Dr. Chikwe Ihekweazu is the Director-General of Nigeria Centre for Disease Control (NCDC). In this interview, he speaks on the centre's coordination of the country's coronavirus (COVID-19); the outbreak, contact- tracing, planned arrival of the Chinese medical team, testing centres and issues with the toll-free lines among others.
Can you describe the experience of the NCDC in responding to the coronavirus outbreak in the country so far?
The world is responding to a pandemic caused by a new virus. In Nigeria, like several other countries, our experience has been a learning curve. We do not know what the best strategy or approach is and we will continue to learn more as we respond.
It is not the most ideal approach, but we must remember that during a pandemic, there is no "one size fits all" approach. What has worked in one country, may not work in the other. We will continue to ensure that our experience is driven by science and evidence.
Some politicians and VIPs reportedly refuse to be treated in public hospitals or isolation centres. How are you handling this?
The majority of people who are infected with coronavirus are either asymptomatic or experience mild that can be treated at home. Our strategy is to ensure that confirmed cases are treated in isolation, do not have direct contact with others and are managed to recover.
We must remain conscious of the fact that our health system is becoming overwhelmed with cases of other infectious diseases including a large Lassa fever outbreak. The critical point is that confirmed cases remain in isolation without contact, especially where they have mild symptoms.
Some VIPs have also refused to abide by the NCDC guidelines on self- isolation after returning from endemic countries, thereby subjecting more Nigerians to risk of infection. Any measures to address this?
President Muhammadu Buhari has ordered the closure of land and air borders, providing us with a window of opportunity to flatten the curve. We continue to urge all Nigerians who have returned from other countries in the last 14 days or been in contact with a confirmed case to remain in self-isolation for 14 days. The social distancing measures in place such as this will help us find cases early before the virus is spread.
Nigeria has been discharging patients when deaths are being recorded from the disease in other countries .What is responsible for the low fatality rate in the country? What is the modality of treatment responsible for the patients' recovery?
We have adhered to the World Health Organisation (WHO)'s treatment protocol for case management. It is still too early in the outbreak, to comment on the low fatality rate in Nigeria.
We are very grateful for the health workers at our treatment centres that are working very hard, in difficult circumstances. We know from evidence that most people who die from COVID-19 complications are elderly or have underlying health conditions.
What is the situation with contact- tracing now?
Since the outbreak began, we have had 7,868 persons under follow up. Of this number, over 70% have completed their follow up period which is 14 days without symptoms. We are now following up with 2,378 people as at the 4th of April. These numbers continue to increase, as we record more cases. We remain committed to following up closely with contacts, as this is an important strategy in our response.
The announcement that Chinese doctors and donations would soon be coming to the country has generated reactions from Nigerians, with many calling for outright rejection of the medical team and goods, citing instances of what happened in Italy after such a gesture. What is your take on this?
There is a lot for us to learn from the Government of China's response to the COVID-19 outbreak. This is not the time for misinformation and conspiracy theories. If there is anything we have learned from this pandemic, it is that all countries must see each other as partners. We are working with our colleagues in NAFDAC and the Medical Laboratory Science Council of Nigeria to further validate all medical commodities that we receive from across the world.
What are you doing to get more Nigerians tested?
Within three weeks of the confirmation of the first COVID-19 cases in China in January, we set up testing capacity in five laboratories in Nigeria. At the time, Nigeria had not recorded any case. The fifth laboratory was added in February. With the increase in cases in Nigeria in the last one week, we have included two more laboratories. Overall, there are eight laboratories with the capacity to test for COVID-19 in Nigeria. We are including at least six more laboratories in the next one month.
At the moment, the validated method for COVID-19 diagnosis can only be carried out in molecular laboratories. A brand new molecular laboratory requires extensive financial resources, time and human resources. We have had to focus on building COVID-19 testing capacity in existing molecular laboratories.
With new methods such as the use of Gene-Xpert machines, we hope to continue to scale up this capacity. With increasing demand globally for limited reagents, this could take longer than we would like.
We also continue to adapt the national case definition as the situation changes globally and in Nigeria. We are prioritising testing for people who have COVID-19 symptoms, with a travel history outside Nigeria in the last 14 days, contact with a confirmed case or unknown source in states with high prevalence.
How do you plan to address the issues with the NCDC toll-free call line as people keep complaining that they don't receive response even when they fulfill criteria for testing?
In the first two weeks of confirmation of the first few cases, our call centres were overwhelmed as people were panicking and sought more information. We have learned from this and expanded the lines.
At the moment, we receive a minimum of 4,000 calls daily. We have also encouraged states to set up hotlines for state-level response. Finally, we have created several alternative platforms such as Whatsapp, Twitter messaging and an up-to-date microsite for people who do not have urgent queries to access. We will continue to learn and improve on this.
How has the lockdown helped in the COVID-19 response?
In the absence of a vaccine for this disease, we have to depend on non-pharmaceutical interventions such as the closure of large gatherings and cessation of movements.
There is a strong chance that if these interventions are properly implemented and adhered to, we can flatten the curve and control this outbreak. By limiting movements, we are reducing the possibility of spread of the virus causing COVID-19, which is highly transmissible.
How involved is Nigeria in clinical trials for a possible cure for COVID-19?
Clinical trials for therapeutics are led by our sister agency - NAFDAC. We are well aware of global opportunities and will continue to engage as required. The Government of Nigeria is fully committed to being part of research and development efforts for COVID-19.
What is your advice for the public on COVID-19?
These are very difficult times for countries across the world including Nigeria. There is no better time than now for us to pull together in responding to one common challenge which is COVID-19.
Measures such as the cessation of movements can be difficult. However, these are sacrifices we have to make as we respond to this pandemic. We urge Nigerians to adhere to measures put in place.
The virus is transmitted through respiratory droplets from an infected person. Please stay at home to stay safe and only go out when it is essential. Please avoid large gatherings at this time. Wash your hands regularly with soap and running water as the virus can be transmitted by touching contaminated surfaces and touching parts of your body.
Use a hand sanitiser where running water is not available. If you are ill, please stay in self- isolation and contact your State Ministry of Health or NCDC through our toll-free number- 080097000010.
We must all #TakeResponsibility- as individuals, families, private sectors and the government. We can take responsibility by supporting ongoing response efforts, adhering to measures in place and, importantly, sharing only verified information.
What is your take on keying into new technologies for COVID-19?
The world is moving fast to find new solutions such as vaccines, diagnostics, therapeutics, and others. However, we must keep in mind that these technologies must go through a process of validation.
At the moment, there is no rapid testing kit validated for use by the World Health Organisation (WHO). This means the current rapid test kits will produce false results. The NCDC is keeping abreast of new technologies and will access these, as soon as they are approved for use. We urge Nigerians to be patient and only share verified information and resources.
Finally, we are grateful for the efforts of state governments who continue to rise to the challenge. It is important that we are prepared at the national and state levels to respond effectively to COVID-19.