Abimiku: Nigeria Should Prepare for Ventilators Now, Set up Team of Leaders to Tackle COVID-19 Pandemic

Alash’le Abimiku

Alash’le Abimiku is a Professor of Medicine at the University of Maryland, United States, and the Executive Director, International Research for Human Virology Nigeria. In this interview with Martins Ifijeh, the respected virologist and researcher shared light on the nature of COVID-19 and what government at all levels, stakeholders and the citizens must do to defeat the growing spread of the pandemic in Nigeria. She also spoke on the need for governments to prepare for ventilators now, why chloroquine is not the answer, and when there is likely going to be vaccines and cure for the dreaded virus

Is chloroquine a treatment regime for COVID-19?
This has not been established scientifically. In medicine, it is not unusual that a drug that has been used for one treatment has an activity against another kind of infection. Sometimes, people will tell you they are treating malaria and suddenly their hypertension is getting better.

Chloroquine hasn’t been proven, but the person pushing it says it may have some anti-viral activities as well. We know chloroquine is used to treat malaria which is a parasite, and COVID-19 is a virus, so it is possible it may have some viral activities for COVID-19, but there has to be some scientific trials to show that if you have COVID-19 and when you take chloroquine it will do better for the illness.
For me, if for instance I have COVID-19, I will not go to the pharmacy to buy chloroquine because it has not been proven. I would rather take extractive juice, water melon, cucumber, bitter leaf, etc. I would make sure I am exercising and taking those juices good for my immune system than running around to buying chloroquine. If I have malaria I could buy chloroquin, but not for COVID-19.

Is there any form of immunity against COVID-19?
We know research institutes are making money available for research. I heard even the Central Bank of Nigeria is making money available for research.
We know for a fact that if you get infected, one of the reasons you get better is because your immune system fights it, and you get immune responses, but this disease just started, so we don’t know how long this immune response last. Overtime, individuals will be studied to know whether they have been able to mount up the appropriate immune response against the disease, and how long the immune response can last. All of that hasn’t been studied. But I am sure that right, especially in China; people are looking at those aspects. But usually that’s what these viruses do. When they come we mount up immune responses.

If someone’s immune system at the time he or she gets rid of COVID-19 is at certain level, and after a while it goes down, it means the person will succumb to infection. But for instance, yellow fever vaccination for life ensures the person’s immune system stays above the infection for life.

We hear of cases of people who after treatment for COVID-19, eventually die of lung issues. Is this true?
I don’t think we have had enough time after infection with COVID-19 to really know what happens. Thousands of people have been treated successfully for COVID-19, especially in China; those people will have to be monitored for a period of time to see how well they do.
Part of the treatment for COVID-19 is to make the lungs function better. That is why ventilators are very important. We know there are people that have COVID-19 and remain well for a period of time. We don’t know if after a while they succumb to some of the clinical symptoms. We know the incubation period is within 14 days. There was a case of someone who began to show symptoms after 27 days. We really have to follow a few for much longer to see what happens.

When the test is done you might be negative at that time. Nobody knows what happens a day after because if you touch surfaces or touch someone who has it, you might contact it. That is why we must continue to push the idea of distancing, hand washing, and be careful not to put our hands to our face. It is good for us to be tested, but we do not want a situation where someone is tested and goes about to say he does not have to worry about COVID-19 anymore.

What do we do right now since the outbreak is already in Nigeria?
With our population, we don’t have enough infrastructure and testing facilities to tackle COVID-19. So one thing we know we can do something about is the messaging. We should see our president talking about it all the time; we should see all of our governors, local government chairmen, imams and pastors talking about it. Messages of prevention are very important at this time. There is no treatment, all we have is prevention and we need to let the people know this. What the common Nigerian on the street has in his hand is all of the precautions. Social distancing should be observed, stay at home, and those who have gone to high risk countries should observe 14 days self-isolation. We need to prepare for ventilators. If the United States is running out of ventilators, it shows Nigeria must prepare in hand for it now.

We often establish several securities as a nation; from cyber security to financial security. Is there any virology security in Nigeria?
The only security we can get against the virus is vaccine but right now we do not have a vaccine. This is still a challenge. Right now we can’t protect our borders or dictate where the viruses go to so I am not sure we have any security against vaccines.
Is Nigeria ready to tackle disease outbreaks, especially COVID-19, considering the lean amount budgeted for national health security?
I don’t think Nigeria is the United States where disease prevention is giving so much priority. Nevertheless, it doesn’t sound like we have appropriately budgeted for health in general.

When you look at the situation, you will see everyone has a role to play. What we do at home is prevention, and then NCDC does surveillance, informs us of what should watch out for. Then if the disease breaks through these barriers, do we have the health facility for it, we do not have ventilators, etc.

So, if you look at this continuum of care, it is totally under budgeted. Nigeria in 2001 agreed at the Abuja declaration that 15 per cent of the entire budget should go to health, but we have not done it. I don’t think we are well funded.

What are we doing with all the resources we have in Nigeria? What are we doing to solve this problem. How are we bringing all of the media people, churches, market women, mosques, economists, public private partnerships, academia, researchers, the Dangotes of this world and all of that together to solve the problem?
Are we getting ventilators, laboratories for testing? We are not doing that right now. We have NAFDAC, pharmaceutical firms, airlines for moving cargos, etc, there is a role everyone can play. Government’s role is not only to bring out the money, but leadership. I am worried for us because I am not seeing the leadership at the moment.

