Responding to The Unknown: Lessons from Edo State COVID-19 Response

Coronavirus or wetin you call am no dey. Na lie government dey use am chop money as usual. In fact, even if e dey, na only politicians and rich men e dey catch” said Osazee Timothy (not real name), a commuter in Benin city, the Edo State Capital.

He and other passengers in the vehicle engaged in a conversation that soon snowballed into a heated debate.  More than half of the passengers in the 18-seater bus didn’t wear face masks and physical distancing guidelines were disregarded.

Another passenger asked why there was no adherence to social distancing protocols from the Federal Government as most political parties in the State disregarded the guidelines in the just concluded gubernatorial elections. She maintained that all the rallies that didn’t comply with the guidelines should have been stopped by government if they wanted people to take them seriously.

Tension rose even further when a passenger mentioned latest COVID-19 figures from the Nigeria Centre for Disease Control (NCDC). The driver, who at first seemed uninterested in the discussion, added that NCDC made up those figures daily to join the government in siphoning money.

Nigerians went about their normal businesses in Nigeria until 27th February when the country recorded its first case of COVID-19 in Lagos. In mid-March, when the numbers increased, the government intensified efforts towards containing the disease including a nationwide lockdown.

Edo State serves as gateway to different parts of the country. The state government expected that given this reality, the virus would eventually get to the state.

On March 23rd, 2020, Edo State recorded her index case in a 50-year old man who had travel history to the United Kingdom. He was managed at home on self-isolation by physicians from the Irrua Specialist Teaching Hospital (ISTH). With that case, the State government knew it had to step up efforts to protect its citizens.

Edo State Epidemologist, Dr. Uwafiokun Okhuarobo, in a meeting with the State Disease Surveillance Notification Officers

Dr Uwa Okhuarobo, the State Epidemiologist, argued that the State was ready for COVID-19 before the first case. “We always knew Edo state can’t be spared from the infection because of our strategic location. We took immediate action including setting up a COVID-19 task force headed by the State Governor, Mr. Godwin Obaseki. Other key actors taking decisions on health matters were included in the taskforce”, he said. Dr Uwa added that the task force immediately activated the State Emergency Operation Centre (EOC) and set up isolation centres at Stella Obasanjo Hospital with a 300-bed capacity, University of Benin Teaching Hospital (UBTH) with 35 beds and ISTH with 25 beds. This came to a total of 360 beds available for the response. To further consolidate and strengthen testing capacity, they setup laboratories at UBTH, ISTH, Edo Specialist Hospital (ESH) and Lily Hospital.

Dr Uwa said that they successfully screened 500,000 persons and tested 5,000 between April to June while managing 2,430 to wellness out of 2615 cases recorded as at 23rd September 2020.

Fear of the Unknown

The afternoon sun blazed over the roof of the UBTH isolation centre. Activities progressed smoothly and one of the nurses can be seen attending to a patient. The number of patients in the ward has reduced as not all beds were occupied. Dr Benson Okwara, the Head of the Rapid Response Team at the Centre said that things are gradually returning to normal and he was no longer as busy as it was at the peak of the pandemic.

UBTH recorded its index case on 31st March 2020. Two males aged 35 and 44 reported to the emergency unit with symptoms suggestive of COVID-19 infection. Their COVID-19 tests came back positive on 2nd April 2020. Unfortunately, the 44 years old had kidney infection and died after leaving the isolation centre after 28 days of treatment. This started the hospital’s journey towards containing the infection in the state.

The hospital which lacked an isolation ward for infectious disease immediately converted the yet to be commissioned research laboratory into a temporary isolation ward. They also sent out several health advisories to members of staff as well as those residing within the Ugbowo community where the hospital is located. Still not satisfied with the level of preparation, the Chief Medical Director (CMD), Professor Darlington Obaseki directed that the old medical emergency unit be renovated to serve as the new isolation centre. They also started training of different cadre of health workers on what to expect and how to respond.

Our greatest challenge managing COVID-19 at UBTH was fear of the unknown. There were lots of obscurity surrounding this infection which left many apprehensive. For a long time, we struggled to convince staff to volunteer in working at the isolation centre after stratifying them based on risk level but met a brick wall. Not until we took up the task of learning more about COVID-19 and demystifying myth surrounding it, few persons were willing to join our team at the isolation centre,” Okwara said.

