In this concluding part of a series, Associate Editor ADEKUNLE YUSUF sheds light on the COVID-19 challenge in Lagos.
As a matter of COVID-19 response policy of the state government, all treatments are entirely free – from testing to admission in the isolation center. Some of the patients, who spoke with The Nation in the male ward, said the government provides free treatment, including basic COVID-19 pack containing antiretroviral drugs, vitamins and so on.
However, as one doctor explained, many COVID-19 patients do come into the facility with pre-existing debilitating ailments such as diabetes, hypertension or asthma, which require extra drugs and resources to manage. It is such categories of patients that are required to procure drugs for their additional ailments. “When you are in the ward, you will need basic things, which you must get ready because you may have anybody to send around. The cost of assembling doctors and the cost of care – everything is free. Admission, which is probably N5,000 per night in some public hospitals, is free. Consultation is free. The cost of care is free. Oxygen, which costs a minimum of N5000 in some government hospitals, is free. Bed space is free. Nursing care is free. COVID-19 drugs are free.”
A state-of-the-art bio-bank to the rescue
Even long before Nigeria joined the rest of the world to slip into the fierce grip of Coronavirus, Lagos appeared to have imbibed the motto of the Scouting movement: “Be prepared.” Signs of having prepared ahead for any major public health challenge emerged in October 2018, when the state government inaugurated a world-class bio-bank facility and held a stakeholders’ engagement forum that attracted top local and international professionals ranging from medical doctors, nurses, biomedical and mechanical engineers to nurses, veterinary doctors, laboratory technologists and pharmacists.
Thus, with a state-of-the-art bio-bank already in place by the time the dreaded virus sneaked into the country like a thief in the night in February last year, many stakeholders in the health sector believed it merely tapped Africa’s most populous city on the shoulders to roll up its sleeves and start reaping the reward of planning. But the feat did not just happen in isolation. The outbreak of Ebola in July 2014, which started when an infected Liberian man flew into Lagos, caught the country unawares. More than expected, the outbreak, which claimed at least seven lives in Nigeria before it was nipped in the bud, provided the much-needed fillip that propelled into action, as officials disclosed that it was the Ebola crisis that provided the right learning curve on which the state leveraged to prepare for future public health emergencies.
The Nation learnt that the biosecurity initiative was conceived to strengthen the state’s capacity to contain and respond to all biological threats – from infectious disease outbreaks to biological terrorist attacks or bioterrorism. The the $4.5 million biobank laboratory was a dream that came true through a partnership arrangement between the Lagos and Canadian governments. It was birthed during the administration of Akinwunmi Ambode. The facility, located in Mainland Hospital in Yaba, was designed to ensure effective management of infectious disease outbreaks with a special focus on containing and strengthening the state’s capacity to prevent, detect and respond to all biological threats.
Abayomi explained that the biobank is equipped with laboratories such as the biosafety level (BSL) 1 for normal laboratory procedures, BSL 2 for dangerous pathogens, and BSL 3 for very dangerous pathogens. There is only one BSL 4 in the whole of Africa – in South Africa. The biobank is a containment laboratory and secure storage facility for biological samples. In other words, it’s a place where human elements (blood, tissue, urine, cells, etc.) and their data are stored or preserved, to support research, the development of vaccines and treatments, personalised medicine, and more. The facility, manned by specially trained professionals, has come in handy as the fire of COVID-19 rages.
But Lagos is not relying on its bio-bank resources alone in the prosecution of its war against the spread of the virus. In June last year, as part of efforts to expand the diagnostic testing capacity to ensure a larger number of people have access to the Covid-19 test, the state approved the inclusion of seven private laboratories, namely Total Medical Services, SynLab, 54 Gene, Medbury Medical Services, Biologix Medical Services, 02 Medical Services and Clina Lancent Laboratories.
While formally introducing the private laboratories to the public, Abayomi explained that a key element in the next phase of the state’s response strategy is to expand diagnostic testing to strategically ensure a larger number of people have access to the COVID-19 test, stressing that the state government has developed an inclusive strategy that aims to harness the public and private sectors to rapidly expand the state’s capacity to meet the growing demand for testing in the next stage of the state’s biosecurity road map.
“We recognise the need to expand our testing capacity, especially to the local government areas that are most affected by the community transmission of the virus and, as Lagos State continuously manages the public crises caused by COVID-19, it simultaneously attempts to open up various aspects of its economy. Both efforts make it imperative that COVID-19 tests are widely available to members of the public.
“In a bid to ramp up our testing capacity, we have taken a strategic decision to include private laboratories in the testing of COVID-19. However, the State’s COVID-19 response will remain a centrally managed emergency response by the state government and the need to test will be surveillance driven and based on a clear case definition,” he said.
Abayomi, who said Lagos has increased its daily testing capacity from 2,000 to 3,000 samples daily, stressed that the state’s goal from inception was to flatten the curve. He promised that the state would intensify its strategies of identifying, testing, isolating, and management of cases to reduce the rate of transmission.
“Living with the pandemic means that you should wear your face mask everywhere, follow physical distancing rules, avoid social gatherings, ensure regular hand washing or hand sanitising. If you feel unwell, get tested; if positive, self-isolate or present to any isolation centre or follow up clinics.”
