A patient who is suspected of suffering from COVID-19 coronavirus undergoes testing at the University of Maiduguri Teaching Hospital isolation centre on May 10, 2020.
A patient who is suspected of suffering from COVID-19 coronavirus undergoes testing at the University of Maiduguri Teaching Hospital isolation centre on May 10, 2020. Photo: AUDU MARTE/AFP via Getty Images

How Nigeria Defied Dire Predictions in the Battle Against COVID

Despite warnings of bodies on the street, Nigerian scientists' experience battling Ebola has seen the country respond to COVID arguably more skilfully than many Western nations.
December 9, 2020, 2:05pm

Everything changed in Nigeria on the 24th of February, when an Italian man flew into the country on a Turkish airline flight from Milan to inspect equipment at a factory owned by a cement manufacturing company. He landed in Lagos and was chauffeured by the company’s driver to the Airport Hotel in Ikeja – less than ten kilometres from the city’s international airport – where he spent the night before heading to Ewekoro, Ogun state, in southwest Nigeria, the following day. 

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Two days later, he began to display various symptoms: fever, headaches, muscle pain, and fatigue. Unsure of what was going on, he went to a local clinic to receive treatment. After reviewing his symptoms, medical and travel history, Dr. Amarachukwu Allison, a site medical officer at International SOS, suspected that he had the coronavirus. She immediately gave him a mask and ensured that he was isolated. Government biosecurity officers were alerted and they moved him to the isolation facility at the Mainland Hospital in Yaba, Lagos, widely seen as specialising in infectious diseases. His sample – tested at the Virology Laboratory of the Lagos University Teaching Hospital, a part of the Laboratory Network of the Nigeria Centre for Disease Control (NCDC) – came back positive.

On the 28th of February, the Federal Minister of Health made the announcement: Nigeria’s battle with the coronavirus had begun.

“It was inevitable,” Dr. Femi Adewuyi, who volunteered as a medical officer at the Mainland Hospital, tells VICE World News. “We knew it would eventually get to Nigeria, irrespective of how hard we tried.” 

Prior to the index case in Nigeria, thousands of people across about 50 countries (including two African countries – Egypt and Algeria) had already been infected. The World Health Organisation had by then declared it a global health emergency.

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As soon as the first case was confirmed, all the required national agencies and institutions involved sprang into action. The management at Lafarge Plc., the company that owned the factory, closed the clinic where the Italian had been initially diagnosed, and placed all the members of staff who had been on duty that day on compulsory 14-day quarantine. A team of epidemiologists began tracing the Nigerians who might have been in contact with the infected Italian man to ensure that they were isolated and quarantined. Strict screening measures, documentation, temperature checks, and disinfection were also heightened at points of entry into the country. 

But Nigeria’s response to the coronavirus began long before it arrived within its borders – when many still considered it a distant threat. Since January, health care workers had been undergoing training and tabletop sessions with the World Health Organisation and NCDC to prepare them for the possibility of an outbreak in Nigeria.

The Isolation Centre at the Mainland Hospital quickly became the epicentre of the coronavirus response in Nigeria, and the possibility of a surge in the number of infected cases drove the hospital to make adjustments – all previous medical operations carried out at the hospital stopped as all admitted patients were either transferred to another hospital or discharged.

After three weeks, the Italian man was discharged, but the number of active cases had continued to increase, with most of the new infections recorded in Lagos State. To limit the spread and facilitate faster testing, the government imposed a lockdown in the states with rising cases, banned inter-state travel, and closed all airports. All within a couple of weeks of the first confirmed case.

It didn’t take long for the gloom and doom forecasts to begin. As the outbreak spread across Africa, development experts lamented the mass coronavirus deaths imminent for African countries with a shortage of doctors, crumbling health infrastructure, poor housing facilities, lack of access to water, and poor general hygiene. In an interview, Melinda Gates speculated that, like Ecuador, African countries would be “putting bodies out on the street”. 

Many health experts disagreed, however, insisting that Nigeria was prepared to battle another pandemic after the lessons learned, and the capacity built, from the nation’s success story with the 2014 Ebola crisis. “We are very accustomed to dealing with pathogens of high consequence,” the Lagos State Health Commissioner, Prof. Akin Abayomi said. “It is a skill, and it is something that we have been refining since the Ebola outbreak.”

