SPECIAL LECTURE SERIES

  • Posted on: 22 June 2020
  • By: Prof Julie Umukoro

NIGERIA’S RESPONSE TO THE COVID-19 PANDEMIC: OUR CHALLENGES AND THE WAY FORWARD

BEING A PAPER PRESENTED AT A SPECIAL LECTURE SERIES OF THE ASSOCIATION OF NDOKWA PROFESSIONALS IN ACADEMIA ON JUNE 7, 2020

BY 

PROFESSOR FREDERICK IKECHUKWU ESUMEH

DEPARTMENT OF MICROBIOLOGY, AMBROSE ALLI UNIVERSITY, EKPOMA, EDO STATE, NIGERIA

PREAMBLE:

COVID-19 simply means coronavirus disease 2019 and the disease is caused by a novel member of the coronavirus family. The first case of the present coronavirus infection was reported in December 2019 in Wuhan, Hubei Province, China (Yuki, Fujiogi and Koutsogiannaki, 2020). With increase in travels, the COVID-19 infection soon spread to the entire continents of the world, prompting the World Health Organization in March 2020 to declare the disease a pandemic (WHO, 2020).
Globally, the ravaging COVID-19 has placed many countries of the world and their leaders on the edge. The manifestation of the pandemic is such that no one is safe, except we are all safe. Many of our industrially advanced countries whose health system used to be the “safe haven” of some of our African including Nigerian aristocrats are feeling the devastating effects of the disease. As at 2nd June 2020, the global COVID-19 cases stood at 6,403,001 with 378,112 fatalities. The USA, Brazil, Russia, Spain, UK and Italy are leading with high number of cases. The figures are still rising by the day.
In Nigeria, starting with the index case of 27th February 2020, the figure has climbed to 10,578 cases, with 299 deaths as at 2nd June 2020 14.05 GMT; and with clear indices of exponential increase in the number of cases in the coming weeks. It has been opined by many concerned Nigerians that the figures stated above may not reflect the actual cases of COVID-19 in Nigeria because of poor self-reporting practices and low testing capacity. As reported by the Nigerian Centre for Disease Control (NCDC), the figures above according to States are shown in Table 1Faced with the COVID-19 pandemic, most industrialized countries turned to their universities and research institutes for solutions, while rolling out several containment measures. The question is what was/were the response(s) from Nigerian Government. Let me place it on record that it took Nigeria several weeks from the first case to close its air space and borders to other countries. This singular act led us to the current situation where we are struggling with our efforts to contain the pandemic in Nigeria. Of course, there was no recourse to Nigerian universities and research institutions because of their parlous state of funding and general lack of trust in the output from these institutions. 
More importantly, and despite Nigerian government guidelines to contain the spread of COVID-19, many Nigerians received the birth of the pandemic on our shores with disbelief and as a hoax. Some say there is nothing like coronavirus; COVID-19 is a disease of the Western countries; it is nothing but common cold/ catarrh which can be cured with our herbal concoctions/ “agbo”, and others say it is caused by a bacterium. Thus, this highly summarized narrative is to set the records straight by giving highlight on aspects of COVID-19, our challenges in the response to the pandemic and what possibly are ahead of the Nigerian citizens

CAUSATIVE AGENT OF COVID-19/ HISTORY OF CORONAVIRUSES

As earlier stated, coronavirus disease 2019 (COVID-19) is caused by a virus known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic ( HYPERLINK "https://pubmed.ncbi.nlm.nih.gov/?term=Cucinotta+D&cauthor_id=32191675" Domenico and   HYPERLINK "https://pubmed.ncbi.nlm.nih.gov/?term=Vanelli+M&cauthor_id=32191675" Maurizio 2020). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the newest member of the Coronaviruses family. There is much more to coronaviruses than SARS-CoV-2. The name "coronavirus" is derived from Latin word corona, meaning "crown" because of the protein spikes that projects from the surface, resembling a crown.  Most viruses in this family infect animals such as bats, chickens, camels and cats. Occasionally, viruses that infect one species can mutate in such a way that allows them to start infecting another species (Wei et al., 2020). This is called “cross-species transmission” or “spillover”. 
The first coronavirus was discovered in chickens in the 1930s while the first human coronaviruses were identified in the 1960s. According to CDC (2020), to date, seven coronaviruses have the ability to cause disease in humans, four of which cause mild to moderate diseases and are called: 229E, OC43, NL63 and HKU1. The other three can cause much more serious and even fatal diseases. These are:
Severe acute respiratory syndrome coronavirus (SARS-CoV) which causes severe acute respiratory syndrome (SARS), first detected in November 2002 in Foshan County, Guangdong Province, China.
Middle East respiratory syndrome coronavirus (MERS-CoV) causes Middle East respiratory syndrome (MERS) which occurred first in Saudi Arabia. There were two further MERS outbreaks: South Korea in 2015 and Saudi Arabia in 2018. There are a handful of MERS cases every year, but the outbreaks are usually well contained. 
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus disease 2019 (COVID-19) – the ongoing pandemic was first detected in late 2019 in Wuhan, Hubei Province, China.

