Transitioning from Lassa Fever to COVID-19 – The Irrua Specialist Teaching Hospital Experience

It was a calm afternoon. The birds chirped and the wind blew in from the east. A few people stood within the hospital premises, which was barricaded with barbed wire and a single gate for crowd control. Beside the entrance gate was a roofed, open space doubly serving as a security post and patient screening point. To the far right was a 3-storey uncompleted building which would serve as the new isolation centre for the hospital. A small, detached bungalow, currently serving as the infectious disease isolation centre was just opposite. Although some health workers manned their usual stations in anticipation of COVID-19 patients, the ward was empty: the centre was winning the war against COVID-19.

This was the scene at Irrua Specialist Teaching Hospital (ISTH) Isolation Centre in Irrua, Edo State in December of 2020. The facility was established in early 2008 after Lassa fever (a viral haemorrhagic fever) wiped out an entire family in Ekpoma. In the past, the isolation centre had been used for managing patients with infectious diseases like yellow fever, monkey pox and Lassa fever, and was currently being used for COVID-19. According to Dr Edeawe Osarogie, a senior clinician at the isolation centre, transitioning from Lassa fever to COVID-19 management didn’t come easy for the team, but with support from the Chief Medical Director (CMD), Professor Sylvanus Okogbenin, they have been able to cope.

“My CMD called us for a meeting a few days after COVID-19 was recorded in Lagos and told us to brace up for the battle ahead because, according to him, there was no way COVID-19 will get to Lagos without us having a fair share of patients to manage,” said Dr Osarogie. “He promised us that although we didn’t have all we needed for the fight, he would stretch beyond his limit to ensure we got the necessary support. This promise was one of the motivations that kept me going,” he said.

Dr Osarogie also revealed that at the time of COVID-19 outbreak in Edo State, rainy season was approaching, a period in which there were few cases of Lassa fever, making the transition to COVID-19 response a little easier. The hospital converted the old Lassa fever isolation ward to a COVID-19 isolation centre and new staff were deployed to various units in the hospital. In supporting the Federal Government, the ISTH management also deployed some health workers from the ISTH to Lagos, Abuja, Kano and Benin City to help in the response to the virus outbreak. To avoid leaving their base, ISTH, unattended to while on national assignment, a proportion of the hospital staff were at ISTH to help manage any case admitted to the centre. To ensure constant supply of adequate personal protective equipment (PPE), the hospital management commissioned the laundry section to begin production and recycling of PPE.

After April, 2020, when the first case of COVID-19 was admitted at the centre, the number of cases increased gradually until there was an overflow of patients. “At some point, we had to manage COVID-19 and Lassa fever patients in the same ward because we had infrastructure constraints. Sometimes we even had to use the same sphygmomanometer for blood pressure management on both patients; this wasn’t supposed to be so”, said Dr Osarogie.

Considering that COVID-19 was a novel disease, and that the hospital was located in a semi-urban community surrounded by rural communities where awareness was poor, the health education unit of the hospital had a new challenge. They were now tasked with the responsibility of properly educating the rural dwellers and visitors to the hospital about what COVID-19 was and their role in managing the outbreak. They achieved this by sending out weekly health advisories, stationing a big signboard to enlighten visitors about the disease and hosting weekly community health education sessions in various communities surrounding the hospital. For diagnostic support, Dr Osarogie revealed that the ISTH Molecular Laboratory was on standby 24/7 to provide laboratory services and results were never delayed, which helped improve patient care outcome.

Mr Peter Ejefor is a public health nurse at the isolation centre who was involved with COVID-19 response. According to him, joining the team to respond to COVID-19 outbreak was a learning experience for him. He said that two unique features that set ISTH staff apart in responding to COVID-19 and other infectious diseases are courage and ability to use available resources for the optimal outcome. “Many people have asked why ISTH seems to be number one in infectious disease management and we keep telling them that our unique characteristics is the courage our team displays alongside the ability to use available resources in managing patients for the better outcome. This has helped us in achieving a very high success rate over the years despite the kind of infectious diseases we have had to deal with,” he said.

Moving forward, Mr Ejefor and Dr Osarogie calls on the Nigerian government to continue to strengthen public health infrastructure across the country in infectious disease management. 

At present, there are no patients in the ward and the staff workload is low, however, according to Dr Osarogie, the team is on alert waiting for the next patient that will come through the doors. “Over the years, we have done well at ISTH and have shown that we are leaders in managing any infectious disease including COVID-19 in the country. It will be right for the government to note the areas they can support us to perform even better,” he said.

This narrative was done in February 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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