Nigeria: Tension As Experts Warn of 'Second Spike' of COVID-19

'If you follow other pandemics, they have different waves; for example, the flu pandemic of 1918 to 1920, the greatest number of cases came with the second spike'

Tomorrow, the lockdown imposed on Lagos and Ogun States as well as the Federal Capital Territory, FCT, Abuja by the Federal Government will be partially lifted.

But experts are warning of possible 'second spike' of Covid-19 cases and resultant deaths if the measures put in place by government are not appropriately implemented amid the virus graph "going sharply up".

The first 14 days of lockdown was imposed on March 31 and renewed for another 14 days on April 13.

The second segment expired on April 27 but extended by one week.

The extension expires tomorrow.

Since the announcement of the relaxation of the lockdown by President Muhammadu Buhari on Monday, there have been various predictions on what will happen in the post-lockdown era, especially after the country started having exponential rise in confirmed cases.

The social media has, immediately after the announcement, gone wild with all sorts of predictions.

But how have countries which eased lockdown ahead of Nigeria fared?

Many apparently suffered a setback.

A case in point is that of Nigeria's neighbour, Ghana.

A day after the country eased its lockdown, Covid-19 cases skyrocketed.

This sort of vindicated the World Health Organisation's WHO, which, in an advisory late last week, said it was not yet time to ease lockdown in the face of exponential rise in cases.

The Nigerian Medical Association, NMA, backed the WHO advisory, worrying that lifting the lockdown was likely to increase cases which may overwhelm the Nigerian health system.

Guerrilla warfare

Meanwhile, some Nigerian medical professionals, who spoke to Sunday Vanguard, say government should have at the back of its mind that fighting community transmission of the disease is like engaging in guerrilla warfare.

They warned that Nigeria's impatience to ease lockdown may herald massive deaths from COVID-19.

Spike

As of 11:50pm, Friday, May 1, 2020, Nigeria had recorded 2170 confirmed cases of COVID-19 with 351 discharged and 68 deaths.

Daily figure was 238 which was the highest daily report by the Nigerian Centre for Disease Control (NCDC) since the epidemic started in February.

Today, there is anxiety in many quarters, particularly among health workers, that Covid-19 may spike in the post-lockdown period.

In most hospitals in Nigeria, every patient is treated as a potential COVID-19 case because of fear.

Investigation by Sunday Vanguard on emergency cases in hospitals shows that patients are made to stay for hours outside before they are admitted.

Amidst the exponential rise in cases, health experts maintain that although palliatives are not available especially for the vulnerable people, easing lockdown without adequate social distancing measures will be worse.

According to the President of the Nigerian Medical Association, NMA, Dr Francis Faduyile, it was not yet time to ease up lockdown, whether partial or total, now that Nigeria is having an exponential rise in confirmed cases.

"If you follow other pandemics, they have different waves; for example, the flu pandemic of 1918 to 1920, the greatest number of cases came with the second spike", Faduyile said.

"I think we have to be wary".

He said Nigeria cannot afford to ease lockdown when states like Kano, among others, are in crisis and the graph is going sharply up.

To him, it is premature and not the time to relax lockdown, which is the most stringent method you need to contain the outbreak.

Massive deaths

On his part, the President of the Nigeria Healthcare Providers Association of Nigeria, Dr Adeyeye Jimmy Arigbabuwo, said government's impatience and anxiety to bolt away from the lockdown may herald massive deaths.

Regretting many Nigerians' unbelief about the virus due to socio-religious and cultural factors, he said the country was currently fighting community infection which is more of guerrilla warfare.

"The enemy is unseen. To win this battle we must all be ready to sacrifice in no small way. Blaming government and our leaders may not solve anything", he said.

"My appeal to our leaders is to avoid playing politics with COVID-19.

"We are in for real mess. Whistleblowing is crucial. We are kidding as far as I can see because even the palliative measures now are political.

"Who are the real poor? We do not know as far as the implementation of the palliative measures is concerned. I mean the real vulnerable people are not getting anything palliative".

Speaking on how Nigerians should conduct themselves from tomorrow (post-lockdown era), Arigbabuwo explained that people should maintain a social distancing of 2 metres or 1.5metres apart as the medical community was still studying if the novel virus is airborne or not.

