COVID-19 : We need more sensitization to curb community spread – MOHs (INTERVIEW)

ECHONEWS WEBINAR

COVID-19 : We need more sensitization to curb community spread – MOHs

The deadly coronavirus continues to spread in various communities across Lagos State and the nation. In line with the social responsibility role of the press, Echonews held a webinar on the management of the pandemic in our communities.

We express our sincere thanks to the Medical Officers of Health, Isolo and Ejigbo LCDAs, Dr. Baqiah Nojimudeen-Yesufu and Dr. Olawale Agosu respectively for honouring our invitation at short notice.

Speaking during the first ECHONEWS Webinar COVID-19 Management Show, the MOHs, who have been in the field combating the virus noted that low awareness, ignorance coupled with hunger made compliance with governments’ directives on coronavirus such as self-isolation, stay-at-home order, etc at the grassroots very low.

Read their full discussion moderated by the Publisher of ECHONEWS Newspaper, Mr. Kehinde Bamigbetan below:

What is COVID-19?

Dr. Yesufu: Thanks for having me here and thank you very much for this question. COVID-19 is the name given to the viral infection that is being caused by the Coronavirus. When we say virus, these are micro organisms which can’t be seen with our naked eyes but they cause a lot of harm to both human and animals. So, COVID-19 is one of those viruses tagged as respiratory virus that affects the upper respiratory tract of human beings.

How can someone know that he is infected by COVID-19?

Dr. Agosu: COVID-19, as my colleague rightly said, is a disease that is caused by respiratory viruses. They are called SARS-COV-2. This is the symptom of severe acute respiratory syndrome COV2.  Now, because it affects the upper respiratory tract too, it brings about symptoms that are related to normal cold. The person could start with all the symptoms like coughing, sneezing then fever. That is, high grade fever beginning from 38°C and above. Normal temperature is between 33.5°C to 37.5°C. But before someone starts having the temperature from 38°C and above, they will feel unwell. The person might feel as if it is common cold. The person will be sneezing and experiencing body pain. Those are the early symptoms of this COVID-19.

However, because we have the upper respiratory tract system and the lower respiratory tract system, by the time it gets severe, the person will begin experiencing breathlessness in the lungs. If it has got to that level, definitely the person is showing late signs of COVID-19. So, for the first symptoms, the person will start coughing and sneezing. He may have high temperature from 38°C.

There is a dry cough and the other one comes with a runny nose, which one should be taken serious?

Dr. Yesufu: Basically, the major symptoms as regards coronavirus include dry cough, you can’t have a wet cough. However, both coughs are symptomatic, they shouldn’t be overlooked. Sore throat is one of the symptoms of Covid-19; basic symptoms we can find in Flu are there in COVID-19. Whether there is history of travel to any high risk country or not; whether there has been contact with somebody who has just come back from any high risk country or as we’ve been seeing lately or not, one may be affected with coronavirus. There could be no history of travel but we could have reason why the person is having cough for over two weeks or three weeks, it might be COVID-19.

At what point should someone with any of the symptoms be tested?

Dr. Agosu: Initially, before we got to this level of community spread, when someone came up with any of the symptoms highlighted earlier, government advised that such a person should go into self-isolation for 14 days. It takes 14 days before these symptoms could convincingly manifest. Though, before 14 days, if the person is already a carrier, he or she might not know because the symptoms may not show. He or she might have started spreading the virus unknowingly. So, if that person self-isolates, within that 14 days the person would have exhibited those clear symptoms. However, because of the community spread, we can’t overlook any symptom. It has been advised that the person should visit a nearby hospital so that the doctors will begin to, from their clinical acumen, examine if it is a symptom of COVID-19 or not. What they will do when the symptoms indicate COVID-19 is to isolate the person while they contact NCDC.

What has been the degree of compliance in Isolo with self-isolation?

Dr. Yesufu: To be factual, the degree of compliance has been poor though we have some few members of the community who understand the reasons behind the self-isolation especially those who have at one point in time had contact and are fearful of the virus. Self-isolation is self-responsibility that we expect every member of the community to take upon themselves, especially for those who have been exposed at a point in time.