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But even with the rising number of reported cases in Nigeria and across the world, many Nigerians refused to take the virus outbreak seriously, claiming that it was all a government gimmick. “It’s not real,” one man had told the BBC. “They are using it to defraud the masses who are already suffering.”

At first, while the number of cases was more manageable, things were fairly relaxed. “A good number of them didn’t have any life-threatening symptoms,” Dr. Adewuyi says. “It looked like Malaria.” This fuelled the suspicion, even among patients, that COVID-19 wasn’t anything to fear and wasn’t as serious as the government was making it seem. “There were a number of times we were even threatened as doctors that we are holding them against their will; that COVID-19 was a scam, and the government was trying to make money off them,” he adds. But the isolation centre at Yaba would soon start telling a very different story.

Dr. Adewuyi did not begin his COVID-19 volunteering stint at the Mainland Hospital as a doctor, but as a photographer – a hobby he took up in his second year of medical school, which he went full time into after about 4 years of medical practice. But after a month of volunteering as a photographer, his skills as a doctor were needed. The numbers were rapidly increasing, and many of the doctors had been exposed to the virus and were required to go into isolation. In September, the World Health Organisation reported that over 2,000 healthcare workers in Nigeria had tested positive, a figure that’s higher than most other countries on the continent.  

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The Mainland Hospital was also where Oluwaseun Ayodeji Osowobi eventually ended up. The 29-year-old was on her way back to Lagos from London – where she had attended the Commonwealth Day Service – in March when she started noticing that she might be sick. “I felt something was wrong with my body, but I just imagined it was because I had an extremely packed week at the Commonwealth,” she says. But she began to worry after she was told to step aside during the thermal screening process at the airport in Lagos. Her temperature was checked again, but it had normalised and she was freed to go. 

After she got home and her illness intensified, she decided to isolate herself first. From her home in Lagos, she started searching for her symptoms on Google. “I kept reading, and reading. I was really scared,” she says. But having other non-COVID-19 symptoms like vomiting and diarrhoea made her sceptical. To rule out the worst possible situation, she called the NCDC helplines to demand for a COVID-19 test.

She woke up a few hours after her test, at midnight, to loud knocks on her door and several missed calls. Curious, she opened the door to see medical personnel dressed in full PPE saying they had been told to come and get her as her sample had returned positive. “Everything in me sunk,” she remembers. “The tears started rolling down my face.” 

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When she got into the ward, she discovered she had been the first woman to have been admitted. “It was quiet,” Osowobi remembers. “It was lonely. I could hear cricket sounds. I was scared. It was a terrible experience.”

Her experience of the coronavirus had been one of the worst she saw throughout her time at the isolation centre. Her illness intensified, her vomiting got more frequent, and she couldn’t eat for loss of appetite. At some point, she was sure she was going to die. Weeks later, however, after consistent treatment at the isolation centre, she recovered and was discharged.

The coronavirus response got into its second phase in May, a few weeks after Nigeria recorded its first casualty from COVID-19 – a 67-year-old man with an underlying case of myeloma and diabetes, who was also undergoing chemotherapy. During this time, the number of isolation centres and testing facilities in the country had increased, and cases in Nigeria were at their all-time high. On the 11th of June, the NCDC announced 681 new infections, beating the previous record of a few days before – 663. The medical state of the infected patients had also worsened. “By the peak season,” Dr. Adewuyi says, “about 80 percent of the patients needed oxygen, and within a short while – about June/July – the hospital was filled to capacity.” In Yaba, the men’s ward was filled to capacity.

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The Nigerian government has not been alone in the fight against COVID-19 — private institutions and individuals have joined forces in creating support and response teams to mitigate the effect of the outbreak on government-owned resources and creative solutions in areas where there wasn’t any. Coalition Against COVID-19 (CACOVID), a task force spearheaded by Aliko Dangote, Africa’s richest man, and other private sector leaders was created weeks into Nigeria’s novel case. Since then, the organisation, along with other private businesses and religious organisations, has equipped healthcare centres around the country with molecular testing labs, ambulances, Intensive Care Units, beds and masks. They also created communication and awareness materials, renovated several isolation centres, supplied palliatives to low-income individuals to ease the effect of the lockdown, provided accommodation for healthcare workers during the lockdown, and built a new permanent isolation centre inside the Mainland Hospital. Private Medical Organisations also set up free COVID-19 testing booths across the country, supplying medical equipment and disposables, and also creating ICU centres. 

