The challenge of testing Nigerians for COVID-19

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The coronavirus (COVID-19) pandemic has killed 39,025 people globally, with 803,011 confirmed cases of the virus. 172,396 have so far recovered for the disease.

Domestic statistics in the country from the Nigeria Centre for Disease Control (NCDC), as at the time of this report, shows that there are 97 confirmed cases.

Nigeria was said to be a low-risk country, however, it is now picking up the pace and adding significantly to the troubling statistics of confirmed cases world-wide. The only hope we cling to for now, is the fact that three (3) people have recovered, with 2 deaths recorded so far. We have 130 active cases in the country at the moment.

However, the World Health Organization (WHO) has continued to emphasize the critically important role ‘testing’ plays in curbing the spread and transmission of the COVID-19. In fact, it describes it as a game-changer.

According to a report by the Nigeria Centre for Disease Control (NCDC), only 846 people have been tested so far as of March 26th, 2020. The total number of people tested till date is not only depressing but might also be a forewarning that the current numbers of infected persons may be way higher than the numbers reported by the NCDC.

This is because, for a country estimated to have 200 million people, testing a little over 800 persons is abysmal.

For example, Ghana with an estimated population of about 30 million people, and recording its first index case of COVID-19 on March 11 (nearly two weeks after Nigeria recorded hers), as at March 28, has tested 2,519 persons for COVID-19. This is according to the Ghana Health Services.

Also, South Africa with an estimated population of about 59 million people, and recording its first index case of COVID-19 on March 4 (nearly one week after Nigeria recorded hers), has tested 31,963 persons for COVID-19. This is according to the National Institute for Communicable Diseases in SA.

Many other countries are carrying out tests in their tens and hundreds of thousands in a few weeks. It is therefore clear that something is fundamentally wrong with the country’s testing processes and capacity.

The Nigeria Centre for Disease Control (NCDC), being the frontline government agency in this fight is saddled with the sacred obligation and responsibility of ensuring that the country is safe and free from epidemics and pandemics ravaging the world today.

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In this stead, the NCDC released their toll-free numbers (0080097000010 or 112) with which persons who suspect they might have acquired the coronavirus – either by recently coming into the country from ‘high-risk’ countries or have close contact with a confirmed case, can contact the NCDC and possibly get tested.

However, a lot of people have heaped up complaints about the effectiveness of the testing procedures and arrangements by the NCDC, as they either do not get a response through the lines or are declined access to get tested by the NCDC representative on the line based on technical grounds. Using the case definition for determining those to get tested may also not be as effective after all.

More worrisome is the fact that even when some persons report that they have some obvious symptoms of the coronavirus (COVID-19), they are still left unattended to until they escalate the situation on social media. The toll-free lines are obviously very ineffective and needs a lot of scaling up in terms of staff strength and competence.

With the current situation, the country might as well have a time bomb waiting to explode on our hands, as these complaints from different quarters, might as well mean that our cases in the country are under-reported because of under-testing. If this is true, we may be heading the path of community transmission.

Currently, it has six laboratories in Nigeria with a capacity for in-country testing of the COVID-19 virus. The laboratories are – NCDC National Reference Laboratory in Abuja, Nigeria Institute of Medical Research in Lagos, Lagos State University Teaching Hospital, Irrua Specialist Teaching Hospital in Edo state, African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) in Osun State, and University College Hospital, Ibadan.

With these six labs not evenly spread across the six geo-political zones in the country, the government might as well be on their toes to scale up the process of getting more centres that can carry out such specialised tests.

Averagely, the time it takes the NCDC from collection of samples, to testing, and to sending results of tests may sometimes take days – over 72 hours. This is partly because of transit time for the samples to get to the designated laboratories.

To clear all misconceptions, the NCDC continues to restate that anyone who suspects that they may have developed some symptoms of the COVID-19 should call their toll free lines. Nobody is expected to report to any test lab for screening.

If the person is suspected to have acquired the virus, the NCDC drives to wherever he or she is (mostly their homes), collect samples and take it to their lab for screening and testing. At this time the person is supposed to be in self-isolation.

So, depending on the result, the person is either advised to complete the 14-days isolation process or is immediately taken to one of the isolation centres in the country if the result is positive.

However, an investigation by The Nation revealed that the NCDC also engages motorbikes to bring in samples. The Nation reporter witnessed this as a motorcyclist carried a box containing sample into the NCDC National Reference Laboratory (NRL), Gaduwa, Abuja. The security man asked the motorcyclist if he was carrying samples and he answered in the affirmative.

This is not to say that the samples brought in by the motorcyclist were for COVID-19; it could be for cholera, Meningitis, etc. However, safety and confidentiality demands that the NCDC engages more decent and secure methods of couriering samples to their labs other than the use of local bikes, without any form of security apparatuses.

Nigerians, experts query approach to testing

Nigerians are taking to their social platforms to express their grievances and disappointments concerning the laid down procedures of the NCDC with regards to testing, as some have reported issues of frustrations and outright rejection by those who are supposed to ensure that they get tested.

Many are saying the government is adopting a double standard for testing Nigerians depending on the social, political and economic status. This is not yet confirmed, but, the entire narrative makes it look like the greatest sin you can commit in the country is to be sick and broke at the same time because we have a very faulty health system.