PATHOGENESIS:

The life cycle of the virus within the host consists of the following 5 steps: attachment, penetration, biosynthesis, maturation and release. Once viruses bind to host receptors (attachment), they enter host cells through endocytosis or membrane fusion (penetration). Then viral contents are released inside the host cells where their RNA enters the host nucleus for replication. Viral mRNA is then used to make viral proteins (biosynthesis) from which new viral particles are made (maturation) and released.  
As reported by Yuki et al., (2020) the spike protein used for attachment to the host cell comprises two functional subunits- S1 and S2. The S1 subunit is responsible for binding to the host cell receptor while the S2 subunit is for the fusion of the viral and cellular membranes. Structural and functional analysis showed that the spike for SARS-CoV-2 bound to angiotensin converting enzyme 2 (ACE2). ACE2 expression is high in lung, heart, ileum, kidney and bladder. 

CLINICAL MANIFESTATIONS:

One of the main challenges in containing the SARS-CoV-2 outbreak is that symptoms can be very mild – some people may not even show any symptom at all, but can still infect other people. SARS-CoV-2 is not as deadly as either SARS or MERS, but because it can spread undetected, the numbers of people it will infect and the numbers that will die will be higher than any coronavirus we have ever encountered. The incubation period for the virus is 2 days to 14 days before you notice symptoms.
Some common symptoms that have been specifically linked to COVID-19 include:
shortness of breath
having a cough that gets more severe over time
a low-grade fever that gradually increases in temperature
fatigue
Less common symptoms include:
chills
repeated shaking with chills
sore throat
headache
muscle aches and pains
loss of taste
loss of smell
Source: CDC, (2020)
Emergency medical services as noted by CDC (2020) can be sort for if you or someone you care for have any of the following symptoms: 
trouble breathing
blue lips or face
persistent pain or pressure in the chest
confusion
excessive drowsiness

COVID-19 COMPLICATIONS:

There are several serious complications apart from respiratory failure and they include
A high number of strokes in otherwise healthy young people
Kidney failure
Multiple Organ disease
Severe acute skin diseases in Children
Blood clots in the major vessels that may lead to amputation of limbs

Summarily, COVID-19 is more infective, but less fatal than Flus, Ebola, HIV and SARS. 
Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. 
Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness.

HOW IS COVID-19 TRANSMITTED? (EPIDEMIOLOGY):

The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. 
These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these contaminated objects or surfaces, then touching their eyes, nose or mouth with contaminated hands
People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay up to 2 meters (6 feet) away from a person who is sick.
Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air (Tia, 2020). 
The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19, experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.
It is not certain how long the virus that causes COVID-19 survives on surfaces, but it seems to behave like other coronaviruses. SARS-CoV-2 persist on surfaces for a few hours or up to several days. This may vary under different conditions (e.g. type of surface, temperature or humidity of the environment).
The likelihood of an infected person contaminating commercial goods is low and the risk of catching the virus that causes COVID-19 from a package that has been moved, transported, and exposed to different conditions and temperature is also low.
Blacks/Africans residing in the continent are not protected although evidence so far has shown less mortality compared to the West.
5G network is not responsible for COVID-19. Even countries without the network still have the disease.
There is no gender discrimination as both male and female are infected.

HOW IS SARS CoV-2 TESTED FOR? (LABORATORY DIAGNOSIS):

Samples are collected from the nose, mouth, saliva and occasionally stool and lung secretions using swabs stored in an appropriate media.
Samples are analyzed in molecular biology laboratory in a machine with a technique called real time Reverse Transcriptase Polymerase Chain Reaction (RTPCR).
What the machine does is to detect genetic information of the virus, then amplify them and detect the level in the sample using information provided in the reaction mixture. It takes an average of seven hours to run a batch of tests.
The other test is the Antibody test, but this is limited in result interpretation as it does not prove an active infection, it only shows if you had been exposed to the virus in the past.
In addition to these two approaches, our group is working on the use of radiographic patterns of COVID-19 infected lungs in diagnosis (unpublished data).

