By Dr Umar Tanko Yakasai
The phrase ‘All Hands on Deck’ has a naval origin which is usually sound by the captain of a boat or ship when there is a storm or an emergency. It is a command for all the sailors to come to the deck of the boat or ship to help navigate the storm. There is no better time than now for the Governor of Kano State to sound the command ‘All Hands on Deck’ given the rising cases of Covid-19 infection in Kano and news of alarming, unexplained, sudden death of elderly, prominent citizens of the state. Instead, all that is coming out from the Government of Kano State is denial upon denials while the storm wrecks the ship. Since I am on board this sinking ship, I have decided to sound the command ‘All Hands on Deck’ and I expect every concerned citizen of Kano State to equally join and do the same.
Since the first case of Covid-19 infection was reported in Nigeria, my worst fear is that, if the infection is not contained in Lagos, Kano can be the epicenter of Covid-19 infection should it spread to the ancient city. This is because Kano is the most populous state in Nigeria, densely populated, a center of commerce and sit of the most inept and docile government in the country. My fear was confirmed when the state government refused to take advantage of the lag in recording the first case of Covid-19 infection in the state. This lag lasted several weeks which gave the state government the golden opportunity to achieve the following: Engage in massive risk communication, community sensitization and education on Covid-19 pandemic to enlighten people about the infection addressing personal hygiene, washing of hands with soap and water, cleaning hands with hand sanitizer, maintaining social distancing, addressing myths and misconceptions, detailed understanding of asymptomatic incubation period that predates development of signs and symptoms, highly infectious nature of the disease etc.
Secondly, the state government should have instituted early lockdown of intrastate movement and interstate travels and ensuring strict compliance in congruence with Kaduna State. Every passenger coming into Kano should have been forced to observe strict supervisory self isolation or taken to isolation center to observe strict 14 days isolation before being released to go home. A pool of volunteer health personnel should have been created and trained in all aspects of the pandemic control (testing, contact tracing, infection control, risk communication, clinical care of isolated cases) grouped into units ready to be deployed as at when needed. An appeal should have been made to all healthcare experts from the state residing both locally and across Nigeria to be ready to come home and provide assistance to curb the Covid-19 infection. Logistics should have been organized to rapidly deploy these volunteers to the field in an organized manner to enable scale up should number of cases rise in the state. This also applies to strategy to expand call center in the state.
Thirdly, adequate PPEs should have been secured, stored, and ready for deployment for the safety of frontline health workers. A befitting isolation center should have been established to cater for large number of potential cases of Covid-19. The state government should have approached the NCDC at the federal level to activate a testing center in the state with other additional facilities identified and fully equipped to be activated should the cases rise sharply. The state assembly should have been approached to legislate on funds to be available to purchase palliative items should a total lockdown be instituted with a well thought out strategy on distribution to all that might need it. I can go on and on listing missed opportunities that should have been utilized before Kano joined the map.
Moving away from dwelling on missed opportunities by the Kano State government before the first index case appeared in Kano, the effectiveness or otherwise of the measures adopted by the state so far is in the public domain for all to judge. However, with the emergence of the first index case in Kano, the state delayed instituting a lockdown for days allowing for the further spread of infection within the community as people went about their normal business. Even the interstate lockdown was not effective with so many commercial vehicles bringing people into Kano from Lagos and other states in the country while at the same time leaving Kano to other states. The failure of the state government to ensure strict compliance with both the intrastate movement and the interstate lockdown was responsible for the rapid spread of the infection in Kano and incidences of exported cases of Covid-19 infections to Gombe, Adamawa, Plateau, Zamfara and others. You can imagine sending an infected Covid-19 patient to Jigawa when the isolation centre in Kano has not been fully utilized, an action that put Jigawa on the map. Lagos I hail thee.
It took a lot of hues and cry from people on social media handles for the state to abandon the dilapidated isolation center at Yargaya, to a more befitting one at Kwanar Dawaki. Thanks to Aliko Dangote for the 600 bed capacity isolation centre donated to the state. The call center in the state is overwhelmed without commensurate increase in trained personnel to man it. Measures to distribute palliatives were not instituted until few days ago when the citizens started complaining of hunger and lack of food items to feed themselves and their families during the lockdown. The sudden news of infection of some of the critical members of the state task force on Covid-19 by the coronavirus put the entire committee in disarray for days coupled with the strangulating effect of nepotism as widely acclaimed in the social media. The most worrisome state of affairs was that of persistent denial of factual news on sudden increase in unexplained death of prominent elderly people in the state and the closure of the NCDC testing facility in AKTH.
