DR EGBERONGBE MUBIN is a Senior Registrar and Associate Fellow of the Faculty of Radiology of the West African College of Surgeons. He is a member of the Nigerian Society of Interventional Radiology, and Radiology Society of North America. He also holds a diploma in Leadership and Management in Health from the University of Washington, USA. Presently working for the Lagos University Teaching Hospital (LUTH) Idi Araba, he shares his views on the Covid 19 pandemic with TELIAT SULE; Excepts:
What is your view on this pandemic; its similarities and differences with previously known viruses such as Ebola, SARS, MERS, etc?
The novel coronavirus pandemic is a one-of-the-rare extraordinary worldwide health events that have tested the limits of medical science in the 21st century. The closest similitude is the Spanish Influenza pandemic of 1918-1920 in which an estimated 50-100 million people died worldwide. In fact, it is a respiratory disease just like influenza and can spread in asymptomatic people in the same way. Coronaviruses are a large family of enveloped RNA viruses that mostly infect birds and mammals. SARS and MERS viruses which have caused smaller epidemics of 2003 and 2008 are also coronaviruses. As long mankind exists, sporadic infectious disease outbreaks will keep occurring as viruses and bacteria are essential components of the biological ecosystem. It is up to us as humans to explore the boundaries of science and tech to protect ourselves and livelihoods as well.
How has Nigeria fared so far in the handling covid 19 pandemics?
Nigeria hasn’t fared badly to be honest, but there are things we did either late or did not do well or have not yet done at all. For a country with a weak health system, and even weaker social support system for its citizens, it was always going to be a big challenge to manage an epidemic of this scale. Despite the fact we are by far the largest population on the continent, the north African nations and South Africa have more cases. Our mortality rate amongst the infected also hovers around 2.5-3% which also average globally. Some European nations with advanced health systems have mortalities as high as 10% for Spain, 13 % Italy and 15% for the UK. Among nations, we are not faring badly.
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Are there things Nigeria ought to have done better in the management of this pandemic? What are they and why do you think those measures would have made the difference?
There are several things we could have done better. Closing the borders was about 3-4 weeks later than should have been. International travel is the major backbone of any pandemic. Curtailing travel should be a major component of any national response. Also, the level of awareness of the populace was grossly inadequate. Mass media campaigns and sensitization using social media and local community influencers such as clerics and traditional leaders would have been useful. Lockdown was not effective as the populace did not fully appreciate the enormity of the disease. So, sacrificing their livelihoods for a disease they don’t understand was doubtful. Medically speaking, our greatest blunder was the slow pace in testing. You can’t pick the virus except through testing the people. What makes Covid19 very contagious is the ability to be spread by a person who is asymptomatic.
This means he is clinically stable with no complaints yet he has the virus and spreads it to his contacts. Unlike Ebola which is though quite deadly, killing one in four patients but usually spread by mostly sick patients. It is easy for people to avoid a person already sick and showing symptoms but Covid 19 can spread among healthy individuals which means you can’t rely on symptoms to pick patients. It would be too late. Aggressive testing was the sure way to capture as many would-be carriers as possible. This is an area we are still very much behind. World Health Organization sent a clear message to all countries in mid-March: test, test, and test. The more tests that are conducted, the easier it becomes to track the spread of the virus and reduce transmission.
For effective comparison, Ghana has done over 250,000 tests while we are at about 71,000 tests. South Africa has done 920,000 while the US has over 21 million tests as at June 7, 2020. Lastly, aside the federal government, many state governments need to step up the game. A pandemic is not the avenue to play politics, soothe egos, embezzle monies, or favour any part of the country. As we can see Covid 19 does not care if you are black, Caucasian, rich, poor or famous. Reports of mysterious deaths in the north should very worrisome. Though we are yet to get official confirmation, initial evidences point towards Covid19 as a contributory factor. If this is the case then we are grossly underreporting the cases we have in Nigeria. We may have six to ten times the official figures in reality.
Based on the figures on positive cases, active cases, discharged and deaths from Covid 19, when do you think the curve will flatten?
It is difficult for anyone to say when the curve will flatten or when it will be over. We can say we have brought this under control. We may experience surges and periods of lull in cases but we don’t yet know a lot about this virus. What is clear is that if we keep doing the right things, and commit all resources needed to this fight we will overcome this. China, South Korea, Germany and Taiwan are good examples of the nations in which the spread has been managed significantly.
