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COVID-19: WHY NIGERIA NEED TO CONTAIN THE SPREAD OF DISEASE

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By: Ademola Orunbon

What began with a handful of mysterious illness in a vast central China city has traveled the world, jumping from animals to humans and from obscurity to international headlines? First detected on the last day of 2019, the novel coronavirus has infected tens of thousands of people-within China’s borders and beyond them – and has killed more than 8,272. It has triggered unprecedented quarantines, stock market upheaval and dangerous conspiracy theories. Indeed, most cases are mild, but health officials say the virus’s spread through the United States appears inevitable. As the country and its health-care system prepares, much is still unknown about the virus that causes the disease now named COVID-19.

There are many compelling reasons to conclude that SARS-CoV-2, the virus that causes COVID-19, is not nearly as deadly as is currently feared. But COVID-19 panic has set in nonetheless. You can’t find hand sanitizer in stores, and N300 face masks are being sold online for exorbitant prices, never mind that neither is the best way to protect against the virus (yes, just wash your hands). The public is behaving as if this epidemic is the next Spanish flu, which is frankly understandable given that initial reports have staked COVID-19 mortality at about 2–3 percent, quite similar to the 1918 pandemic that killed tens of millions of people.

Allow me to be the bearer of good news. These frightening numbers are unlikely to hold. The true case fatality rate, known as CFR, of this virus is likely to be far lower than current reports suggest. Even some lower estimates, such as the 1 percent death rate recently mentioned by the directors of the National Institutes of Health and the Centers for Disease Control and Prevention, likely substantially overstate the case. We shouldn’t be surprised that the numbers are inflated. In past epidemics, initial CFRs were floridly exaggerated. For example, in the 2009 H1N1 pandemic some early estimates were 10 times greater than the eventual CFR, of 1.28 percent. Epidemiologists think and quibble in terms of numerators and denominators—which patients were included when fractional estimates were calculated, which weren’t, were those decisions valid—and the results change a lot as a result. We are already seeing this.

In the early days of the crisis in Wuhan, China, the CFR was more than 4 percent. As the virus spread to other parts of Hubei, the number fell to 2 percent. As it spread through China, the reported CFR dropped further, to 0.2 to 0.4 percent. As testing begin to include more asymptomatic and mild cases, more realistic numbers are starting to surface. New reports from the World Health Organization (WHO) that estimate the global death rate of COVID-19 to be 3.4 percent, higher than previously believed, is not cause for further panic. This number is subject to the same usual forces that we would normally expect to inaccurately embellish death rate statistics early in an epidemic. If anything, it underscores just how early we are in this.

But the most straightforward and compelling evidence that the true case fatality rate of SARS-CoV-2 is well under 1 percent comes not from statistical trends and methodological massage, but from data from the Diamond Princess cruise outbreak and subsequent quarantine off the coast of Japan. A quarantined boat is an ideal—if unfortunate—natural laboratory to study a virus. Many variables normally impossible to control are controlled. We know that all but one patient boarded the boat without the virus. We know that the other passengers were healthy enough to travel. We know their whereabouts and exposures. While the numbers coming out of China are scary, we don’t know how many of those patients were already ill for other reasons. How many were already hospitalized for another life-threatening illness and then caught the virus? How many were completely healthy, caught the virus, and developed a critical illness? In the real world, we just don’t know.

Here’s the problem with looking at mortality numbers in a general setting: In China, 9 million people die per year, which comes out to 25,000 people every single day or around 1.5 million people over the past two months alone. A significant fraction of these deaths results from diseases like emphysema/COPD, lower respiratory infections, and cancers of the lung and airway whose symptoms are clinically indistinguishable from the nonspecific symptoms seen in severe COVID-19 cases. And, perhaps unsurprisingly, the death rate from COVID-19 in China spiked precisely among the same age groups in which these chronic diseases first become common. During the peak of the outbreak in China in January and early February, around 25 patients per day were dying with SARS-CoV-2. Most were older patients in whom the chronic diseases listed above are prevalent. Most deaths occurred in Hubei province, an area in which lung cancer and emphysema/COPD are significantly higher than national averages in China, a country where half of all men smoke. How doctors were supposed to sort out which of those 25 out of 25,000 daily deaths were solely due to coronavirus, and which were more complicated? What we need to know is how many excess deaths this virus causes.

