Jide Akintunde, Managing Editor/CEO, Financial Nigeria International Limited

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Why COVID-19 was not killing many people in Nigeria 18 Feb 2021


A view of Lagos Business District as deserted during the COVID-19 lockdown on
March 31, 2020


The first case of COVID-19 infection was confirmed in Nigeria in late February 2020. Over the next eight months during which the first wave of the pandemic hit the country, some prominent Nigerians died from the novel coronavirus disease. But the death toll was minimal. The prognosis that the virus could see dead bodies littering Africa’s streets did not happen in Nigeria, or anywhere on the continent.
    
For many, the escape from the worst-case scenarios, including the projection, last April, of up to 3.3 million COVID-19 deaths in Africa by United Nations Economic Commission for Africa (UNECA), was a non-event: the pandemic was altogether a hoax. Those less in denial, believed the tropical African weather neutralises the transmissibility of the virus responsible for the highly infectious disease. These and other unscientific ideas received potency from political conspiracy theories.

Even now that the virus is on its worst killing spree around the world, disinformation remains a major obstacle to containing the spread of the infection. False information is also likely to fuel hesitancy to the use of the COVID-19 vaccines that were developed and certified through established scientific processes.

It is important to debunk the claims that COVID-19 is a hoax. During the campaign for the November 2020 general election in the United States, then-President Donald Trump said “Covid, Covid, Covid, Covid” was being chanted, simply to undermine his re-election. After he was roundly defeated in both the Electoral College and popular votes by then-former Vice President Joe Biden, now President, the pandemic reached new peaks of daily infections and deaths in the U.S. The poor handling of the pandemic by the Trump administration was certainly a major contributory factor to his electoral defeats.

With the exception of China, virtually all the nuclear-power nations and the world’s largest economies bear the heaviest brunts of the pandemic. It is incredulous to affirm that a hoax, and not a naturally virulent infectious disease, is behind the massive economic disruptions and deaths that have been associated with the pandemic. If, as rumoured, the pandemic was caused by a laboratory-engineered virus by the Chinese state, military offensives – even if they only guarantee mutually-assured destruction – would have been the prominent response.

COVID-19 was not running rampant in Nigeria during the first wave for a number of reasons. Key among the reasons was the “draconian” lockdown announced by the federal and state governments from the end of March. Compliance with the control measures was very high, especially in the cities. This was despite the gross inadequacy of the provision of palliatives to vulnerable citizens affected by the acute economic disruptions. The lack of resistance to the lockdowns demonstrated the ease of capture or surrender of democratic freedom in the country. It also suggested that, like in Japan, Nigerians are willing to obey the government.

The virus was restricted to the cities. The success of isolation of cases, which is a key control measure against COVID-19, was driven by historical and cultural factors. More generally, diseases cause stigmatisation in our society. The responses often include isolation. This remains the case, whether we are dealing with psychiatric disorders – which are noncommunicable – or contagious diseases like leprosy. While we don’t really know the extent of community spread of the coronavirus beyond the major cities of Lagos and Abuja and the state capitals, cases in the rural areas would have been contained by longstanding practices of isolation of illnesses – this time amounting to a good public health practice.
    
For the urban population, COVID-19 evoked recent memories of Ebola, the awful viral disease that bares its virulence on the surface of the skin. The experience with Ebola also drove compliance with hygiene practices for controlling COVID-19 infections. It must have been very helpful that Ebola, with its physical symptom, preceded the COVID-19 outbreak. Because of the skin rash it causes, some Nigerians were using salt-water to bathe as a preventive measure against Ebola. While it was unlikely that the disease would be ignored on account of the symptoms, it would have been likely to more generally downplay COVID-19 that could be asymptomatic and that causes common symptoms like fever, sore throat and shortness of breath.
    
