As the COVID-19 pandemic ravages the entire globe, with over 15 million cases, about three and half million in the United States alone, more than 770 dead in Nigeria and unimaginable effects on health, economic and social lives, attention is now focused on the medical community more than ever before
In this interview with BIYI ADEGOROYE, the National President of the Nigeria Medical Association, (NMA), Prof Innocent Ujah, who is a former DG of the Nigerian Institute of Medical Research, examines global and local responses to the pandemic, the state of our medical facilities and spirited agitations especially by some governors for re-opening of schools
Congratulations on your election in May. Now, coming at this critical time, what is your impression on the destructive effects of Coronavirus?
Thank you very much. I am sure everybody is aware of the effect. It started as a health issue, but it has expanded to social and economic issues now. So as a pandemic, it is not only a health issue, but also a social and economic one, such that both the health system and economic activities are clearly very affected.
Could you give us an insight once again into the nature of the virus and modus of transmission?
Well, I am not a micro-biologist, but a medical doctor. We know that it is an infectious disease caused by coronavirus, and coronavirus are of different groups, because we have MESS, we have Severe Acute Respiratory Syndrome (SARS), caused by coronavirus also. And this is because of its peculiar group has been called COVID-19 to give it a code. It is a virus which nobody in the whole world has experienced in the study of biology or the disease that it causes, we do not know. It came as a bang and it took the whole world, Europe, America, Asia by surprise.
You know the reality is that we never knew that any health issue can negatively affect Europe and America this way, but today, with COVID-19, all countries of the world are affected, and it is even worse for the developed countries. Because for Africa, infectious diseases like bacteria, parasites, viruses are all over West Africa.
If you recall in 2014, even before now had Ebola Virus, those hemorrhagic diseases, you know that Lassa fever is endemic, cholera is all over the place and gastro-enteritis too. So infectious diseases appear to be resident in African countries, but that is not the same with coronavirus. It is a pandemic and affects all the countries of the world, both developed and developing ones. It is clearly a novel disease; nobody has been able to know its epidemiology. When we talk about epidemiology, we are talking about what is involved, how it evolves where it evolves and when? This is because, we map out diseases epidemiologically.
For instance, we know that coronavirus will affect everybody but more of the elderlies are likely to die, and those who have co-morbidities. And when we talk about co-morbidities, we are talking about hypertension, HIV, diabetes, renal diseases, lever and heart diseases. So, despite the fact that it is more predominant epidemiologically, among the elderly, those who are dying are more likely to have other clinical conditions and that is what we call co-morbidities.
By and large, it is a disease that has never been known in the history of the world, and therefore, it has taken the world by storm. You can see that America is lying prostrate; Europe is lying prostrate and Africa in this case, I’m not sure, but we can say that the numbers we are having does not justify environment that is ready to receive such condition like the viruses.
How would you assess the response of the medical community to this pandemic?
Well, unless you do a thorough and detailed study, it is difficult to come up with outcome of assessment, because I don’t want to make a statement that will be quoted out of context. But generally, the medical community has responded well.
They started looking at what the disease is. As I talk to you, many laboratories and scientists are working on the virus. It is just like when HIV came out, little was known about it. There was not cure, and there is still no cure, and there was no drug that was readily available to treat HIV, but today it is like a chronic disease like diabetes.
So at the moment, a lot of work is being done, but you know scientists don’t make noise. They are doing their work in the laboratories. You also know that when it broke out, many countries were not ready for it; certainly, Nigeria was not ready. Because then we had about five facilities that can do molecular biology of the disease, but today we are told that we have about 53.
Now, respecting the epidemiological responses, that is the emergency preparedness and response, the medical community is doing its best. You can see that they are committed to the response. And they are doing the best they can and the fact that they are at the forefront shows the commitment.
One thing you must have also taken note of is that knowledge of COVID-19 is being improved upon every day. You remember when we started, they said the transmission is droplet, now we are hearing that it is aerosol. We didn’t know that we should use face masks, but today, you see people wearing face mask everywhere in the world, except probably in Africa where some people are still in denial of the disease. That is how to respond to emergencies like this. Whether it is catching up with the spread of the disease is a different thing.
It has been said science should take the lead in this fight against COVID-19, but in some cases like Nigeria, non-medical experts are leading the fight. How do you view this?
Well, I think to lead is not the issue. We can have a non-political leader. Ideally it should be a scientist leading. When I said scientist, I did not mean medical scientists, but of relevance, he should be a medical scientists, because he is the one that knows both the clinical and laboratory aspects of the virus. But if you have a leader who is no-medical, and you have scientists, core scientists, they are the one that would fit into the leadership.
