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Why Nigeria Might have the highest Coronavirus patients!


Before I dive in, let me quickly state that
Corona virus (COVID-19) is not one of Nigeria's most pressing health issues, neither is it Nigeria's most pressing societal problems. Bad leadership and corruption take number one and two. This combination, has birthed the whole lot of hunger, unemployment, insecurity. Corruption and bad leadership are the principal reasons everything about the country's fight against many diseases, including Covid-19 is beleaguered.

It is not surprising that the impact of Covid-19, like many others, is not being given attention in Nigeria. It is a country with about 90 million people living below poverty line. Many other poverty related factors (disease and non disease conditions) are more likely to kill you, as a Nigerian, before covid-19 does. You can clearly understand why, the battle to survive, is greater than the battle to not be in a situation to battle to survive (read that again).

Worryingly, there is jubilation, and a sense of victory, over the 'succesful containment' of the less than a handful of cases currently recorded in the country.

Alongside the jubilation, is the conspiracy theory being propagated in some quarters, which has it that Nigeria's only confirmed case (before yesterday), is being stage-managed by Federal Ministry of Health (FMoH) and Nigeria's Center for Disease Control (NCDC)

Another, is the (fake) news, being circulated on social media spaces, saying that Africans are 'built' genetically to stand the virus (the "germ has no power in African stomach" sort of mantra). And that Africa's tropical climate is not 'conducive' for the virus.

At the early days of the disease outbreak, it was mostly seen as a "Chinese and Oriental thing".  A month after, it caught fire. Hitting all known corners of the earth where there is civilization. Every morning, we woke up to news of a continuing spread to more countries and growing numbers of infections and casualties in countries with cases confirmed.

(Un)surprisingly, Africa (and Latin America) were missing in the COVID-19 table. This, again, reinforced the Nigerian  believe that the African man has innate resilience to this white man's disease (No longer Chinese disease).
However, a section of the public (including yours sincerely), saw it as an anomalous situation, and that the conspicuous absence of Africa on the COVID-19 'gathering' was rather ominous, and not to be celebrated. The simple explanation being that, the two continents with no recorded cases, have the most unreliable healthcare services and the most corrupt systems on earth.

After a long "wait", the 1st confirmed cases in Africa were reported in North African countries. Then followed Nigeria, South Africa and several other African countries.

It is most amazing, the conspiracy theories being leveled against FMoH and NCDC of staging the disease just to "chop money". Also amazing is the question of "oh it is not an African thing. If it is, why haven't those with confirmed diagnosis died?" Others took solace from the fact that, only less than 3% of infected persons, die from the disease.

There are few reasons, why all the above seem to be true, but generally untrue, when analysed in the Nigerian context.

A lot of diseases (including COVID-19) are not being diagnosed in Nigeria, due to lack of necessary health equipments and expertise to man those equipment.

To diagnose Covid-19, for example, you need a Polymerase Chain Reaction (PCR) machine. Another way to screen for COVID-19 is using a Computed Tomography Scan (CT scan), provided patient meets certain criteria. The use of CT scan was born out if neccesity in China. They were running out of capacity to handle covid-19 samples as their PCR machines became overwhelmed. They had to devise another means to screen possible cases, which was with CT scans. This, with the PCR machines, helped them to stay aboard.

A RELIABLE PCR machine costs between 5k to 15k US Dollars to procure. For this reason, it is a rare sighting in health facilities in Nigeria. It can be counted with fingers, how many government health facilities have FUNCTIONAL PCR machines. A 'water drop' number of private laboratories in Nigeria posses it. A CT scan machine, which is far so commonly available to the white man in this age, is still scarce in Nigeria. A RELIABLE CT scan machine costs between 50k to 100k US Dollars.  A Nigerian town with population of about 100,000 inhabitants may have just one functional CT scan machine, which probing further, is usually in the hands of privately run laboratories.

Government subsidies aside, each of PCR test or CT scan run into tens of thousands of naira, in a country with 90 million people living below 2 dollars per day, and with minimum wage of 30K.

Now you would understand the grim situation of Nigerian healthcare system, which makes it next to impossible for doctors to diagnose COVID-19. Simply put, doctors are not diagnosing this viral infection, because they lack the resources to do so.

To quickly put aside the believe that it has not killed Africans yet,  I pose this question,
"Do we have any figures (even if it is dotted with inaccuracies) of how many Nigerians that died across the country just yesterday, for example?" Nobody knows. Ok, assuming we know the number of deaths yesterday, do we know the cause of their deaths?
Accidents, 'Village people', 'the will of God', 'he has been ill for long', are the answers you get.

Another confusing situation is the fact the worst hit places, are known to be favourite destinations for Nigerians, who are known to travel a lot to China, Italy, UK, US, Saudi Arabia. Nigerian officials say they are screening people at airports, by temperature checks. Do they know COVID-19 has an incubation period of 14 days, and that the symptoms of fever only start manifesting from around the 13th day? Not minding the fact that Nigeria has at least 1400 unmanned crossing points into and out of the country.

Let me be silent on 'Contact Tracing'. Nobody seems to understand what that means in Nigeria.

As crucial as the above in painting a gross picture, is the published covid-19 fatality of 3%, mostly individuals who have co-morbidities and with immunities categorised as "immunosuppressed", since most people that come down with the infection never progress to develop life-threatening, clinical symptoms. That would seem like a "happy ending" and something to take some solace in. But that stat of 3% should only apply to environments that have seen civilization, where there are all levels of life support equipments and capabilities to cater for the very sick. Nigeria has a significant number of people in the category of "immunosuppressed". We know HIV is in epidemic proportions in Nigeria. We know Diabetes is in epidemic proportions in Nigeria. We also know that Nigeria has one of the highest birth rate in the world. So a good number of their women of childbearing age are pregnant at any given moment. Pregnancy is classed as an immunosuppressive state. We also know that the number of under 1 in Africa is one of the highest on the planet. Under ones are seen as lacking optimal immunity as they are still developing it at that age. Not forgetting that we have a sizeable population of the elderly, who, like the under 1, are medically regarded as having weak immune system. If Nigeria has these numbers as immunosuppressed, and with a comatose healthcare system, how then do you believe that the fatality is also the same with the civilized world at less than 3%, when we do not have facilities for critical care?

Piecing the above together, you can begin to question if the number of infected, symptomatic persons may  just be 2 as currently reported, or they may in fact be in tens of thousands, walking the streets, all undiagnosed or being managed for a 'red herring'.

Lastly, Nigerian CDC has published the genome sequence of the COVID-19 isolated in Nigeria, from the sample of the index patient. In case any of the conspiracists  want to go and 'check something'.

Just like Garba Shehu said in a controversial tweet, that deaths from Malaria should give us more 'headache' than Covid-19. Shehu posited that we have a lot on our hands already to worry about dying from Corona virus.  And frankly he is right. Malaria, for example, kills more people in Nigeria weekly, than Covid-19 has killed in total in China. But it is a damning indictment of the very government he is a senior official in... we are not even certain it is malaria that killed these "more people" in Nigeria.

DR. IKENGA Is a Nigerian based medical practitioner



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