By Racheal Abujah
It has been nine months of rigorous response against the COVID-19 pandemic by the Nigerian authorities. The activity, which has been centrally coordinated by the Nigerian Centre for Disease Control (NCDC) and the Presidential Task Force (PTF), has witnessed vigorous implementation of medical and preventive guidelines.
While the lockdowns, social restrictions and border closures were being reviewed periodically, both nationally and across the states, a flurry of activities had been launched either in the form of the establishment of quarantine, treatment and testing centres, or the inauguration of Public Health Emergency Operation Centres and special committees to address specific tasks.
While some commentators have maintained that the low rate of mortality in Nigeria was due to the strategic response of the government, and the commanding steps taken by the authorities, others have been derisive against the national response.
The critics insisted that the government had not been transparent enough in its dealings, especially with regards to the management of donor funds. They frowned at the declared expenditures and questioned the sharing of palliatives.
It was further observed that some of the advisories released by the government were not based on evidence, pointing to the need for evidence-based public health policies rather than the adoption of advisories from other climes, simply because they were successful there.
There is no gainsaying the fact that the COVID-19 outbreak shocked the world, and overwhelmed the health systems of even high-income countries. Predictably, the situation had elicited social and medical responses from the public and governments, respectively.
Nigeria recorded an imported case from Italy on February 27, 2020, to effectively signal the outbreak in the country. This raised concerns about the effectiveness of airport surveillance and, by extension, the country’s general preparedness.
Upon the detection of the index case, the NCDC, activated a multi-sectoral National Emergency Operations Centre (EOC) to oversee the national response to the pandemic. Subsequently, President Muhammadu Buhari established the Presidential Task Force (PTF) for the control of COVID-19 on March 7, with an initial mandate of six months.
To effectively achieve the mandate of the PTF, the Secretary to the Government of the Federation (SGF), Boss Mustapha, was appointed Chairman and a National COVID-19 Response Centre (NCRC) was established within the PTF. Headed by the National Coordinator of the PTF, Dr Sanni Aliyu, the NCRC was mandated to provide strategic guidance and coordination of the efforts of multi-sectoral and multilateral actors, as well as resources committed to the national response, to ensure proper synergy and efficiency.
The PTF developed the National Pandemic Response Plan (PRP). To drive its implementation, the PTF Secretariat established 10 functional working groups under an Incident Management System led by the Incident Manager. The PTF developed an initial budget totalling N83,895,139,427 to finance Nigeria’s response.
The funds were expected from three key sources; the Federal budget, a special Federal Government account for COVID-19 and expected donations from Development Partners and the Private Sector. The portion expected from donors was to support the expansion of healthcare.
The Federal Government’s contribution to this budget, included part of the 2020 budget and COVID-19 special levy contributions, totalling N49,401,508,854, has been fully approved for release. Development Partners and the Private Sector, however, donated more than the N34.4 billion expected from them, though their funds were not disbursed directly to the PTF.
The PTF Public health education and risk communication campaigns on COVID-19 commenced in earnest sequel to the index case. Both conventional and social media, including WhatsApp, Twitter, and Facebook, assisted in disseminating updates on the virus. Messages on the COVID-19 infection were equally translated into local languages to reach the general populace. The NCDC’s key message in its communication campaign #Takeresponsibility, inundated Social Media for the Nigerian audience.
This was to emphasize the role of the individual, both in the prevention of COVID-19 and the upkeep of their health, while the pandemic raged. However, it remained a moot point as to whether the NCDC’s public health education had influenced positive behavioural changes among Nigerians.
For instance, in spite of the media messages, it was observed that many people, including faith-based organizations, have continued to defy the directives on physical distancing and public gatherings by organizing social events, while some worship centres also conducted congregational services.
At one of its briefings, Mustapha said that the PTF adopted enforcement strategies through the deployment of police, military, and paramilitary organizations.
However, this development simply generated more problems due to the brutality of some security officers.
Another vital response was the imposition of lockdowns to prevent community transmission of COVID-19 in the country. The SGF announced a lockdown in two states-Lagos and Ogun and the FCT, for four weeks that took effect from 30 March, 2020, with restrictions on inter-state travels throughout the country.
The relaxed lockdown began on May 4, replacing the total lockdown, with a curfew from 8:pm to 6:am, while there was an interstate travel ban in place. Both the lockdown and the curfew exempted workers on essential services- health workers, security personnel, journalists and those involved in the movement of essential commodities (food and drugs).