There are rumours making the round that the Covid 19 was made in a lab. What is your view on this claim?
As scientists we don’t entertain rumours. We all have to realize that this pandemic was inevitable. Ebola, SARS and MERS were all forewarnings. The extent we interact with nature as humans have reached unprecedented levels. People have pets of various kinds and eat various things. There have been plagues, pandemics and epidemics at various times in history. In any case, all the major economic powers have also suffered financially and it will not be fair to point accusing fingers at anyone without evidence. A lab made virus can also be identified by virologists but we should be concentrating efforts on curtailing the spread; we can do thorough investigations later.
What can you say about Nigeria’s preparedness for addressing virus of this nature?
Ebola served as a good forewarning for Nigeria. It was after Ebola that the federal government established the Nigeria Centre for Disease Control (NCDC) we have today. Lagos also strengthened IDH in Yaba after Ebola. However, we are very much behind in preparedness for this pandemic. Well trained and skilled manpower is the main backbone of any strong health system. Unfortunately, we have started to export doctors and other health workers like crude oil. This is largely due to poor remuneration and career growth. Underfunding of the health sector has been sustained by every government in this country like it is a deliberate government policy. We hope this experience will raise the consciousness of government at all levels to protect its citizens. We need more standard hospitals, extensive community health services, an effective health insurance and happy satisfied healthcare workers.
What medical gadgets are usually found in a Covid 19 treatment centre? What is the relevance of each gadget?
Covid 19 patient may be asymptomatic, have mild to moderate symptoms or severely sick. A typical Covid 19 centre have different sections for patients depending on the level of symptoms. Essentially all health workers involved are adequately protected with personal protective equipment. This includes facemasks(N95), faceshields, hazmat suits, boots and gloves. These are very important. Oxygen tanks and ventilators are two critical tools to sustain patients with respiratory distress. Other necessary gadgets include diagnostic machines like mobile X-ray, vital signs monitor, a decent ICU unit and a standard nearby laboratory. Patients should also feel at home in a conducive atmosphere. Reports of patients escaping from centres and protests are quite appalling.
So many drugs have made the news headlines as efficacious in treating Covid 19.
What can you say about all these drugs?
Drug research is a very delicate topic that we must understand well. Yes, various drugs have been touted for Covid 19 but early research results are not encouraging. Chloroquine and zinc combination appeared promising because it stopped viral replication in laboratory testing. However, clinical testing with patients was less fruitful. Other drugs like remdesevir and Aluvia have also been tried. However, we should be careful of claims of cure without thorough testing. Any drug should have established and proven pharmacokinetics and pharmacodynamics of disease control. We first establish a theory in which a drug works. Then, lab tests are first conducted. The next stage is to do animal testing in which you induce the disease in a mammal and observe the response. Then, human testing can follow. Randomised, multicentre, double blinded control trials are the gold standard for testing any drug. Until then claims are claims. The only established fact yet is that high immunity levels benefits the patient. So, immune boosters like vitamins and supplements will be useful to support treatment. Natural immune boosting fruits, vegetables and herbs may also help. Vaccines also been tested but we have to wait for another 8-15 months for any proven to be approved.
Why is it that orthodox medicine practitioners and herbal medicine experts are always at logger head? Most times, when the latter announce herbal cure for a disease, the former seem to always counter them. Why are the two professions not complementary in Nigeria as it is countries like India and China?
I do not agree that herbal medicine and orthodox medicine are antagonistic per say. All drugs have botanical and biochemical roots. The problem lies in that we are yet to develop our local herbs to meet international standards and testing. We have to carefully research and isolate active ingredients and chemicals with specific goals. Research is key. The herbal medicine should be reproducible anywhere and not personalized and must be ready to be assessed empirically. Medicine should be medicine anywhere and anytime because it is science. It has nothing to do with voodoo or occult powers. Our pharmacological and pharmacognosy specialists have a lot of work to do.
When do you think this pandemic will be over?
Covid 19 may be well controlled and curtailed in another 6-12 months with minimal threat to everyone just like SARS of 2003 but nobody knows when it will be over. Or it may become endemic like the flu virus have become with us since 1920. Only God knows all. If any lesson should be learned from this pandemic, it is that we humans still have a lot to learn.