TREATMENT OF COVID-19:

Most people who become ill with COVID-19 will be able to recover at home. Currently, no specific treatments for COVID-19 exist. But some of the same things you do to feel better if you have the flu — getting enough rest, staying well hydrated, and taking medications to relieve fever, aches and pains, also help with COVID-19 (Harvard Health Publishing, 2020).
In the meantime, scientists are working hard to develop effective treatments. Therapies that are under investigation include drugs that have been used to treat malaria and autoimmune diseases; antiviral drugs that were developed to treat other viral infections, and antibodies from people who have recovered from COVID-19. Radiographic evidence and histological patterns of lung tissues of patients with severe COVID-19 will assist in the development of therapies.

VACCINE FOR COVID-19:

No Vaccine has been developed and deployed yet for COVID-19. However, under WHO's coordination, a group of experts with diverse backgrounds is working towards the development of vaccines against the COVID-19. Some are currently at different stages of trial.

HOW DO WE BOOST OUR IMMUNITY IN A PANDEMIC SITUATION?

In the absence of protective vaccine, one can fight the COVID-19 infection by boosting his or her immune status. This can be done through:
Regular and balanced nutrition
Regular physical exercise at least 4 times in a week lasting 20 to 30 minutes
Avoiding stimulants like alcohol and tobacco
Getting good sleep and rest
Avoiding stress
Avoiding being fixated to all the bad news and morbid statistics
Avoiding false news and misinformation
Be good and kind to others, it improves our nice hormones
Take multivitamins, fruits and vegetables as they contain anti-oxidants
If effective vaccines are available, get it
Renew your mind with God's words, confess them and appropriate His promises

RESPONSES TO THE PANDEMIC:

The reality of the existence of COVID-19 is not in doubt as it has robbed us (the world) of the people we love; It has robbed us of lives and livelihoods; It has shaken the foundations of our world and threatens to tear the fabric of international cooperation. COVID-19 has also reminded us that for all our differences, we are one human race, and we are stronger together.
In the face of this crisis, human kind must choose solidarity and cooperation over the pursuit of individual interest. The world must unite under the banner of mutual trust and inclusiveness in the face of deepening COVID-19 crisis.
COVID-19 pandemic had showed that virtually no country has been spared, so no country can solve this problem alone. We must work together. 
The COVID-19 pandemic has reminded us of a simple truth: we are one humanity. Though COVID-19 has taken so much from us, but it has also given us a unique opportunity to: put aside our differences, break down barriers and to see and seek the best in each other, both at individual, national and international levels.
Since 31 December 2019 when the outbreak of SARS-CoV-2 was first reported to the World Health Organization (WHO) Country Office in China, WHO has been working 24/7 to analyse data, provide advice, coordinate with partners, help countries prepare, increase supplies and manage expert networks.
The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020. On 11 February 2020, WHO announced a name for the new coronavirus disease: COVID-19.
Global response to COVID-19 pandemic as coordinated by WHO have revolved around:
- continuing study of the causative agent – SARS-CoV-2
- learning from many countries about what works and sharing that information with the world
- training of health workers
- bringing together experts to exchange knowledge
- provision of technical guidance 
- shipping of medical equipment to countries in need
- global funding of research and development
- removal of trade barriers that put health workers and their patients at risk
- OpenWHO Info/Data (Massive Online Open Courses) on COVID-19 
- dissemination of new resources in different language versions

Going forward, various policies to contain the spread of the virus have been in operation. These includes total or partial lockdown of economies, physical distancing (at least 1 meters apart), use of face mask, use of hand sanitizers, hand washing with soap, prohibition on large gatherings, test-and-trace strategies, self-isolation, use of various therapies, provision of palliatives to cushion the effect of lockdown among others.

NIGERIA CHALLENGES:

Challenges posed by COVID-19 pandemic vary from country to country. The peculiarity in the Nigeria challenge stem from the fact that Nigeria is largely a consumer economy where most of the resources needed for the management of the pandemic are imported from other countries. Aside the paucity of funds for importation, the fact that countries that manufacture such equipment/ material are overwhelmed with the in-country demand poses another dilemma. Consequently, there is inadequacy of testing kits, insufficient and ill-equipped isolation centers, insufficient ventilators and drugs, inadequate personal protective equipment (PPE) and hand sanitizers. 
In fact, the challenges thrown up by COVID-19 birth in Nigeria can be aggregated into socio-cultural, economic, health and educational problems.

