Nigeria: COVID-19 - 20 States Yet to Have Testing Laboratories

As the COVID-19 pandemic rages in the country, 20 states are yet to have testing laboratories. Some of the states experiencing community transmission are among the top 10 with the disease.

This is happening as Nigeria's testing capacity still trails behind what obtains in neighbouring African countries.

As at Friday, Nigeria had 26 laboratories spread iacross 17 states. The country has also tested 40, 043 samples. This is far below the target set by the Federal Government to have about 68 test centres for COVID-19.

The Nigeria Centre for Disease Control (NCDC), in its strategy document published on April 15, projected establishing 68 testing centres and two mobile laboratories within 45 days.

States without COVID-19 laboratories have lamented that they encounter hurdles sending samples to Abuja or other neighbouring states, as well as long waiting time for results. They said the absence of testing centres was one of their major challenges in the ongoing fight against the virus.

Some states have to wait for over a week to get test results, with some of their drivers getting infected in the process of transporting samples.

Checks by Daily Trust Saturday revealed that Akwa Ibom, Benue, Bayelsa, Enugu, Nasarawa, Kebbi, Niger, Jigawa, Yobe, Ekiti, Bauchi, Ondo, Zamfara, Abia, Taraba, Kogi, Cross River, Katsina, Gombe, Kwara have no COVID-19 testing laboratories.

Some states have laboratories in hospitals or private facilities that could be upgraded for COVID-19 testing, however, that has not been done till date. Ogun State, for instance, has established a molecular laboratory but still sends samples to Osun because it awaits NCDC accreditation. The state is in close proximity with Lagos, which has the highest number of COVID-19 cases.

However, some states can boast of two or three laboratories. They are Kano, Ogun, Lagos, Federal Capital Territory (FCT), Kaduna, Sokoto, Edo, Anambra, Borno, Osun, Plateau , Oyo, and Ebonyi, among others.

They, however, said there was minimal support from the NCDC or the Federal Government in setting up or funding most of the laboratories.

In Gombe State, there is no testing laboratory for COVID-19. Here, samples are sent to the NCDC in Abuja for daily test.

The state's focal officer on COVID-19 response, Dr Mohammed Kwami, said the test results usually come out in at least 48 hours, after which they are scanned and sent back to the Special Task Force on COVID-19 secretariat.

He said taking the samples to Abuja on a daily basis was not convenient, but added that they are using the channel as a temporary measure, pending when the state would get its own laboratory.

Addressing newsmen on the preparation to get state-owned laboratory for COVID-19, the chairman of the task force, Professor Idris Mohammed, said the state government had already procured the PCR machine, which is expected to arrive this week.

Bauchi State is one of the top 10 states with COVID-19 cases but has no testing laboratory. The state Task Force Response Committee on COVID-19 initially sent samples to the NCDC laboratory in Abuja, but recently started taking them to the National Research Institute, Vom in Jos, Plateau State.

Also, Nasarawa State does not have a COVID-19 testing lab. Samples are sent to the NCDC reference laboratory in Abuja for tests. Recently, an NCDC driver who helped in transporting samples tested positive for the virus.

However, the state has established six sample collection centres, in addition to the hospitals where samples are taken.

Governor Abdullahi Sule said this became necessary after the state registered its first coronavirus patient. A source in the state Ministry of Health, who preferred anonymity, said it took between four days and one week for results of samples to be returned.

In April, Governor Sule bought 24 Toyota Hilux vehicles, estimated at N21 million each, which were said to be official cars for state lawmakers. The government, however, claimed the cars were ordered before the COVID-19 pandemic.

Also, Niger State does not have a COVID-19 laboratory. Most of the samples it collects are sent to Abuja for tests. The commissioner for health in the state, Dr Muhammed Makusidi, said it took between three to five days before results arrived.

He said the state governor has given approval for the establishment of COVID-19 laboratory.

