After over a year working overseas on the international COVID response, I recently was able to return to Nigeria for a joyous family gathering: my sister’s wedding. A few days later, I tested positive for COVID-19.
Just my luck. The test which was carried out at the NCDC National Reference Laboratory was done free of charge. However, it required a trip that took about 45 minutes to the laboratory. While I had to quarantine to protect vulnerable friends and family from possible exposure to the virus, the whole process was easy enough. But astoundingly, I am one of a tiny number of Nigerians who have actually undergone such a test.
Despite the increased transmissibility of the Omicron variant and the spread of other variants, only 2% of Nigerians have ever been tested. This is about the same number of people tested daily in the United Kingdom.
Scientific studies show that testing is critical to contain and mitigate the COVID-19 pandemic. Testing helps to help prevent further person-to-person transmission by identifying infected individuals. Even though there is talk that COVID-19 is moving from a pandemic to an endemic disease that will always be with us, the World Health Organization (WHO) warns that it is too early for that to be definitive. In the meantime, we need to exercise caution. Yet many African countries still struggle to test in sufficient numbers.
By the beginning of January 2022, around 89 million COVID-19 tests had been conducted in African Union Member States since the pandemic started. By comparison, in the United States, over 700 million tests have been recorded, while India has recorded over 600 million. WHO estimates that only one in seven COVID-19 infections is being detected in Africa. The number of undetected cases not only increases the risks of infection between individuals but means the virus is likely to be spreading unnoticed and underreported. With an ongoing Lassa fever outbreak and an already weak health system, a surge in COVID-19 cases could cripple Nigeria’s health system.
This underreporting, due to lack of data, has undoubtedly fueled low-risk perceptions for COVID-19 in Nigeria. In the last month, I have had several friends in Nigeria fall ill but refuse to get tested for COVID-19, as they did not see a reason to worry. I have lost count of the number of taxi drivers who said to me “There is no COVID in Nigeria”, when I tried to strike up conversations with them. I know people with COVID-like symptoms who have presented at health care centres who are not tested but are instead treated for malaria. Getting tested could help an individual prevent the spread of COVID-19 to their coworkers, friends and loved ones who could be more vulnerable to dying from the disease.
At the beginning of the pandemic, the availability of COVID-19 tests was a major challenge worldwide. The main method available was molecular tests which were expensive, with a relatively long turnaround time of 3-4 days. Thankfully, the swift development of Rapid Diagnostic Tests (RDT) soon made testing far more widely available. Although there is a small risk that RDTs produce false negatives, the results are usually available within minutes and are a powerful public health tool.
In much of the world, RDTs enable people to test at home and help health officials to track the virus and advise governments on how to respond. Governments in Africa on the other hand are flying blind – making decisions based on limited data, or only acting after the virus reaches emergency levels.
The provision of RDTs in strategic locations across Nigeria could be a game-changer for COVID-19 control. It would help identify the true burden of the disease and enable more efficient and appropriate levels of response. It could also improve the perception of the risk of COVID-19 which has continued to decline given the low number of cases in the country. While the low caseload is a blessing, the public health analyst in me worries a lot that we are simply under-counting.
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To bring testing closer to the people, a number of steps are needed. The starting point should be the development of guidelines to establish RDT testing sites by the Nigeria Centre for Disease Control (NCDC), similar to the approach used in setting up COVID-19 sample collection sites at the beginning of the pandemic. The guidelines could then be implemented by State Governments across the country.
The Government will then need to employ strategic communication initiatives to persuade people of the value of testing. This could be through specific testing messages created as billboards, television, radio or social media adverts.
But where to put the sites? Ideally, they would be in outdoor spaces, staffed by trained health workers. The tests should be provided free of charge which means the government, supported by its development partners, would fund the workers needed to carry out the tests and enter the data. In the United Kingdom where RDTs are widely available for at-home use, many test results are not reported. By establishing RDT test sites, Nigeria can reduce the risk of losing valuable data, and use this data in defining its continued response. With Nigeria’s highly social population and weekly Owambe parties, these RDTs could also be sited in event centres to reduce the risk of infection at gatherings. The establishment of mobile COVID-19 RDT sites could further scale up Africa’s testing rates and perhaps be used in rural areas to track outbreaks.
At present we just don’t know enough about the rates of COVID-19 infection in Nigeria or most other African countries. Perhaps we have been lucky, but public health policy needs to rely on more than luck. Governments should be encouraging far more people to be tested and increasing access to RDTs is the game-changer we need.
Oyeronke Oyebanji, a Nigerian public health professional and 2021 Aspen New Voices Fellow, is Strategy Coordinator at the Coalition for Epidemic Preparedness Innovations (CEPI). She worked as an Analyst at the COVAX Strategic Coordination Office from April to November 2021. The views expressed in this opinion piece are the author’s