He further called for compulsory use of face mask in public places, adding that people should avoid black colour cloth face mask.

"White exposes any dirt, so lighter colours and white masks are preferable".

Arigbabuwo, who is a former President of Association of Private Medical Practitioners of Nigeria, lamented Nigerians poor compliance with social distancing.

"I personally see people coming out of commercial vehicles now in large numbers in the mornings without face masks. In fact, the buses are overloaded.

"I weep for all of us as the number of new cases keeps rising. Agreed, increased testing can give paradoxical large 'new' catches as it were.

"They might really not be new catches but cases undetected for long and who's saying the virus had not entered Nigeria long before the Italian Index case?"

Mockery

Expressing the fear that traditional medical practitioners are now seizing the novel nature of the virus to market solutions, he queried states setting up days for markets, saying, "Is there a day the virus has set aside to stop contagiousness?

"So, states setting market days aside are making total mockery of the import of this virus."

Social distancing after lockdown

Also speaking to Sunday Vanguard, President of Commonwealth Medical Association, CMA, Dr. Osahon Enabulele, said Nigeria was not out of the woods yet, hence, the need to maintain social distancing even after lockdown.

He maintained that social distancing was particularly important as the restriction imposed on some businesses, shopping malls and offices will be relaxed from tomorrow.

"Nigeria is not out of the woods, so it is not advisable to alter the social distancing rule which prescribes a physical distance of at least two metres.

"All activities and movements in public places, including the activities of transporters, should be made to still adhere to social distancing prescription," he said.

To prevent a possible second wave of the virus, he said there should be sustained efforts at risk communication and community engagement, particularly on the need for sustained adherence to existing public health measures, including hand and respiratory hygiene, as well as social distancing.

Enabulele, who is also the Coordinator, Coalition of African National Medical Associations, CANMA, called for sustained and improved efforts at testing and contact-tracing.

"Though there has been noticeable improvement in Nigeria's testing capacity with some state governments complementing the efforts of NCDC, a lot still needs to be done to upscale the testing capacity," he stated.

He argued that if less endowed countries, including African nations with far less population figures, have been able to conduct more tests, there is no reason Nigeria cannot do much more to enable her have a truer reflection of the disease burden as well as limit community transmission.

"As of April 30, 2020, South Africa has conducted over 165,000 tests, Ghana has conducted over 60,000 tests, Kenya has conducted over 18,000 tests, while Ethiopia has conducted over 16,000 tests. Nigeria has done paltry 13, 689 tests as of Thursday, April 30

"Increased attention should be paid to the safety, protection and welfare of medical doctors and other health workers in the public and private health sectors.

"This will help to boost their morale and halt the unfortunate rise in the number of health workers infected in the course of duty, and the consequent depletion of the health workforce needed to attend to individuals affected by Covid-19 and those who present with other medical conditions".

The former NMA President added that government at all levels should sustain and improve efforts at strengthening the capacity of their health systems and infrastructure, to enable them cope with the burden and also be ready for quality health care delivery in the post-COVID phase.

"As a way of ensuring that there is less resistance to the prescribed public health measures, there is need for accelerated and equitable distribution of palliative to the vulnerable segments of the Nigerian population across the zones of Nigeria.

"There should be closer collaboration and integration of efforts, particularly between the various state governments, as well as between state governments and non-state actors," Enabulele added.

Right mask

Also speaking with Sunday Vanguard, National President of National Union of Allied Health Professionals, NUAHP, Dr. Obinna Ogbonna, called for the compulsory use of the right mask, social distancing and hand washing/sanitizing.

According to Ogbonna, Nigerians must begin to avoid crowding in worship centres and parties as the rate of transmission will drastically reduce and become like any other infectious disease currently being managed in the country if we do so.

He noted that with no known cure yet, prevention was the most ideal thing to do now."So while gradual resumption of activities in different sectors

is encouraged, we should not lose sight of the various safety precautions as approved by the NCDC.

"If we are cautious and conscious, the second wave would not be significant compared to the first wave and government should continue with house-to-house testing having declared that about three million Nigerians would be tested within a month.

"That's a welcome target and I pray we are able to achieve it."

Vanguard

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