By Dr. Femi Ogunyemi
I published an article in the Vanguard newspaper in 2015 (google “the next ebola Ogunyemi va nguard”)
Many have asked in the last few days, “What should Nigeria do …NOW……In the next hours…today…this week..…March 23rd 2020….?”
Today as I write this at 4pm, Nigeria has recorded its first covid-19 mortality. There are 36 infected cases with 2 discharged home. Two weeks ago…all figures were nothing – ZERO.
NIGERIA needs to do four things NOW:
1. Buy, beg and borrow PPEs.
PPEs are Personal Protective equipment, think “astronauts on the moon” outfits. Nigeria can also to be imaginative. It can create and design its own. EVERYONE taking care of covid19 patients is going to NEED one. Get them now…in thousands.
2. Get ventilators NOW
Death from covid 19 usually results from respiratory failure and/or underlying medical disease.
Once the lungs fail to deliver oxygen to the muscles and vital organs, they start to fail. Organ failure is precisely what ICU is designed for.
Anaesthetists, intensivists and pulmonologists are leading and directing the intensive care of covid 19 patients worldwide.
In Nigeria, old anaesthesia machines abound that can be modified for use in desperate situations. The fine adjustments required for effective care will not be available in these vintage models, but they will still deliver oxygen to the body.
Nigeria does not manufacture ventilators…so we must “buy, beg and borrow”. China, being a manufacturer, was greatly helped in this regard. The US government may have to institute its Defence Act to force companies to produce these machines.
NIGERIA needs them now….in hundreds, maybe thousands.
Cross infection in these machines (if they are in short supply) can worsen the situation and may worsen the outcomes.
3. Start to TRAIN health Personnel NOW
This includes doctors, nurses, technicians, porters…everyone in the healthcare setting.
Cross training may be necessary..i.e. doctors may have to do nurses duties and vice versa; technicians may have to do nurses duties and anaesthetists may have to train other doctors how to intubate and make simple adjustments on ventilators.
They will all need PPEs.
TRAINING should start now while the patient numbers are low.
I emphasized in my 2015 article the joint role of the legislature, judiciary and executive arms at all 3 levels of Govt. As I write, the UK Govt. is about to meet to enact new legislation; the US Congress has been at it for two days. New laws have to be made and they have to be enforced.
The immediate actions I have outlined this article must apply to ALL healthcare facilities that will be responsible or involved in covid 19 care, be it governmental, non- governmental or private.
4. TOTAL LOCKDOWN …NOW
Social distancing is NOT lockdown.
Shutting the airspace is NOT a lockdown.
This is the time for a mandatory and enforced lockdown.
This is hard to do in a free society with individual rights and freedom of movement.
It was easier for China but has been difficult for Italy.
A delay in placing a LOCKDOWN makes it less effective.
Essential services can still be provided in a lockdown scenario. This is what Government is for.
A lockdown in Nigeria NOW will significantly limit the spread of Covid 19.
It must be mandatory AND enforced.
Nigeria has a 250m+ people and is densely populated.
The world, with “corner eye”, is watching and waiting for Nigeria and Covid 19.
A word about Chloroquine, Malaria and Covid 19.
Chloroquine was used (anecdotally) in the early cases in China. It was said to have been effective. But these were no clinical trials involving what we call randomized controls and other criteria. The numbers were small and other (confounding) factors could have existed in those patients.
My thought at that time was: IF, and only IF, the Covid pandemic uniquely spares sub-Saharan Africa, researchers might want to explore whether there is a link between malaria endemicity and resistance to the virus.
Since the China outbreak the virus has permeated west and central Africa but its final course yet undetermined.
The incidents of chloroquine poisoning in Nigeria has now made headlines in the US media.
Many do not know that this medication was actually banned in Nigeria in2005 because the malaria (a parasite, not a virus) developed resistance to it.