Relaxing lockdown poses threat – Report
The daily rise in COVID-19 cases across some states in Nigeria has been a source of concern to many citizens. While the figures in some states are rising, others appear stable.
Our correspondents take a look at these figures from the first index case in Nigeria to the present cases in the top 10 states and the FCT.
There are growing concerns over the steep rise in COVID-19 cases across the states.
As at Friday, Nigeria recorded 5,445 confirmed cases of COVID-19. Out of this 1,320 persons have been discharged, 171 deaths were recorded and 3,954 persons are still infected and on admission across 34 States and the Federal Capital Territory (FCT).
The number of samples tested since the outbreak of the disease in the country totaled 32, 942, according to the Nigeria Centre for Disease Control (NCDC).
Data from the centre also revealed that the five states with the highest cases of COVID-19 are Lagos, Kano, Katsina, Bauchi and the Federal Capital Territory (FCT).
The daily report breakdown as at Saturday indicated that Lagos had 2,278 cases, 1,701 are on admission, it discharged 541 and had recorded 36 deaths. Kano had 761 cases and has recorded 33 deaths already. While 90 patients have recovered and were discharged, 638 others are still on admission in the state.
The FCT had 386 confirmed cases with 291 patients on admission, 88 patients have been discharged and seven patients died. Katsina had 239 cases and has recorded 12 deaths already. While it has discharged 29 recovered patients, 198 are still on admission at isolation centres.
Bauchi State has recorded 210 cases so far with 166 of the patients on admission. It had discharged 41 persons while three died.
How cases rose across states
The federal government on February 27 this year announced the index case of COVID-19 in Lagos and Nigeria. On March 16, the country had recorded three confirmed cases with no deaths. However, on March 29 Nigeria recorded 111 confirmed cases and one death. The number of deaths has since then risen to 171.
In Kano, the NCDC reported the first case of COVID-19 on April 11, when Nigeria recorded 318 cases. However, between then and the weekend, the spike in cases had gone to over 700, in less than a month and overtook the FCT to become the second state with the highest cases.
On March 21, the NCDC announced the first three confirmed cases of COVID-19 in the FCT. Nigeria had recorded a total of 25 confirmed cases then. The cases had grown with the return of Nigerians from abroad through the Nnamdi Azikiwe International Airport, Abuja.
It trailed Lagos until Kano overtook it in mid -April. FCT has recorded minimal but rising cases since then and was at 386 cases on Saturday.
On April 7, Katsina recorded its first case and three days later, it had four cases with one death. The index case was a medical doctor in Daura who returned from Lagos a week earlier, and died of the infection at the Air Force Reference Hospital in Daura. The cases had shot up and pegged at 224 cases, making it the fourth state with the highest cases of COVID-19.
Governor Bala Mohammed was Bauchi’s index case on March 25. However, on May 10, the governor imposed a 10 day 24-hour curfew after cases rose to 210. The cases were mostly in three local government areas bordering Kano State. The state now has 206 cases and is the fifth state with the highest cases.
Mohammed said a large number of the new cases came from Katagum, a local government that shares boundaries with communities in Kano State. He blamed the situation in the area on the “influx of people from Kano State.”
Spike in Borno, Jigawa Kaduna, Ogun, Gombe worrisome
NCDC data showed that Borno recorded its index case, a health worker, on April 18, and by April 21, confirmed COVID-19 cases had risen to four in the state.
From April 19 to May 13, the cases had risen to 188. As at Saturday, Borno had 204 confirmed cases, out of which 140 were still in admission, 44 discharged and 20 others had died. Analysis also indicated that Borno has 69 per cent hospitalisation rate, 21 percent recovery rate, and 10 percent death rate from COVID-19.
Jigawa had 191 cases out of which 184 were still in hospitalised, four discharged and three dead at press time. It has 96 percent hospitalisation rate, two percent recovery rate and 2.13 percent mortality rate from COVID-19.
The first mortality from COVID-19 in Jigawa was a Lagos returnee who self-medicated at home until diagnosed of COVID-19 and passed away shortly after.