Most people aren’t really complying with the self-isolation. They just see it as another holiday, but the real self-isolation is distancing oneself from every other member of the community even ones family and ensuring that particles from either ones mouth or hand do not infect any member of the family. So, what you are trying to do in self-isolation is that you are trying to reduce any form of transmission through coughing, sneezing and or talking in most cases. Basically, the level of compliance has been very low as you can see but we will keep advocating and encouraging people to self isolate.

How can you describe compliance with self-isolation in Ejigbo?

Dr. Agosu: Well, for Ejigbo,  it is nothing far from what my colleague has said about her area. Understanding what self-isolation means is key and that is what we are trying to educate people on. People still need to be educated on what the term isolation means. As she rightly said, people just feel as if this virus is for big men. In fact, on my way coming, I still heard people saying “the virus is for big men, it doesn’t concern us. They are just keeping us at home suffering from hunger.” In Ejigbo, compliance with self-isolation has been poor because we still see people walking on the streets and driving cars as if there is nothing like stay-at-home order. It is not far from what my colleague has said about Isolo.

Who are mostly at risk?

Dr. Agosu: Yes, from recent happenings and research works that are ongoing, we’ve seen that high risk people are the elderly, those 60 years old and above and people with cold motility as well as those that have other forms of diseases such as hypertension, diabetes, Asthma or Hepatitis or any form of underlying disease.  They are at high risk. People that are close to family members who travel forth and back, irrespective of their age or cold motilities, are also high risk members of the population. Not being in that category does not mean you can’t catch the disease. One just has to try as much as possible to stick to the rules.

How do we make a difference between social-distancing and self-isolation?

Dr. Agosu: Social distancing, for example, as we are here we are not in close contact. The recommended social distance is at least 2 meters apart. The reason for this is that when you sneeze; the particles come in droplets, when you sneeze the droplets can’t go farther than 2 meters and drop on nearby surfaces. That is why they asked that we should keep, at least, 2 meters apart. Another way we can do that is self-protection. It is being advocated that people that are healthcare workers, who are in the frontline, should wear facemask. It is not everyone this is recommended for because it has led to shortage of facemask. So, in self-isolation you are indirectly quarantining yourself. You are in seclusion because you don’t want to have contact with anybody. All these are to prevent the spread.

What has been your experience in enforcing social distancing in your community?

Dr. Yesufu: The issue of social distancing as we can see it shows that the majority of the population does not understand the severity of the disease. Should they understand, they would have known that social distancing is highly important. But we are grateful to NCDC; they have been working to ensure that the rate of mortality does not increase. However, we do not have to wait for the mortality to be high before we know that we are, indeed, in an era of worry. In as much as we are trying to avoid panic and anxiety among the people, we should know that we have to reduce the spread.

To just further emphasise on the facemask, if you are going to areas that are crowded, it is advocated that you use facemask. These facemasks are now classified. A cloak-base facemask can suffice for anyone to prevent transmission of our own droplets when you are within an environment that is overcrowded while the surgical mask is what is advised for healthcare workers to use.

But what we see now is the abuse of the surgical mask which has greatly put the healthcare workers at high risk in terms of accessing the basic Personal Protective Equipment (PPE) for use in case of social distancing. At the markets, as you can see, the compliance is low despite the enforcement but we are hoping that in the next few days or weeks, we will see a better compliance and enforcement.

The  EPRT was set up to encourage compliance. What are the challenges?

Dr. Agosu: From my own experience, firstly, people are hungry and we’ve asked them to stay at home for so numbers of days. Fine, some local governments have come up with this stimulus package to alleviate the hunger. In my own opinion, they are not enough. They are doing their best but it is not enough. People are hungry and consequently they are revolting. You ask me to stay at home, how am I going to feed my family? And some people are typical daily earners and in reality of this, how will they feed?. So, it has even affected us, health workers, as we are campaigning from house to house preaching the advocacy. About few days ago, we were in a community. We were trying to create the sensitisation, the youths in the community revolted saying “please pack your COVID ambulance and leave this premises.”

For people to comply they need to be comfortable. You have to support them to stay at home. The youths will not want to stay at home; they are agile, they would want to be involved in activities. So, if there is nothing at home how will they sit at home? Compliance rate is low when it comes to this lockdown, self-isolation.