COVID-19 has so far proved in Nigeria that it is the disease of the political and economic elites and, to some extent, the middle class. This does not mean that the poor cannot be affected. It only means that the virus is more likely to be contracted by privileged citizens with access to international travel and spread to those who have physical proximity to them. Not only is the number of such people relatively very small, compared to the over 100 million citizens living in extreme poverty, Nigeria’s social divide also limits physical interactions. The rich and poor in Nigeria don’t share common transportation, for instance, as they do in the developed countries.

So, why does it now appear that in the second wave of the pandemic there may be a dramatic change of reality? Why are more Nigerians likely to die from COVID-19 this time around?
    
First, higher numbers of COVID-19 infections mean higher numbers of deaths. In spite of the improvements in the therapeutic treatment of the disease, rising number of infections still tends to correlate to rising number of deaths globally. This is the case in the U.S., where rising daily cases during the current wave have conduced to rising daily deaths. Inelastic supply of treatment capacities, including the number of available healthcare workers and hospital beds, have driven the higher fatalities. In the example from California, patients are given just 20 minutes to respond to emergency treatment. After that, it would be the turn of others. In grimmer situations, patients are not even evacuated to hospitals. It was the gross inadequacy of healthcare facilities in Africa and manpower shortages that informed the modelling outputs of catastrophically-high number of COVID-19 deaths for the continent.

Many countries are now reporting new strains of the novel coronavirus that are more transmissible. Although the strains are believed to be less fatal, they nevertheless are driving up the absolute number of deaths. Analysis of data on infections and fatalities in Nigeria suggest the currently-raging second wave of the infections is deadlier. In the first 10 months (leading to December 17, 2020) since the first case was reported in the country, the death toll was 1,201, according to data by Nigeria Centre for Disease Control (NCDC). This averaged 4.0 daily deaths. But in the 30 days leading to January 17, 2021, additional 234 people died, averaging 7.8 daily deaths. The peaks of daily infections since February last year have been in this second wave.
    
Second, the relevant policymakers and the citizens alike have become lethargic to the control measures. This, again, is not an exclusive Nigerian phenomenon. Policy-makers, who seem to have rested on their oars, and citizens weary of lockdowns have allowed the virus to run rampant. Since the development of the vaccines, attention has shifted to their distribution. In the short-term, this has played out to be somewhat diversionary. And, so far in the new waves that have seen more infections and deaths, limited travel restrictions have been imposed. This suggests that the choice between public health and the economy is increasingly being made in favour of the latter. The opposite was more the case during the first wave.

Third, is acute financial constraint of the government. The Nigerian government has no financial power to provide palliatives to the citizens; it is not even making any pretension to meeting this challenge this time around. Even the funding for the purchase of the vaccines were not provided for in the 2021 budget. The dire financial straits have informed the reluctance to impose new lockdowns. The policy implication, certainly not the aim, is more tolerance to rising infections and deaths. As people go about their economic activities, the virus will continue to spread.

During the last Summer, it was clear that warm temperatures do not provide foolproof protection against COVID-19. As Americans and Western Europeans came out of lockdowns to enjoy the warm weather, crowding public places, pubs and recreational facilities, their countries experienced second waves of the infection. India, which has tropical wet and dry climate, has the second-highest number of COVID-19 infections and third-highest number of deaths in the world, according to data by Worldometers.
    
Nigerians cannot entirely rely on warm temperatures to curb the spread of the infection without practising social distancing, regular washing of hands (or using hand sanitiser) and wearing of face masks. These are the practical solutions left and they are affordable. The effective role of the government is now limited to providing public information service to the citizens on these control measures. It would likely take years to vaccinate enough people in the country to achieve herd immunity.
    
Rather optimistically, with a new Biden administration, anti-science hoaxes that deny the pandemic and muddle the scientific control measures will begin to fade away as America re-enacts its global soft power. Ultimately, COVID-19 would be defeated. It will certainly cease to be a major threat to public health.

Jide Akintunde is the Managing Editor of Financial Nigeria publications.