Makusidi also disclosed that the state-owned Ibrahim Badamasi Babangida University, Lapai, had eight PCR machines, adding that the state would leverage on that to set up a laboratory in Minna.

In Yobe, the commissioner for health, who is also the vice chairman of the committee on COVID-19, said the state earlier transported its samples to NCDC accredited laboratories in Abuja for tests. But with the establishment of a molecular laboratory in the neighbouring Borno, Yobe now sends samples to Maiduguri for testing.

The commissioner, however, emphasised that with the new Federal Government's arrangement to convert tuberculosis diagnostic machines for coronavirus detection, the state would soon begin testing as it has the machines on ground.

Furthermore, testing for COVID-19 has not begun in any laboratory in Kogi State. However, the Commissioner for Health, Dr Saka Haruna, said a dedicated Biosafety lab was located at the Specialist Hospital, Lokoja and has the capacity to test the virus.

"We are awaiting the validation of the existing state-owned PCR and GeneXpert machines. We have placed an order for the procurement of a mobile molecular laboratory," he said.

Samples from Kwara State are taken to Ibadan for testing. A member of the State Technical Committee on COVID-19, who does not want his name mentioned, said the time of the results also depended on how quick the samples get there because other states also go there. "But it does not exceed 48 hours for the samples to be returned to the state," he said.

Governor AbdulRahman AbdulRazaq said the NCDC team was expected in the state in the coming days to discuss the possibility of having a testing centre.

Also, the Bayelsa State Government is yet to have a laboratory for COVID-19 patients despite the strenuous processes of transporting samples to Edo, and recently, Rivers State.

The deputy chairman of the COVID-19 Committee on Task Force in the state, Dr Inodu Apoku, recently decried the delay of moving samples from Bayelsa to Irrua Specialist Hospital in Edo State, especially with border restrictions in states.

He said that most times, it takes a week before a sample could be returned after test. But with the recent opening of a modular laboratory in the University of Port Harcourt Teaching Hospital, the sample for the state could be transported for test and returned within hours or few days.

However, earlier this month, the Bayelsa State House of Assembly approved a request from Governor Douye Diri to collect a N2.9 billion loan to purchase operational vehicles for the governor, deputy governor and other top government functionaries.

Governor Diri was granted the loan by the State Assembly following a motion moved by the leader of the House, Monday Bubou-Obolo.

The Abia State Government sends samples to Ebonyi for analysis. A member of the COVID-19 Management Committee in the state said there were plans by government to establish a testing laboratory in the state to bridge the gap between the time samples are taken and when the results come out.

At present, there is no testing centre in Katsina State, but a process is being worked out between the NCDC and a private laboratory to commence testing by next week.

The executive secretary of the state's Primary Health Care Development Agency, Dr Shamsu Yahaya, told our correspondent that the NCDC was expected to accredit the laboratory in line with private-public partnership.

Daily Trust Saturday learnt that collected samples are taken to either Kano or Abuja.

Again, there is no COVID-19 testing centre yet in Zamfara State. Samples are taken to the neighbouring Sokoto for testing, the publicity secretary, Sub-committee on Task Force on COVID 19 in the state, Alhaji Mustapha Jafaru Kaura, told our correspondent.

He said it took 72 hours for results to be returned to them. He also said the state government had purchased testing facilities. "We have invited the NCDC to inspect the facilities," Kaura said.

Governor Matawalle has, however, come under heavy criticisms for purchasing and distributing exotic cars to commissioners in his cabinet despite the challenges of the new coronavirus, especially as there is no testing centre in the state.

The governor was said to have distributed cars to 19 commissioners in the state, which the opposition alleged cost N570million.

Ondo State does not have a testing lab for COVID-19. The driver who takes the samples to Ede contacted the virus and is being treated at an isolation centre.

According an epidemiologist in the state, Dr Stephen Fagbemi, it takes two days to get the results. He said the state was believing that the Federal Government would provide a lab for them, adding that plans are already underway, albeit very slow.

