People & Money

Starting N1.5 M Per Day: Private Management of Covid-19

Nigeria has a total of 30,249 cases, i.e.  people confirmed by a laboratory to have been infected by the new coronavirus regardless of the presence or severity of symptoms, with Lagos having the lion share of 11,670 cases. Despite the widely held belief that the real number of cases would be much higher if more tests are carried out, Nigeria’s 112 treatment and isolation centres which have a total of 5,324 beds are running out of capacity. The problem so far seems to be mainly a pLagos problem; the state government has thus accredited three private clinics to manage Covid-19 patients. (Covid-19 is the name given to the ailment or symptoms caused by the new coronavirus). But the cost of managing Covid-19 symptoms at the private clinics is so prohibitive only the richest Nigerians can afford it. The cost depends on the severity of the cases but the average cost of managing a Covid-19 patient is over N1 million per day. One of the hospitals requires a N13 million deposit while another requires a N3 million deposit before patients could be admitted.

What the money is spent on

These fees seem expensive but considering the procedures and risks involved in managing the highly infectious virus and the complications it causes. It does not seem that the clinics are making a killing. Everyone from doctors, nurses, cleaners to even gate keepers must put on a variety of single-use personal protective equipment (PPE) such as fluid-resistant (Type IIR) surgical masks (FRSM), high-quality eye protection shields, disposable fluid repellent coveralls or long-sleeved disposable fluid repellent gown etc. The average cost of PPE per person in a clinic in Nigeria is N70,000:00 per day. Very expensive machines are also required including ventilators for severe cases requiring respiratory assistance. Severe Covid-19 cases also damage organs such as kidney, hence the clinics must have highly paid specialists such as nephrologists on standby. 

The symptoms the clinics manage

Some infected people never show any symptoms while symptoms vary considerably in people.

Mild cases are individuals with no respiratory illness but have fever, cough, sore throat, malaise, headache, muscle pain. A moderate case is a person with cough, fever, respiratory rate less than 30 breathes per minute, peripheral capillary oxygen saturation (SpO2) less than 90% for adults and more than 92% in children. In a severe case, there is loud breathing, respiratory rate is greater than 30 breathes per minute, oxygen saturation is less than 90% for adults and greater than 92% for children. The patient requires oxygenation. Most critical cases develop organ dysfunction such as Acute Respiratory Syndrome (ARDS), acute kidney injury, cardiac injury, liver dysfunction and pneumothorax. Two or more of their organs are supported for an indefinite period. Mechanical ventilation is also used to aid their breathing. If this takes too long, then a surgical tracheostomy is used; this is a highly aerosol generating procedure. The required skilled specialists to operate the equipment involved are even rarer to find that the machines.

The goal of managing the symptom is to keep the patients alive while the virus runs its course. Fatality rates for cases with underlying diseases are higher than cases with no underlying disease. According to a report in China, the fatality rates are 10.5 % for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 60% for hypertension, 5.6% for cancer and 0.9% for none.

Public authorities incur more costs tracing and testing the contacts of infected people. In Lagos State, the cost of just the test is N50,000:00. A single infected person might have more than 100 contacts. Hitherto, infected but people asymptomatic people were also admitted at the isolation centres in Lagos State. Asymptomatic cases are now to be treated at home.

Cost of managing Covid-19 in other parts of the world

In the United States of America, treating 11.2 million severe cases using 1.6 million ventilators will cost $163.4bn according to the report of a study lead by Public Health Informatics, Computational, and Operations Research (PHICOR) team at the City University of New York. This means that for every 7 severe cases using 1 ventilator, the cost of treatment is $102,000, averaging $14,560 per patient which is about N5,700,000. In government run hospitals in India’s metropolitan cities, managing a severe case’s symptoms is around N872,000 while in private hospitals, approximately N7,300,000. In South Korea where the total medical bill regarding covid-19 cases is entirely covered by the state, the cost ranges from N3,800,000 – N22,334,000 for a severe case and a critical case, respectively.

African Governments are appealing to donors for $40 billion to meet the cost of treating Covid-19 patients and curtailing the spread of the new Coronavirus by rolling out testing. Health insurance doesn’t cover Covid-19 treatment as cost of managing it is too high and too many people are at risk of contracting it so making the pooling of risks unviable.

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