Lagos State is known as the epicentre of the COVID-19 pandemic in Nigeria, and her response structure has evolved since the first case was recorded a little over a year ago. The monitoring and response systems have become more effective in the battle against the pandemic. The response in Lagos began with few staff of the State epidemiology unit and has expanded into several pillars and sub pillars. 

According to the Lagos State COVID-19 Response Pillar Lead for Epidemiology and Surveillance, Dr Abisola Adebayo, a Consultant Public Health Physician and Field Epidemiologist, the State response is made up of several pillars. It is like an eco-system which is structured to reduce the speed of the spread of infections. The response pillars include the Epidemiology and Surveillance Pillar, Laboratory, Case management, Psychosocial team, Infection Prevention and Control, Evacuation Team, Decontamination team, Logistic Pillar, and Risk Communications.  

The coordination pillar is headed by the Incident Manager and State Epidemiologist, Dr Ismail Abdul-Salam. He coordinates the team that operates COVID-19 Emergency Operation Centre. The Commissioner for Health is the Deputy Incident Commander, while the State Governor is the Incident Commander for Lagos. The Permanent Secretaries of the Ministry of Health, Primary Healthcare Board, and Health Service Commission are also integral to the success of the response structure.  The Health Service Commission provides most of the staff who work in the Case Management pillar and operating outside the isolation centre while Primary Health Care board handles the response at the LGA level.

 “The epidemiology and surveillance pillars work closely with the laboratory because a lot of our work depends on the test results.’’ Dr Adebayo said. She emphasised the importance of the Psychosocial team as she pointed out, “Not all the states in Nigeria have a psychosocial team. We learnt from our experience of the Ebola outbreak, and realised that psychosocial support and emotional care are very important parts of the outbreak response.’’ 

A sub pillar in the surveillance team is the Rumour and Alert, which is headed by Dr. Yasheed Omotayo from LASEMA. “He supervises a network of doctors who take the calls made to the hotline. They determine if it is a likely case of COVID-19, or if they are worried and need counselling. They also do follow up, even if it is initially not a case of COVID-19. There are cases where they can tell that it’s an emergency, and immediately call the evacuation team to pick them up.” Dr Adebayo further explained.

Dr Adebayo pointed out that quality data is very important to the Lagos State response strategy. “Mr. Governor has a war cabinet that the Honourable Commissioner for Health is a part of, and they use the data we provide to arrive at decisions. The data team makes up 70 percent of the surveillance pillar. Everything is based on data, so if we give them wrong data, we are misleading them and misrepresenting the response. This is the reason I take meticulous care to ensure that every piece of data tells the true story. It can be overwhelming at times because we deal with a large volume of data, but we cannot afford to make mistakes, as important decisions are made using the information we provide.” She said.

“For effective case investigation and surveillance, we take contact tracing very seriously. When we notice a cluster pattern, we deploy the Infection Prevention Control team. Often, the contacts need to get tested. Our focus is to stop the spread” She added.

The response structure at the Local Government Area (LGA) level has greatly improved. Each LGA has a Rapid Response Team made possible with help of partner organisations like the World Health Organisation (WHO), Africa Centers for Disease Control and Prevention (ACDC), Nigeria Centre for Disease Control (NCDC) and others. There are walk-in sites in the LGA, and they are equipped with surveillance, laboratory, and IPC units. The sites also have data officers who work with Surveillance Outbreak Response Management & Analysis System (SORMAS).

The evacuation and decontamination team work hand in hand. The Evacuation pillar consists of the ambulance service of Lagos State. Adebayo said, “Lagos State has a very functional ambulance team which picks up patients who have tested positive and transports them to the isolation centres. They also transport patients who are suspected to be positive and are already in respiratory distress.’’  The decontamination team also disinfects residences and public spaces, the logistics pillar is the lifeblood of the response structure. They oversee procurement, and make sure that consumables like sanitisers, PPEs and home care packs are always available. The risk communication pillar handles health education in the media, community advocacy, and sends out infection prevention messages.

Lagos State has a surge team domiciled at the Infectious Diseases Hospital, Yaba to address urgent responses, like multiple sample collection at an incident site. This helps to relieve the pressure from other pillars in case of emergencies.

On the challenges they have encountered so far, Dr Adebayo said that funding is the biggest one. There’s so much money that is spent on testing alone, and that’s only a fraction of the overall expenditure in the fight against the deadly virus.

The Lagos State COVID-19 case management response now includes home-based care for mild symptom patients. “Before, we picked up all cases, but we now have Eko Telemedicine working with the LGAs. The officers go round to follow up and administer the home care kit. The teams also contact people in self-isolation. We have our LGA contact tracers, and supervisors for the wards.” Dr Adebayo said.

Concerned that citizens do not come out for testing as they should, Adebayo advised Nigerians to help the government by presenting themselves for testing to curb the spread of the disease. “People are not coming out for testing. Many times, people have symptoms and they say it is not really bad. In the LGAs we have personnel who are rising to the occasion and they must know we are not ignoring their efforts. Not coming out for testing is a major challenge.” She stated.

Dr Adebayo, who was among the ten honoured frontline health workers in the fight against the COVID-19 pandemic as part of activities commemorating the Governor’s first year in office is worried about the full resumption of international flights. She fears that the volume of travellers may overwhelm the system, but she is also aware of the importance of opening the economy. She advised that everyone take responsibility and do their part in curbing the spread of the virus.

This narrative was done in January 2021 as part of the #COVID19NigeriaStories documentation project on state-level responses to COVID-19, implemented by the Nigeria Centre for Disease Control and Nigeria Health Watch with support from the Ford Foundation.

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