Secondly, people are not aware enough; they don’t understand the gravity of this disease. So, I think the governments, at different levels, still need to do a lot of awareness. As you are giving them stimulus, let them know the importance of this stay at home.

We’ve talked about putting more money into advocacy, what will be your recommendation to governments in order to encourage compliance? 

Dr. Yesufu: We’ve learnt that the language we understand is the language of money so it is something that we can always work on. I know, it is something feasible because when people have money in their account and they are boastful enough to say yes, government gave them some amount, they will be willing to listen to whatever the government has to say. There is this kind of trust they would have built between themselves and the society. So, some forms of relief method is another way out as they’ve already been doing but it could be intensified as such that it gets to the people who really need it. It is going to be an encouraging development as time goes on that we look into something like this especially, when we have epidemics and pandemics and the ways to curb it. We have to think about the community first.

It is becoming worrisome that we are now having community spread, beginning from where we are coming from. What is your fear?

Dr. Agosu: Lagos State Government has been proactive enough learning from Ebola in 2014. This had prepared the government to put something in place. You could recall that before the federal government put in the lockdown, Lagos State government had put down some measures to curb community spread. However, we are here now. As per community spread, my fear is, God forbids, it is better we learn from others’ mistakes than learning from ours. It is painful when you are hearing people dying in thousands, the fatality rate in other countries like Italy, Spain even the US. My prayer is that we will not experience such because it is bitter and a very painful thing when you see your loved ones dying. As healthcare workers, we are the first target because we are the ones taking care of these people and the pressure is on healthcare workers. Other countries like Italy and the US are even requesting for more doctors. I hope we will not get there, for us not to get there, that is why we’ve put in this lockdown, self-isolation and social distancing.

If the community spread catches fire, what is your fear? Can we cope?

Dr. Yesufu: Issue of coping is what we should worry about because our healthcare system has been a little bit shaky. We’ve only been trying to improve the Healthcare System. This kind of virus has burdened the healthcare system, which we are beginning to see. For us not to get to that stage, whether we would be able to cope or not, the best for us is to stay at home to prevent community spreading. The reason why we are staying at home is to prevent community spreading. Once we are able to control it at the community level, we will run over COVID-19 and we need to start working against it from now.

In your respective council areas, are there other things you think need to be done in order to help you in your activities?

Dr. Agosu: I want to start by thanking my Chairman, Hon. Monsuru Oloyede. He has done so much as regards stimulus package. In fact, I was impressed with what I saw. Few days ago, I sat with the chairman to analyse how he was going to distribute those commodities in compliance with social distancing and he gave me the structure which began with the CDAs. Sorry I am biased, I am a doctor. We are at the frontline, we will need support as regards PPE so that we will be confident. What we are doing now is acute case search, we go into the community. We just send people into the community we don’t have adequate Personal Protective Equipment (PPE) like facemask; things to protect ourselves. So, if the government at the local level can support. Though, they are doing their bits, if they can support more, as regards PPE, it will go a long way.

Dr. Yesufu: Well, presently my local government chairman, Hon. Shamsudeen Olaleye, has been doing a lot of advocacy meetings with stakeholders in the community. We’ve had to do a lot of awareness campaign as regards COVID-19. However, there is more. In a bid to prevent community transmission comes the issue of active case search. It is a surveillance strategy where we go into the community and look for those people with these symptoms, those who fall into this category and for those that test positive. We isolate them and evacuate them from the community immediately. But, this is going to be faced with a lot of challenges which we are already facing. The issue of PPE is one so also is the issue of actually empowering the volunteers who have volunteered to do this community service. Because we have people who are willing to actually help with the FG, state and LG to identify these ‘persons of interest’ in the society. So, they need to be fully equipped for this job. Both frontline workers and public health workers need to be empowered to be able to carry out this kind of activity.

What has been your experience with Contact Tracing in Oshodi-Isolo?

Dr. Yesufu: The challenges with contact tracing have been enormous. Right from time, for examples, those who come in through airline, getting their names out of the manifests, sometimes the phone numbers are wrong, sometimes we get addresses that do not exist so, all these have been limiting us as regards contact tracing. For some of them, we found out that the areas they are living are hard to reach. It is a huge challenge and stress for the primary healthcare workers who are into contact tracing.