This is where the Diamond Princess data provides important insight. Of the 3,711 people on board, at least 705 have tested positive for the virus (which, considering the confines, conditions, and how contagious this virus appears to be, is surprisingly low). Of those, more than half are asymptomatic, while very few asymptomatic people were detected in China. This alone suggests a halving of the virus’s true fatality rate. On the Diamond Princess, six deaths have occurred among the passengers, constituting a case fatality rate of 0.85 percent. Unlike the data from China and elsewhere, where sorting out why a patient died is extremely difficult, we can assume that these are excess fatalities—they wouldn’t have occurred but for SARS-CoV-2. The most important insight is that all six fatalities occurred in patients who are more than 70 years old. Not a single Diamond Princess patient under age 70 has died. If the numbers from reports out of China had held, the expected number of deaths in those under 70 should have been around four.

The data from the Diamond Princess suggest an eightfold lower mortality amongst patients older than 70 and threefold lower mortality in patients over 80 compared to what was reported in China initially. But even those numbers, 1.1 percent and 4.9 percent respectively, are concerning. But there’s another thing that’s worth remembering: These patients were likely exposed repeatedly to concentrated viral loads (which can cause worse illness). Some treatments were delayed. So even the lower CFR found on the Diamond Princess could have been even lower, with proper protocols. It’s also worth noting that while cruise passengers can be assumed to be healthy enough to travel, they actually tend to reflect the general population, and many patients with chronic illnesses go on cruises. So, the numbers from this ship may be reasonable estimates.

This all suggests that COVID-19 is a relatively benign disease for most young people and a potentially devastating one for the old and chronically ill, albeit not nearly as risky as reported. Given the low mortality rate among younger patients with coronavirus—zero in children 10 or younger among hundreds of cases in China, and 0.2-0.4 percent in most healthy nongeriatric adults (and this is still before accounting for what is likely to be a high number of undetected asymptomatic cases)—we need to divert our focus away from worrying about preventing systemic spread among healthy people—which is likely either inevitable, or out of our control—and commit most if not all of our resources toward protecting those truly at risk of developing critical illness and even death: everyone over 70, and people who are already at higher risk from this kind of virus.

This still largely comes down to hygiene and isolation. But in particular, we need to focus on the right people and the right places. Nursing homes, not schools. Hospitals, not planes. We need to up the hygienic and isolation ante primarily around the subset of people who can’t simply contract SARS-CoV-2 and ride it out the way healthy people should be able to.

Coronavirus in Nigeria, just as in some other African countries, has fortunately not spread the way we feared it would. This has baffled even the WHO. However, a Nigerian, who returned from the United Kingdom last two weeks Friday, has tested positive for the new coronavirus, Lagos State Ministry of Health said on Tuesday? “She is clinically stable and is being treated at the Infectious Disease Hospital, Lagos,” Nigeria’s health minister Dr. Osagie Ehanire said. Also, the Lagos State health ministry said the patient, a 30-year-old Nigerian female, observed self-isolation, developed symptoms and tested positive for the coronavirus.

Nigerians on Twitter are beginning to say government should impose a travel ban in Nigeria with the hashtag #NigeriaNeedsATravelBan. With the first case being from someone who flew into the country and now this, it is no surprise that this is being demanded out of the fear that the virus could spread. But, the government claims to have started looking into the people she had contact with such as the passengers she was on the same flight with. Yes, this disease is real. And, yes, there truly do appear to be vulnerable patients among us, those far more likely to develop critical illness from it. And that relatively small subset, if infected in high numbers, could add up to a tragically high number of fatalities if we fail to adequately protect them.

