COVID-19 Will Not Go Away- Dr Enahoro

BY DR GANI ENAHORO

COVID-19 WILL RUN ITS NATURAL COURSE

Covid-19 is caused by SARS-CoV-2 virus, similar to the coronavirus that caused Severe Acute Respiratory Syndrome (SARS) that ravaged the Asian continent and was transported across several borders in 2002. It had come through bat that served as animal reservoir and mutated yet in another animal- a civet and then got into man in a fashion similar to how Ebola sneaked into humans.

It was labeled SARS-CoV virus and recorded high fatality rate. In 2012, a similar coronavirus mutated in bat and was transmitted into a camel, where it mutated again, became deadly and infected man and caused the Middle East Respiratory Syndrome (MERS) that was also very devastating.

But the new variant of coronavirus, with lower fatality rate that caused Covid-19 today also came through the bat reservoir and transmitted to another animal, suspected to be a pangolin where it mutated and infected man. The character of the new coronavirus is yet to be fully understood and that is why the human symptoms to watch out for, has continued to elongate ever since.

At the beginning it was a mere check for fever, headache, body weakness, slight sore throat, dry unproductive coughing and difficulty in breathing in the symptomatic patients. With time it has added loss of sense of smell and taste as early warning signs, vomiting and even diarrhoea. Time will tell if there won’t be more to know. 

What is certain and medically historic, that we should not pretend about is that Covid-19 will run its natural course fully, short or long, whether we like it or not and whether we do all the things we should do or not.

The morbidity and fatality rate is what we would not know until years to come, with the global figures of confirmed cases rising on a daily basis. So it may just be right to relax our anxiety and just comply with all the instructions from our health authorities to stay at home and lockdown for as long as it would be considered medically reasonable to live our life again in abundance.

The Covid-19 testing centers engaged by Nigeria Center for Disease Control (NCDC) are not enough to give a proper gauge of the aggressive tough-fighting SARS-CoV-2 virus in Nigeria’s almost 200 million population.

Had there been the right capacity for a meaningful sample size of testing, the NCDC figures would have been so frightening as to become the major reason to stay away from the roads and lockdown without persuasion.

Although there was delay in the decision to close our national borders, which have been roundly condemned, it is regrettable that many state governors have not learned from that, they fail to understand the epidemiological benefit in shutting their states down. The Presidential Task Force (PTF) may need more political interactions with them, leveraging on the fact that they are also politicians in government apart from the NCDC boss.

Things have indeed changed; this is no time to arrogate the rights of federacy to any unit. Preventive measures would make meaning only if all aggregate units surrender some rights and cooperate with federal decisions. Ordinarily, one would have canvassed for an all-expert group as PTF, the type that successfully dealt with Ebola virus in the past, with the prospects of a more enduring legacy post Covid-19. However, a desperate situation does not give rooms for rationality.

Well, it is good enough that medical tourism has lost its appeal, even if it is for the meantime by those who for the flimsiest excuses of fever and runny nose would have jumped into the next available flight for hospitals abroad. This is the time for true leaders to deal with infrastructural gaps, think global, imitate what is good and domesticate right principles even for political incorrectness. We should rise from the scars of Covid-19 and gain a lot going forward.

In countries like Czech Republic that shut its borders soon after the announcement of outbreak in China, they are today basking in happiness at a decision, which was considered premature and most unpopular at the beginning, unlike those that relaxed and treated the threat lackadaisically. So the warnings in Covid-19 should not look at political populism by leaders but a display of bravery and visionary prowess.

Watching the PTF daily briefings on television reveals how dedicated our leaders could become when fears overcome them. From the regularity and the content of submissions, they have been very busy, although most times “manufacturing ammunitions at the war front”. We truly didn’t need to be like this.

The best time to prepare for war should be during peacetime and that we failed to do. Because of lack of electricity, that could not be fixed over the years, most people can’t even get the messages firsthand on television or radio and because of the resulting ignorance, a lot of the people don’t believe that coronavirus exist.

Covid-19 could be novel to the earth, that notwithstanding we have battled with more severe haemorrhagic fevers since 1969 when Lassa fever was first discovered in Nigeria without much noise because those who lost their beloved ones were quietly licking their wounds.

Even now, head-to-head we have recorded more deaths to Lassa this year than Covid-19. We had Ebola much recently and contained it admirably. The world saw Lassa and Ebola as a black-man-problem and cared little, supporting to the extent that we should not export the diseases beyond West Africa.

If we had not reduced ourselves to a beggarly country that prefers to wait for foreign aids and international donations to deal with local issues, today we could have been shoulder high as lead consultants for WHO, profiting from exporting home grown strategies to all corners of the world on how to battle Covid-19.

I feel so much for our health workers at the frontline, who are regularly exposed to hazards, with little armours of defense, due to no fault of theirs, and also from patients telling lies of all sorts denying their travel history, in their fears of quarantine.

The PTF must go beyond the Covid-19 emergency and help to refocus the nation towards a better managed public health, by taking onboard other segments equally vital that have been ignored so far in this outbreak, which could later become the Achilles’ heel in no distant future.

For instance during the H5N1 “Bird Flu” outbreak in 2006 and again a few years later, there were fears of a likely pandemic worldwide, people were frightened of the zoonosis and warned to avoid eating eggs and if they must, should cook thoroughly and so many other conditions were publicised, but Nigerian veterinarians and supporting animal health workers in public service and the private sector collaborated to tame the disease to just the poultry farms and saved man from the pandemic.

