Covid-19: No More Isolation Beds? No Cause for Alarm

 These are very uncertain times, and with such uncertainty comes heightened emotions. At the best of times, Nigerians have little trust in Government. According to the most recent data, the country ranks 130^th in the World Bank’s Index of Public Trust in Politicians; Ghana, Switzerland and Malaysia respectively rank 52nd, 9th and 29th. The Elderman Trust Barometer revealed that confidence in the country’s institutions dropped from 66% in 2018 to 42% in 2019. These are far from normal times. A killer pandemic is in the air.  The response of Nigerian Government[s] have not been stellar. States have accused the Federal Government of distributing rotten rice. Residents have accused state governments of giving a bag of rice to ten streets in the name of palliative. There’s controversy over the criteria the Federal Government has employed to distribute bundles of cash to vulnerable Nigerians. Out of a population of roughly 200 million, only 12,000 tests had been administered as at April 26 while Ghana, with a population of some 30 million people, had conducted 110,000 tests.  There is a pervasive feeling that Nigeria’s response to the pandemic is wobbly.

The latest alarm has been set off by the Government itself when the Minister of Health, Dr. Osagie Ehanire publicly appealed to Nigerians to donate buildings to be used as isolation centres. This sounds as an alarm for unnecessary panic. Was the Minister asking for buildings that will be fitted with medical  equipment, including oxygen cylinders and ventilators or plain buildings with beds when Nigerians infected by the coronavirus could live in isolation while they wait for the virus to clear or  to be transferred to a medical facility if the symptoms become severe?

The number of diagnoses does not have to equal the number of hospital beds as most people will not need to be hospitalised. Most people recover at home with no medical supervision needed. Only 20% of coronavirus cases actually require hospitalization, with 5% requiring to be placed in intensive care units (ICU). Even A-list patients like Tom Hanks and Idris Elba had to self-isolated at home until the infection cleared.  Boris Johnson, the Prime Minister of Britain was admitted in the hospital only when his condition deteriorated. He had self-isolated at home. In India,  80% of COVID-19 patients exhibit mild or no symptoms at all, 15% need oxygen, while only 5% require serious medical treatment. To manage space, asymptomatic patients and those with only mild symptoms are typically sent home with very strict guidelines on what to do and what not to do.

Promoting Self-Isolation at Home

Official statements risks entrenching the perception of the coronavirus infection as a lethal disease like ebola that requires serious medical attention. For most of the people that will be infected, it will be nothing more than a very bad flu. Some infected people will not even have any symptoms.  The Government would be wasting limited capacity if it aspires to take on the responsibility of isolating all Nigerians who are infected with the coronavirus. The strategy should be:

1. Roll out testing, making it very accessible especially in cities with high number of cases.
2. Encourage people to quickly report for testing if they think they have symptoms.
3. Trace and test people anyone who tests positive has come in contact with.
4. Develop a system to monitor people who test positive so that they self-isolate and don’t infect others and to transfer them to hospitals if and when they develop serious complications. This should include health officials physically checking up on them at home.

We don’t have the resources to put everyone who is infected under the care of the Government in isolation centres with medical equipment and staff – even countries like the United Kingdom, Germany, the USA, Japan etc. don’t have the capacity. Yet, we may also lack the discipline to self-isolate or the capacity to trace, test and monitor infected people. But it seems promoting and monitoring self-isolation tasks our limited capacity less. Some classes of infected people could automatically be offered limited spaces in isolation centres. This include:

• People living in overcrowded houses where they can easily infect other people and/or may be subject to stigmatisation.
• People with underlying symptoms
• People living alone who would need help getting food and other necessities

Isolation centres need not come with medical gizmos. Experience has shown that ventilators have not been very useful in saving lives, apart from the fact that the overwhelming majority of the people will not need them. Simple hotels in the neigbhourhood will be fine. Private clinics, where a significant proportion of Nigerians receive healthcare must be part of the solution. They should be equipped with personal protective equipment and rigorously trained in how to manage patients. Most of this training will have to be through video instructions conducted in pidgin English and Nigerian languages.

Effective communication is critical. Understanding of the risk of coronavirus should shift from personal illness or death to the dangers of spreading the infection. People should feel they are very unlikely to die from the infection but risk passing it to others, especially older people who are less capable of fighting it. Telephone hotlines through which people could book tests or anonymously report suspected cases should be widely advertised.

Why does Nigeria need more Covid-19 hospital beds when it is lifting the lockdown?

If the Minister of Health is asking for more hospital beds, then he cannot be faulted. Nigeria has less than one hospital bed for every 1,000 Nigerians. The global average is 2.3 beds. But the question would arise about why Nigeria is lifting the lockdown in its most infected cities, except Kano, if it is expecting infection to rise up to a point where the ratio of infected people who would require hospitalisation would overwhelm existing capacity? The goal of the lockdown everywhere is to prevent this scenario. If the Health Minister’s appeal means that Nigeria is running out of beds where patients who develop serious complications could be treated, then Lagos and Ogun States and Abuja should still be subject to the stay-at-home order. Private clinics are perfectly suitable for treating these patients, once the staff are trained and equipped, but we should never allow ourselves to get near the point where Nigeria would need a significant number of private hospital beds to admit Covid-19 patients.