‘Lack of adherence to Covid-19 protocol led to spike in Nigeria but cases declining’

Chikwe Ihekweazu, director of Nigeria Centre for Disease Control, on the country's efforts to curb the pandemic and access vaccines

By Bennett Oghifo
Published: Friday 02 April 2021

Many countries across the world are experiencing a spike in cases of the novel coronavirus disease (COVID-19) within a couple of months of containing the first wave. Nigeria is not an exception.

The caseload in the country, like many others in Africa, was relatively low in the early months of the pandemic.

From late November, 2020 through March, 2021, the number of infections swelled in this west African country. The surge followed a dip in cases in September and October.

Data suggests the country has also been able to tackle this year’s wave. Chikwe Ihekweazu, director of Nigeria Centre for Disease Control in Abuja, talks about the steps taken and the road ahead. Edited excerpts:

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

Chikwe Ihekweazu: In the last few weeks, we have seen a decline in the number of new COVID-19 cases. However, we must interpret this carefully.

We are detecting cases of the B.1.1.7 variant that is associated with increased transmissibility. Therefore, the government and citizens must continue playing their parts to reduce the risk of transmission of the virus.

BO: What is responsible for this surge? Is it because of the new strain?

CI: Human behavior is a factor. COVID-19 precautions such as physical distancing, handwashing and mask-wearing are not followed by everyone, creating opportunities for the virus to spread.

There are more studies needed to understand the link between the variants and increasing transmission. In Nigeria, we have established a SARS-CoV-2 Genomic Sequencing Implementation Group that will pool efforts and existing capacity in the country, to better understand the impact of the variants.

BO: How did the surge impact health infrastructure?

CI: We have had more people in need of specialised care, with many requiring supplemental oxygen and ventilators.

We work with states, the private sector and our partners to ensure every confirmed case in Nigeria receives optimal care.

For milder cases, we recently published a patient’s handbook for home-based care in collaboration with the Federal Ministry of Health.

Asymptomatic and mild cases can be managed at home, if they meet specific requirements.

Patients unable to self-isolate at home will not be turned from treatment centres.

There are countries which face the harsh reality of triaging patients and making difficult decisions regarding treatment due to limited availability of hospital beds and oxygen supply.

We are not at this stage in Nigeria but we recognise the risk and will continue working hard to prevent this.

BO: Is there a law in Nigeria that comes into force as soon as an epidemic/pandemic is declared?

CI: President Muhammadu Buhari signed the COVID-19 Health Protection Regulations into law in January 2021.

This enforces the proper use of face masks, limitation of gatherings and other measures to prevent the spread of the disease.

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

CI: Scientific understanding of the virus is still evolving. Many variables may contribute to this difference. These include population density and age distribution, governments’ experience with previous outbreaks and low prevalence of non-communicable diseases compared to most other countries in the global north.

Although the number of cases and deaths in Nigeria and the rest of Africa have been less than other countries, the pandemic took a toll on lives and livelihood.

It has also provided an opportunity for further investment in health security.

Our immediate focus is to control the acute phase of the pandemic. Many countries outside Nigeria have started  to record a decline in the number of cases with vaccination.  

BO: What was the role of community health workers in tackling the pandemic?

CI: Since the beginning of the pandemic, health workers across the country have been working incredibly hard.

They have been involved in the collection and testing of thousands of samples daily, contact tracing to prevent further spread of the virus, data collation and analysis for public communications and decision making.

In addition to COVID-19, there are other infectious diseases affecting our country. Our health workers have sustained the response to such outbreaks.

BO: What was the government’s first reaction to the presence of Covid-19 in the country?

CI: We started monitoring the COVID-19 outbreak in China before the first case was confirmed in Nigeria on Februiary 27, 2020.

The NCDC carried out a national risk assessment and identified some states as priority areas. The initial risk assessment revealed significant gaps in critical areas like  surveillance, points-of-entry monitoring, case management, laboratory, logistics and infection prevention and control.

The first public health advisory was published on January 22, 2020 and widely circulated. A multisectoral National Coronavirus Preparedness Group was established on January 26.

The group began work by identifying laboratories to establish capacity for COVID-19 testing.

Before Nigeria’s first case was confirmed, testing capacity was established at the NCDC National Reference  Laboratory, Abuja and three existing laboratories within the NCDC molecular laboratory network.

The NCDC also began working with states and tertiary hospitals to map out and establish isolation and treatment centres for managing COVID-19 cases. It simultaneously started training health workers across states, among other things.

Since the beginning of our response, we have been scaling up our capacity that can also be used for future outbreaks.

BO: Is Nigeria able to access vaccines?

CI: Our sister agency National Primary Health Care Development Agency (NPHCDA) has been leading efforts to ensure Nigeria has access to COVID-19 vaccines. The government is putting in best efforts towards this.

The COVID-19 vaccine is unique, as all countries need it for their entire populations. Just as we saw at the beginning of the pandemic with diagnostics, the demand is outweighing the supply.

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

CI: In addition to the government of Nigeria’s investments, we have received incredible support from the organised private sector through the task force Coalition against COVID-19 in procuring testing kits and PPE suits.

The Africa Centres for Disease Control and Prevention also created a platform so that African countries can pool their resources and access testing kits and PPEs rapidly.

Many community groups came together to support their states and government associations. 

BO: How is the country doing in terms of testing?

CI: Nearly 1.5 million samples were tested across the country as on February 25. We have established molecular laboratories in all states of the country.

In the last four weeks, we have begun the roll out of approved antigen-based rapid diagnostic tests in health facilities.

Testing in all public health laboratories remains free of charge. 

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