Socio-cultural issues:
 Where people who live largely a communal lifestyle and engages in active social life are told to stay at home, maintain physical distancing etc. is challenging.

Economic issues:
 It is worthy of note that majority of Nigerian earn their living largely from the informal sector of the economy, thus the mass lockdown weigh most heavily on them, for a day without work means a day without food.

Health Sector problem: Stems from decades of gross neglect in the provision of facilities, training and re-training of personnel. In addition, there exist the problem of manpower shortage to cater for the over 200 million Nigerians.

Education sector quagmire: Another major sector where Nigeria’s response to the COVID-19 has been exposed is education. Being academics, permit me to elaborate further on this challenge. For instance: 

-Perennial decrease in funding of education and research by the Government has over the years affected input of local content in manufacturing and other sectors of the economy.

-Lack of encouragement, incentive and support for development of indigenous technology by the government has promoted brain and technology drain. Example is the discovery of Niprisan for the treatment of sickle cell anemia by biomedical scientists from Ibadan, Ife, and Zaria but the franchise to produce it was licensed to a US drug firm because of lack of recognition and support from Nigerian government. Also there has been reported cases of discoveries of ventilators, automatic hand washing devices and medicinal plant therapies that have not gained recognition/ government attention.

-The ill-preparedness of our educational system at all levels for Remote Learning is having a telling effect on students/ pupils following the lockdown order. The lip service attention Government have paid to education over the years has led to inadequate infrastructure, epileptic power supply and limited access to the internet. This makes the possibility of a quick switch to e-learning under emergency situation, a bleak.
Although, government of Nigeria rolled out a number of interventions measures (lockdown, stay at home) to contain the spread of COVID-19, the challenges mentioned above, especially on socio-cultural and economic issues, has seen a lot of Nigerians disobeying those directives

WAY FORWARD:

As a way forward, Nigeria will need to adopt a holistic approach towards addressing the challenges and lessons learnt from the COVID-19 pandemic. These approaches may include but not limited to: (1) growing the economy, particularly the non-petroleum sector, (2) building critical infrastructure, (3) investing in knowledge driven economy, and (4) cutting cost of governance. There is an urgent need for Nigeria leaders to bring back the culture of nationalism, through the belief in the citizens and the Nigerian State.
Once again for the education sector, going forward will include the followings:

*First, I will advocate for the setting up of an Advisory/Technical Committee (experts in the relevant fields) that will report to the present Presidential Task Force (PTF) on COVID-19; a big role that has been left only for the Nigerian Centre for Disease Control (NCDC). 

*The government should as matter of urgency bring to an end the era of lip service to the funding of education and research so that the necessary infrastructure for effective research and teaching (including remote teaching/learning) can be put in place. In almost all our public schools, facilities for online lectures is not in place hence pupils and students are idling away. Therefore, enough is enough to the lip service attention paid to education in the past years. 

 *Government should encourage indigenous research and promote products of such research specifically in the areas of discoveries and innovations. For instance, the production of prototype ventilators and automatic hand washing devices made by several universities in response to the COVID-19 in Nigeria should be encouraged. 
*Agencies of government and private organizations should take pragmatic approach and a more critical look at the various claims to herbal cures of COVID-19 and other illnesses with a view to validating such claims and offering grants for improvement.

NDOKWA NATION'S RESPONSE: 

The existence of COVID-19 is real and cannot be wished away by the wave of the hand. Our belief system or denial of this fact does not make any difference. It is therefore pertinent that as a people, we should harness the business and educational opportunities the COVID-19 pandemic offers. Amongst others, we should use the opportunity of the lockdown to invest in farming thereby putting into use our natural endowment of vast and fertile land. Farming should be treated as essential service and should now be given top priorities. Educated and wealthy people should give farming a shot. The implications of this venture are: 
*surplus of food for our people in the months ahead
*reduction in crime through worthy engagement of our youths
*economic gains from sales of farm produce
*reduction in the number of unplanned/ unwanted pregnancies as WHO has estimated that about 20 million children will be given birth to in the world between December, 2020 and February, 2021 as a result of the stay at home order of March to May 2020.