To cap it all, the state is on record to have turned down offers of help by highly professional and competent health care experts who are indigenes of the state that offered to volunteer to provide expertise to fight the Covid-19 pandemic free of charge in order to save the people of Kano. All these characterize the state response to the Covid-19 pandemic which has threatened to become the epicenter of the disease not only in Nigeria but Africa at large. How can a state that is in perpetual self denials and who has politicized everything including the coronavirus pandemic ever adopt the strategy of looking for help both within and outside the state? The state must have a rethink and a change of mindset in order to deal with the rising Covid-19 pandemic.
It is at this point in time that I say salvaging Kano from the ravaging effect of the coronavirus pandemic is everyone’s responsibility within and outside the state. Right from the health professionals, to business community, the ulamas, media in the state and above all the federal government. To achieve this gargantuan task, ‘All Hands Must is on Deck’. I will start by highlighting what needs to be improved upon by the Kano taskforce on Covid-19 and the SMOH to arrest the growing cases of the Covid-19 infection in the state and achieve control. This is without prejudice to the work they are already doing which I acknowledge.
Manpower: Kano state is blessed with a large number of highly trained medical professionals residing within and outside the state. For decades, Aminu Kano Teaching Hospital has churned out fellows in different specialties in the field of Medicine (Community Medicine, Pulmonologist, Infectious Disease, Intensive Care, Laboratory Medicine- Microbiology etc) who are critical to the Covid-19 pandemic response. Also, within a decade Kano is among the states in Nigeria with the highest number of NCDC 2 year Masters Degree program graduate from ‘The Nigeria Field Epidemiology and Laboratory Training Program (NFELTP)’, a program designed to train health workers in disease surveillance and epidemic response. The state government can mobilize all these health personnel working in the state including AKTH and in other federal tertiary institutions to come back to Kano to help their state and people to fight the coronavirus pandemic.
These health experts must be given the free hand to work with the state taskforce on Covid-19 based on their expertise without any nepotic encumbrances. A massive recruitment of other health personnel in the state should be done with a quick training on NCDC guidelines on different aspects of the response. Teams should be formed and allocated into Contact tracing, Infection Control, Risk Communication and Clinical Care with a clear strategy developed to immediately activate and deploy them within the state dictated by the trend of infection. The services of anyone who can provide technical expertise should be solicited by the state government irrespective of differences to defeat the coronavirus.
Logistics arrangement: A massive logistics arrangement must be made with adequate planning to rapidly increase call center capacity to respond to SOS calls, deploy monitoring charts and digital thermometers to contacts on supervised self isolation as well as adequate transportations for contact tracing and line listing. Multiple, decentralized sample collection sites must be quickly established in all of the 8 metropolitan LGAs in Kano and 2 in each of the geopolitical zones across the state to cope with the population size in Kano. The state should pool massive amount of ambulances and PPEs for rapid response to evacuate positive cases to isolation centers within 6 hours of a positive test results. Arrangements should be made to either produce face masks locally or procured to be used during the latter part of the pandemic when lockdown measures will be eased and everyone expected to wear one.
The 21 ambulances currently operating in the state might be inadequate to cope with the large population of Kano. Efforts should be made to improvise by converting hundreds of Kano Line buses lying fallow at the headquarters by removing the sits and placing a stretcher to serve as a temporary ambulance for conveying positive cases. Adequate logistics arrangement should also be made to take care of the welfare of the front line health workers including a robustly planned shift to allow for adequate rest and smooth transition. Adequate logistics arrangement should be made for trucks, PPEs, disinfectants and equipments needed for infection control including disinfection of streets, buildings, premises etc. There should be proper logistic arrangement for the disposal of corpses of Covid-19 patients.
Testing Centre: The state government should request the support of NCDC to establish additional testing centers in Kano to increase the number to at least three to cater for the increasing number of cases in Kano. However, the state must provide the needed resources to meet NCDC criteria for the setting up of a testing center and its activation. This is one area where the illustrious sons and daughters of Kano endowed with huge financial resources can assist the state in meeting up with NCDC requirement. The availability of additional testing centers will go a long way in scaling up testing and return of results in good time to promptly isolate positive cases and contact trace effectively and efficiently. Strict adherence to infection control measures must be done to prevent a recurrence of staff contracting the Covid-19 infection through retraining, quality control and assurance and provision of adequate number of PPEs.
Enforcing Public Health Measures: The state government must be seen to enforce public health measures it has instituted in the state to curb the pandemic. So far it has proved incapable of doing that due to weakness and lack of trust by the citizens. The social media is awashed with clips of mass gathering of people playing and watching football, large gatherings of people in a joint within neighborhoods gisting, massive crowds attending burials of loved ones at graveyards and several small shops operating within areas under lockdown. All these activities fuel the spread of the infection within communities thus defeating the social distancing measures and leading to exponential rise in cases of coronavirus in the state. In order to curtail these risky behaviours the state must utilize all security organizations and outfits in the state ranging from police, to civil defence, Hisbah and local vigilante groups trained to discharge their duties professionally without violations of people’s human rights.