Now, Nigeria has confirmed five new cases of the coronavirus in four weeks but not recorded any death. The latest cases bring the total confirmed cases so far to eight. All five cases had a travel history to the UK and USA according to the Nigeria Centre for Disease Control (NCDC). The agency also implored Nigerians to remain calm as public health response activities are intensified across the country. “A detailed travel history of each case is being compiled and contact tracing has begun, Our National Emergency Operation Centre is supporting response in the states. The Federal Government of Nigeria has also suspended the issuance of visas on arrival to travelers from these countries (the affected countries),” said Chikwe Ihekwazu Director General NCDC.

We have learnt that Nigeria has placed travel restrictions to 13 countries. The countries include China, Italy, Iran, South Korea, Spain, Japan, France, Germany, the United States of America, Norway, the United Kingdom, Netherlands and Switzerland. Now, all travelers returning from these countries prior to the restriction will be in supervised self-isolation, monitored by Nigeria Centre for Disease Control (NCDC) and Port Health Services which could also curb the spread of coronavirus in the country. Indeed, Nigeria is country which usually take the precautionary motive with levity, otherwise we might not have being recorded more than one, the country can closed the land borders for almost one and half years not but could not as well take necessary measure to secure our air ports from being infected or imported the virus into the country.

The good news is that we have huge advantages to leverage: We already know all of this and have learned it remarkably quickly. We know how this virus spreads. We know how long people are contagious. We know who the most vulnerable patients are likely to be, and where they are. Healthy people who are hoarding food, masks, and hand sanitizer may feel like they are doing the right thing. But, all good intentions aside, these actions probably represent misdirected anxieties. When such efforts are not directly in service of protecting the right people, not only do they miss the point of everything we have learned so far, they may actually unwittingly be squandering what have suddenly become precious and limited resources.

Orunbon, a journalist and public affairs analyst, writes in from Abeokuta, Ogun State, Can be reached via: orunbonibrahimademola@gmail.com or 08034493944 and 08029301122.

 

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Health

UNICEF, WHO rally support for breastfeeding

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The United Nations Children’s Fund (UNICEF) and the  World Health Organisation (WHO) say that they are rallying supports for breastfeeding as the first pathway to preserving a  healthier planet.

The Nutritional Officer of  UNICEF in Ebonyi, Mr Cyprain Ogbonna,  gave the encouragement to people on Saturday in Abakaliki during an event to mark the starting of the  2020 celebration of World Breastfeeding week.

The theme of the World Breastfeeding Week 2020 is “Support breastfeeding for a healthier planet”.

The event is marked every year between Aug. 1 and  Aug. 7 to raise awareness on the importance of breastfeeding for mothers and infants.

Ogbonna said that adequate breastfeeding had, over the years , prevented several childhood diseases and brought  lifelong positive benefits associated with child spacing.

He said  that other benefits include: risk reduction for some breast and ovarian cancers as well as hypertension.

He described breast milk as a nature-given-first food that needed to be preserved for its undebatable benefits to a mother and her baby.

He added that the milk was a critical part of a sustainable food system.

He said that it would be best to start breastfeeding within one hour of birth and exclusively done for the  first six months of life, after which mothers should introduce  appropriate complementary foods to her baby for  two years and beyond.

He  stated that misuse of breast milk substitutes should be condemned.

He advised that breastfeeding should be maintained, but hygienically done during this COVID-19 pandemic.

Ogbonna said: “Mothers are recommended to breastfeed their child or children within 30 minutes of birth.

“While mothers doing exclusive breastfeeds go for the first six months of life.

“Also mother or caregiver timely introduces complementary feeding based on local food products at six months while continuing breastfeeding up to two years and beyond,” he said.

Also, the Nutrition Manager of UNICEF in Enugu, Hanifa Namusoke, said that she had championed the cause in Ebonyi to increase the valve and improve the well being of mother and child.

Namusoke said in line with the theme, WHO and UNICEF called on governments to protect and promote a critical component of breastfeeding support.

“Breast milk is complete for a healthier planet and that is why WHO and UNICEF recommend optimal infant and young child feeding practices with emphasis on early initiation of breastfeeding within one hour of birth,” Namusoke said.

NAN

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Covid-19: FCT Minister tasks health professionals on synergy

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The FCT Minister, Malam Muhammad Bello, on Friday enjoined all health professionals to collaborate with each other to defeat the COVID-19 pandemic.