Why Lagos is witnessing rising infections
Immediately after lifting the grinding nationwide lockdown imposed on human and vehicular movements in June to curtail the spread of Covid-19 in the country, not a few Nigerians saw it as a moment to return to normal ways of doing things in a season of the new normal. In many quarters, it was a feeling of déjà vu, as club houses, recreational centers, worship houses, schools, and other avenues of mass gatherings began to do business as usual. Pronto, international travels into the country followed suit as long as evidence of a recent negative PCR test can be presented to immigration officials at the airports, which opened vistas of opportunity for unscrupulous individuals to do brisk business by facilitating fake PCR test results for desperate travelers.
Sadly, Lagos, home to one of the nation’s two busiest international airports, is one of the states that seem to be reeling from unintended consequences of the new policy. While analyzing factors that plunged the country into second wave of Coronavirus, Abayomi hit the nail on the head, saying Nigerians simply let down their guards in false belief that the war against the virus has been won. He listed general laxity among the populace, false sense of security, non-adherence to guidelines, reopening of schools and the economy, large social, political and religious gatherings as some of the reasons that pushed Nigeria back into a new and probably stronger wave of infections.
To win the battle against the virus, the renowned expert in internal medicine and bio-banking urged Lagosians and Nigerians in general to embark on lifestyle adjustments, including adhering to the gospel of non-pharmaceutical protocols being preached by the state and federal health authorities. For Lagosians, he admonished residents to follow COVID-19 safety protocols by always using face masks, observing social and physical distancing guidelines, and avoiding mass gatherings as much as possible. This should be complemented with regular hand washing and respiratory hygiene, while people feeling unwell should submit themselves for tests or present early to an isolation centre for treatment.
“People need to take responsibility for the infection. We will deploy effective messaging and education via our various public information channels and platforms, while we enforce all guidelines through the respective state agencies.”
The Commissioner, while reiterating the resolve of Governor Babajide Sanwo-Olu’s administration to win the fight against COVID-19 transmission, also urged the general public that “it is also important that citizens take responsibility and adhere strictly to safety protocols and government guidelines to curtail the spread of the infection.”
While enforcing all guidelines through the respective state agencies, he also vowed that the state would deploy effective messaging and public enlightenment campaigns education through its various platforms. Abayomi, who revealed that Lagos has increased its daily testing capacity from August to December from 2,000 and 3,000 samples daily, said that the state’s goal from inception was to flatten the curve. He promised that the state would intensify its strategies of identifying, testing, isolating, and management of cases to reduce the rate of transmission.
“Living with the pandemic means that you should wear your face mask everywhere, follow physical distancing rules, avoid social gatherings, ensure regular hand washing or hand sanitising. If you feel unwell, get tested; if positive, self-isolate or present to any isolation centre or follow up clinics.”
On COVID-19 positivity of inbound travelers, Abayomi said imported infections are high among such travelers, a problem he attributed to the large number of Nigerians in the Diaspora returning to Lagos. All inbound travelers to Lagos should self-isolate for seven days after arrival and submit themselves for testing at government-accredited private laboratories upon expiration of the self-isolation period, he said.
“According to the provisional quarantine protocol, all intending inbound passengers must test negative by polymerase chain reaction (PCR) done in the country of departure within 72 hours of boarding and are required to register via – http://nitp.ncdc.gov.ng and pay for a repeat (second) PCR test to be done upon arrival in Nigeria on day 7 at an accredited lab of their choice. Passengers must also before boarding fill in an online Health Declaration/Self-Reporting form located on the Nigeria International Travel Portal which must be submitted online or printed for presentation on arrival in Nigeria.
“On arrival in Nigeria, passengers must show evidence of payment with an appointment for a repeat PCR test in-country following which passengers will be cleared through the Nigeria Immigration Service. Passengers must then proceed on a 7-day self-isolation as per protocol and present at the designated accredited sample collection sites on the 7th day of arrival. Passengers who test negative after seven days will end self-isolation on the 8th day.”
Commendations galore for LASG
Moved by the quality health care being offered at the hospital, patients and their families were effusive in praises for the team of medical professionals who work under tremendous pressures and risks to deliver care in the facility and the state government in its handling of COVID-19 emergency so far. A patient, who spent a week in isolation 2 and was about to be discharged, said he will forever remain indebted to the state government for nurturing him back to full health.
He got infected when he attended a Christmas dinner party. Although everybody at the party put on a face mask, he said things changed when it was time for drinking and eating, as many people pulled off their masks as they bantered during the festivities. Trouble began three days later, which took him to IDH after home treatment failed.
“The experience has not been an unpleasant one. The nurses and the doctors have been generally helpful. They are trying always trying to cheer us up. Except that they go on errands and you don’t see them again for about thirty minutes for something you need to do immediately. If there are some people out there who still believe COVID-19 is not real in spite of everything in the news, I don’t know what to say to convince them.
“They need to come and see that this place (isolation ward) is full; as they discharge people, other people are taking over the vacant space immediately. I am sure if I leave later tonight, somebody else will take over my bed space.”
But a retired major, Peter Omoniyi, 77, was not infected through a breach of COVID-19 protocols. In fact, he still did not know how the virus penetrated and compromised his fragile body. Having imbibed the strict military discipline, he said he observed all necessary non-pharmaceutical guidelines religiously to the point that people almost started mocking him.
After recovering in isolation 2, the ex-soldier was so impressed by the quality of care, which he admitted is free, that he declared that “Lagos has shown it is the father of Yorubaland.” “As an instructor in the army, I followed all the COVID-19 rules. I fumigated my surroundings every time. I did everything possible not to get the virus. It is still a surprise that I have the virus – maybe because of my age.”
