Strategies adopted by the Nigerian government, and those of low and middle-income countries to contain the spread of the rampaging COVID-19 pandemic have come under attack.
An international team of researchers want governments to seriously recognize that preserving people’s health is as important as reviving the economy.
According to them, strategies need to be based on the local epidemic growth rate at the time, social and economic costs, existing health systems capabilities and detailed plans to implement and sustain the strategy.
But, in a seemingly desperate bid to halt the surging virus transmission, the Federal Government on Monday, imposed a ban on meetings and domestic travels by its officials.
Henceforth, all government or board meetings should be conducted virtually until further notice, it directed.
Secretary to the Government of the Federation and Chairman of the Presidential Task Force (PTF) on COVID-19, Boss Mustapha, announced this in a briefing in Abuja, and reiterated the call for citizens to remain vigilant as the pandemic will not go away by a wish, neither will it go away if people refuse to keep safe.
The new measures are coming as the Nigeria Centre for Disease Control (NCDC) on Monday announced 595 new confirmed cases and four deaths recorded in the country, thus bringing the national tally to 33153 confirmed cases, 13671 discharged patients, and 744 deaths.
Of the new 595 cases reported from 20 states, Lagos logged 156, Oyo 141, Abuja 99, Edo 47, Kaduna 27, Ondo 22), Rivers 20, Osun 17, Imo 13, Plateau 10, Nasarawa -eight, Anambra -eight, Kano -five, Benue -five, Borno -five, Ogun -four, Taraba -three, Gombe -three, Kebbi, and Cross River one case each.
Globally, the pandemic has been responsible for over half a million deaths. Like Nigeria, many low-income countries have introduced a number of measures from physical distancing to strict social distancing.
Though these measures have proved relatively successful in containing the disease and limiting the number of deaths in places where the risk of transmission is high, but public health systems and usage are suboptimal and awareness of disease prevention practices is low.
Experts say there are tremendous negative social, economic and psychological effects on these measures.
To prevent further negative impacts of lockdown, many countries are now looking to ‘reopen’, risking population health, especially given shortcomings in surveillance infrastructure and poor diagnostic capabilities.
In a paper published in the European Journal of Epidemiology, a team of epidemiologists from the University of Cambridge, the University of Bern, BRAC University and the National Heart Foundation in Bangladesh, have examined three community-based exit strategies, and recommend their scopes, limitations and the appropriate application in the LMICs.
Dr. Rajiv Chowdhury from the University of Cambridge, lead author of the paper, says: “Successfully re-opening a country requires consideration of both the economic and social costs. Governments should approach these options with a mind-set that health and economy both are equally important to protect—reviving the economy should not take priority over preserving people’s health.”
The three approaches considered are:
Sustained mitigation
Sustained ‘mitigation-only’ approaches such as those adopted in the United Kingdom, Switzerland and other European countries, involve basic prevention measures such as mask-wearing, physical distancing and the isolation of positive cases after testing.
However, the researchers point out that the relative success and ease of implementation of these approaches in high-income settings was aided by a number of factors. For example, high-income countries have the capacity to implement mass testing, population surveillance and case isolation to contain the epidemic, in addition to a high number of trained contact tracers operating in a relatively small and sparse population and high levels of adherence to the measures, including home quarantine and hygiene advice.
By contrast, in LMICs, a sustained mitigation-only approach may be unfeasible due to poor or absent nationwide population surveillance, contact tracing, testing infrastructure and critical care. For example, LMICs generally have limited supply of ventilators (around 48,000 for India’s 1.3 billion people), personal protective equipment, trained healthcare personnel and safe working conditions, compromising the healthcare system’s effectiveness.
Zonal lockdowns
Zonal lockdowns involve identifying and ‘cordoning off’ new outbreak clusters with a high number of cases, keeping contact between zones low and containing the disease within a small geographic area.
However, the authors point out that any successful implementation of zonal lockdown requires regular data feedback operations in real-time to identify hotspots, including information on newly confirmed cases, updated region-specific reproduction and growth rates, and deaths by age. This may be especially difficult to introduce in LMICs due to the absence of widespread population surveillance on random selections of the population and poor reporting and testing capabilities—for example, Pakistan conducts only 0.09 tests daily per 1,000 individuals compared to 0.52 in France.