Ogun has recorded 145 cases, out of which 81 are still on treatment, 59 discharged and five dead. That is 56 percent hospitalization rate, 41 percent recovery and one percent mortality rate. The state recorded its index case on March 9, the second case of a Nigerian who had contact with the Italian citizen, the index case in Lagos.
Gombe recorded 124 cases, out of which 32 are on admission, 90 discharged and two died. The state has 26 percent admission rate, 73 percent recovery rate and two percent mortality rate. The analysis also indicates that the state has one of the best recovery rates and lowest death rates in the country.
Kaduna recorded 134 cases as at Saturday: 78 cases were on admission while 53 cases had been discharged with three recorded deaths at the time of filing this report. Its hospitalisation rate is 58 percent, the recovery rate is 40 percent and mortality rate is three percent.
Ekiti, others record few cases
Among the 12 states at the bottom of the table, eight states had no record of death from coronavirus, but one death was reported in Ekiti yesterday.
The index case in Taraba was reported on April 26. Six cases were among 130 travelers from Bauchi, Kano, Jigawa, Borno, Ogun and Lagos states who were intercepted by the state’s taskforce. As at May 13, there were 17 people with COVID-19 in the state while one patient had been discharged from the state’s isolation and treatment centre. The state did not report any case for three days.
In Enugu State, the index case was reported on March 28. A new case was reported two weeks later while the state’s Commissioner for Health, Prof. Ikechukwu Obi, said the cases had travel history. Nobody had died from the virus in the state as 12 cases were confirmed and 10 were still active while two cases had recovered.
There are 14 confirmed cases of coronavirus in Niger State. The state’s index case was reported on April 11 in Limawa area of the state capital. The state is battling with the influx of travelers as the third case was a driver from Kano who was driving though Minna when he was intercepted for flouting the interstate travel ban and got tested. Of the 10 cases, eight are active while two patients recovered. With its proximity to the FCT, its cases are relatively low.
On April 26, Bayelsa State reported its first case. The next four cases in the state were relatives of the index case. A new case was reported on May 10, which brought the total confirmed cases in the state to six. Three cases were active while three patients recovered.
The first case of coronavirus was reported in Benue on March 28. The case, of a United Kingdom returnee, generated controversy but the second clear case was reported on May 6. The state now has four confirmed cases, which are all active.
Of the seven confirmed cases in Imo State, five recovered with two patients still at the isolation centre.
Anambra and Abia have the least number of coronavirus cases. The states have only have one person each on admission and one each discharged. The index case in Anambra was reported on April 13 while that of Abia was on April 20.
Why cases are increasing – Experts, Report
Analysts have said a number of factors contributed to the spike in cases across the states. They said they include delay in closure of international borders by the federal government, inadequate testing centres and low testing rate in the country, inaction by some state governors, delay in ordering lockdown as well as violation of the lockdown, and lack of belief in the existence of COVID-19 and flouting of preventive measures among others. The country had recorded a number of cases from contacts of people returning from abroad for some time as a result of the delayed ban on flights before community transmission set in.
Unlike China which declared a total lockdown of Wuhan Province immediately, Nigeria failed to take early actions, reports said. Although Lagos began contract tracing immediately, arrivals at the international airports had continued in Lagos, Abuja, and Kano.
The Nigerian Civil Aviation Authority (NCCA) announced the shutdown of Lagos and Abuja airports on March 23, 26 days after the index case in Nigeria through the Murtala Mohammed International Airport, Lagos. A day before the shutdown of the two airports, Nigeria had recorded 22 cases, of which three were in Abuja already. The land borders were also shut afterwards.
Lack of test centres was also an issue for the NCDC as fewer centres existed as at March 25, 2020. NCDC had only five testing centres at the beginning of the outbreak and has only 17 till date with the addition of two molecular centres recently.
President Muhammadu Buhari announced the lockdown of Lagos, Ogun and the FCT on March 29 after recording 111 cases across 12 states. The presidential action came slightly over a month after Nigeria recorded the index case, a situation experts attributed to the steep rise in the confirmed cases. Lagos and FCT were still leading with two cases in Bauchi, no case in Kano, and Katsina during that period.
