The COVID-19 pandemic revealed the commitment of healthcare workers to improve outcomes in the frail healthcare system in the country. As nations ease lockdowns and establish preventive measures, there is still a journey ahead in the fight against COVID-19. Key lessons from the management of COVID-19 so far should help Nigeria prepare for future disease outbreaks of public health concern.
The outbreak laid the foundation for an unprecedented response from various stakeholders. Nigeria recorded her first case on February 27, 2020. Following confirmation of the first three COVID-19 cases in the Federal Capital Territory (FCT) on 20th March 2020, a COVID-19 Emergency Operations Centre (EOC) was activated on 23rd March 2020 with the Public Health Department of the Health and Human Services Secretariat in the frontlines of the FCT’s response.
As a key stakeholder for disease surveillance and outbreak response in the FCT, the public health team had the responsibility of ensuring effective response to the pandemic.
Dr. Josephine Okechukwu, the Director of Public Health, Health and Human Services Secretariat, Federal Capital Territory Authority (FCTA), said the department was already in an alert mode before the first case was detected in the country. “We started by sensitising and training healthcare workers. In addition, we engaged communities across the six area councils, and trained staff to appropriately detect and diagnose the virus.”
They started sensitising communities using various mass media platforms and physically going into communities even before the first case in the country.
”Before it got to the FCT we were fully aware, especially in the city centre and some other area councils. We can’t say we were fully prepared, no country was, but we were trained, and we responded appropriately” Dr. Okechukwu said. A ministerial advisory committee was inaugurated on March 26, 2020, to help anchor the COVID-19 response in the FCT.
Nine key pillars were activated for the EOC, and the first treatment centre at University of Abuja Teaching Hospital Gwagwalada was activated.
Tackling Community Spread
At the beginning of the outbreak, the national strategy which the FCT team adopted for detecting suspected COVID-19 cases was mainly passive through receipt of alerts/calls from suspected cases or their proxies (e.g. relations, neighbors or clinicians). The surveillance team in turn verify that the suspected case satisfies the COVID-19 case definition before arranging for sample collection either in the homes of suspected cases or at the sample collection center located within the International Conference Centre (ICC). Samples were only collected from symptomatic suspected cases at that time.
The pilot started in Mpape – a slum settlement neighbouring Maitama which then was responsible for about 40% of all reported confirmed COVID-19 cases in the FCT. This however, transformed from Mpape to involve other settlements like Mabushi, Jabi, and Garki village, within the Municipal area council. The outcome of this strategy provided evidence of ongoing community transmission within the municipal area council.
The strategy was further expanded to five communities in each of the remaining 5 Area Councils. This created an opportunity for the team to sensitise the communities on the presence of COVID-19 in the FCT, on the facts, and how to protect themselves, and prevent further transmission.
Five communities were picked from each area council, with the team working for one day in each community. It was discovered that all communities had several cases of COVID-19, establishing that there was already community spread taking place in the FCT. In Abaji, 387 samples were taken and 50 out of those were positive. Although AMAC had a higher number of cases, Abaji area council still had the highest positivity rate, making it imminent that more testing and sensitisation continue in all the community.
The majority of those who came back positive were admitted to the treatment centres, but some resisted the request to be admitted. As the cases increased, there was need to open other treatment centres across the FCT. In total right now, 10 treatment centres have been set up, including the Asokoro District Hospital, the Karu Treatment Centre and the Idu Treatment Centre.
Successes in FCT’s COVID-19 Response
As at Sunday, 25th of October, 2020, the FCT had tested 74,943 samples, and 5,967 samples tested positive. For patients admitted into treatment centres, 5,336 people have been discharged (source: NCDC). Some declined admission, insisting on home management. Patients are categorised based on the level of their symptoms, with mild cases being referred to the Idu Treatment Centre. Severe cases are sent to National Hospital and the University of Abuja Teaching Hospital. ”There has been a lot of testimonies of the high standard of the centres from people who have been discharged”, said Dr. Josephine Okechukwu. The response by the Public Health and Human Services Department also extended to people outside Nigeria, passengers who indicated interest in coming back to the country were put on institutionalised quarantine, on arrival for a period of 14 days, monitored, and tested, during the lockdown. The FCT team has now resorted to a 14 days self-quarantine advise for all international passengers coming into the country.