EXPECTATIONS FROM US AS ACADEMIA:

*We should embark on COVID-19 related impactful researches in our various fields of endeavours for the benefit of Ndokwa nation in particular and the world in general
*Enroll for online courses to increase our capacities
 *Engage in e-commerce for safety and economic reasons
*Education/enlightenment of our people to avoid at risk behaviour that could expose them to SARS-CoV-2 infection; encouraging them to adjust to the “new normal” such as use face mask, hand sanitizers, maintaining physical distancing, avoiding large gathering and washing hand with soap regularly.
*Letting the young people know that they are not invincible. The fact that older people are the hardest hit, does not mean that younger people are spared. Even if younger people don’t easily get sick of COVID-19, the choices they make about where to go could be the difference between life and death for someone else.
*Being kind to people through provision of palliatives to the less privileged.

CONCLUDING REMARKS:

It is clear that as a country, the late closure of our air space, land and sea borders has manifested in the continual rise in the number of COVID-19 cases. There is therefore the need to be proactive in our response should similar situation occur in future. For now,
*COVID-19 has forced some of us to rest, stay indoors, take leave or vacation, something we didn't have the luxury of doing in the past.
*We can also use the period to increase bonding to our spouses and children and other relatives.
*Vaccines are beneficial but at the moment, there's no known anti-COVID-19 vaccine. 
*Prevention can be achieved by staying home, keeping safe distance of at least 1metres (3ft) from another person, use of face masks, frequently washing our hands thoroughly with soap for at least 20 secs and use of alcohol-based hand sanitizer.
*If you think a surface may be infected, clean it with simple disinfectant to kill the virus and protect yourself and others. Avoid touching your eyes, mouth, or nose.
*No known cure, though some trial drugs seem to show some levels of effectiveness.
*We can also put pen to paper and write the books we had always desired to write but never had the time.
*There are available online courses we can engage in both in our disciplines and other areas.
*Reject rumors, only obtain and share information from trusted sources.
*The stay at home order should affords us the opportunity of reviewing lives goals and aspirations in relation to divine purpose.

Finally, one lesson the experience of COVID-19 has taught us is that we live in an increasingly interdependent world, where the riches or the poor, the high or the lowly, no one is more human than the other. Therefore, for Nigeria to play its critical role in the interdependence global space, it must invest in the knowledge industry.

May the Almighty God protect us, save the Ndokwa nation and the world at large from the COVID-19 pandemic. I join the WHO Director-General to urge all members of ANPA to be safe, smart and kind. 
I thank you all for your attention.

Acknowledgements:

I am grateful to the Association of Ndokwa Professionals in Academia for this opportunity. Dr A.R. Akpe is highly appreciated for his resourcefulness during the preparation of this manuscript.

REFERENCES:

Centre for Disease Control and Prevention (2020) Human Coronavirus types., National Center for Immunization and Respiratory Diseases (NCIRD)Division of Viral Diseases. February 15, 2020

Centre for Disease Control and Prevention (2020) Symptoms of Coronavirus. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. May 13, 2020 

Centre for Disease Control and Prevention (2020) People Who Are at Higher Risk for Severe Illness. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. May 14, 2020 

Domenico Cucinotta  and   HYPERLINK "https://pubmed.ncbi.nlm.nih.gov/?term=Vanelli+M&cauthor_id=32191675" Maurizio Vanelli (2020) WHO Declares COVID-19 a Pandemic. Acta Biomed 91(1):157-160. doi: 10.23750/abm.v91i1.9397.

Harvard Health Publishing Coronavirus Resource Center. Treatment for COVID-19.
Published: March, 2020, Updated: May 26, 2020.

Nigeria Centre for Disease Control (NCDC) (2020) COVID-19 Nigeria. Tuesday 2:05 pm 2 Jun 2020. https://covid19.ncdc.gov.ng/

Tia Ghose (2020). How are people being infected with COVID-19? Live Science Publishing April 07, 2020 

Wei Ji, Wei Wang, Xiaofang Zhao, Junjie Zai and Xingguang Li (2020) Cross‐species transmission of the newly identified coronavirus 2019‐nCoV. J Med Virol. 2020;92:433–440. https://doi.org/10.1002/jmv.25682

World Health Organization (2020) WHO declares COVID-19 a pandemic. WHO Bulletin Volume 98 

Yuki, K., Fujiogi, M. and Koutsogiannaki, S (2000). COVID-19 Pathophysiology: A review. Clinical Immunology https://doi.org/10.1016/J.clim.2020.108427