Nigeria must learn from history in fighting Covid-19

28 Apr 2020
Mustapha Danesi

Summary

Most of the fatalities in the Spanish Flu happened in the second wave.

Professor Mustapha Danesi

Mustapha Danesi, Consultant Physician, Professor of Neurology, and Chairman of the National Polio Expert Committee, spoke with Jide Akintunde, Managing Editor of Financial Nigeria, on Nigeria’s efforts to curtail the spread of Covid-19, and provides key advice on reopening the economy.

Jide Akintunde (JA): As at April 14th, Nigeria officially recorded 343 Covid-19 infections, and 10 fatalities from the confirmed cases. How would you put these numbers in perspectives, vis-à-vis the numbers from around the world?
 
Mustapha Danesi (MD): These numbers were relatively few compared to Europe, North America, Asia as well as some African countries such as Egypt, South Africa and Morocco. The 10 deaths translated to a fatality rate of 2.92 per cent, which falls within 2.5 per cent average fatality rate estimated for Covid 19. However, as at 27th of April, Nigeria recorded 1,337 cases and 40 deaths. These new figures translate to 2.99 per cent case fatality rate (not too different from the earlier rate).

This number of cases is still relatively small compared to many countries in Europe, Middle East, Asia, North and South America and some countries in Africa. The number of cases in Nigeria per one million population is six, which is less than most African countries except Ethiopia, Democratic Republic of Congo, Tanzania, Uganda, Zambia, Madagascar, Malawi, Mozambique, Burundi, Zimbabwe, Angola, South Sudan, Chad, Gambia, Mauritania and Republic of Benin.
 
The total number of people affected in Africa as of the 28th of April is 34,197, which is less than the numbers in many countries in Europe as well as the United States, Iran, China and Brazil. India alone has 29,451.   

JA: Nigeria has arguably under-tested for the virus, based on our population and the total number of tests that have been conducted in the country, which stood at around 5,000 in the second week of April. Are we in alternative reality in Nigeria on probable significant divergence between actual number of cases and deaths compared to the official numbers?

MD: Nigeria has obviously undertested, compared to many countries. As of the 27th of April, the country has done 10,918 tests, which translate to 53 tests per one million population. This is less than most countries in the world, including many African countries. The only countries that have done less tests per one million population than Nigeria are Malawi with 36, Burundi with 24 and Yemen with 4.

However, there are several countries where official testing figures are unavailable for comparison. Among such countries where testing figures are not reported are China, Cameroon, Ivory Coast, and Angola.

JA: The science of Covid-19, including the medical science, is nascent and fast evolving. Nigeria has almost completely depended on knowledge development on the virus from the advanced countries and the expertise of China. Is this the best we can do as a country?

MD: For now, this is the best we can do. Nigeria has lagged behind many countries in regards to development in medical science. To develop a vaccine for Covid 19, many countries have sequenced the DNA structure of the virus. Only three African countries have been able to do this: Egypt, South Africa and Ghana. Without African input into the genomic structure of Covid 19, it would have been uncertain if the vaccine eventually developed would be effective in the continent.

JA: Immediately following the outbreak in Nigeria, we saw resources mobilized by the private sector essentially deployed to building some emergency medical facilities. Looking ahead, how should the country proceed with building capacity to systematically manage this and other future epidemics and global pandemics in the country?

MD: These emergency medical facilities are the wrong approach to development of healthcare infrastructure. We had not developed health infrastructure before the pandemic. Many African countries with better infrastructures have had lower Covid-19 mortality rates than Nigeria, namely South Africa, with 1.88 per cent; Gabon, 1.4 per cent; Ivory Coast, 1.2 per cent; Senegal, 1.2 per cent; Ghana, 0.7 per cent; Guinea 0.6 per cent. Rwanda has recorded no death. I excluded African countries with less than 100 cases in this analysis. I do hope Nigeria will proceed to build the capacity to systematically manage future epidemics. This is just a hope.

JA: A senior-ranking government official said he was not aware of the deplorable state of the Nigerian healthcare system until this outbreak. Are you confident, based on your decades of experience as a physician and professor of neurology at the Lagos University Teaching Hospital (LUTH) that the country can use this crisis to turn around our healthcare system?

MD: Let us hope the country can do that. Many senior government officials and wealthy Nigerians have not been utilizing Nigerian health institutions when they fall ill. They go to hospitals in Europe, India, Dubai or North America. This pandemic has taught many of them the lesson that, sometimes, it might not be possible to utilise foreign healthcare institutions as the current travel bans have demonstrated. Maybe they would start looking inwards. Again, this is just a hope.

JA: The big debate now is how to reopen the country and not risk increased rate of infections or a second wave of infections. Here, public health and economic considerations are in seeming conflict. What is your argument for healthcare to be the overriding consideration, in Nigeria?

MD: This is a very complex issue. The economic cost of lockdowns has been devastatingly heavy in Nigeria, given the weak economic growth in the last few years and the government’s already fragile fiscal position. However, uncontrolled reopening because of economic pressure will be disastrous.

Let us take a lesson in history. The most severe pandemic in history was the Spanish Flu of 1918. It lasted for two years, and occurred in three waves. 500 million people were infected and 50 million deaths were recorded. Most of the fatalities happened in the second wave. The people were so affected by the quarantine and social distancing measures during the first wave that when the measures were lifted, they rejoiced in the streets with reckless abandon. Within the following weeks, the second wave occurred, followed by tens of millions of deaths. Let us not repeat history in this Covid-19 pandemic.

Notwithstanding the need to be vigilant, if we continue the lockdowns, it will further damage our economy beyond repair and cause social unrest. It is, therefore, advisable that we embark on guided reopening in several phases, maintaining social distancing, frequent hand hygiene, universal wearing of masks and frequent decontaminations of public places and offices. There must be regular and adequate education of the public. There are World Health Organisation (WHO) guidelines on how businesses can safely reopen and how hospitals can safely operate.  

JA: How are you enjoying your recent retirement?

MD: I disengaged from teaching at the University of Lagos and working as a Consultant Neurologist to the Lagos University Teaching Hospital in August 2018. But I am still very busy. I have been very much engaged with WHO polio eradication programme in Nigeria in my capacity as the Chairman of the National Polio Expert Committee. I also run a private neurological practice and a medical education outfit, called Medical Tutors Ltd, which is accredited by the Medical and Dental Council of Nigeria (MDCN) to provide continuing professional development for practicing doctors. The company also provides health education for the public on its website, medicaltutors.com.

The spiritual law of motion does not allow for standstill and demands that as long as one is alive and healthy, one should continue to engage in meaningful activities.