Some states also lifted lockdowns for religious celebrations and gatherings during the outbreak. Dr. Francis A. Faduyile, the president of the Nigerian Medical Association had warned that such move was counter-productive.
The president of the Nigerian Academy of Sciences, Prof. Kalu Mosto Onuoha, decried the relaxation of the ban on gatherings to allow for Easter celebration, saying it violated the rule on social distancing, exposed more people to infection and affected the target for the total lockdown.
In Katsina and Kano, there were reports of the lifting of ban on religious gatherings after they had their confirmed cases. Infected persons were said to have mingled with others during prayers in the states.
Kano got a taskforce on March 23, headed by the Deputy Governor, Dr Nasiru Yusuf Gawuna, who is the chairman of the task force. By April 17, three members of the team had tested positive, including the co-chairman, Abdulrazaq Garba Habib.
The taskforce also said the lockdown it activated was flouted by residents with many disbelieving the reality of COVID-19. As cases shot up along with reports of mass deaths, President Buhari ordered a two-week lockdown as the federal government intervened from April 27.
The chairman of the Borno State Committee on COVID-19, Umar Kadafur, attributed the spike in the state to importation from Lagos and increased local transmission. In Jigawa, the State COVID-19 task force chairman, Abba Zakari, said most of the confirmed cases of the disease in the state were the almajirai returned from Kano State.
This was also the case for Kaduna. The state Commissioner for Health, Dr Amina Mohammed Baloni, said the return of almajirai from Kano pushed up the figure.
The proximity of Ogun State to Lagos had largely been linked to the rise in cases as some cases in Lagos had contacts in Ogun.
Prof. Oyewale Tomori, a virologist and chairman of the National Laboratory Technical Working Group (NLTWG), said the increasing number of cases was expected and a natural follow up to the late start in instituting appropriate preventive measures.
He said Nigeria should have closed its borders right from the first day it recorded its index case.
“On that day, we should have sealed and closed all our borders to all travelers from COVID-19 affected countries. But no, we waited until 23rd March, almost a month later and by which time we had at least 40 cases,” he said.
Prof Abdulsalami Nasidi, an epidemiologist and pioneer chief executive officer of the Nigeria Centre for Disease Control (NCDC), had also in an interview said poor testing rate and tracing of contacts made cases grow worse.
A medical doctor, Dr Ndubuisi Onuoha said if the necessary measure of closing airports had been taken earlier, Nigeria wouldn’t have got to where it is today.
Onuoha noted that testing started immediately in Lagos after the index case, but not mass testing.
“Testing has to be done base on contact tracing if not it will amount to waste of test kits. Where you do random testing, you will not have enough kits to focus on contact testing,” he said.
He said the recent relaxation of ban on religious gatherings in Borno, Adamawa and Gombe may likely lead to increase in cases.
“The mosques are crowded even though the prayer time may not be more than 15 to 20 minutes but this short time is enough for people to be infected with the virus,” Onuoha noted.
“I will say the mosques may transmit it less compared to churches because activities are many in church. In churches, people sing loud, the more you talk the more you are likely to infect another person. Talking loud also provokes cough. Churches are also crowded, and the period of service is long,” he added.
He urged the government to implement the compulsory use of face masks in public places and ensure that other measures such as frequent hand washing, use of sanitizer and practicing social distancing.
“I also suggest that people should build up their immune system which has to do with vitamin supplements, eating of raw vegetables before you eat any cooked food, some hours of exposure to sunlight, frequent intake of water, and adequate rest,” he said.
He urged stoppage of the use of hand gloves, saying it aids transmission of COVID-19.
On testing, Dr Ifeanyichukwu Casmir, the national publicity secretary of the Association of Medical Laboratory Scientists of Nigeria (ALMSN), said “We are not testing enough, with all the hue and cry. In the first eight weeks we had tested less than 6,000 out of a population of 200 million, and out of that we got less than 300 positive cases. I expected that the lockdown would provide avenue for increased testing, but that was not done.”
