The most important universal shock that has flowed from the COVID-19 pandemic is that most governments in the world were unable and often unwilling to address the crisis in a manner that protected peoples' health, welfare and lives. They have shown very poor governance abilities but demonstrated great skills in lying to the people. Their concerns have been at best self-serving and in most cases cynical if not outright wicked. In most advanced countries, the most vulnerable segment of society, the elderly, whether in old people's homes or in their own homes were denied testing for COVID-19 because there was a cynical, even if unstated decision, that most of them would die anyway, but also that they would clog the hospitals beds which should cater for younger more productive segments of the population.
The governmental consensus has been that the elderly should be denied life-saving resources and be allowed to die. To mess up future epidemiological studies, their precise cause of death would remain unknown, no testing, so that ruling classes with responsibility of the actions would not be asked to account for their actions and above all refusal to act. A state, a society, that allows people to die without trying to save them is wicked and callous and has no respect for human and democratic values.
Over the past three weeks, there has been a spike of deaths affecting mainly elderly people in Kano metropolitan and citizens and the media have been talking of mysterious deaths. The existence of a spike in deaths is difficult to assert because there are no records so how can you establish that there is a spike if there are no prior records to compare current figures with? It was a good excuse for the Kano State government, which declared emphatically that there is no increase in the death rate, that the reports circulating were fake news and they warned purveyors of the alleged fake news that they would be prosecuted for their lies. They forgot that the first law is that you cannot hide death in a pandemic for the simple reason that the whole community is affected.
Citizens, NGOs and journalists started camping in graveyards and interviewing grave diggers and it became clear that not only was there a spike, but that the death rate was increasing. It was in this context that the Kano State government changed its position and admitted that there was indeed a spike in deaths but then explained that it was not COVID-19 but the four common diseases of diabetes, hypertension, meningitis and acute malaria. Of course, these diseases were endemic and greatly affect elderly people but the argument that it was not the virus was simply silly because it was already known that people with pre-existing conditions die quickly with COVID-19 infections and testing was not happening so the best they could have said was that they did not know.
It was in this context that three young female doctors from Kano, Maryam Nasir MBBS MSC; Zainab Mahmoud MD DTMH and Khadija Rufai MD MHA decided to investigate the matter. They used the verbal autopsy method, used by the World Health Organisation (WHO) during the Ebola outbreak. They disseminated a message via social media encouraging people who have heard of deaths in the metropolis to report. They gathered two sets of data - from direct family members of the deceased and the second data set from indirect sources (friends, neighbours or relatives of the deceased). Over the span of 48 hours, they received reports of 183 deaths in Kano metropolis that occurred between April 18 to April 25, 2020. Following the interviews, they obtained direct information on 51 deaths and their findings indicated a trend of febrile and respiratory illness that progresses to death within one to two weeks of predominantly elderly people with underlying medical conditions. The findings mirrored severe COVID-19 cases reported around and made clear the evidence for urgent investigation about community spread of COVID-19 in Kano.
It is important to point out that with the lockdown, most private clinics in the state shut down and those that remained open were not allowed to admit patients or refused to admit them fearing contamination as they had no personal protection equipment and many were simply afraid of being infected. The Aminu Kano Teaching Hospital and the three other general hospitals were also allowing access only to emergency services so many people with different medical conditions could not get access to adequate medical attention worsening the situation. Meanwhile, the lockdown did not work well as kids were playing football in their neighbourhoods watched by large crowds of adults. Friday congregation prayers were stopped in mosques but other congregation prayers went on and there was clearly a limited understanding of what physical distancing meant. This meant the spread of the disease was not adequately curtailed.
When testing for COVID-19 began in Kano, cases went up from one to 74 in five days. The index case in Plateau State was a visitor from Kano and when Kano "deported" almajirai back to their states of origin, (there is another issue whether Nigerian citizens can be deported to another state), five were found to have COVID-19. The period of denial by the state government cost time that could have been used more constructively to combat the disease. It was interesting that Kano was second state to close it borders to stop importation of #Covid-19 from neighbouring states only for us to find out that the state was among the exporters.
The spread of COVID-19 in Kano was catastrophic and marked by a triple crisis of governance. In the same week, the unique testing centre in the state got contaminated and three of its staff infected themselves through poor handling of the samples. The same thing happened with some of the rapid response test teams sent to the state to extend testing. Thirdly, some members of the Kano State Task Force on COVID-19 also got infected with the disease. The critical teams, federal and state, therefore all had to go into quarantine bringing all efforts in the state to a complete stop. Clearly, NCDC had been sloppy in its training of the personnel and paid the heavy price of prolonged delay. Meanwhile, information filtered out that the governor's daughter, Dr. Amina Ganduje, was the one calling the shots in the task force raising the temper amongst citizens. As for the governor, he was focused on getting the federal government to provide 15 billion Naira to combat the disease, which he had said earlier was not spreading in the state. The argument was Lagos got 10 billion and Kano has a larger population and should get more. He did not take account of the fact that Lagos State used a lot of its own resources to combat the disease and much of the money they got was a refund.
Kano citizens got concerned that the focus of the state government was not on combatting the disease and many groups of citizens reached out to the president and federal bodies to take measures to save lives in the state. The federal government sent a team to investigate community spread in the state led by Dr. Sani Nasiru Gwarzo and Professor Abdulsalam Nasidi, a renowned international expert, both of whom are Kano citizens. The National Coordinator of the Presidential Task Force on COVID-19, Dr. Sani Aliyu is also from Kano and there was widespread anger that Kano has huge human technical resources that could have been tapped from the very beginning but the state government was more focused on money and politics than establishing the facts of what was going on and seeking solutions.
It was when Kano citizens started calling for a state of emergency and federal takeover that the state government accepted there was indeed a medical emergency and welcomed technical support from the federal government, the private sector and development partners. Had citizens not shown their anger and taken various actions, the situation would have been much worse. The governor who had earlier castigated the Presidential Task Force on BBC Hausa service for being the problem, calmed down and welcomed federal aid.
For me, the lesson is that governments around the world are not really interested in saving the people from the pandemic, the core objective they have is to pretend that they are. The salvation for the people lies in engaging in citizen action to cajole, fight, expose and shame them into action so that as many persons as possible could be saved from this ogre that is the new coronavirus.