The increase in the number of confirmed cases of coronavirus in Nigeria has triggered fear and governments both at the federal and state levels are scrambling to implement measures that they hope would stop the spread of the disease.
As of March 19, the confirmed cases of COVID-19 in Nigeria was 12. Lagos, the country’s commercial capital with over 20 million people has eleven cases while Ekiti, a state in the southwest has recorded one case. Many state governments have ordered the shutdown of Schools, churches and sporting activities. The Federal Government has ordered schools across the country to shut down.
Bothered by the spread of the disease in Europe, the Middle east and North America, many Nigerians called on President Buhari to close the land borders and ban travelers from countries with high burden of COVID-19, but the Nigerian Government said it was not considering restricting travels. While President Buhari told Nigerians to not panic, the country’s health officials said they were capable of handling the disease. On the day health authorities announced that COVID-19 case had risen to eight – one of the cases came in through the land border with Benin Republic and other cases came from countries with high burden of the disease — the federal government finally announced the restriction of travels to Nigeria from 13 countries – all have over 1000 confirmed cases of the infection. A move some criticised as reactive rather than proactive and was coming when the disease already had a head start.
“As it is now, we have a combination of imported cases and local transmission,” Professor Akin Abayomi, Commissioner for health in Lagos said while announcing that Nigeria has 12 confirmed cases of coronavirus. “Currently, we are following over 1,300 people right now to find information about the state of their health and the number is increasing.”
Nigeria’s health authorities are now battling with how to prevent the spread of the disease. A major part of the task is contact tracing and testing.
In a country where there is no effective and unified identity management structure, tracing persons suspected to have been infected will be a huge task. Some weeks ago, Prof Abayomi had to reveal the identity of two persons who were on the same flight with the index case to the press because they could neither be reached through the phone number they provided at the airport nor were they found when traced to the destination addresses they provided. There are fears that some people gave fake contact details at the airports.
The government has asked people coming into Nigeria from countries with high burden of the disease to self isolate. It is known that an infected person who is asymptomatic can infect other people. This raises concerns that some people who do not feel ill may not self isolate especially if not monitored or if there are no consequences for non-compliance.
The stage of tracing and testing suspected persons are very crucial in determining whether Nigeria’s cases of infected persons would rise.
Singapore’s use of contact tracing has been praised by experts and the World Health Organisation (WHO). The country’s use of the system was described by Havard epidemiologists as a “gold standard of near-perfect detection.”
The Asian country was able to slow the spread of the disease even after it had spread into a local community by using a combination of CCTV footage, police investigation and old fashioned, labour-intensive detective work – which starts with a telephone call.
According to the Singapore Ministry of Health, as of March 16, there were 243 confirmed cases. Details of the cases show that while 96 had been contacted before diagnosis, 147 includes imported cases – cases linked after diagnosis and unlinked cases. 5,711 close contacts of cases have been traced.
“We would have ended up like Wuhan. The hospitals would be overwhelmed,” Leong Hoe Nam, an Infectious diseases specialist at the Mount Elizabeth Novena Hospital and a Singapore government advisor told the BBC.
In Singapore, tracing contacts involves multiple agencies. When health officials cannot reach suspected persons, the police criminal investigation unit is brought on the case. Between 50 to 100 police officers work on contact tracing everyday in addition to regular police duties. Singapore’s infectious diseases act makes it lllegal to refuse to cooperate with the police in their attempts to gather information.
A person suspected to be infected is traced, tested and then asked to self –isolate after signing a quarantine order — which makes it clear that disobedience of the order will attract either a fine — 10,000 Singapore Dollars (about N2.5 million) — jail time or both.
The gold standard contact tracing by Singapore involve health officials working closely with the police who modified criminal Investigation tactics, leverage on technology and legislation to prevent the spread of COVID-19.
While years of poor investment in technology could make contact tracing cumbersome for Nigeria’s health officials, the country could still adopt some measures used by countries who have effectively slowed the rate of new infections. Passing legislations that would help prevent the spread of infectious diseases requires lawmakers to work closely with the executive arm of government.
Preventing the spread of disease goes beyond shutting the borders and banning large gathering of people. Although the government believes otherwise, some say Nigeria was never prepared for COVID-19. The next disease outbreak would tell whether the government learned any lesson from the one it is currently battling.
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