However, the Minister of Health, Dr Osagie Ehanire, said the increase in cases was expected during the lockdown as a measure of improvement in case finding.
Lifting lockdown, ban on gatherings may raise cases – Report
A group of experts from the Yusuf Maitama Sule University, Kano, Ahmadu Bello University Zaria and Lancaster University, United Kingdom, recently released a report projecting a spike in COVID-19 in Lagos and Kano in June and early July if the lockdown in the states is relaxed.
Reports on Thursday said, Borno, Gombe and Adamawa states had ended their lockdown and lifted the ban on religious gatherings, asking religious places to maintain social distancing rules.
The executive report led by Yusuf Yau Gambo, an Applied Mathematician and Data Analyst, and Yunus A. Abdulhameed, a Biomedical Physicist, both of the Yusuf Maitama Sule University, Kano, predicted that if the restrictions are lifted entirely in Lagos and Kano, the cases could hit 1.788 million.
The breakdown shows that Lagos may record 868,700 cases in early July and Kano could record 919,900 total cases by early June, without any form of restriction in place.
The Commissioner for Health in Lagos, Prof Akin Abayomi, had also projected that the state may record between 90,000 and 120,000 cases of the virus within the same period.
The report which was reviewed by Professor (Emeritus) Peter McClintock, an expert in Biomedical Physics, Nonlinear Dynamics and Low Temperature Physics at the Lancaster University, United Kingdom and Professor Basant Kumar Jha, an expert in Mathematical Modeling at the Ahmadu Bello University, Zaria, also noted that as the movement restriction eases by 50 percent in Lagos and Kano, Kano could overtake Lagos in the confirmed cases.
“With a 50 percent increase in mobility, people leaving their homes, shopping, going to work and socializing, the number would leap to 748,100 cases in the two states. There may be 102,600 cases in Lagos and 645,500 Kano State by early July 2020,” it said.
It urged authorities to keep the restrictions in place to check the spike in COVID-19 cases.
How countries suppressed COVID-19
Most of the countries battling COVID-19 have adopted ingenious ways of increasing their number of testing while checking the spread.
The United States does molecular tests that take from 12 to 24 hours. According to a survey by the Massachusetts Institute of Technology (MIT) posted on its Technology Review website, US allows tests to be conducted in hospital laboratories and commercial laboratories, beside those of the Centre for Disease Control and Prevention (CDC) which was overwhelmed initially. Most of the hospitals that conduct tests in-house could produce the result in less than a day.
However in Nigeria, only the 17 NCDC laboratories conduct COVID-19 tests. This has further delayed testing and the period for confirming cases. Urgent actions may not be taken promptly, especially in tracing contacts of confirmed cases due to the delay in tests.
South Africa which has the highest test rate in Africa, does so with the approval of private laboratories to test COVID-19 samples, just like in the US. According to the United Nations, South Africa has the capacity to conduct over 5,000 tests for COVID-19 daily. It has 180 testing sites and 320 testing units.
In April, the country introduced 60 mobile labs to boost testing, raising its mobile testing centres under the National Health Laboratory Service (NHLS) to 67. The mobile units can also be used for rapid test kits when they become available. However, Nigeria has just 17 NCDC laboratories and two mobile test centres.
Although Ghana has two test centres, it deploys drones to accelerate test time, and mostly return results in 12 to 48 hours. Daily Trust had on Monday reported that test results in Nigeria sometimes take seven days before they are ready. Experts had pointed at transportation and logistics hiccups and lack of personal protective equipment among others to reduce test time frame.
But Ghana has dealt with the transport hiccup. The Voice of America (VOA) reports that Ghana engages the Silicon Valley company, Zipline, to use their drones to deliver COVID-19 test samples from rural areas and districts like Sekyere Central District to the country’s two test centres in Accra and Kumasi in at most 30 minutes.
Daniel Marfo, the general manager of Zipline in Ghana, said the drone deliveries save time for rural health facilities and are more efficient than road transportation.
Cosmas Tibe Maakuu, a disease control officer, confirmed this, saying, “All samples, when taken, need to get to the testing laboratories as soon as possible to maintain sample quality.”