When the recent Coronavirus (COVID-19) pandemic broke out in Nigeria, Lagos easily emerged as its epicenter on account of its position as the nation’s aviation and maritime hubs and, therefore, the de facto gateway to the federation. Lagos and Ogun states are the indisputable industrial nerve centres of the West African region. It was only a matter of time before Abuja came into the picture as a hotbed for the pandemic, given its political status and the next in command to Lagos as an international travel destination.
Authorities in other states, such as Oyo, Rivers and Kaduna, with huge metropolitan centres (Ibadan, Port Harcourt and Kaduna, respectively) quickly jumped into action with stringent containment measures. In the process, Oyo’s Seyi Makinde got infected, along with Kaduna’s Nasir el Rufai, Bauchi’s Bala Muhammed and Ondo’s Rotimi Akeredolu.
Meanwhile, the whole world was waiting on Kano, the most populous state in the federation. With no cases of COVID-19 infections reported for a long spell, it was like “waiting in vain”, as reggae maestro Bob Nesta Marley would put it – or almost. This obviously created in the authorities in the state a false sense of security and safety from the rampaging virus that has literally sent the entire world into a global lockdown, with national economies lying prostrate. Various theories were advanced to explain why the corona virus had found Kano impenetrable, including the idea that the hot climate inhibited its spread. But those who gleefully bandied this viewpoint forgot that Iran, the cauldron of a country, was reeling in the pandemic!
However, the bubble soon burst. Soon the media were reporting hundreds of deaths due to unexplained causes. To make matters worse, authorities in the state went into denial. To compound a really bad situation, the vast majority of the deaths were not interrogated by way of autopsies.
As many as 1,750 people died in the region during the period of April-May, prompting investigations to determine whether they were related to COVID-19.
In a situation where hundreds of dead persons were buried without the conventional autopsy, Garba Shehu, senior special assistant on publicity to the President Muhammadu Buhari, said in a statement that “While some may wish to believe that there are other causes at play like hypertension, diabetes, meningitis, and acute malaria, there are others who say it is COVID-19.”
At this stage, the federal government stepped in, when the federal ministry of health set up h-powered team to undertake missions to Kano and other neighboring states, including Jigwa, where similar “mysterious” deaths were also being reported. The team was led by Nasir Sani-Gwarzo, who was in charge of the National AIDS Control Programme (NASCP) during the peak of the Acquired Immunodeficiency Syndrome (AIDS) in the mid-1990s and is currently permanent secretary of the federal ministry of Industry, Trade and Investment. The Consultant to the team was another well-known epidemiologist, Abdulsalam Nasidi, the pioneer Director-General and CEO of the National Centre for Disease Control (NCDC).
In the process, a new terminology crept into the lexicon of public health discourse in Nigeria – “verbal autopsy” – applied by epidemiologist to the system of gathering information about symptoms and circumstances for a deceased on whom no autopsy could be performed.
For cultural reasons, those who died during this period were immediately buried. So, health officials could not reach any of them for the conventional autopsy, and had to resort to the verbal autopsy by interviewing relatives and following up to the grave yards to see what happened to them before they died and get the medical history of the deceased. COVID-19 containment officials tested those that died while they were on ground, to determine what they had died of, including those that did not see obvious symptoms of Covid-19. They also took samples from relatives of the dead.
It was estimated that up to 65-68 percent of those that died actually complained of corona symptoms like coughing, difficulty in breathing, headaches, loss sense of smell, some abdominal pain, just what you see in Covid-19 patients before they die, in addition to the fact they had other comorbidities like diabetes, hypertension, pneumonia amongst others. Indeed, in all probability, the vast majority of the deaths were actually triggered by coronavirus.
Kano quickly became a State to look out for, as it quickly shot up from no cases to being among the top 5, in the list of State with high numbers of Covid-19 infections in the country. In an interesting twist, the former commissioner for works, Mu’azu Magaji, who had recently been sacked for his inappropriate response to the death from COVID-19 of President Buhari’s chief of staff Abba Kyari, was reported to have contracted the coronavirus.
Meanwhile, after Abdullahi Umar Ganduje sparked massive criticism for denying that Kano had recorded any strange deaths, the Kano State governor threw his weight behind the work of the Sani Gwarzo-led team. Although he later denied that the percentage of the deaths that had covid 19 were up to 60%. The Federal explained that it did not state that 60% had COVID19, but that their death could have been triggered by Coronavirus. The Minister of Health promised to present the full report of the Mortality survey to the Governor when the study is completed,
Government then intensified testing and tracing contacts of the deceased. Help came in torrents. One of the earliest donors was Aliko Dangote Foundation, run by Africa’s richest man and a Kano native, which provided one of the testing laboratories in the state. The labs offer a combined capacity of 1,000 tests per day.
The state had also to grapple with implementation of lockdown measures amidst difficult economic environment and lack of trust between the state and the people due to recent political issues.
As at the time of this report (June 4 2020), as would be reasonably expected for demographic reasons, Kano (with 1,262 reported cases) was in the fifth position, with Lagos (10,910) topping the league, followed by FCT (2,080), with Oyo(1,451) and Ondo(1,266) following among the states of the federation and Abuja. It would certainly have been worse.
In a recent exclusive interview with BusinessDay newspaper, Dr. Sani-Gwarzo looks back at the achievements of the team:
“We went to Kano on the 28th of April, with people dying, and more cases of Covid-19 being reported. We could see the concern of people, the apprehension and the confusion.
“That was the situation. But I am happy to say that at the end of our assignment, the situation has stabilized and normalcy is returning — it has not returned fully, but the death rate has started reducing to a pre-epidemic level; and although the number of Covid-19 cases was rising, hope in the minds of people increased, and people started accepting the disease as a reality, going for testing; with those who test positive no longer scared to go for treatment. The treatment centers are performing and people are being discharged from the centers. More people are coming forth to volunteer to support. People who had tested positive and tested negative at the end of the day were openly requesting to be made public.”
In a similar vein, Prof. Nasidi reflects:
Before we came, there were many things put in place by the State Government Task Force but while some were functioning, others were not functioning well. Some of the things that were functioning well, to some extent were the handling of patients in the case management section and the issue of doing surveillance, following up to see where the disease is, and also the issue of establishing more treatment centers and test-turn around leading to delay in release of results.
But, unfortunately, there was no coordinated approach to all these because some of the task force members became affected. With 5 or 6 members in isolation, the taskforce was virtually paralyzed. So, this meant that the virus was traveling wide in communities. As soon as we came, we quickly organized training in groups — the doctors, the nurses, the laboratory workers immediately on how to prevent transmission of the virus, which is infection prevention and control. We did practical demonstrations at the centers. Since we left, no transmission has been reported among health workers and the laboratories resumed full work.
We managed to stabilize that and built the confidence of the health care workers to prevent them from abandoning their duties. We also fast-tracked the process of laboratory tests and release of results, to reduce the amount of time that people were kept in isolation centers.
The situation presented by Kano demonstrates the importance of concerted action in an emergency.
Deservedly, therefore, plaudits go to President Buhari and the Minister of Health Dr. Osagie Ehanire who constituted a team that included experts from the Irrua Specialist Hospital to help Kano state out of a veritable quagmire; the government of Kano state led by governor Abdullahi Umar Ganduje that was receptive to new ideas for its containment efforts; the media that drew attention to a grim situation; and civil society that out pressure on relevant authorities to act.