An evaluation of the situation at this point indicated that Nigeria recorded relative increase in the number of COVID-19 cases during the relaxed lockdown. From May 18, two weeks after the relaxed lockdown to June 7, a total of 20 days, Nigeria recorded 6,527 positive cases, or a 52 per cent increase in the number of all positive cases during the lockdown.
The task force also restricted travellers from COVID-19 high-risk countries from entering the country. The Port Health Services and NCDC monitored the self-isolation of returnees from the affected countries from then onward. The concern from several quarters was that the ban on high-risk countries should have taken immediate effect. Unfortunately, most of those who arrived in the country did not comply with the 14-day self-isolation recommended by the NCDC.
Significantly, there were remarkable progresses recorded in the area of infrastructure, as the PTF announced an increase in the number of laboratories from four to 69 with at least one per state, also seven corporate labs with over 17,000 health workers trained.
There was also a marked increase in the procurement of testing kits and Personal Protection Kits with over 7,040, 256 ICU beds available in 131 treatment centers for isolation and case management nationwide.
Through these facilities, 838,333 people were tested, with 72, 767 testing positive. 65,850 of the cases were successfully treated and discharged, while 1,194 died.
This is a case fatality rate of 1.68%, which was lower than the global rate of 3.5%.
A Public Health expert, Dr Gabriel Adakole, said that in dealing with an outbreak such as COVID-19, the PTF should adopt a way of customising all interventions to local settings.
“The PTF should rapidly find every infected person, trace their close contacts and place them under quarantine. The PTF should also promote basic hygiene measures with Nigerians, such as frequent hand washing, cancelling public gatherings, closing schools, closing offices, for at least three months so, that its mandate of two million tests can be met once and for all,” he said.
A psychologist, Mr Pius Adenuga alleged that the PTF did not address stigma and discrimination properly in the COVID-19 response. Adenuga said that stigma was associated with a lack of knowledge about how COVID-19 spreads a need to blame someone, fear of the disease and death, and gossip that spreads rumours and myths.
He noted that to tackle social stigma derived from COVID-19, the PTF should have created an environment for open discussion among Nigerians and healthcare workers.
“How we communicate about COVID-19 is critical in supporting people to take effective action to help combat the disease and to avoid fuelling fear and stigma. Words matter and using language that perpetuates existing stereotypes can drive people away from getting tested and taking the actions they need to protect themselves and their communities,” he said.
In spite of the remarkable success recorded over the period, the PTF had to deal with some challenges including; logistics bottlenecks, shortages of Personal Protective Equipment (PPE), high cost involved in procurement, lack of testing capacity, difficulty testing suspected individuals and contact tracing, among others.
The challenges faced by the PTF can be categorised across these areas: Delay in the supply of PPE; Disrupted supply chains; Inadequate Healthcare Infrastructure; Increased citizen apathy; Data Challenges and the increased cost of procurement.
Delay in the supply of Personal Protective Equipment
Healthcare workers rely on PPEs to protect themselves and their patients from being infected and infecting others. The limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons especially at the early days of the response left HCWs under-equipped to care for COVID-19 patients.
The shortages resulted from various factors such as increased importation lead times, interstate travel restrictions, an interception by border authorities, and low PPE inventory levels.
A rapid needs assessment was conducted by the Department of Hospital Services, Federal Ministry of Health at the beginning of the COVID-19 pandemic. The results showed that infrastructure and equipment levels were sub-optimal to support the national response. Testing facilities, treatment facilities, ICU beds, ventilators, ambulances, dialyzers, and body bags were all grossly inadequate.
The country also had a slow start to testing because of the limited number of testing kits, laboratories, trained staff, and delayed shipment of equipment to conduct molecular testing.
Data needed to support prompt decision-making was not always available. For example, due to limited investment in laboratory diagnostics, LIMS, result reporting, and data management capacities were lacking and slowed down turnaround time and reporting.
There have also been challenges with optimizing the epidemiological data as well as linking epidemiological data from each person tested with lab data. Even where the Presidential Task Force on COVID – 19 data was available, managing it in a coordinated manner by the multiple agencies involved as well as the states, was challenging.
As a result of the COVID-19 pandemic, procurement and delivery of essential items were impacted. Nigeria is dependent on raw materials/products from leading export countries like China, Germany, etc.
