In response to the World Health Organisation (WHO) declaration of the new coronavirus (COVID-19) outbreak a Public Health Emergency of International Concern (PHEOIC) in January 2020, the Nigeria Centre for Disease Control (NCDC) organised a 2-day simulation exercise for states on the outbreak response in Abuja.
On February 27, 2020, the first day of the exercise, Nigeria confirmed its first case of COVID-19 in Lagos, making it the first confirmed case in sub-Saharan Africa and the third on the continent after Egypt and Algeria.
“On the next day of the exercise we found no one in attendance except a few of us because most of the major stakeholders have been deployed to Lagos for a cogent response,” says Dr. Bashir Lawal Muhammad, the Kano State Epidemiologist and representative in the simulation exercise. “The preparedness in Kano State started even before Nigeria recorded any case of COVID-19. But with the first case through Lagos, we even became more vigilant,” he said.
Following the shutdown of the International Wing of Mallam Aminu Kano International Airport (MAKIA) by the Nigeria Civil Aviation Authority (NCAA) on March 21, 2020, the Kano State Government in what it called a “hard” but “absolutely necessary” decision, ordered the closure of land borders and routes linking the state to other parts of the country, placing 14 different border check points in response to the ravaging COVID-19 pandemic. “Even those coming to Kano through Domestic Wing of MAKIA will remain at the airport, without getting access into the city,” said Abba Anwar, chief press secretary to the Kano State governor. To enforce compliance to the border closure, the police, members of the Kano Road Transport Authority (KAROTA), Kano State Hisbah Corps and other security agencies were mobilised. “The Governor himself was part of the supervisory team at the border checkpoints to see that operationalisation has been ensured.” Said Dr. Bashir Lawal.
On March 30, 2020 Kano State Governor, Dr. Abdullahi Umar Ganduje inaugurated a 50-member Task Force Committee on COVID-19 outbreak response under the chairmanship of Dr. Nasiru Yusuf Gawuna, the Deputy Governor of Kano State co-chairing with Prof. Habeeb Garba, a specialist and Professor of Infectious Diseases. The State Task Force (STF) committee which is inter-ministerial, multi-sectoral, multi-disciplinary in structure has as its cardinal focus preventive, curative and palliative approaches as a measure of response to the outbreak. It was also to be giving weekly updates to the governor at the Government House.
The STF initially had one syndicate group and five major thematic pillars as follows:
- Surveillance/Laboratory Pillar
- Case Management Pillar,
- Risk Communications and Community Engagement (RCCE) Pillar
- Logistics Pillar
- Coordination Pillar
Five other pillars were later developed from the major ones: the Surveillance and Epidemiology Pillar, Laboratory, Point of Entry, Monitoring and Evaluation and Research, Safety and Security, and Infections Prevention and Control (IPC) Pillars. Guiding all the pillars is what the task force called “an incidence action plan”, a robust plan of activities involving training of staff and coordination to be conducted under the thematic pillars which is updated regularly.
In choosing the first isolation centre in Kano, Dr. Bashir Lawan who also doubles as the Incident Manager for the Emergency Operations Centre (EOC), said, “We inspected a number of health facilities and considered ‘Yar gaya isolation centre where we usually manage Lassa fever and other viral hemorrhagic cases. But we later saw that it wasn’t going to be adequate for us because in accordance with the NCDC guidelines, there are equipment and measures needed for a befitting isolation centre. As a result our focus was shifted to the state of the art Disease Control and Diagnostic Centre at Kwanar Dawaki, where we were able to come up with a 72-bed capacity isolation centre; five of the beds were reserved for critical cases, to serve as an Intensive Care Unit (ICU).”
The STF reached out to partners such as WHO, United Nations Children’s Emergency Fund (UNICEF), the African Centre for Disease Control (African CDC), the Bill & Melinda Gates Foundation (BMGF), the Aliko Dangote Foundation (ADF), the International Committee of the Red Cross (ICRC) and others. “They have come together to see where to give their support. Aliko Dangote Foundation was able to use the Sani Abacha Stadium with a 500-bed capacity to provide a temporary isolation centre with 250 beds for men and 250 for women,” Dr. Lawan said.
A few weeks into the response in Kano, more cases emerged, so many that the 72-bed capacity isolation centre at Kwanar Dawaki could not contain, prompting the team to consider Muhammadu Buhari Specialist Hospital as another isolation centre. Daula Hotel was also renovated and some part of Abubakar Imam Neurology Centre was co-opted to serve as an isolation centre.