Nigeria budgets highly for national security, especially because of insurgency, kidnapping at the likes. Shouldn’t this priority be given to national health security as well?
This is an area I speak as a common man because that is not my area of expertise. How can we talk about national security and we are not securing the health of the nation. Why are we having this artificial division? If you are a governor of a state and your citizens are dying for COVID-19 then who are you governing?
There must be security against kidnapping and all, but you also need to have security for their health and economy. What should be happening is discussion across all individuals, including the military, economy, medical personnel, etc whether for kidnapping or from a disease so that we can put our resources where it should be.
Why protect me against kidnapping when I can die from diseases due to poor healthcare. Right now the priority is COVID-19, so government must move resources to where it is needed. This is how I will expect my government to protect me. That is my security.

What is the potential damage of COVID-19 to Nigeria?
Do you ever think that a virus will bring us to a standstill? That we will close our borders totally? I was to have a meeting this March somewhere, but I told people I will watch what happens in China regarding COVID-19 before I make any travel. I told them not to buy my ticket. The danger we have as human beings is that we say it is happening far away from us, so it’s not our business. Look at HIV; it was exactly the same problem. We were thinking they are the ones kissing dogs and that we don’t do that here in Nigeria, before you knew it, we started having it. When COVID-19 started, US described it as China’s problem, but now it is US’s problem.

The governments on the African continent will not be forgiving in history because Africa was the last continent to be hit by COVID-19. We had all of the opportunities to learn from other continents when it started ravaging them. We had all the opportunities to prevent this, but we never took action.

When are we expecting vaccines and drugs for cure for COVID-19?
Unlike bacteria, viruses are very difficult to get cures on. HIV broke that circle. Companies worked really hard for antiretroviral drugs for treatment. But if you think of the viral infections we are having, most of the drugs we have are vaccines. I believe there will be a vaccine for COVID-19, but whether it will be developed on time is what we do not know for now.

Companies are putting a 24-hour resources together to ensure vaccines are developed in record time but it will take time. It will take about another nine months. More and more industries have been encouraged to target different parts of the virus to see if they can develop drugs against it.

Viruses, than other organisms, have the capacity to mutate. That is why vaccines are very important. Vaccines put the body ahead of the virus such that the virus has no time to multiply and mutate. Without vaccine and immunity, virus has the capacity to mutate and spread. It also sharpens its capability. That is why sometimes one gets virus, and the virus finds a way to resist what you are applying to kill it, hence newly mutated ones are more dangerous than the previous ones. That is what is happening with HIV right now. You can no longer find the weak HIV strain we used to have. What we have now is the tough strain.

Some people say when one is exposed to the virus and touches his mouth the virus can actually go down to the digestive system where acid could kill it off. They say the issue is only in the nose since it resides in the respiratory tract. Kindly clarify whether the virus latches only to the nose or could go through into the body through anywhere in the face?
Our skin by nature helps protect the body against infections and there is a thick layer between the skin and the blood vessels. But it is not the same for our face. Around our mouth, nose and eyes, our membranes are thin and blood vessels are very close to the surfaces of the skin. It is easy to scratch the surface around these places and one will bleed.

You have done researches on Lassa fever. When are we having a cure?
We are working towards getting a vaccine against it. I don’t think we will have a cure just yet. We are very focused towards three areas; one is improving the diagnosis so that samples can be collected immediately and results are available. People will no longer have to wait for two weeks to get their results. You know people can die waiting. So we are working on a very simple point of care so that any laboratory can do the diagnosis.
The second thing is that we are trying to see some similarities between Lassa fever and HIV. Then the third research that we are part of is trying to see whether our site can test the experimental vaccine to see which one would be effective. This fever has gone on for too long, may be because it is an African thing, so the rest of the world is uninterested in pulling any money into it.

Why don’t we have a cure for HIV AIDS yet?
We don’t have a cure and we don’t have a vaccine for HIV just yet. This is not because of lack of efforts. It is just a virus that has a lot of potential to mutate. It is also a virus we refer to as retrovirus because it takes over the machinery of your body system.

So, anything that may hit the virus will make sure that it protects the body but the fact that the HIV virus integrates into the genome of the cell to produce its self makes it even twice as hard because how can you separate the virus from your own body? So that’s the challenge because honestly when I did my post graduate in the US in 1996, all of my work was testing various experimental cases that are coming from Africa and I can’t believe that 30 years after, we still don’t have a vaccine. I think because of these two things; it integrates into our cells and replicates its self in the whole body DNA. That is why they call it retro because it produces its self, using the body’s own DNA machinery.

When people talk about conspiracy theories like planting some biological weapons to kill the world, I refer them to HIV. What can be more brilliant or dangerous than HIV.

Why is it that in Nigeria, HIV pregnant women who take their drugs are advised to breastfeed, while in the US they are advised not to even though their viral loads comes down to zero?
This depends on where the person is. The US health system is high enough for mothers not to breast feed and their infants will still be protected, because the infant gets all the vaccinations, gets all the supplementary feeding such that the infant is not missing out any essential nutrient. Their environments are clean.

But here, if you tell the woman not to breastfeed, what are the alternatives. Does supplementary feeding have what it takes to protect the infant? Can the mothers protect them against the environment? So they are asked to breastfeed because the alternative is not there. How many of these mothers can afford even formula let alone clean water. All these things have no capacity to protect the child against diseases.
The breast milk is sterile, it is clean, there isn’t much more to do because there is a lot of nutrients in breast milk.