According to the President of the Nigerian Medical Association (NMA), Dr. Francis Faduyile, “Let’s not be deceived, we say we have 97 cases in the country, the question now is how many of the contacts of these cases have been tested?  The Minister of Information said they are tracing 4,370 contacts. If peradventure 25 per cent of these numbers have it, or even if it is 10 per cent, and they are free in the community, then, there will be a problem because we have a very short window period, and if we fail to use it well, the spread will become full-blown.

“We do not have enough health workers, therefore, if we are overwhelmed by the increasing numbers, it will be catastrophic.

“The test on COVID-19 or such deadly diseases, cannot be done in any laboratory. There are different grades of laboratories –  there are laboratory grade 1, 2, 3, 4, and 5. The grade of the laboratory that should be testing these should be from grades 2.5 and above.

“I want to believe that it is not possible for us to have proliferation of test centres, but are the test centres we have in the country today adequate for 200 million people? The answer is no.

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“We have failed during the time of peace to prepare for war. It is, therefore, not at this time of war that we want to start thinking of setting up labs, so it is very difficult. But the ones we have can be congregated and put together, but may not be as effective because over the years we have failed to do what we needed to do.

“In as much as we must maintain standards, and it is desirable to have more labs which is the normal thing, but it may be difficult for us to have more because of the emergency situation in our hands”.

The President of the College of Nigerian Pathologists (CNP), Prof. P. O. Olatunji, in a statement over the weekend, called on the Federal Government to substantially decentralise testing centres from the five centres currently carrying out the tests for coronavirus (COVID-19) in the country, to other tertiary health centres. The University College Hospital, Ibadan, was just added over the weekend. This makes it six test centres.

According to him, “The CNP notes with concern the inadequacy of testing centres across the country and urges governments to substantially decentralise the testing centres as a strategy to accelerate the control of the outbreak. We do not see any reason why our tertiary health care centres, where competent pathologists and medical laboratory scientists are situated, cannot carry out COVID-19 tests.

“We urge the Federal and State governments to deploy a portion of the COVID-19 budget to bridge whatever deficiencies exist in our tertiary diagnostic laboratories.

“We are aware of the advertisement of a few rapid serological test kits being touted for the diagnosis of COVID-19, and some are already showing interest.

“In the first instance, many of these kits are antibody-based and may not be appropriate for an accurate diagnosis. Secondly, they are not validated, hence their sensitivity and specificity are unknown. While we caution against using these test kits, we recommend that an in-country evaluation could be done for some that are said to be antigen-based.

“We are of the view that anything that can positively contribute to the control of the pandemic should be embraced. While we recommend that at these critical moment, diagnostic utility should employ the NCDC recommended Real-Time Polymerase Chain Reaction (RT-PCR), we call for a more innovative and quicker diagnostic approach”.

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What the NCDC is saying about testing

The Nigeria Centre for Disease Control (NCDC) has revealed that additional three test laboratories will be added to the existing six test labs in the country to scale-up testing capacities.

The new labs to be located in Abakaliki, Port Harcourt and Kaduna, will be ready in the next week.

This was disclosed by the Director-General of the NCDC, Dr. Chikwe Ihekweazu, during an interview on a cable TV.

According to him, “In terms of testing, there are two short-term interventions that we are carrying out. First, we are using some processed engineering to improve the throughput in our existing labs. In the Abuja lab for example, we have moved to a shift system. So, we are working 24-hours in three shifts.

“In the next week, we are going to add four new labs to our network. We have worked in Ibadan over the past couple of days and we should activate it today. I have a team that has been in Ibadan for the past two days, then, we will go to Abakaliki where we have an existing lab, then we will go to Port Harcourt and Kaduna. So, these four should be ready in the next week and add to the existing capacity”.

He further added: “We are also going to convert some of the high throughput tests available for HIV. There is a PCR diagnostics that can test a large number of cases at the same time but the technology itself has to be changed and adapted for this new virus.

“That will take two to three weeks, and once we get the reagent for that, then we can do some high throughput testing and test thousands at the same time. But that will not happen until the next 2 to 3 weeks. This is the next strand of expansion that we are working on.

“There are also new diagnostics. There are people working on rapid diagnostics tests kits, and we are hoping that it can be brought to the market and we will make our purchases and procurement as soon as possible.

“Nigerians are not going to pay for any of these tests; as long as you need it, we will support the test through a public sector fund. Of course, if you want to have the test privately, we don’t have any private provision as at now, but there are groups working on it.

“If you want it done in the convenience of your house or wherever you want, there should be a private sector that can offer that to you. But that does not exist at the moment for any validated care. We are working with a group of private-sector colleagues to make this happen in Lagos in the short-term and then, in Abuja and spread it to the other cities.

“We are scaling our testing capacity across the country, particularly in Lagos. So, we are testing more because people are more aware. Those with severe respiratory symptoms and other mild symptoms are pushing to get tested. We apply the case definition, but sometimes we just have to go ahead and test. So, generally, we are improving the entire system from the collection to testing, and to send results.

“I do not think that it is unlikely that we’ll see a continuous increase of new cases in the short term, as the measures we have instituted, are new measures that will become effective in the next few days.”

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