Laboratories for testing samples in Kano were a major problem in the early days of the response. “We didn’t have a single laboratory where we could go and test for COVID-19 within the state. We usually sent samples to the NCDC National Reference Laboratory (NRL) in Gaduwa, Abuja”, said Hamza Shuaibu Fagge, the State Program Officer and Lead-Laboratory Pillar. The State Task Force collaborated with the federal government and the private health providers to come up with five laboratories with capacity to test COVID-19 in the State. The government owned laboratories are the Aminu Kano Teaching Hospital (AKTH) laboratory in collaboration with the NCDC and the Bayero University Kano (BUK) laboratory, both situated within the AKTH. The privately owned ones came through the support of 54gene; a mobile lab supported by Aliko Dangote Foundation, one from eHealth Africa and another from International Foundation against Infectious Diseases (IFAIN). All these labs collectively had capacity to test about 800 samples. However, Fagge said the IFAIN lab stopped functioning on August 31, 2020 due to lack of funds. Therefore, Kano State presently has four functional testing laboratories.
The State and its task force were not spared from challenges. One of the first and major challenges was the infection of six members of the core technical task force by the virus, a few weeks after the onset of the outbreak in the State. This was a blow to the outbreak response. It led to the shutdown of the call centre which receives and make calls. The call centre, situated at the EOC, links suspected individuals to the Rapid Response Team (RRT). It was moved to the eHealth Headquarters when the task force members were infected before the State government finally secured a location for them at a hotel. “But because of the proactiveness and innovative ideas of the State government, a new approach was designed where we have a coordinator in the person of Dr. Tijjani Hussain, driving the response,” Dr. Lawan said, adding, “With that, there was reorientation of the organogram as a structure for the outbreak response.”
The infection within the STF coincided with the spread of rumours, misinformation and disinformation, not just in Nigeria, but globally. “We’re not just fighting an epidemic; we’re fighting an ‘infodemic’”, said Dr. Ghebreyesus of the WHO. Many false stories and misinformation were spread regarding Kano State particularly during the time of “mysterious deaths” which claimed hundreds of lives including the Emir of Rano and seven professors from the BUK.
In response, the risk communication and community engagement pillar of the STF worked hand in hand with the media to mitigate fake news and misinformation about the virus in the state.
Dr. Lawan said, “We also co-opted the Monitoring and Evaluation and Research pillar to investigate the issue of the mysterious deaths. So, critical and in-depth appraisals were done and emergency operational research was put in place where we worked on not less than 1,604 corpses as a form of verbal autopsy. The team included many sets of individuals including the academia and other specialists and experts. Summarily, about 255 or 16% of deaths were thought to have inclination or relationship with COVID-19.”
The NCDC also deployed a search team to Kano for support. In his visit to the State in April, the Director-General of the NCDC, Dr. Chikwe Ihekweazu, speaking to the State Governor, said, “We appreciate your good support and contribution in the State response team. We have a collective responsibility to do our best to make sure that Kano State is supported to move forward”. Another team called the ministerial team from Lagos, Osun and Ogun also came on board to support Kano State. “We had several discussions and supervisory visits to the laboratories and at the isolation centres, presentations were made based on our existing pillars on what we are doing innovatively and adopting the NCDC guidelines and protocol as far as the national outlook of the response that was critically appraised,” said Dr. Lawan.
Existing challenges that continue to slow down the outbreak response in the State, according to Dr. Lawan, include the issue of limited funds and delay in turn-around-time (TAT) of samples collected. TAT is the time between receiving samples at the laboratory and receiving results. For COVID-19, the ideal TAT is 6 hours minimum and 24 hours maximum but unfortunately, sometimes it takes up to five days before a result is received. Hamza Shuaibu said that in September the STF received a letter from the NCDC expressing concerns about the turn-around time for samples testing, and made suggestions on how to address these issues. The letter read in part, “Recently, we have noticed a significant increase in sample collection and a drop in COVID-19 positivity rate. While this is highly commendable, it has resulted in a backlog of samples not tested, thereby, creating a time lag for results.” Some of the recommendations included suspending community sampling temporarily to clear the backlog of samples, refocusing the sampling strategy on specific target groups, and decentralising the response from the State to the local governments for sustainability.
Asked what he learnt so far from the outbreak response, Dr. Lawan said, “It is not always about acting by the book; it is an issue of practical reality. And it is something that you must come together and stay together, to stay safe. It also needs patience, diligence, courage and fearlessness in as much as you want to control and contain an outbreak. It has also served as a searchlight, to identify and know our weaknesses and to know how to approach responses based on our own peculiarities”.
This narrative is part of the #COVID19NigeriaStories documentation project on state level responses to COVID-19, powered by Nigeria Health Watch with support from the Ford Foundation.