By Prof. Usman Yusuf
16th May 2020
- To paraphrase the words of a wise man who once said that “Leaders have forfeited the right to make excuses”, but, what I keep hearing from our seats of power all across the land are spate of excuses as reasons for why our elderly and people with weakened immunity are dying at an unusually high rate.
- With the exception of very few State Governments who have made serious and commendable efforts in spite of all the challenges to mitigate the effects of this virus, the response of the vast majority of State Governments is either outright denial of the presence of the disease in their States or half-hearted measures put up just for the cameras.
- “Mysterious illness claims the lives of so many”, “People are dying of a strange illness”, “Almajiris are breeding grounds for Coronavirus“, “We are under pressure to report coronavirus cases”. These are some of the excuses making the headlines coming particularly from States in Northern Nigeria where infection and death rates from COVID-19 have been steadily and alarmingly on the increase.
- In my previous write ups, I asked what illness could be stranger than COVID-19 anywhere in the world at this time in human history? Every day, we hear of the sudden death of a person mostly above the age of fifty who more often than not has a preexisting illness like diabetes, hypertension or asthma. We now know that these types of patients are the most vulnerable and more likely to succumb to this virus. Instead of our Governors acknowledging these deaths for what they are (COVID-19 related), they keep spinning tales of denials.
- In Psychiatry, the patient who has what is called “insight” (acknowledges his/her illness), has a better outcome than one that doesn’t. The first step to controlling this pandemic has to be for our State Governors to acknowledge the presence of COVID-19 disease in their States. Only then can we start talking about any meaningful mitigation measures.
- Nigeria is already coming into this pandemic saddled with a lot of handicaps like, frail health infrastructures, inadequate health human capacity, neglected healthcare systems and dwindling resources to mention just a few. To compound this, there is an acute shortage of testing kits for detecting this virus.
- The World Health Organisation (WHO) advised nations that testing, testing, and more testing is the key to controlling this pandemic. It is an indispensable tool in identifying, isolating, treating cases to reduce mortality and actively tracing their contacts. It also guides policy makers in making sensible decisions like ordering lockdowns or deploying vital resources where needed.
- Nigeria with a population of almost 200 million has tested less than 30,000 of its people. Inadequate testing makes any official data not a true reflection of the reality on the ground in terms of new infections or deaths from COVID-19. This makes controlling this pandemic immensely difficult.
- These challenges are exactly the reasons why preventive measures especially social distancing remain our only hope of reducing the spread of this virus in our communities, preventing the prospect of overwhelming our fragile healthcare system, reducing exposure and infection of our frontline healthcare workers and reducing mortality until such a time when a vaccine is developed and widely distributed.
- Federal and State governments are now wrestling with how to continue social distancing measures. It is undeniable that prolonged lockdown is realistically just not sustainable in our setting. It is a balancing act between saving people’s lives vs. saving their livelihoods. Policy makers are caught between the proverbial rock and a hard place.
- If we do not perform physical distancing or other measures to slow the spread of this virus, it will definitely spread and infect many more people in a matter of a few months. This would overwhelm our hospitals and lead to high death rates.
On the other hand, continuing the lockdown without actionable testing data is like walking down a cliff with your eyes closed. Also, many people may die at home from hunger and other non-COVID-19 illnesses.
- Leaders all over the world are confronted with pressures to reopen up their economies as soon as possible while Scientists are cautioning against the dangers of such actions. I have frequently been asked “Isn’t our only hope relying on herd immunity, what is herd immunity”?
- The Coronavirus causing COVID-19 Pandemic was able to spread quickly across the world because nobody had immunity to it. Stopping it’s spread will require a significant percentage of people in the community to be immune. This is called herd immunity which essentially means, when most people in any given population are immune to an infectious disease, this immunity provides indirect protection to those who are not immune to the disease.
- There are two ways to achieve herd immunity: A large proportion of the population either gets infected by the virus or gets a protective vaccine. Based on early estimates of Coronavirus’s infectiousness, at least 70% of the population in the community will need to be immune to achieve herd immunity.
- People ask, if herd immunity is good why is it not a good idea to let many people get infected to offer protection for all? For less severe diseases like chickenpox, this approach might be reasonable. But the situation for Coronavirus is very different because COVID-19 carries a much higher risk of severe disease and death, about 10 times higher than it’s cousin the flu. It is higher still among vulnerable groups like the elderly and people with weakened immune systems.
- To establish herd immunity in Nigeria as a community, it is estimated that at least 140 million (70% of 200m) people will need to get infected with this virus. This is a frightening scenario knowing fully well that our hospitals and healthcare workers will be overwhelmed leading to many avoidable deaths. Our governments and people should do whatever is possible to prevent this from happening.
- Governments should prepare for the worst by urgently increasing access to and capacities for testing nationwide, improving capacities in our hospitals and providing Personal Protective Equipment (PPE) to healthcare workers while hoping and praying for the best.
- Government at all levels should launch aggressive public enlightenment campaign to sensitize people particularly the vulnerable about COVID-19. An enlightened community is better protected than one that is not.
Traditional, Religious and Community leaders are pivotal in explaining any government policy to their respective communities.
- We should all prepare for the long haul because this virus is going to be with us for a long time until a vaccine is developed and widely distributed. Governments need to therefore develop policies that will be sustainable in the long term.
~Usman Yusuf is a Professor of Haematology-Oncology and Bone Marrow Transplantation