Before mid-August 2020, cases per day were recorded in the hundreds, but currently, less than 50 cases are recorded per day. Dr. Okechukwu said this could be as a result of more people being aware of the virus and taking precautionary measures to curtail its spread. It could also be as a result of the fact that nationally FCT currently has the highest testing per-million population rate – 9,886 per million – even more than the national testing rate, Okechukwu said.
”The response to COVID-19 has been successful. At some point there was a peak and cases were on the rise, but by mid-August, we saw a decline and that decline has been consistent,” she said.
Even though 20 FCT team members tested positive for the virus, there was no mortality, the director said, adding that team members were eager to come back to work once they got discharged from the Treatment Centres. ”The permanent secretary came down with COVID-19 and two days after, he was discharged. He resumed duty showing his commitment to saving lives. We are the frontliners, if we refuse to go to the battlefield, who will go?” she said.
Work in Progress Despite Challenges
The key challenge faced was funding the response which had direct impact on sustaining staff motivation. People who didn’t want to get tested despite having symptoms also proved a challenge to the response.
Dr. Josephine Okechukwu said, “There were financial challenges, but the FCT Minister was able to find a way to surmount that. At some point due to nonpayment of their stipends, the healthcare workers went on strike, but some who were committed stayed to do the work. Some people who may have been previously tested were reluctant to get re-rested. The FCT Minister, Mallam Musa Bello, and the Acting Secretary Health and Human Services Secretariat also cooperated and supported the response efforts.”
She said partners such as Nigeria Centre for Disease Control (NCDC), Africa Centre Disease Control (Africa CDC), Africa Field Epidemiology Network (AFENET), World Health Organization (WHO), Medical Association of Nigeria (NMA), Clinton Health Access Initiative (CHAI), were supportive. Some private organisations also brought in human resource and consumables to facilitate the response. Nigerian National Petroleum Corporation (NNPC), Central Bank of Nigeria (CBN), IHS and Salini Nigeria Limited supported the response with vehicles
”There was a strong brotherhood in the fight against COVID-19. From the Presidential Task Force, the President and the ministerial committee, to the Minister of FCT supported us fully. The permanent secretary, Mr. Christian Oha, and the Acting Secretary Dr. Muhammed Kau, every staff of Public Health Department, and every frontliner, participated in the fight,” she said.
She noted that the EOC met daily to plan, identify and manage patients, and were able to do this in unity. ”The unity and support from my colleagues were enormous, no one chickened out, and everyone was on board. For every patient that we identified, we managed appropriately. We did all we could to save every life, even for those lives that were lost”, she said.
She agrees they could have handled recruitment of the healthcare workers who came in as volunteers differently. “There was an open invitation for the response, such that volunteers came in from both the public and private sector to join the fight against COVID-19. At the time we didn’t envisage how long the virus would be here, so we didn’t have an articulated modality for engagement of the volunteers, which created the crisis, when they were agitating for their payment. We would have documented their positions properly, having contracts in place.”
With the passion and experience of one who has experienced firsthand the rigours of managing the pandemic in the FCT, she said that COVID-19 has brought a lot of things to light. The outbreak broadened their understanding in the areas of patient management and organising systems, especially the health care system where there are a number of complexities.
She shared important lessons she’s learned in managing the FCT’s response:
- We need to build the capacity of every healthcare worker to effectively manage every disease process.
- We need to strengthen the health system in Nigeria, the system needs to be organised by the government, so we have no need to travel out of the country for treatment. If we can manage this pandemic in the country successfully to this level, then we can manage any disease process.
- There is need to make available health care systems in every locality. There are communities where there are no primary healthcare centres to access treatment. COVID-19 will come and go, but we do not need to revert to the former system, the system needs to be built to world class standard for every state and community.
- Our people need to take responsibility for their health and well-being. For example, the instructions given to wear face mask as a preventive measure for COVID-19 is not being adhered to by some people. Nigerians need to go beyond where we are now, bearing in mind that life has no duplicate and there is no life immunity to COVID-19.
Though there is currently a decline in the number of cases, we are still in the battlefield, and COVID-19 is not over yet. These lessons from the FCT public health department are vital not just for the FCT, but for the entire nation.
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.