COVID-19: Flattening The Curve In Abia State
By John Okiyi Kalu
According to scientists, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), the respiratory illness responsible for the COVID-19 pandemic. In our environment, this highly contagious virus, when in a human host, is known simply as the coronavirus.
While many are aware of the above, it appears not many understand the emphasis on “severe” and “acute” associated with this and other related respiratory diseases, hence, they lose thier lives or that of their loved ones.
Describing something as “severe acute” should warn of very dangerous clinical nature of a disease signposted by sudden onset, lasting for a short time and requiring urgent medical care. Indeed, the duration of illness between life and death, for highly symptomatic COVID-19 patients may not be longer than 5 days from the first day of manifestation of symptoms to death, unless a prompt medical intervention is made in between.
Sadly, in the Nigerian environment, the average number of days between submission of sample and release of test results is sometimes more than 4 days. Hence, many of those recorded as COVID-19 related deaths in Nigeria actually die between the time of sample collection and the intervening period of awaiting result. Within that window, patients suffer from rejection by some clinics as medical practitioners would rather exclude COVID-19 and its associated contagious nature before they take the patients in for proper care. While this is a terribly dangerous practice, experience has shown that medics are also at risk, indeed much more than the rest of us, hence, the need to also take measures to stay alive even while trying to help others.
Practice expectation is that when medics have strong suspicion of likelihood of a patient presenting with COVID-19 they (where space is available for case holding) should not turn away the patient but instead wear full personal protective equipment (PPEs) to engage and stabilize the patient then invite the lab scientists to come forward and collect samples for testing. But this is not the case currently. To worsen our peculiar situation, when fully licensed public healthcare facilities turn away suspected patients they end up in prayer houses or traditional healing homes. In either case, the outcome is same: undocumented deaths from COVID-19 and rapid community spreading of the disease.
During a pandemic, a global outbreak of disease, and other escalating health crises, public health statisticians from leading organizations, such as the Nigeria Center for Disease Control (NCDC) and the World Health Organization (WHO), track the number of confirmed cases, deaths and recovery cases.
What is flattening the curve?
In epidemiology, the curve refers to the projected number of new cases over a period of time. In contrast to a steep rise of coronavirus infections, a more gradual uptick of cases will see the same number of people get infected, but without overburdening the health-care system at any particular time. The idea of flattening the curve is therefore to stagger the number of new cases over a longer period of time, so that people have better access to care.
The word curve in the term “flattening the curve” doesn’t refer to the actual number of COVID-19 cases. Rather, it refers to the projected number of people who will contract the coronavirus diaease.
More specifically, the curve is actually two curves in a chart that demonstrate the spread of the virus with and without protective measures, such as social distancing.
To avoid overloading the health care systems in our communities, because of rising number of people needing to be hospitalized as a result of COVID-19 infection, flattening the curve means slowing the spread of this virus over time using social distancing and wearing of protective face mask, which looks like a lower, smoother curve on the chart. Based on past experiences, the most critical keys to flattening the curve are social distancing and wearing of face mask in public places. That also include closure of schools, people remaining at home for as long as possible, avoidance of worship centers and other gatherings where one is likely to come into contact with infected persons some of whom are asymptomatic and may not know they are carrying and spreading the virus.
With WHO confirmation that COVID-19 is likely airborne and spread through aerosols, it is even more crucial now to avoid gathering within enclosed spaces such as worship centers and event halls.
Within the Abia environment, the challenge remains testing as many people as possible to, as much as possible, determine the spread of the disease with a view to putting in place necessary measures to control, manage and ultimately rid the state of the virus. In this wise, Abia state government had on Monday, 20th July, 2020, formally launched a mass community testing program across the 17 LGAs, in partnership with World Health Organization (WHO) and Nigeria Center for Disease Control (NCDC), starting with Umuahia South LGA. The program which is expected to last for one month has as its main goal the breaking of the chain of transmission of COVID-19 in Abia State with the following measurable specific objectives:
1. To identify cases of COVID-19 in the state.
2. Isolate cases from the communities
3. Manage identified cases
4. Protect the entire population of the state from the infection
With 480 confirmed positive cases, as at Sunday, 19th July 2020, and 1,182 negative cases from 1,871 tests conducted in the state, it is expected that the community testing initiative will likely drive the number of confirmed cases in the state up as more than 10,000 samples are expected to be collected and tested. Ultimately, the state hopes to decentralize the response to the pandemic to LGAs where sample collection and surveillance activities will now be initiated and executed.
It is instructive to note that with the measures put in place by Governor Okezie Ikpeazu’s administration since the outbreak of the pandemic, the state’s public health infrastructure is not in anyway overwhelmed at the moment. With 365 patients discharged and 110 active cases in the state (majority of whom are showing zero to mild symptoms) no single patient has been lost from any of the isolation and treatment facilities in the state.
In addition, two of the isolation facilities put in place by the state government with combined bed spaces of 135, including the fully equipped 100-bed overflow at Amachara and the Infectious Disease Hospital (IDH) in Aba which are yet to be used. Only the main isolation center at the Specialist Hospital and Diagnostic Center in Amachara and that of the Federal Medical Center, Umuahia, have so far received and managed COVID-19 patients in the state.
As obtainable in wider Nigeria, most of Abia COVID-19 patients are either asymptomatic or mildly symptomatic thereby meeting part of the NCDC guideline for managed home isolation after proper review by medical experts in the state. It is therefore not expected that the ongoing case search and aggressive testing ordered by Governor Ikpeazu will overwhelm our medical response infrastructure. Similarly, with 2 state-owned NCDC approved testing facilities already in use and additional 2 facilities expected this week, it can be anticipated that the turn around time from sample collection to analysis will be much more reduced compared to the earlier days of the state response when samples were sent to Edo, Ebonyi and FCT for analysis.
If all go according to plan, we estimate that by year end the state would have fully stabilized its response to COVID-19 pandemic and possibly manage the disease as a routine clinical challenge with designated facilities that test, isolate and treat patients. Until then, all citizens are strongly advised to compulsorily wear face mask when leaving their homes and observe other protocols on social distancing and regular hand washing with soap under running water.
As stated by NCDC, Community surveillance is key for prompt identification, isolation and treatment of COVID-19 cases, to slow the spread of the virus. But ultimate responsibility for our collective protection rests with each one of us. If you protect yourself and I protect myself we will all be safe from Coronavirus.