‘Second wave more severe in Nigeria; third wave imminent if COVID-19 rules not followed’

Several parts of the world are in the grip of a second wave of the novel coronavirus disease (COVID-19) pandemic. Africa, which registered a 30 per cent hike in the number of cases since last year, and continues to be in throes of a poor health infrastructure, faces a mounting challenge.

Virologist Oyewole Tomori speaks about Nigeria's experience with the second wave as well as the measures taken to arrest the spread of infection. Edited excerpts: 

Bennett Oghifo: Nigeria is experiencing a surge in COVID-19 cases. What is the current status?

Oyewole Tomori: The surge seems to be subsiding as the number of cases has dropped. But we may not be out of the woods yet.

We may be setting ourselves up for a third wave if we don’t comply with social distancing norms and avoid large gatherings. The emergence of new variants also poses a threat.

BO: In July 2020, everybody believed Africa had successfully fought the pandemic with cases peaking and sliding down rapidly. But the situation appears to have changed from November.

OT: We know better now. We may see another surge, especially if the vaccines do not arrive on time or the uptake is low.

BO: Is the new strain responsible for the surge?

OT: It is not confirmed so far. We need to evaluate other epidemiological data, the travel history of people coming from outside, etc.

We must also remember that we have largely failed to curb the transmission of the virus through our disregard for and non-compliance with non-pharmaceutical interventions.

BO: What has been the impact of the surge on healthcare infrastructure?

OT: The year-long pandemic has adversely affected our basic healthcare delivery activities, including routine medical services, immunisation exercises and surveillance exercises for other diseases.

We may never know the full impact until we do a comprehensive check on the number of cases and deaths caused by other diseases that COVID-19 has shifted attention from. Even before COVID-19, our healthcare system barely met needs of our people.

BO: How is the current surge and its impact different from the situation in the beginning of the pandemic?

OT: The second wave is more severe than the situation during February-October 2020, when we reported about 63,000 cases (about 8, 000 cases per month). Between November 2020 and February 2021, we reported about 92, 000 cases (18,000 cases per month).

BO: Is there a law in Nigeria that comes into force when an epidemic / pandemic is declared? What kind of measures come into play once the law is enforced?  

OT: The 1926 Quarantine Law was enforced by the President to deal with the COVID-19 epidemic. Two attempts by the National Assembly to amend the law have not succeeded. The law permits the President to declare a state of health emergency to stop the spread of the disease.

BO: Why is the reported death per capita in Nigeria among the lowest in the world?

OT: Some of the reasons given above could separately or collectively be responsible for the low number of cases and deaths. However, they remain unproven.

More important than these is the fact that we have a national issue with data, incomplete, poorly collected and poorly analysed data.

Add the issue of inadequate testing and you find the daily reported COVID-19 cases and deaths may be a reflection of the poor quality and low standard of data here.

BO: What action could the governments and international agencies have taken to avert the infection spread?

OT: The poor state of preparedness to prevent and control epidemics remain the stumbling block to early detection and diagnosis. 

BO: Now that vaccines are available, is Nigeria able to access them? Or does the government continue to face the brunt of vaccine nationalism?

OT: Vaccine nationalism is indeed a major obstacle to equitable distribution of vaccines. However, while most countries have bought available vaccines, the others scrambling have themselves to blame.

There are four categories of countries with regard to vaccine supply. The proactive countries took a gamble and paid for vaccines that were still at the developmental level. There were others who were post-active, waiting for crumbs from donors and waiting a bit too more to negotiate and buy vaccines. Nigeria falls within the latter group.

The third group is the ‘anti-actives’, who deny the existence of the disease and are not even thinking of purchasing vaccines.

BO: How have communities worked together to overcome the shortage of testing kits and PPEs?

OT: I have not seen communities participate on the issue of test kits and PPEs. It has been a purely government activity.

BO: Is there any effort by the government to make vaccines within the country or by getting into an agreement with other African countries to ensure self-sufficiency in vaccines?

OT: Yes, Nigeria is working with COVAX. Bilateral discussions are underway between Nigeria and vaccine manufacturers.

BO: Why does Lagos have the maximum number of cases and deaths?

OT: It is a major port of entry into Nigeria and many initial cases were detected among inbound travellers arriving in Lagos a bit too late. We failed to rapidly initiate isolation of cases and begin contact tracing. This made it easier for the inbound travellers to spread the virus.

BO: Tell us how the first wave was limited, and where and how it couldn’t spread.

OT: The first wave was not limited. Our testing was poor and inadequate. As the cases increased, we lost control of contact tracing. Many states did not fully cooperate with the federal government. They denied the existence of COVID-19 and even refused to get tested.

BO: How are we doing in terms of testing?

OT: We are not doing as well as we should. A year after the outbreak, we have tested less than one per cent of our population. Many countries have tested between 3 and 5 per cent of their population.

BO: What do you think about the recent resurgences?

OT: The resurgence is global. We will continue to experience disease transmission until we improve on our compliance with the guidelines and start vaccination.

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