But unfortunately in this Presidential Task Force, I have not seen that; it is unfortunate really, but I think it maybe the way it was constituted, they thought this disease would not affect so many people. You know sometimes, it is very difficult to change if there are some errors, but there is nothing wrong in infusing more people into it.
I know that during Ebola, the scientists were the leaders in the battle. The head of the team was Professor Onyebuchi Chwukwu who is a renowned orthopedic surgeon and the Minister of Health then. And he, under the leadership of the President then, effectively moved people around and the response, in my opinion was very good.
So politics, yes, and politics in this case would provide the necessary environment like funding and oversight functions of the activities of the scientists, but I think we need to infuse more scientists into the PTF. Though I’m told that there is a technical team that comprises of many scientists but I don’t have the details.
But in essence, what I’m saying is the quality and quantity of such scientists and those with experience. We know that in Nigeria here we have people like Professor Oyewale Tomori, who is a renowned virologist, who has participated severally in the control of many epidemic diseases. During Ebola, he was all over the place.
We also have Prof. Sidii Abdusalami and Prof. Morris Iwu who is a pioneer Director- General of National Centre for Disease Control, and has been in infectious disease control since 1981, and therefore, his experience is very very very important, because these things require experience.
I also know that during Ebola, Nigeria trained over 250 scientists and other workers to go and help in Liberia, in Guinea and Seirra Leone. I don’t know where they are because I’m not in the team and I do not know whether they have been incorporated or not. Maybe they are, because these are the people who have experience and when you have such you bring it to fore to confront challenges like this pandemic. So, they are doing their best, but I think they should continually review.
Look, for instance, during Ebola, we had what we called Ebola Treatment Research Group. I was a co-chair as the DG of Nigeria Institute of Medical Research and Prof. Kamiyus Shingu Gamaliel, he then DG of the Nigeria Institute of Pharmaceutical Research and Development NIPRID, was another-chair and we were doing our own bits while those on the fields were feeding us with reports. We were mapping and looking at the response. What I would have thought, I’m not sure they have, is a very strong research team that will monitor and evaluate the response.
Now in this case, we want to know what is happening, how well we are doing and what can we do better if we are not doing well. If we are not doing well, why are we not doing well? That is where the knowledge management laboratory and brain-storming comes in to bring out the best so that we they can infuse fillip into the management strategies that are on at the moment.
I don’t know whether we have that because in circumstances like this, in Africa, and Nigeria in particular, research is driven into the background, and I don’t think that is the right thing to do, because it is research findings that will help those in the field.
Even in war, we have a crack team of military strategists that monitor and evaluate actions, stating that probably this has been done, these errors have been committed and the right thing should be done. In a case like this it is very difficult to know what is happening and though we have figures that they give us on a daily basis and we need more than the figures. We need to know more than what we are being told. By and large, I suppose they are doing their best.
Despite all the containment measures against the virus, the figures are spiking by the day. What do you think account for this?
Well, let me say this, there are two or three factors that give us the impression that the figure is increasing. First of all, as you know when this disease was reported on 27 of February, there were certain things we should have done which would have been very drastic and Nigerians would have complained, because Nigerians complain about everything.
We should have closed all our international airports very early since it is an imported virus. It would have been a momentary setback but it would have long term benefits, because we knew that it is not within rather it came from outside, and most of the time, if you look at the index figures, you would recall they were those who flew into the country. So if we had closed the international airports we would have been better than where we are now.
They are doing their best, but the stage we are now is where you have community transmission, which means that the virus has penetrated the community and when more tests are being done, the figures will increase. And it is good that we are doing more tests, and I am happy that even states that are doing more tests are now reporting cases, because we know epidemiological characterisation of the diseases.
There is no way every other state will have COVID-19 and Kogi and Cross River will say they don’t have. Are they on this planet? So it is not by wish but by evidence. And we have shown that coronavirus exists in Cross River and Kogi states. What I’m saying in effect is that we have now got to the next stage and that is community transmission which is now backed up by more tests.
I think that there is gap in reporting. They should tell us how many tests they do and how many of those tests are positive. Because that would give us the trends of the reality on ground, because if we don’t know how many tests you do and you are just giving us positive results, then it does not give us all the answers.
For instance, if you conduct 10 tests today and four are positive and you do 10 tests tomorrow and eight are positive, then we will begin to look at the trend. In that case, we would be able to take a position that it is probably because of more tests we are doing or the disease is actually penetrating the communities.
