics, the development of a vaccine, and at least two clinical trials of two potential herbal treatment of symptoms associated with the virus.

Development of a rapid test, vaccine

At the forefront of these efforts is the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), located at Redeemer University in Ede, Osun State.

The centre rose to national prominence during the 2014-2016 Ebola outbreak after it developed a five-minute diagnostics test for Ebola. Going forward the centre also developed a five-minute test for Lassa fever.

Keeping with its pacesetting tradition, ACEGID, in collaboration with researchers from other institutions, did the first genomic sequence of SARS-CoV-2. Christian Happi, the coordinator of the centre told PREMIUM TIMES that the sequence was done within 48 hours, which he said was unprecedented globally.

Just like it did during the outbreak of Ebola, and with Lassa fever, Mr Happi, a professor, told PREMIUM TIMES that the centre is working on developing a rapid 10-minute diagnostics for coronavirus, which could help improve Nigeria’s abysmal testing numbers.

“We are working on developing rapid diagnostics. We are working to produce a-10-minutes rapid diagnostics. The Ebola diagnostics is different, but we are using the same technology to develop something similar. We are not there yet. I just want people to know that we have the technology. And we have done the same thing for Lassa fever. And we want to believe we would do the same thing for COVID-19,” he said.

Mr Happi, also added that his centre is working on the development of a vaccine in collaboration with the University of Cambridge. He explained this was possible because of the successful genomic sequence of a sample of virus collected from Nigeria’s index case, an Italian.

“Because we were able to sequence the whole genome, we have the ability to see the virus and see the areas of strength and areas of weakness of the virus. So, we want to use the areas of weakness of the virus to develop and vaccine.

“We are working quietly on it, but we are at the very early stage. We are working on a collaboration with the University of Cambridge. It has cost implications but what we are doing right now is to put together a technology that can drive the production of the vaccine. We need additional technology to do that and that is what we are doing,” he said.

He explained that because the virus is easily mutable, his institution is working to develop a technology that does not only lead to the production of a vaccine but one that makes it possible to adapt to a new strain of the virus within days.

“If you are reading the literature, there is almost 30 strains of the virus circulating now This virus has the ability to change very fast so we are working on a technology that will be agile. If we see a new strain within three or four days, we can adapt our technology for that strain. We need technology and innovation; we need creativity in order to fight this virus. It is not business as usual. We have to keep an open mind that accepts and embrace innovation,” he said.

Clinical trial of ‘repurposed’ drugs

Mr Salako, the director of the NIMR, also told PREMIUM TIMES that country isn’t left out from the global experimentation of treating coronavirus patients with drugs which have been previously used to treat diseases such as HIV, Ebola and malaria. He said the study is being done in collaboration with foremost Nigerian tertiary medical institutions such as the College of Medicine at the University of Ibadan, Lagos University Teaching Hospitals and isolation centres across the country.

“One of the drugs is Remdesivir which is used for Ebola virus and then there are other drugs for HIV virus and chloroquine and hydroxychloroquine. These drugs have been used in several places since the advent of COVID-19. Reports from China and France and a few other places show that chloroquine and hydroxychloroquine help the outcome of the disease. There are others that show that it didn’t help, so there is no consensus about the use of chloroquine.

“But we thought we should also look at chloroquine and hydroxychloroquine and because this is a drug we have used for donkey years in Nigeria and so we are capable of knowing what side effect that can come from that drug and capable of managing those side effects,” he said.

Herbal remedies

Scientists at the University of Ibadan and the Federal University Dutse (FUD) have also commenced the study of herbal remedies to treat some of the symptoms in critical cases of the virus.

At the University of Ibadan, researchers have started the clinical trial of a trial called Euphorbia Hirta to treat symptoms such as dry cough, fever and respiratory ailment associated with COVID-19.

When reached for comment about the study, Idayat Gbadamosi, a member of the team of researcher told PREMIUM TIMES that they decided to study the plant following ethnobotanical information and the experience of users.

She, however, refused to give details about the size of the population sample and preliminary results of the study.

“We are conducting a clinical trial. We won’t divulge information until we are doing with the research,” she said.

Similarly, at FUD, scientists are at the early stages of studying plants to treat acute pneumonia, fever and other symptoms of COVID-19.

Salihu Ibrahim, the head of the research team, told PREMIUM TIMES that they are working in collaboration with traditional medicinal practitioners.

“Eighty per cent of the population in Africa relies on traditional medicines because of accessibility and affordability. Traditional medical practitioners have vest knowledge of plants which they used to take care of diseases. The University is an institution for teaching, research and making policy.

He said the clinical trial will test those plants for toxicity and long-term side effects.

When asked if his team was working with local laboratories such as ACEGID, that has done the genomic sequence of the virus, Mr Ibrahim said, the research was in progress and it was too early to reveal details of what his team are exploring.

“When the results are out, we shall call the press to tell them our findings,” he said.