Additionally, control of transmission within zones may be an enormous undertaking. In India, where this approach has been employed, the infection size within a cordoned zone can be as high as 100-200 times that outside the zone.
Countries seeking to introduce such measures should establish within the lockdown zone public health measures, including house-to-house surveillance and case-referral systems, and emergency services. They should also create buffer zones to reduce the rates of transmission from outside the zone. Such measures may only be effective when overall population transmission is relatively low and reducing.
Rolling lockdowns
Intermittent rolling lockdowns are now advocated by the World Health Organization in various LMICs. These involve implementing strict social distancing for a set number of days before a period of relaxation. Rolling lockdowns may be particularly useful in LMICs with dense populations, where this is a high potential for contact, weak health systems and poor contact tracing.
A modelling study published by the team in May showed that a system involving 50 days of strict lockdown followed by 30 days of relaxation, enabling the economy to ‘breathe’ and recuperate, could reduce the reproduction number to 0.5, reduce the strain on health systems and considerably reduce the number of deaths compared to a situation with no lockdown.
Professor Oscar Franco, of the University of Bern and senior author of the paper, said: “Rolling lockdowns need to be flexible and tailored to the specific country. The frequency and duration of the lockdowns or relaxed periods should be determined by the country based on local circumstances. They don’t necessarily need to be nationwide—they can also involve a large zone or province with a very high incidence of COVID-19.”
Dr. Shammi Luhar of the University of Cambridge and co-author of the paper, added: “These three strategies should not be considered as one or the other. A country should further adapt and could combine them as needed.”
In the meantime, Mustapha has pleaded: “Please let us all resolve to play our part, while the government does its best to save lives and livelihood. To this end, all government offices shall continue to hold virtual meetings in their offices especially where participants exceed four persons and suspend all unnecessary travels for meetings.
“For corporate organisations, board members, among others, the reopening of the domestic flights should not be misconstrued. The PTF strongly encourages virtual meetings as well; we still urge places of worship to cautiously follow the guidelines on public gatherings.
“We urge members of the political class to exercise utmost circumspection in their gathering for whatever reasons.
To speed up COVID-19 tests, Abuja says it will establish sample collection centre in each of the 774 local government areas of the country, harping that contacting COVID-19 is not a death sentence.
While Mustapha said not presenting oneself for testing or treatment when symptoms become observable could likely lead to avoidable death, he announced that a sample collection centre has been set up at ThisDay Dome, Abuja and that all government hospitals in the FCT have been designated as sample collection centres.
According to him, the decision is part of the outcome of the PTF mid-term Review of the National Response Strategy, pointing out that the mid-term review had in attendance legislators including the Chairmen of the relevant Committees on Health in the Senate and House of Representatives, the Office of the Vice-President, ministers, diplomatic community as well as development partners.
On the case management deficit, the PTF boss says the focus is on having enough oxygen nationwide as the number of hospitalised person increases, adding, ‘’a cross-cutting initiative, is an enhanced Risk Communication Strategy designed not only to educate the citizenry on the virulence of the virus and individual and collective roles but more importantly to tackle the deliberate misinformation being bandied around especially in the social media.
“An enhanced Risk Communication strategy becomes inevitable when we realise that within the last 24 hours, the world witnessed the largest single-day cases of 230,370 while in Nigeria the last week recorded the highest weekly fatality of 70 deaths.”
Continuing, he said the rising fatality in Nigeria was not unconnected with denial and delay in seeking help, adding that the PTF is also encouraged by the compliance messages that have gone viral on the social media and that one of those that caught his attention gives three major reasons why COVID-19 is spreading fast.
“They are my colleagues, so, I can speak without a mask; they are my close friends, so, I can speak without a mask; they are my relations, so, I can speak without a mask. This message is so poignant that if we juxtapose it with the fact that crowded places and closed spaces create an environment for the spread, we should behave more responsibly”, he says.