Yet one of the failures of Nigeria’s response to the outbreak has been the low testing rates. On the 28th of April, the Director-General of the NCDC announced an “ambitious target” to test at least two million people within three months of the announcement. As of the beginning of November, however, barely over six hundred thousand samples had been tested.

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Dr. Olushola*, who works at the Mainland Hospital and asked for anonymity to speak openly about the challenges, tells VICE World News that the problem of testing in Nigeria is linked to infrastructure. “The testing kits weren’t really available,” he says. “And the little that comes in, they are prioritised for people to test.” The criteria for prioritisation of testing was based on people with confirmed symptoms and close exposure to confirmed cases. Because of this, it was impossible to embark on mass testing as initially planned. 

Although slow, there has been some testing successes. At the end of September, The Federal Minister of Health announced a molecular testing kit developed by the National Institute of Molecular Research that could deliver results in less than 40 minutes and is cheaper than the usual test kits. In October, the NCDC announced that all 36 states in Nigeria finally had at least one COVID-19 testing centre. 

Not everyone is as lucky as Osowobi. Since the beginning of the outbreak in March, Nigeria has recorded a death toll of over 1,000 deaths from the coronavirus – including some prominent political figures, such as President Buhari’s chief of staff, Abba Kyari. 

As expected, it’s also been a huge challenge for frontline workers. “Initially, when we got deployed to the field, we worked so much that there was a lot of burnout,” Dr. Olushola says. “And there was a particular time that there [were a lot of] healthcare workers infections.” To relieve the adverse mental health challenges on the healthcare workers, The Lagos State Government organised a psychosocial team that initiated workshops for health workers and provided emergency helpline numbers that they could call for psychological and emotional support. The hospital leadership also ensured that they were always accessible to the healthcare workers in case they needed an opportunity to talk.

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Not extending this service to other Nigerians, especially those who went through the horror of battling the virus, Osowobi says, is where the Lagos State Government “dropped the ball”. After sharing her story, she had received a lot of negative responses claiming that she was not infected and had been paid by the government to make up a story. Her family also began to receive disapproving looks and gestures from neighbours. Coupled with memories from the isolation centre, Osowobi’s mental health began to deteriorate. “I was experiencing PTSD. I was depressed at some point,” she says. “You can’t experience what I experienced and be normal”. 

She is not alone in this. In April, Dr. Victor Ugo, founder of Mentally Aware Nigeria, launched PROJECT COVID, an arm of their mental health response, after an exponential increase in calls to the NGO helpline with the incidence of COVID-19. “When there’s a pandemic, people are very anxious about getting the virus and also anxious about how to survive, both economically [and] financially, in such a period,” he says. The goal for PROJECT COVID, Dr. Ugo says, is to provide useful resources that people could use to cope with the adverse mental health challenges that came with the COVID-19. 

Nigeria’s response is in its third phase. The daily infection rates have declined drastically and life has returned to some semblance of normalcy across the country. Schools, churches, event centres, and clubs have reopened. Many isolation centres around the country have been shut down, and even at the Mainland Hospital, normal hospital duties have also resumed alongside the COVID-19 response. 

Dr. Olushola believes that although Nigeria’s success so far with COVID-19 could be attributed to many other unknown factors, the immediate response by the government played a huge role in curtailing the outbreak. Some experts also believe that Nigeria’s young population. Unlike Europe and the US with an average age of 40, the average age of Nigeria’s population is 18. Research shows that between 0.3 percent and 1.2 percent of symptomatic 10 to 19-year-olds require hospitalisation, while between 3 percent and 5 percent of symptomatic 40-year-olds will require hospitalisation.

But Nigeria is not completely COVID-19 free. Medical experts warn about the possibility of a second outbreak, especially since compliance to COVID-19 safety practices like mask wearing, social distancing, and compulsory self-isolation for travellers are at an all-time low. Since October, Lagos has recorded two cases of COVID-19 in boarding schools. 

It’s been 9 months into Nigeria’s journey with the coronavirus. The end is still not in sight. “COVID did not give us an expiry date,” Osowobi says. “Take precautionary measures, practice social distancing, wear [your] masks, stay at home if you don’t have to be outside.”

*Name changed to protect his identity.