In Ekiti State, there's no testing laboratory for COVID-19. Samples are taken to Ede in Osun State or Lagos, as well as the NCDC lab in Abuja.

Checks by our correspondent showed that the results come out between 24 to 72 hours, depending on the number of samples.

The Task Force Committee on COVID-19 recently announced the arrival of its molecular laboratory in Ado-Ekiti, but testing has not begun.

States with testing centres and what they cost

In Sokoto, the chairman of the State Task Force on COVID-19 and commissioner for health, Dr Ali Inname, said there's one COVID-19 laboratory in the state at the Centre for Advanced Medical Research and Training (CAMRET), Usmanu Danfodiyo University, Sokoto.

On how much it cost the state or Federal Government to upgrade it for COVID-19 testing molecular laboratory, he said, "The laboratory was already there; the machines were there. It was new consumables and other things that were needed. We supported the laboratory with N5.9million for them to buy the consumables."

In Osun State, there is only one COVID-19 lab, called the African Centre of Excellence for Genomics of Infectious Diseases, Ede. The laboratory is World Bank-funded and in collaboration with Redeemers' University.

The commissioner for health in the state, Dr Rafiu Isamotu, said the state government supported the centre with materials and medical consumables,

In April, the government of Ogun State purchased and installed a molecular laboratory at the Olabisi Onabanjo University Teaching Hospital, Sagamu, as part of its efforts at flattening the coronavirus pandemic in the state.

Governor Dapo Abiodun, who was, however, silent on the cost implication of the laboratory, said the state government awaited accreditation from the NCDC for the full operation of the lab.

In Kano, there are three functional coronavirus testing laboratories located at different places within the state capital, including Aminu Kano Teaching Hospital (AKTH), Muhammadu Buhari Specialist Hospital, Giginyu, as well as the Centre for Infectious Diseases Research and Control, Bayero University.

Apart from the Federal Government's lab at the AKTH, two other molecular laboratories, namely Dangote Mobile Lab and BUK COVID-19 Test Centre, were donated by the Dangote Foundation and Bayero University respectively to upscale coronavirus testing capacity in the state.

With almost 20million people, the first laboratory was seen to be inadequate for Kano and the neighbouring states; hence the intervention by respective institutions to create windows for people to have access to testing facilities.

Findings revealed that the only commitment of the Kano State Government to the running of the three test facilities was periodic provision of protective equipment and other consumables needed for the day-to-day running of the laboratories.

There is only one modular laboratory in Borno State, which is located at the University of Maiduguri Teaching Hospital.

"Presently, the lab has the capacity to test 80 to 100 persons," Dr. Sule Mele, head of the media team of the state's COVID-19 Prevention and Control Committee, said, adding, "We are exploring the possibility of raising its capacity to 300."

Kaduna State has two active molecular diagnostic laboratories. Governor Nasir el-Rufai said on Tuesday that the third laboratory was expected within the week.

There are three molecular laboratories in Lagos State. Two of them are managed by the NCDC while the other one was built and managed by the Lagos State Government.

The director, Department of Public Affairs in the Lagos State Ministry of Health, Mr Tunbosun Ogunbanwo, told our correspondent that he and other ministry officials could not reveal the amount spent by the state to erect and equip the structure.

Edo State has two COVID-19 laboratories in the University of Benin Teaching (UBTH) and Irrua Specialist Teaching Hospital (ISTH).The laboratory at the UBTH was commissioned by the NCDC. Daily Trust Saturday could not get the cost of the laboratories at press time.

Experts task states on testing centres

A medical and molecular microbiologist, Dr Ifeanyi Cajetan Casmir, who is also the national publicity secretary of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), said every state in the country and the Federal Capital Territory (FCT) should upgrade laboratories in their teaching hospitals. Where a teaching hospital is not available, specialist hospitals should be used as COVID-19 testing centres.