Risk Communication: The viral video going round from the isolation centre in Kano coupled with other news in the mainstream media showed there is high level of denial of Covid-19 infection in Kano. This has made people not to adhere to public health measures leading to risky behaviours and undermining of the control measures. Massive community engagement and sensitization must be done across the nooks and crannies of the state using social and traditional media, electronic and print to rapidly increase awareness and knowledge about coronavirus. This must be done consistently paying deliberate attention to addressing myths and misconceptions about the diseases.
The content of the messages must address things such as traditional treatments of Covid-19 and local methods of prevention which are not scientific but have gained ground in the hearts and minds of the populace. The state taskforce on Covid-19 must establish a professionally functional media unit that responds promptly to misinformation circulating in the society through various social media handles in a coordinated and systematic way that does not send out mix-messages or engage in unnecessary controversies and denials. Engagements with prints and electronic media must be centralized, organized, coordinated and factual to avoid contradictory posts that are dished out by too many individuals all speaking for the response in the state.
Medical Care: Due to the coronavirus pandemic, most government owned hospitals in the state have scaled down health care delivery services in the state. All GOPDs and routine clinics including specialty clinics have been shut down leaving entry point to health care through Accidents and Emergency Units in some hospitals. This has overstretched the A&E units with so many emergency cases been either neglected or sent away from hospitals. The A&E in AKTH Kano is a nightmare with health personnel finding it difficult to cope with the high volume of patients coming for care. This has been made worse by the massive referrals of patients with any combinations of signs and symptoms that mimic Covid-19 infection by private hospitals. With the scaling down of hospital activities across the state, many health personnel have become idle except those directly engaged in the Covid-19 response in the state. This has led to a situation whereby many people with chronic illnesses in the state particularly the elderly, lacking access to care to manage their chronic diseases such as diabetes, hypertension, heart diseases, renal diseases etc. Many resort to home visits and consultations by medical personnel some of which are quacks. This could probably be the reason for the sudden increase in unexplained death of over 600 people in the state within a week including prominent elders of Kano. Perhaps, it might also be due to the community transmission of Covid-19 infection in the state.
The state ministry of health must therefore design a strategy to utilize its abundant manpower in the health sector to attend to the medical needs of the citizens with such chronic illnesses through the multiple secondary health facilities existing in the state. It must sought the cooperation of the Nigeria Medical Association in the state and other unions to galvanize their members to show ingenuity and compassion by attending to these patients while at the same time ensuring their personal safety, protection and welfare. Medical care should not be neglected and simply abandoned in the state just because of Covid-19 infection. Kano and Nigeria has not reached the level of pandemic seen in other countries were hospitals are overwhelmed with Covid-19 patients to the extent that other diseases and medical conditions were jettisoned. Many of the isolation centers have not been fully utilized to the extent that we see spillage to normal hospitals within the state.
Investigation of sudden rise in unexplained death: It is morally wrong to just simply dismiss and deny the sudden increase in unexplained death of elderly people in the state without doing any scientific investigation to ascertain the veracity or otherwise of the events. The state government must seek the help of professionals within and outside the state as well as organizations such as NCDC, WHO and the Federal Government to immediately commission a research to find out the course of death and provide convincing answers to the general public to avert the impending calamity. This will allay the growing anxiety among the good people of Kano and Nigeria at large.
Palliatives during lockdown: No lockdown can be meaningful and sustained for months without adequate palliative measures put in place to provide succor to the poor and needy. We have seen globally how lockdowns have been extended for several months and Kano will not be different. The state has a lot of people who are unemployed, living under abject poverty that depends on daily jobs to be able to put food on the table. With so many family members to feed coupled with abject poverty in a densely populated state like Kano, a lockdown without well designed palliative strategy is bound to fail after certain duration of time. Hunger can make people take risk beyond the imagination and the contemplation of any government.
With a population of close to 20 million people in the state, a palliative measures that targets 50,000 households is a joke. The government must deploy a lot of resources to purchase and distribute palliative materials to as many citizens as possible within the shortest possible time to avoid civil unrest. This is one area where the federal government and illustrious sons and daughters of Kano who are financially endowed must assist to cover large number of people. Everyone too with enough resources can assist by donating generously to his neighbors and community to alleviate the sufferings of the less privilege in the society who have nothing to eat. It is a clarion that should be answered by every patriotic citizen of Kano.
Federal Government Interventions: The Federal Government must declare state of emergency in the health sector in Kano to derive powers to take over the response to Covid-19 pandemic in the state. Providing technical and managerial leadership as well as massive logistical intervention to save the state and the country from the disastrous and perilous path the state government has set us on to.
I must say the time has come for all concerned citizens to add their voice to the clarion call to save Kano from an incompetent self serving government before it consumes us all. Salvaging Kano is now the responsibility of everyone and all hands must be on deck.