Government preparedness and response towards COVID-19 outbreak in Nigeria: A retrospective analysis of the last 6 months

www.jogh.org • doi: 10.7189/jogh.10.020382 1 December 2020 • Vol. 10 No. 2 • 020382 In December 2019, a cluster of atypical cases of pneumoniae were reported in individuals who had come in contact with the Huanan Seafood Market in Wuhan, China. The causative agent was soon identified to be SARS-CoV-2 – a novel member of the β-coronaviridae family [1]. By the end of January 2020, the World Health Organisation (WHO) had declared the outbreak a Public Health Emergency of International Concern (PHEIC), and by March 11, 2020, a full-blown pandemic [2]. On February 27, 2020, Nigeria recorded its first case of COVID-19 in an Italian man who had gained entry into the country over 48hours earlier and travelled inter-state before developing symptoms and eventually deciding to self-isolate [3]. This incident marked the onset of the COVID-19 outbreak in Nigeria, resulting in 46 577 confirmed cases and 945 deaths by August 10, 2020 [4]. This viewpoint evaluates some of the preparedness/response strategies deployed by the Nigerian Government to flatten the curve (Figure 1), by highlighting the series of events that have played out before and after the arrival of patient zero.

I n December 2019, a cluster of atypical cases of pneumoniae were reported in individuals who had come in contact with the Huanan Seafood Market in Wuhan, China. The causative agent was soon identified to be SARS-CoV-2 -a novel member of the β-coronaviridae family [1]. By the end of January 2020, the World Health Organisation (WHO) had declared the outbreak a Public Health Emergency of International Concern (PHEIC), and by March 11, 2020, a full-blown pandemic [2]. On February 27, 2020, Nigeria recorded its first case of COVID-19 in an Italian man who had gained entry into the country over 48hours earlier and travelled inter-state before developing symptoms and eventually deciding to self-isolate [3]. This incident marked the onset of the COVID-19 outbreak in Nigeria, resulting in 46 577 confirmed cases and 945 deaths by August 10, 2020 [4]. This viewpoint evaluates some of the preparedness/response strategies deployed by the Nigerian Government to flatten the curve (Figure 1), by highlighting the series of events that have played out before and after the arrival of patient zero. On February 27, 2020, Nigeria recorded its first case of COVID-19 in an Italian man who had gained entry into the country over 48 hours earlier and travelled inter-state before developing symptoms and eventually deciding to self-isolate.

BEFORE THE INDEX CASE
fledgling public health care system [7], certainly COVID-19 which barely kills 5% of infected patients shouldn't be much of a problem. Well, so it seemed.

AFTER THE INDEX CASE
Following the arrival of patient zero, the Federal Government instituted the COVID-19 Presidential Task Force (PTF) to provide daily updates on the evolving situation of the outbreak in the country to the public; however, little planning went towards the preparation of palliative measures for the citizens in the event of a nationwide lockdown and enforcement of the self-isolation directive for individuals coming into the country from COVID-19 hotspots was lax. This was evident in the fact that the index case had traveled inter-state on arrival into the country, making primary and secondary contacts and not self-isolating until he became symptomatic. A more confusing scenario was the refusal of the government to institute a travel ban on flights from the most hard-hit countries, until about 3 weeks from the date the first case was reported, a time by which many believed was a little too late [8], as the virus had gained sufficient entry into the country to trigger the ensuing community spread.

ON TESTING
Prior to the onset of the COVID-19 outbreak the NCDC managed a molecular RT-PCR laboratory network of 6 laboratories in 3 states (out of 36) and the Federal Capital Territory (FCT). Though small, this was sufficient to handle the nation's diagnostic needs at the time, which mainly involved the diagnosis of Lassa fever, yellow fever and cholera, the 3 major outbreaks the country dealt with periodically. Fortunately, all six laboratories were biosafety level-3 (BSL-3) certified, a step higher than the CDC recommended BSL-2, for routine COVID-19 diagnostic procedures [9]. This meant that these facilities could be deployed immediately for diagnosing As evidence of community transmission emerged, the need to expand testing capacity further in order to gain an accurate picture of case incidence figures became imperative, leading the NCDC to publish a national strategy for the expansion of COVID-19 testing capacity. COVID-19 cases across the country. They however soon became overwhelmed, leading the NCDC to activate the laboratories of three federal teaching hospitals to bring the total number of COVID-19 diagnostic laboratories to 9 in 6 states, by April, providing a total of 2500 tests per day [

ON SOCIO-ECONOMIC IMPACT AND PALLIATIVE MEASURES
Following an accelerated spread of COVID-19 in Nigeria, the Federal Government ordered an initial 2-week lockdown on March 30th, in 2 states (Lagos and Ogun) as well as the FCT, which was extended by an additional 2 weeks on April 13th. With a teeming population of over 200 million people, 50% of which were living below the international poverty line of US$ 1.25/d [14], the informal economy represents a crucial lifeline for the increasing number of people unable to secure white collar jobs in Nigeria. The National Bureau of Statistics (NBS) reported that the informal sector was responsible for 80% of job creation in 2019 and contributed 58% to the nation's Gross Domestic Product (GDP) [14]. In lieu of this numbers, the preventive measures associated with the imposed lockdown, such as: movement restrictions, interstate travel ban and physical distancing meant that millions of people in the informal sector, relying on daily income for survival, were rendered unemployed and without a source of income [14]. In recognition of this dilemma, the government had promised palliative measures in form of conditional cash transfers for about 3.6 million vulnerable citizens; however, the eligibility criteria for this measure, including: referral by community leaders and available bank balance below N5000 (US$ 13), as well as unproven claims of misappropriation, made this scheme largely ineffective [15]. This, coupled with human rights violations by security personnel responsible for enforcing the lockdown directive resulted in demonstrations and widespread disobedience of the directive by many, effectively rendering it redundant, and contributing to community transmission of COVID-19 [14].