He said the AMLSN was willing to partner with the NCDC and all state governments to overcome all challenges with testing.

"The ALMSN is willing to provide technical and human support to any state that desires to establish its own molecular laboratory testing centre for COVID-19," Casmir said.

Also, Dr Francis Ohanyido a public health expert, said there was the need to broaden the country's testing capacity, adding that state governments should establish COVID -19 testing laboratories instead of looking up to the NCDC.

The Nigerian Medical Association (NMA), in a statement signed by its president, Dr. Francis A. Faduyile and the secretary-general, Dr. Olumuyiwa P. Odusote, said its review revealed verifiable difficulties in collecting samples and transporting them, as well as dearth of testing kits by coordinating authorities.

The association stated that the challenges were caused by poor coordination, planning, forecasting and slow response to developments, adding that it could wipe away the efforts made so far by the government.

The association advised the Presidential Task Force (PTF) on COVID-19 and the NCDC to find the fastest workable solutions to fix the challenge, "including incorporating the approved private sector laboratories that already have established specimen pick-up and transport modalities."

The director-general of the NCDC, Dr Chikwe Ihekweazu, told Daily Trust Saturday that government and the Centre were working hard to set up new laboratories.

"We will keep pushing until every state across the coubtry has molecular laboratories," Ihekweazu said.

The Minister of Health, Dr Osagie Ehanire, however, saw the increase from five laboratories to 26 in a positive light. He said, "We now have 26 laboratories spread in 17 states. This has increased our testing capacity. However, while our daily testing capacity is presently at 2,500, unfortunately, we are able to test less than 1,500. This is due largely to inadequate surveillance and contact tracing in the states.

"As more laboratories come on board, I would like to use this opportunity to call on state governments to increase the number of surveillance teams so that more tests can be done in the laboratories."

According to the NCDC, the first step was to expand from the nine active laboratories earlier, to over 15 laboratories, by adding six more. Our checks showed that this was attained as the Centre reported 12 laboratories on April 14 across Lagos, six other states and the FCT, with 2,500 tests per day capacity.

As confirmed cases of COVID-19 increased, the second prong of providing test centres was to leverage on the capacity within six high-throughput HIV molecular testing laboratories in five states, still within the 30-day period, to raise test capacity to 5,000 daily nationwide.

These six mega-PCR labs have 18 very high throughput machines that can expand COVID-19 testing to 7,000 tests per day. The six mega-PCR laboratories are the NCDC National Reference Laboratory, Gaduwa and the Defence Reference Laboratory, Asokoro, in Abuja with four Roche C8800 test machines, and the Nigeria Institute of Medical Research Lagos with one Roche C8800 machine.

Others are the Federal Medical Centre, Makurdi in Benue, the Uyo University Teaching Hospital in Akwa Ibom and the Dim Odumegu Ojukwu Teaching Hospital, Awka, Anambra State. Each of the three facilities has four Abbott M2000 machines.

Findings also showed that in response to global demand for rapid testing, Roche and Abbot technologies are validated and have received the U.S Emergency Use Authorisation (EUA) for the use of these platforms for SARS COV2 testing. But the Benue and Akwa Ibom laboratories have not been activated, in spite of their huge potentials.

To solve logistics problems, the NCDC said it had developed the National Integrated Sample Referral Network (NISRN) across states to support ongoing transportation mechanism, using TRANEX, a courier firm for rapid sample referral to these five states.

However, many states said test results for their samples were taking up to one week to return, nearly two months after activating the COVID-19 national testing strategy.

The third prong was for the NCDC to also work with state governments to expand COVID-19 testing, using Tuberculosis (TB) Testing GeneXpert machines. It also has the fourth prong, which is to be achieved in 60 days from April, through the activation of private COVID-19 test laboratories.

Daily Trust Saturday observed that there is none yet, even as the two-month timeline elapses by June. If they are activated, the initial selected ones could test between 100 and 500 samples daily.

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