There is no doubt that Lagos State is the epicentre of the COVID-19 pandemic in Nigeria. Being the foremost teaching hospital in Lagos and one willing to take responsibility regarding the management of COVID-19 in Nigeria, Lagos University Teaching Hospital (LUTH) recorded what we can conveniently call an effective response management. They admitted the first set of patients (four) on 7th April 2020 and their sample collection numbered 10,292 as at 14th December, 2020. The LUTH response team worked alongside the Lagos State team and has been involved in psychosocial issues relating to COVID-19. This is in line with the national COVID-19 management protocol which demands that each state manages their own cases of COVID-19.
In December 2020, Professor Wasiu Adeyemo, the Chairman Medical Advisory (CMAC) Board, and Dr. Iorhen Ahkase, Head of Department, Infectious Disease Unit LUTH who also doubles as the Coordinator of the COVID-19 response team in LUTH spoke about the motivation of the LUTH management in terms of case management through the COVID-19 pandemic in Nigeria and the factors behind this commitment.
Going down memory lane, Prof Adeyemo says, “When we admitted our first four patients on the 7th of April, 2020, we didn’t know what we were going into because nobody had experienced anything like this in a hundred years. We were at loss, but we knew we needed to put our best foot forward if we were going to successfully combat the disease. We knew we needed to try, even when we weren’t sure it would be enough.”
In an enquiry of the structures that helped LUTH as a health facility in COVID-19 management and how the front-line workers operated, he explained:
“Prior to the index case in Nigeria and our first set of admissions, we had heard so much about COVID-19 and its ravaging effects in other parts of the world and seen how the virus was ravaging ‘resourceful’ nations. Taking cognizance of the fact that we are a resource-limited nation, and that COVID-19 is a highly infectious disease, it was obvious that we were going to get a little bit anxious.”
Even though the national COVID-19 management protocols require each state to take responsibility for the management of cases, LUTH, a Federal Teaching Hospital reported cases through Lagos State Ministry of Health. This meant that the LUTH team merged with the state team to achieve success in response strategy. Apart from case management, they were involved in diagnosis alongside the Lagos state team, and managed psychosocial issues relating to COVID-19. LUTH staff were also part of contact tracing, which was quite challenging at the onset of the response.
Prof Adeyemo says that a big part of their success story is training. “First, we trained our people, and the initial reaction we got when we commenced training was scepticism. For fear of the unknown, many people left the hospital.” Prof Adeyemo said that the team realized that with training comes knowledge that will help conquer fear, so they strategized, and solicited for volunteers to be trained. “Upon the call for volunteers, we had more than 100 people volunteer and participate in the training”. The training saved the day and helped the response team in no small way.
We had two training sessions; one in Infectious Diseases Management, and the other in Infection, Prevention and Control (IPC). This training produced our first set of COVID-19 warriors who were deployed to the ward where we managed the COVID-19 cases. As the team started getting the hang of case management, their colleagues realised that the predicted health worker casualties were not as high as feared. The scepticism level dropped, and this led to training of more healthcare professionals. We trained more than 1600 personnel, including those from other public teaching hospitals within and outside the state. The training was headed by Dr Akhase and his colleagues in the Infectious Disease Unit, LUTH.”
The knowledge acquired through the training improved safety in LUTH when the need to reopen the economy arose. The trained staff were aware of the standard procedures in infection prevention, diagnosis and referral. Prof. Adeyemo acknowledged the fact that work was easier with well trained and motivated staff alongside the several sponsorships the institution enjoyed from both corporate and private individuals which helped the institution in no small way. The hospital also had received support from the Federal Government, the State Government, and the NCDC.
Measures adopted to ensure a hitch free response process included ensuring that any staff infected with the virus is treated in LUTH. Due to the active and full involvement of the LUTH staff in COVID-19 case management, many of them got infected, some from the hospital, others from the community spread. Prof Adeyemo pointed out that LUTH is not just a hospital but also a community with residential areas. He proudly stated that despite all challenges, LUTH as an institution in the COVID-19 response did not lose any member of staff.
“Now that we have the second wave, we’ll see what we can do to continue to sustain this positive trend.”
Responding to how the health equipment help in managing the COVID-19 cases, Dr. Akhase mentioned lack of capacity for intensive care for COVID-19 patients as one of the challenges in managing the first wave in LUTH and this led to creation of alternatives by the hospital management. “LUTH has ventilators for other ICU needs, but we initially couldn’t mobilize ventilators for COVID-19 care. As the pandemic continued, knowledge became available that we do not necessarily need those machines to ventilate COVID-19 patients, so we deployed mini ventilators.”
Dr. Akhase described the Lagos response model as one with various isolation facilities providing different levels of care. “Facilities like IDH, Landmark and First Cardiologist could offer intensive care like intubation, some could do dialysis, etc. This way, LUTH did not necessarily have to duplicate everything. LUTH has multiple specialty care surgeons, cardiologists, endocrinologists, gynaecologists, etc. For instance, a COVID-19 positive pregnant woman who needs to be delivered of her baby can be easily referred to LUTH.”
Dr. Akhase also spoke about the first wave experience which helped the LUTH response team to gain better understanding in managing the virus. “At the beginning everybody who tested positive to COVID-19 was admitted to the hospital. Now, the team understands that not everybody needs to be in the hospital. They also learnt that the solution to COVID-19 is not the ventilator. “At the start of the pandemic, everyone was worried about the number of ventilators available. However, we now know that ventilators are not the only solution, and that those who have underlying conditions need more care.”
In Prof Adeyemo’s words, “Keeping staff members motivated in Nigeria, especially under the circumstances we have found ourselves is very challenging. The number one motivation that resonates with everyone here is money, no matter what anybody says.” He agrees the Federal Government did her best in this regard and also commended the Lagos State Government, while acknowledging some initial challenges which were surmounted. The LUTH management also rose to the occasion when funds were not initially forthcoming from the government and this timely intervention helped stabilize and motivate the response team in LUTH.
One of the major challenges we encountered is that LUTH had her fair share of the several conspiracy theories making the rounds. “It got to a point where the management made facemasks and face shields available, and people refused to wear them for fear of contracting the virus from the items.
“Ultimately, knowledge is absolutely important. People have to go to work, and we are trying our best to manage the situation. We hope everyone cooperates with us and adheres strictly to the safety protocols. If not, even the government will have a lot of trouble, and it is going to be extremely difficult to shut down the economy again. The government has done its best, we as front liners have done our best, but we need more people to take responsibility. I was in Ibadan some few weeks ago, I spent 48 hours in Ibadan, and I did not see a single person wearing a face mask. What is worse, more conspiracy theories abound now that we have the vaccine.” Prof Adeyemo added. Dr. Ahkase as an advocate of prevention stated that one outbreak is enough trouble.
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.