Dr. Okwara revealed that when the pandemic started, samples were still being sent to ISTH which takes about two hours from the city. This delayed treatment initiation.

Our hospital management led by Prof. Obaseki told us in one of the meetings that he is not happy with the arrangement of sending samples to ISTH and took efforts towards signing a Memorandum of Understanding (MOU) with Professor Friday Okonofua, the coordinator of the Centre for Excellence in Reproductive Health Initiative (CERHI) at the University of Benin who donated a Polymerase Chain Reaction (PCR) machine which we deployed for testing till date. This has led to better patient management at UBTH”, Dr Okwara said.

Access to specialised procedures for COVID-19 at the isolation Centre remain a challenge for Dr Okwara and his team. Although the number of cases continues to drop, Dr Okwara expressed fears that the delay in accessing procedures like hemodialysis is impacting negatively on treatment outcomes. He said a key outcome of their meeting with the CMD is the structure being put in place to prioritise COVID-19 patients.

Opportunities and lessons

Beyond COVID-19, Dr Okwara is excited that UBTH is looking towards becoming a centre for managing endemic diseases in the country. “Over the years, we never had an isolation centre but with COVID-19, we had to quickly come up with one and the CMD is already working out plans to ensure that everything doesn’t just end with COVID-19. There are other endemic disease and we want to take up the challenge as the foremost health institution in South-South Nigeria,” he said.

Seven months on, Dr Okwara said the sanctity of life and need for everyone to give their best always were his greatest lessons managing COVID-19 patients. The consultant dermatologist and infectious diseases expert said he is happy that his team managed severely ill patients to wellness and calls on all Nigerians to be involved in the fight against COVID-19. He said the nonchalance of many towards the infection can reverse progress made so far.

He said he never entertained fears of contracting the virus because as a medical practitioner, he is akin to a soldier who goes to war with the goal of winning the battle.

While he is speaking, staff at the centre brought in a middle-aged female patient, who has just finished from a procedure and was being returned to the ward. “This is one of our patients who came in a bad state, but we are happy she is doing better and will be discharged soon”, Dr Okwara declared, adding that he wished he could bring back the patients they lost to the virus.

A top destination for COVID-19 cases

The calm ambience at the Stella Obasanjo Hospital isolation centre is inviting. Dr Osariemen Augustine Osunbor who heads the centre said they recorded the highest number of confirmed cases, least number of deaths and highest recovery in the state. They achieved this because they managed every case as a multisystemic disease rather than focus on just the respiratory system.

The consultant nephrologist said that the hospital gained a lot during the COVID-19 response as the hospital which once had 150 bed capacity was upgraded to 300 bed spaces. In addition, they received a donation of a 30-bed isolation centre from Peculiar Ultimate Concerns Limited, the company that renovated the Samuel Ogbemudia Stadium in Benin City.

At the onset of the COVID-19 outbreak, the whole world focused on the respiratory component of the disease forgetting that it is multisystemic. That was why the whole focus was on getting ventilators. However, despite having 14 ventilators in our centre, we never had need for any one of them and didn’t use them. Yet, many of our patients were managed to wellness” Dr Osunbor said. He commended the State government for the efforts towards ensuring the isolation centre never lacked Personal Protective Equipment (PPE) till date.

In the wake of the outbreak and all through our work here till now, I can categorically say that we never lacked PPE. In fact, we had more than enough,” Dr Osunbor added.

Although health workers got infected in isolation centres across the State, there were no mortalities. Dr Osunbor shared the story of a nurse that got infected and spent long time in isolation. He says they all rejoiced when she finally recovered.

Sustainability challenges

Despite the challenges so far, the State is not resting in the fight against COVID-19. Recently, Edo State was awarded the Incident Action Fund (IAF) from the World Health Organisation (WHO) with which the team hopes to kickstart activities once the concept note is completed. As the fight against COVID-19 continues, the hope is that the government will take advantage of the lessons learned from this response to prepare for future outbreaks.


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.

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