An Opportunity to Strengthen Weak Health Systems

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Ugochukwu Timothy Eze submits that the 2019 nCoV pandemic is a golden opportunity for Lagos State Government to attract funding to revamp her infectious disease hospital to a global standard

Someone once said, “Don’t let any crisis go to waste.” It means there is a seed of opportunity in every crisis which can be harnessed for development purposes. The world started the new decade with the terrifying news of a new virus called the 2019 novel Corona Virus (2019 nCoV) causing outbreaks of pneumonia in Wuhan City, Hubei Province in China. The source of the outbreak was linked to the illegal trade in wildlife in a seafood market in the Wuhan city. The initial cases were thought to result from animal to human transmissions but human to human transmission was later established and was responsible for the sustained outbreaks. Knowledge about the virus kept evolving and we now know that the rapidly rising cases of the virus may be due to the ability of the virus to be transmitted during the incubation period (before symptoms start showing). As at today, over 42,000 cases and over 1000 deaths have been reported including 412 cases reported in other countries outside China.

The World Health Organisation (WHO) couldn’t declare the pandemic a public health emergency of international (PHEIC) concern until after the second meeting of the International Health Regulation (IHR) Emergency Committee. One of the strong reasons for the eventual declaration of PHEIC was to protect countries with weak health systems. The virus is capable of wrecking severe havoc in countries with weak health. The WHO was also advocating that high income countries, private organizations and individuals of means should rally support around countries with weak health systems in terms of preparedness and response readiness for the novel virus. Areas that will need strengthening include capacity to detect (surveillance) any case of the novel virus especially at the points of entry, laboratory capacity to confirm diagnosis, capacity for case management of this highly infectious disease, etc. Nigeria is among such countries with very weak health system. The Nigeria Centre for Disease Control National Reference Laboratory in Abuja has been supported to acquire the capacity for confirmation of the diagnosis of the novel virus. Also, a lot of support is currently being given to the international air point of entries located in Lagos, Abuja, Kano, Port Harcourt and Enugu. I’m concerned about case management.

Lagos State is the home to the largest Chinese community in Nigeria. Also, the international airport in Lagos is the busiest in terms of indirect flights to and fro China. Lagos State is at a high risk of importation of the cases of 2019 nCoV and with such a large population density, it will be very easy for the virus to spread rapidly if care is not taken. The Lagos State Government has designated her infectious disease hospital, a secondary health facility in Yaba as the facility to manage any case of the novel virus that may be imported into the state. This facility has been in use for the management of Tuberculosis (TB) patients but during the Ebola Virus Disease (EVD) outbreak in Nigeria in 2014, it was used for the management of EVD cases. This same facility continued to be used for the management of infectious diseases such as TB especially multi-drug resistant (MDR) TB after EVD outbreak was declared over. It is important to note that the management of MDR TB now takes a community approach and it is unlikely that this facility admits cases of MDR TB.

Unlike EVD that requires close contact with body fluids of an infected person, 2019 nCoV is airborne and highly infectious with an estimated case reproduction number of between 1.4 and 2.5. It means that a single infected person could infect up to 3 more persons. So what kind of facility will be needed to manage such a highly infectious disease? Such facility will need health workers who are well trained in the management of highly infectious disease. This kind of training will involve all cadres of health workers including security guards, drivers and ward attendants. These health workers will need constant simulation in order to be able to tackle real life cases at a reflex level. Bulk of their training will focus on infection prevention control and patients care. Also, such a facility should have a regular supply of IPC equipments, materials and safe medical waste disposal system. Furthermore, the facility should have infrastructures for IPC including isolation units with negative pressure, steady water supply, adequate ventilation etc. Finally, the facility should have dedicated intensive care units with many ventilators, dialysis machines, uninterrupted power supply etc.

The 2019 nCoV pandemic is a golden opportunity for Lagos State Government to attract funding to revamp her infectious disease hospital to a global standard that can safely manage highly pathogenous infections without amplifying its outbreak. I don’t know the current state of the facility, nor the level of training of the health workers, nor the level of IPC supplies (gowns, N95 respirators, safety boots, googles, etc), nor the state of the isolation units. However, preventing the amplification of the outbreak of a highly infectious airborne disease like the 2019 nCoV will require a standard infectious disease hospital; nothing less.

What should Lagos State Government do? They should develop a costed proposal for a quick expansion and upgrading of the infectious disease hospital in Yaba to a global standard. This proposal should be funded through a public-private partnership model. Many private organizations operating in Lagos and Nigeria are most likely to support such initiative in the light of the current 2019 nCoV pandemic that has caused heavy economic losses to China. In order to sustain steady development in this facility even after this pandemic is declared over, the hospital should be upgraded to a teaching hospital as an annex of the Lagos State University Teaching Hospital. It should also be affiliated to the College of Medicine, Lagos State University. They should appoint an infectious disease specialist that is well researched and well experienced in the management of highly pathogenous diseases to head the facility. The person should be expected to drive research, training and improve management of infectious disease in this centre. The person should also have the capacity for attracting grants for the further development of the facility.

It is time for Nigeria to have a specialised infectious disease hospital that the world can trust; a facility that can comfortably manage both current and future outbreaks of highly pathogenous diseases. The window of opportunity for bilateral and private support brought about by the 2019 nCoV pandemic should not be allowed to go to waste.

* Eze is of the Department of Community Health,
Lagos University Teaching Hospital