Another dimension is that frontline workers like medical staff, over 200 of them and even journalists have contracted this virus. What does this portend for the fight?
Let me just say this, as doctors and medical staff, we are trained about the risks and hazards associated with our profession. But they can be prevented and that is why we have what we call universal precautions, and particularly in preparing for epidemics, where we talk about infections’ prevention and control. Anyone that is involved should be trained and retrained so as to protect him and herself and the patients from further infections.
So it is sad and unfortunate that some of our colleagues have tested positive and some of them are dead while others are recuperating, but that is the risk of the profession, which until now that Nigerians did not understand. Each time we asked government to provide this and that, they said we are looking for money, but now they have seen the gap that existed since the COVID-19 started that we have a very weak heath system.
That was why we are praying that we should contain it before it began to spread, but Nigerians would not listen to experts, rather everyone is an expert when it comes to medicine. Now you can see that many of our health workers are being infected and they cannot run away because of the oath, which doctors in particular took, will not allow them to abandon the patients.
So they must essentially work to prevent the patients from dying or recover, but it is expected that the personal protective equipment are provided for health workers so as we will minimise it, since we cannot say eliminate the risk health workers face in the process of this national response. I want to use this opportunity to plead with the government and the private sector to provide such PPEs to enable us respond actively to this national emergency -prevention and control of COVID-19.
The PTF has received over N27 billion in donations. What impact do you think this should have on our health system which you said is very weak at this stage and even medical research?
It is not just the money donated by philanthropists because funds donated in one year alone would not make any impact if it is not utilised properly. And one of the gaps we have is the weak health research system. We should be learning and be documenting the issues and the challenges as we go on such that in the end this COVID-19 would have brought a better outcome to our health delivery system, and therefore we should be prepared to respond appropriately to the health situation of Nigerians.
Doctors have been crying. You will remember that in 1883 and early 1984, one of the issues that led to the overthrow of government was the fact that the hospitals had become more like consulting units. That was over 36 years ago and when doctors went on strike at that time, the NMA was proscribed, on the claim that we were fighting the government. The strike was to bring out the message that the health system has collapsed, and we ought to have been building this gradually – we are not saying that it should be done in one or two years. But the willingness and commitment would have helped us a lot.
For instance, you know that the primary healthcare system has collapsed completely in Nigeria. But the doctors and civil society groups fought for so many years to ensure that the National Health Bill was passed into law. And now we have what we call the Basic Healthcare Provision Fund, but how effectively has this been deployed? Remember this is designed to improve primary healthcare system in Nigeria. So you can see that we have not learnt any lessons.
Now we have over N27 billion given by the private sector. If I were with them I would have segmented the fund. This should be used for this and this for that, without forgetting the research components. Attention should also be paid to the consumables, including personal protection equipment, ventilators and all the other things that will help improve the healthcare delivery system in Nigeria. So, I suppose that will be done. I’m not in position to know government’s plans in this regard, but I believe that is something on which people have to sit down, brainstorm and come out with the best options that can improve the healthcare system in Nigeria.
How do you see the calls for re-opening of schools?
Well, you know that NMA has a very strong position on this. It is not time to reopen schools because we are not prepared. We have said we are not ready to reopen schools, and the truth of the matter is that at the rate we are going, when people are in denial, and the children will go to school, you can only guarantee safety if you will have one child per classroom.
You see, Nigerians are very layby. I’m very sorry to say that. We fall on anything and use our own personal experience to express collective feelings. I would not want any of my children to go to school at this time because I’m sure we are not ready to contain the disease.
The private schools might be able to afford to re-open, but what about public schools? You should go and survey public schools where some of the children of the downtrodden are attending. Now if they get there and contract this virus, what will happen? Are we going to be able to contain it? It is only the living that goes to school.
Some decades ago or so, when there was no pandemic, I know of some universities that lost some sessions; I know of some that lost at least a session. But the world have not collapsed, rather education continues. So why don’t we temporise and look at where we are going first. Some are crying they will miss WASCE, so what? Why should we expose our children only to lament later? That is my fear.
But some governors have said they will reopen schools early August?
We have no control over the governors but we can give professional advice and warning. If I were the President, I would let them know this is a national emergency and prevail on the governors; give them an order, a directive, because in any emergency situation, the whole country becomes the President’s constituency.
The President has the power to say ‘this is what should happen at this time.’ This is an emergency as far I’m concerned. This is a war time as far as health is concerned and I believe that there is unity of command. If the Federal Government gives such directive, it goes down to all the states and local governments. It is a national health emergency and the President has the power to order the governors not to reopen schools until evaluations are made and we are ready to do so.