Bello gave the advice when a delegation from the FCT Pharmaceutical Society of Nigeria (PSN) paid a courtesy call on him in Abuja.

He noted that the successes recorded in the fight against the COVID-19 pandemic was largely due to the synergy between the various health professionals in the FCT.

Bello, therefore, urged them to continue to function as a unified team in the fight against COVID-19.

The minister commended the good works of all the health workers in the FCT especially for their efforts at combating the Coronavirus disease.

He pledged that the FCT Administration would continue to partner with the PSN as a large number of its members are staff of the FCTA who are also involved in the fight against the COVID-19.

Bello urged the PSN to forge a robust relationship with the National Drug Law enforcement Agency (NDLEA) in order to reduce the menace of drug abuse among residents of the territory.

Earlier, Chairman of the FCT PSN, Mr Jelili Kilani, commended the FCTA for the support it has always rendered to the association.

Kilani emphasised the need for greater collaboration between the PSN and the FCTA.

The News Agency of Nigeria (NAN) reports that the PSN used the visit to donates Personal Protective Equipments, First Aid materials and hand hygiene products to the FCTA.

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Africa records 30% increase in COVID-19 cases– WHO

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By Cecilia Ologunagba

The World Health Organisation (WHO) says there has been 30 per cent increase in the number of confirmed cases of Coronavirus (COVID-19) in the African Region in the past week.

WHO Regional Office for Africa in Brazzaville, Congo, disclosed this in COVID-19 Situation Report posted on its official Twitter account @WHOAFRO on Thursday.

In external situation report number 19 issued on July 8, it stated that COVID-19 outbreak continued to grow in the WHO African Region.

It said the virus continued to grow since it was first detected in Algeria on 25 February, 2020.

“Since our last External Situation Report 18 issued on 1 July, 2020, a total of 91, 038 new confirmed COVID-19 cases (a 30 per cent increase) was reported from 45 countries.

“Of the 91, 038 reported new cases in the region, the majority 71 per cent (64, 646) were recorded in South Africa.

“South Africa remains the epicentre of the COVID-19 outbreak in the region and the country is now among the top 15 most affected countries globally.

“South Africa has the cumulative number of cases (215, 855) exceeding that for Turkey (206, 844), Germany (196, 944) and France (159, 568), which previously reported the highest numbers.

“On 4 July 2020, the WHO African Region and South Africa recorded their highest daily case count of 13, 474 and 10 853, respectively.’’

Similarly, it said the WHO African Region and South Africa registered the highest daily death toll of 225 and 192, respectively, on 7 July 2020.

“During this period, five countries in the region observed the highest percentage increase in incidence cases.

“Lesotho recorded 237 per cent increase (from 27 to 91 cases), Namibia 166 per cent (from 203 to 539 cases) and Madagascar 57 per cent (from 2, 214 to 3, 472 cases).

“Also, Malawi recorded 48 per cent increased (from 1,265 to 1, 877 cases) and South Africa 43 per cent (from 151, 209 to 215, 855 cases).

“Equatorial Guinea and United Republic of Tanzania did not officially submit reports indicating any confirmed case.

“A total of 119 new health worker infections were recorded from three countries: Ghana (70), Malawi (38), South Sudan (7), Sierra Leone (2), Gambia (1) and Lesotho (1).

“Two countries: Gambia and Lesotho reported their first health worker infection this reporting period,’’ it stated.

In addition, it stated that from 1 to 7 July, 2020, 1, 221 new COVID-19 related deaths (20 per cent increase) were registered in 33 countries, with 845 (69 per cent) of the deaths recorded in South Africa

This was followed by Nigeria, with 79 (6.5 per cent) deaths and then Algeria with 56 (4.6 per cent) deaths.

The report further stated that currently, 33 (70 per cent) countries in the region were experiencing community transmission, seven (15 per cent) have clusters of cases and seven (15 per cent) have sporadic cases of COVID-19.

It stated that the region had also observed increased incidence of importation of cases from affected countries within the region, largely fueled by long-distance truck drivers and illicit movement through porous borders.

(NAN)

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