Nigeria was globally rated well for its containment plans and capacity, and when Ebola disease also stared us in the face, the contact tracing skills and management dexterity by the health authorities also received worldwide applause, First Consultants Medical Centre, a private Hospital where the heroine Dr. Ameyo Stella Adadevoh worked scored the best goal.

That collaboration and partnership with the private medical practitioners during that time seems missing in todays Covid-19 battle, its all like a government show so far. The rich lessons of the glorious past should not be lost on us. 

There was something unique that gave the nation its peculiar success at that time, the creation of human and animal components as a containment strategy. It is a settled medical fact that about 65% of infectious diseases in man are traceable to animal sources, including the current Covid-19 outbreak, justifying the creation again of a very active animal component towards resolving this present disease and possibly such developments in future.

Veterinarians are experts in population medicine and infectious diseases management, because of their professional roles in local herds, regional and national disease outbreaks, which they contend with seasonally in their livestock patients.

The present management of Covid-19 pandemic in Nigeria is commendable despite so much emphasis on intensive critical care and building of more isolation centers. More efforts must go to preventive medicine, as well and there must be a deliberate and long-term controlled strategy to minimize new infections, but would allow people to acquire immunity through supervised exposure to the virus pending when vaccines would be ready for use in 2021 or 2022.

The world obviously must brace up to live for a very long time with community transmission of this disease because of the stubbornness and mobility of man, no matter how hard we try to flatten the curve and there is nothing anyone can do about that.

The dream of instant victory and elimination of the Covid-19 virus from the earth surface is a wishful thinking, its not going to go away like that and the very vulnerable persons will continue to succumb. The policy of lockdown, as good as it is epidemiologically has an expiry date otherwise it could lead to financial and economic ruin of the people and the country, which is also dangerous.

What we must develop going forward is the predict-and-prevent strategies of preventive medicine that is used efficiently in managing animal herds, which includes biosecurity, biocontainment, surveillance and resilience. I will dwell more on these in subsequent articles. All of the warnings on hand washing, sanitation, respiratory hygiene, social distancing are generally ingredients of biosecurity.

Lockdown belongs to biocontainment and surveillance is where all hands must be on the deck and that should include a broad spectrum of professional involvement. The sudden inexplicable deaths of thousands, possibly millions of fishes, the Croaker type reported at the Bonny waterways since late days of March 2020, have been trending in the social media with frightening pictures of layers upon layers of dead fishes deposited at the shores, this must not be glossed over by the PTF.

Reports have it that fishermen have been picking these dead fishes and some that are very weak but struggling to stay alive (breathing difficulties) for their consumption and for sale as smoked fish in open markets in Bonny and Port Harcourt without caution. Ignorantly feasting on dead fishes, thinking it could be their own equivalents of the proverbial “manna” from heaven that was sent to the Israelites in the wilderness is a potential risk. We must act now. The PTF must show sufficient concern about this development, which is another reason in support of activating the animal component in resolving all that may remotely or directly connect with Covid-19 pandemic.

During the PTF daily briefing on Friday, April 10, 2020 a journalist asked to know why the Minister of Agriculture was not a member, to bring forth the animal health perspectives into its workings, every responder avoided the question like the plague. But three days later, the President approved the inclusion of the Honourable Minister of Agriculture in a manner suggestive of hearkening to the observation of the journalist, alas his inclusion was specifically to worry about food security during the lockdown.

Although movement of farm products and food animals are equally very important to the nation, the feedback mechanism that got to the President had missed a valid contribution by the journalist. What he knew from uncommon exposure was that the world have long gone beyond looking at diseases and its management from the narrow spectrum of a single profession, instead a more rewarding One-Health approach is the new way in a prismatic structure that involves human, animal and environment.

Specie specific coronaviruses are known to have affected birds, cats, dogs and pigs. Recently, dogs, cats and at least a tiger have all tested positive to Covid-19 virus following close contact with infected owners or worker, although no evidence exist so far that the infected animals have any role in the spread of Covid-19. Who knows what holds for tomorrow, Nigeria might just be the pathfinder for a permanent resolution of Covid-19, because we are blessed in all ramifications. The accreditation of the BSL-3 Laboratory of the National Veterinary Research Institute (NVRI), Vom, Plateau State as one of the Covid-19 testing centers by the PTF is commendable and a fantastic starting point in the spirit of one-health.

Several Nigerian veterinarians are playing key roles all over the world as global experts with huge access to valuable resources and Nigeria would be better for it if their experiences are harnessed. For instance, Prof. Oyewale Tomori needs no introduction for his works on Lassa Fever since its discovery in 1969. He was fittingly the Chairman, National Committee on Ebola, and had been Regional Consultant for WHO for ten years before then.

For me humbly, I have been Councilor for Africa and Policy Committee Chairman for the World Veterinary Association (WVA) in the past three years, and was part of a 5-man team at Brussels in early February 3-8, 2020 for a strategy planning workshop to develop diverse priority policies for the organization, including preparedness strategies on animal welfare and public health, including the Covid-19 that was at the time mathematically modeled to ravage the world.

COVID-19 will not go away.

Prof. Haruna Kazeem and I were participants at the One-Health Global Summit that held last year at Costa Rica and also I was a panelist at the 2018 edition in Barcelona featuring World Health Organisation (WHO), World Animal Health Organization (OIE), Food and Agriculture Organization (FAO) of the United Nations and the World Medical Association. We also have Dr. Tunji Nasir who is the current President of Commonwealth Veterinary Association amongst many others who are natural assets to this country. Let the PTF broaden the horizon and the country will be better for it.

Dr Enahoro is the Councillor for Africa at World Veterinary Association (WVA)
Vice President, African Veterinary Association (AVA)
Former National President, Nigerian Veterinary Medical Association (NVMA).