Due to the pandemic, countries were forced to close their borders and shut down production which affected importation activities in Nigeria. This eventually led to reduced inventory levels of essential supplies including medical equipment, PPEs, etc. It also led to an increase in the cost of essential goods and services required to cushion the effect of the COVID-19 pandemic.
Sensitization programmes were organised to engage the community and create awareness of the COVID-19. In spite of this effort, however, there is still a lack of compliance to safety protocols, such as getting tested if ill, social distancing, quarantine, and wearing of face masks among the citizens.
It was observed that the citizens were resistant to sampling and testing; some confirmed cases refused to be evacuated to the designated treatment centres, and returnees who were expected to get tested and self-isolate for a period did not comply. This was caused by a general lack of trust in the government and misinformation among groups about the severity of the COVID-19 pandemic.
The increased cost of procurement due to naira devaluation
The COVID-19 pandemic has hurt the country’s exchange rate resulting in a forced devaluation of the currency against the dollar. The impact of COVID-19 resulted in decline in oil prices and supply in the global markets.
Nigeria mainly depends on revenues from oil to fund the external reserves, finance government spending, and supply forex for the imports of goods and services. The devaluation has caused the price of imported items such as essential medical supplies and equipment to increase.
Although the Nigerian Government executed various strategies in responding to the COVID-19 pandemic in the period under review, several initiatives/decisions, if implemented, may have led to a reduction in the number of imported cases from returnees and possibly the overall number of cases.
Late involvement of the Federal Ministry of Education
The educational sector has been greatly impacted by the COVID-19 pandemic in the country. In planning for the COVID-19 pandemic response, the Federal Ministry of Education was not initially considered when the PTF pillars were established.
Before the pandemic, the country struggled to ensure young children (majorly in the rural areas) stayed in school and had access to proper education. As a result of the pandemic, children in these communities were left behind as the schools, students, and teachers were not equipped to transition to new methods of learning.
Involving the Federal Ministry of Education early could have led to the development of an online curriculum for students of all classes, training and equipping of teachers on adapting digital tools, and better preparation in responding to the pandemic.
Limited focus on economic recovery
While a total lockdown in the country was a good response to curb the spread of the COVID-19 pandemic, it had several economic consequences. Economic activities were frozen resulting in job losses and supply chain disruptions.
More importantly, the country’s reliance on oil as a major source of revenue and foreign exchange made it more susceptible to severe oil market volatility that resulted from a fall in demand.
The plan for post-pandemic economic recovery for the country was not clearly articulated in the Pandemic Response Plan of the PTF. The Government should consider prioritizing the creation of jobs in key areas like agriculture, promoting manufacturing and local production, etc. to cushion the economic effects of the lockdown on its citizens.
Delayed closure of local and international borders
The Government could have reacted quicker by closing its international borders as soon as the index case in Nigeria was confirmed. The three-week window resulted in the influx of individuals into the country from countries with high rates of COVID-19 infections.
Locally, early enforcement of a nation-wide lockdown and inter-state travel restrictions not only across high-risk areas such as Abuja, Lagos, and Ogun would have prevented or reduced the spread of the virus across states.
Poor tracking and monitoring of travellers before airspace closure
Due to the high cost of implementing a compulsory sample collection and 14-day quarantine for travellers who returned before the international airspace was closed, these travellers were required to go home and self-isolate. However, it was discovered that most did not comply with this instruction.
This resulted from the lack of effective measures for monitoring their movements as well as the absence of enforcement of the mandatory quarantine and testing procedures. The Government could have considered using public properties such as public training institutes, with boarding facilities, and government institutions, such as university hostels to quarantine the returning travellers.
Dr Solomon Chollom a Jos- based Virologist, said as the country and indeed the world battled the pandemic in the face of an anticipated second wave, the PTF needs to do a thorough evaluation of the national response, to identify areas of strength to consolidate, and areas of weakness to strengthen.
“It is also essential to give attention to efforts on making vaccines available against the virus, as this remains one sure way of beating the pandemic. The PTF should leverage fully on the expertise of health professionals in modifying policies and implementing them. Also, the need to ensure the welfare of health professionals as well as the provision of the right working environment to enhance their productivity,” he advised.
In the meantime, many believe that the country is on the threshold of a second wave of the pandemic after it chalked a single day infection rate of 796 in the past week, the highest since the outbreak of the pandemic in the country in March. PTF chairman Mustapha, in a recent briefing, says the taskforce shall be submitting its report to the President before the end of December. It remains to be seen what recommendations they would be submitting to government. (NAN)