Easing lockdowns, Nigeria bets on aggressive contact tracing
Nigeria joins Ghana in easing major lockdowns. But the underlying numbers are different
Anxiety over a potentially damaging economic crash has prompted Nigeria’s President Muhammadu Buhari to ease coronavirus lockdowns in the Federal Capital Territory, and in Lagos and Ogun states.
Mobility restrictions went into effect on March 30 and were extended for an additional two-week period after the first expired on April 13.
Citing “very heavy economic costs” so far, Buhari said mass movement will be gradually scaled up in the three localities from May 4. A curfew between 8pm and 6am still imposes a minimised restriction on movement.
By that date, Lagos – Nigeria’s commercial capital, tech hub and coronavirus epicenter – would have been under lockdown for five weeks.
The end of the strict lockdown will lead to a gradual increase in economic activity within the state, from mass transit and street trading, to the re-opening of formal businesses. Buhari’s latest broadcast permits non-essential services providers to resume operations, though social and religious gatherings remain prohibited.
“However, this will be followed strictly with aggressive reinforcement of testing and contact tracing measures while allowing the restoration of some economic and business activities in certain sectors,” he said.
In essence, health authorities at federal and state levels – particularly the NCDC and Lagos state Ministry of Health – are expected to devote more resources and logistics to carrying out contact tracing.
Buhari’s announcement mirrors that of his Ghanaian compatriot Nana Akufo-Addo.
In lifting Ghana’s lockdown on April 20, the Ghanaian president based his decision on his country’s ability to “undertake aggressive contact tracing of infected persons, the enhancement of our capacity to test, the expansion in the numbers of our treatment and isolation centers.”
What has changed since the lockdowns?
It’s not like COVID-19 has stopped spreading in Abuja, Ogun and Lagos.
On April 12, when the lockdown was extended by 14 days, there were 323 cases nationwide with 11 deaths and 99 discharged cases.
Hours after Buhari finished his newest broadcast, the number of cases in Lagos alone stood at 764 with 19 deaths. Indeed, the president acknowledged in his speech that cases have continued to rise.
So why is the lockdown being eased at this time?
This decision to ease lockdowns comes a day after Buhari received the Minister of Health, Osagie Ehanire, and the NCDC director general, Chikwe Ihekweazu, in Abuja.
Between the presidency and the health authorities, there appears to be an understanding that the path of the epidemiological curve in Lagos and the two other locations can be adequately tempered with improved testing and contact tracing.
The Presidency’s confidence, according to Buhari’s explanation, partly rests in the fact that “initial models predicted that Nigeria will record an estimated 2,000 confirmed cases in the first month after the index case.”
As of April 28, Nigeria has not hit that mark. To Buhari, it means measures like the lockdown have “yielded positive outcomes.”
But has Nigeria traced and tested enough?
Ghana’s lockdown of Accra and Kumasi lasted for three weeks. To boost its testing, the Akufo-Addo government said it would recalibrate 100 tuberculosis GeneXpert labs to ensure Ghana has a minimum of one testing centre per region.
A country of about 30 million people, Ghana has 16 regions (equivalent to states in Nigeria). Ashanti and Greater Accra are the most populous with a combined population of about 10 million people.
Since their first case on March 12 – two weeks after Nigeria’s first case – Ghana has traced more than 86,000 contacts, with test results obtained for at least 68,591 persons. From this effort, there has been 1550 cases and 11 deaths. They have started using drones to transport samples to labs to speed up the whole chain of containment.
Nigeria has also begun repurposing TB and HIV testing equipment to increase COVID-19 detection. There are now 15 labs in the country, up from 6 as of the beginning of the official lockdown.
However, Nigeria’s aggregate test capacity is at 2,500 tests per day. Less than 12,000 samples had been tested as of April 26 (which means less than 12,000 people have been tested) even as the disease has now spread to all but three states – Kogi, Yobe and Nasarawa.
Contact tracing will not be rosy
For aggressive contact tracing to work, government and health authorities will have to find ways to overcome logistical challenges that could threaten containment efforts.
The other day, Ihekweazu, the NCDC boss, made a desperate appeal for extraction kits, a crucial component for testing.
“We have a supply chain of all the commodities but there are supply chain challenges in things coming into the country now,” Ihekweazu later said at a press briefing, explaining the decision to tweet out loud.
”This is the consequences [sic] of the situation we are in now and the global demand for the same thing. So these are things that we had ordered and they were in process of coming in but we suddenly ran out.
“Rather than shut down a network of 15 laboratories in the country, I put out that tweet,” he said.
Lagos is not out of the woods
Ihekweazu and the NCDC team get good marks for crisis communication and honesty.
But residents of a bustling 22-million-people city like Lagos will want to know that there are sufficient tools in place to mitigate against the risk of breaking social distancing while COVID-19 remains a threat.
Babajide Sanwo-Olu, the Lagos state Governor, said he will share a broader framework for easing restrictions in the next few days. The wearing of masks in public will be mandatory. Non-essential interstate travel is off limits. If you can keep working from home, continue.
Buhari’s attention turns to Kano, the northern state vying to become Nigeria’s new coronavirus headache. A two-week “total lockdown” will now commence there as federal and state agencies join heads to stem the tide that has birthed 77 cases and “strange deaths” in the virus’s first two weeks of arrival.
Reports of bribery at state borders and checkpoints mean the spread in Kano and other states will continue to bother Lagos, Abuja and Ogun. In a sense, the phased ending of the lockdown is a transition from a notorious traffic jam to an anxious ‘go slow’.
Make no mistake, the threat of the fast spreading fatal disease abides in Lagos. As Tedros Ghebreyesus, the WHO director general said last week: “Lifting so-called lockdown restrictions is not the end of the epidemic in any country, it’s just the beginning of the next phase.”
Lagosians now look forward to returning to normal life on May 4 and may the force be with them. But it’s not yet time to resume touching faces, shaking hands or sharing hugs.
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