Dr Uche Diala

Since the first positive case of the Coronavirus was confirmed in Nigeria on the 28th of February 2020, a lot has happened with respect to the COVID-19 pandemic in Nigeria.

In this installment of my updates, I intend to attempt to crush the numbers, review how far we have come on our COVID-19 journey, where we are presently, and look at our road ahead and in so doing, maybe inspire a factual assessment of our situation and an objective and realistic conversation on our way forward.

Number Of Positive COVID-19 Cases (Weekly Intervals).
Source: NCDC

28th February - 01
22nd March - 30
29th March - 111
7th April - 254
14th April - 373
18th April - 541

▪︎On the 20th of March, the Federal government banned all international flights coming into Nigeria.
▪︎On the 30th of March, the President ordered full lockdown of Lagos, FCT and Ogun for 2 weeks.
▪︎On the 14th of April, the lockdown was extended by another 2 weeks.

▪︎3 weeks after the first case was announced in Nigeria (28th February - 28th March), the number of confirmed cases stood at 111.
▪︎A day before the banning of international flights (19th March), the number of positive cases was 12.
▪︎On the day the 2 weeks lockdown was announced (30th March), the number of cases was 131.
▪︎2 weeks after the lockdown was announced (14th April), the number of cases stood at 373.
▪︎Currently (as at 18th April), 18 days after the first 2 weeks of lockdown and 4 days into the extension of the lockdown, the total number of positive cases stands at 541 with 166 discharged and 19 deaths nationwide.
▪︎19 states + FCT have reported positive cases with Lagos (306), FCT (81), Kano (37) and Osun (20) taking the lead. 17 states have not officially reported a confirmed case so far.

▪︎Total number of new cases from Index case (28th February) to Flight Ban (20th March) - 21 Days - 12.
▪︎Total number of new cases from Index case (28th February) to start of lockdown (30th March) - 32 Days - 131.
▪︎Total number of new cases from ban of International flights (20th March) to start of lockdown (30th March) - 10 Days - 119.
▪︎Total number of new cases from ban of International flights (20th March) to Date (18th April) - 29 Days - 529.
▪︎Total number of new cases from start of lockdown (30th March) to Date (18th April) - 18 Days - 410.

A number of issues and some pertinent questions arise from these figures and statistics.

1. It is clear that the number of new cases has continued to rise and with a higher margin.

2. The increase has continued in spite of the containment measures deployed like ban on incoming international flights, lockdown and physical distancing.
As a matter of fact the number of new cases rose by 24.2% from the day the lockdown started (30th March) to Date (18th April).

As much as one can realistically argue that the increase is inevitable, the following questions crop up nonetheless:

1. Why the consistent increase in number of cases and rising margins?

2. Are the lockdown and other measures actually yielding the desired results which is to slow down the transmission of the virus and ultimately flatten the curve?

3. What is the possibility of easing the lockdown measures in Nigeria and re-opening the nation? How soon and in what way?

I will attempt to answer these questions:

As at 18th of April 2020, Nigeria has conducted an estimated 6,649 tests for COVID-19 which is an improvement but still falls short considering the Nigerian population.

The NCDC is surely scaling up testing for the virus, setting up new laboratories nationwide and it plans to roll out "mass testing" by May 2020.

It is widely believed that as the scale of testing increases, the number of positive cases would continue to rise. But for how long?

The Phases of the pandemic, as defined by the WHO are: Containment Phase, Transition Phase, Localized Community Transmission Phase, Widespread community transmission Phase and Waning transmission Phase.

Based on the facts and figures above, it is proper to assume that   Nigeria is now in the 'Localized Community Transmission Phase'.

The NCDC must expand and intensify the ongoing house to house testing.

2. It is difficult to say if the containment measures are yielding desired results going by the data and other intervening parameters like scale of testing.

Surely, there is no question that the limitation of person to person contact as a result of lockdowns in Lagos, FCT, Ogun and ban in public gatherings also in place in some other states must have reduced the risk and hopefully the rate of person to person transmission of the virus. The exact degree of that would be a subject of a more scientific study.

However, it is very clear that the cooperation and compliance with the containment measures by the citizenry have been lack lustre and discouraging. Equally, the enforcement of the measures like the lockdown has been haphazard, not well coordinated and not strictly enforced by governments at all levels as well as unprofessional by some security operatives in many cases.

The danger of these is that we might fail to attain the goal of reaching the peak of transmissions and enter the 'Waning Transmission Phase' of the pandemic at the end of the extended lockdown by the 28th of April. Which begs the next question; Where do we go from here?

3. On the 1st of April, I made a projection based on the facts and figures and I projected that all things being equal, Nigeria might be reaching its peak at about the 17th of April. I of course stated that it would depend on how diligently the containment measures were deployed and enforced. That was the reason I then advocated an extension of the lockdown period and to extend it to the entire states of the federation.

Today is 19th of April and it doesn't seem from the data available that we have gotten to the point desired or anticipated.
So do we proceed to open up the country at the end of April or not? If yes; How?

Using the United States as a case study, despite its desire to "reopen" its economy before May, the White House laid out a Three-phase Plan aimed at "guiding parts of the country to move incrementally toward loosening restrictions on businesses and individuals."

However, before entering the first phase, the guidelines issued say that the number of cases, positive tests and reports of flu- or Covid 19-like symptoms in a state or region should be trending downward.
It further requires that there should also be a "robust testing program in place for at-risk healthcare workers, including emerging antibody testing".
Phase One of the plan says that "all vulnerable individuals" should continue to shelter in place and it encourages everyone to maintain various social distancing practices when in public.
But it also advises employers to "return to work in phases" if possible, while taking precautions such as closing common areas and minimizing nonessential travel.

Are we there yet?
Do we have enough data based on sufficient testing to begin to make those decisions?
Can we try opening only states with zero cases presently and states whose status has remind unchanged after a reasonable length of time?
Considering our low scale of testing can we realistically conclude that states that have zero or few COVID-19 cases as at today, actually do not have any cases at all or more than already reported?
Do we have the sophisticated system and disciplined citizenry that would enable each state open and operate independently and keep possible cases from other states from entering the state?

These and more are critical questions that the government at both the federal and state levels, Health officials, NCDC and indeed Nigerians have to answer as we navigate our way through this unique and historic viral challenge.

For now government must intensify the containment measures and we must continue to observe the measures, obey all regulations and authorities, #StayHome and #StaySafe.


@Dr Uche Diala