For some, we have incomplete data because of some reasons or the other. And we have this problem of people not self-isolating. Ideally, when you come into the country you should first isolate yourself for 14 days. We found out the otherwise is done. So, we have to start looking out for them from one place to another which is very risky for members of the community. Basically, that is an issue on contact tracing. PPE is another issue because front line healthcare workers who are into Contact Tracing need to, at all point in time, protect themselves from contracting the virus from other persons. But, we found out that because of the shortage, it is not done in that way.

How many members do you have in your surveillance team?

Dr. Yesufu: There is what we call the Rapid Response Team; they are the ones who will go into the community to conduct the contact tracing and follow up. It is a group of 7 members, they are the ones who follow up and because of that we have close communication with those people, even outside your local council because every LCDA ought to have that team for easy communication and connection.

In terms of Contact Tracing, how close are you to the CDAs, to what extent do they give information?  

Dr. Agosu: Categorically, I will say that we got 90 per cent of the cases we’ve experienced regarding self-isolation or suspected persons of interest through the CDAs. They have done fantastically well. Whenever they see any suspicious case of someone who has just come into the country, they alert us. For example, sometime in March, I got an anonymous message saying so so person had just come in from the US and had been moving up and down the streets. Immediately, our Rapid Response Team went there to confirm if it was true. We saw the person, in fact, to my dismay, that person was not willing to comply with us. He was saying, “I am not a child.” In fact, he threatened to pour oil on us. We talked to him like a gentleman. However, he refused to cooperate. We had to upscale him to the law enforcement agents.. When we got there the following day, he began cooperating with us. We had to monitor his temperature for 14 days and he was okay. Complying with this self-isolation is actually the key issue.

Do you share the concerns of the NMA against the coming of Chinese Doctors?

Dr. Yesufu: Well, the concern the NMA has raised is the issue that we are having an ongoing pandemic and we all know that this pandemic came from China. Over here, we are having health system that is still trying to be strong; we would not want to expose the community unduly to any form of thing that will harass the mind of the people. To me, their coming is a good thing but, I would have felt that what they want to teach us be done in a more technological sense. These days we now have Telemedicine and the like. At this stage of technological advancement that we are in, there is nothing they want to tell us that they can’t do through internet and we know that we have a healthcare system that needs to be worked on. For us to get to their level, we need to confidently strengthen our healthcare system further and basically, the basic has to be done but we are not doing that by inviting them.

Dr. Agosu,do  you share the same thing?

Dr. Agosu: Yes sir. We have experts here too, people of high caliber that have been trained. Epidemiologist – people that are experienced. My take is that, the amount of money you are going to spend on these experts from China, why don’t you use them to get Personal Protective Equipment (PPE), basic things to be supplied? If the money is expended on building our healthcare system even from the basics, from primary healthcare to secondary and tertiary level, it will go a long way. And telemedicine, tele-health; there is no limitation to their reach, anywhere globally. The minister of health claimed that they are not going to touch our people, just to give us advice. This advice can be given via telecommunication so, the money we are going to spend on these people can be spent to strengthen our healthcare system. .

Before COVID-19, there has been the issue of Lassa fever recording several deaths, does that not make your work rather too difficult? 

Dr. Yesufu: It is the same message, be it Lassa fever or COVID-19, it is all about personal hygiene, taking personal hygiene so serious. We have been advocating that we should constantly wash our hands. Not only washing of hands but ensuring that our environment is tidy and also try as much as possible to ensure that it is rodents free. These are basic personal hygiene methods that we ought to have put in place. With the advent of COVID-19, it just came to strengthen this methodology that we have slackened in a bit. As it is right now, everybody is conscious. We are trying to stay safe, protecting our environment and in a bid of doing this, any form of emerging disease will slow down. That is where we are on Lassa fever. It is the same message.

Dr. Agosu: As she said, it is taking us back to the basics,, keeping ourselves clean and our environment. Lassa fever is a seasonal infection. It comes in dry season. You will see that when the rainy season comes, the rodents are not much around, they go into hidings. Because it is seasonal, it has been advocated that we should keep our environment clean. We were doing monthly environmental sanitation before government put in place great measure to ensure this. The message to the people remains hygiene, hygiene, hygiene!