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COVID19 AND THE NIGERIAN NATION

COVID-19 AND THE NIGERIAN NATION An overview of the ongoing pandemic, the local response, and prospects for the future By Femi Olugbile History The virus SARS-COV-2 is now known the world over as the cause of the pandemic disease known as COVID-19. The effect of the virus was first noted in Wuhan, China, in December 2019. A pattern of illness characterized by fever, cough, difficulty in breathing, severe weakness and body pains as well as a variety of other possible symptoms was observed in increasing numbers. Over time the source was traced to a corona virus that appeared to have ‘jumped’ from an animal host to infect a human victim. There were two possibilities – that the virus had mutated to a more harmful variant before it made the ‘jump’, or that it mutated after getting into the human body, becoming capable of human to human transmission. The suspected animal hosts were bats and pangolins. It would appear that the Chinese authorities were slow off the mark and initially reluctant to admit the full scale of the COVID-19 problem when it started in Wuhan. China, despite the friendly face it seeks to present to the world, is an authoritarian society where information flow to Chinese citizens and the outside world is closely controlled by the ruling Communist Party. In the event, the approach of the Chinese New Year became a complicating issue. The New Year is the largest celebration in the Chinese calendar. It is the time when Chinese on the mainland as well as Chinese from all across the world travel home to celebrate with their families. The world at large was only just becoming aware that something big and bad was going on in Wuhan and threatening other districts of China when the New Year mass movement began. Eventually the government of China went into overdrive, locking down Wuhan and scaling up medical services by dramatic gestures such as rushing through the construction of two mega-hospitals in a matter of days. The scale of the response opened the eyes of the world to the fact that a major crisis was unfolding, and the international community began to take notice. On 30th January 2020, the World Health Organization (WHO) declared the outbreak of CoVID-19 as a Public Health Emergency of International Concern (PHEIC). It was meant to highlight concern about the spread of the disease, but also to let it be known that it still fell short of the criteria for a pandemic. Meanwhile, with uniquely deadly efficiency, COVID-19 proceeded to seep its way – first into China’s Asian neighbours, then eventually into the European mainland and the Americas. By the time the WHO Director General, Dr Tedros Adhanom Ghebreyesus declared the disease a pandemic on the 11th of March 2020, the horse had bolted from the stables, and all the world could do was scramble frantically to catch up with it. COVID-19 has to date led to the greatest social, economic and health disruption the world has seen in peacetime in living memory. It has established a presence in 195 countries. While it has not yet reached the cataclysmic proportions of the so-called ‘Spanish Flu’- the influenza pandemic which devastated the world (including four year old ‘Nigeria’, which lost an estimated 500,000 dead from a population that was less than one tenth of its present population!) from January 1918 to December 2020, infecting a quarter of the world’s population and causing an estimated 50 million deaths. But in an age where human beings have walked on the moon and man is inclined to see himself as the master of the universe, armed with a solution to everything, COVID-19 has brought man’s Ego to heel in a way which even the Spanish flu never did. It has the most powerful nation the world has ever seen, the United States of America, quaking in its grip, with a leader who is forced every new day to eat the blustery words he uttered only yesterday in a vain effort to reassure his people. The global order is in shambles. The most economically successful nations in the world are facing recession, and the behemoths of Big Business are facing bankruptcy. More than two billion of the world’s population, including India, are in partial or full lock-down. COVID-19 in Nigeria On the 22nd of February, an Italian national, who had recently arrived in Lagos became the first documented patient with the virus in Nigeria. Despite the fact that Lagos, the host state had been preparing for the possibility of just such a development and had activated an Incident Command Centre four weeks before the index case, it was a bit of a rude awakening for the nation when the pandemic finally arrived on its shores. The patient was admitted to the Isolation Unit at the Infectious Diseases Hospital in Yaba. In time, he made a full recovery from the illness, and he was discharged after several days of treatment. Since the index case, the numbers of ‘Persons of Interest’ (POI) and ‘Confirmed Cases’ have risen, but perhaps not as steeply as some people might have expected given the figures elsewhere on the continent and in the world at large. Interesting emerging trends (as at the end of March, 2020) included the fact that 82% of total confirmed cases were people who had recently returned from nations known as hotspots of the disease, including China, the UK and the USA. 16% were persons who had not travelled, but who had been in contact with others who had. The origin of infection for 2% of the cases could not be ascertained. 16% of all confirmed cases were foreign nationals, and 84% were Nigerians. According to a situation report from the office of the Honourable Commissioner for Health in Lagos State, as at the end of March, 2,645 persons had been kept under Surveillance since the arrival of CoVID-19 as ‘Persons Of Interest’. Of these, 352 had gone beyond the Incubation Period of the disease and their follow-up had been discontinued. Lagos has clearly learned from experience and deepened the infrastructure it developed since 2014 when it efficiently contained a threatened epidemic of Ebola Virus Disease. THE PICTURE As at Friday, 3rd April 2020, the following were the statistics across the world: Total Confirmed cases: 1,023,401 Total Mortality: 53,528 Severe illness: 34,134 Recovered: 212,408 World-wide, the top 20 most affected countries (at that date) were as follows: By number of Cases By number of Deaths United States 245,389 Italy 13,974 Italy 115,495 Spain 10,348 Spain 102,000 USA 6,095 Germany 85,871 France 5,387 China 83,269 China 3,322 France 59,105 Iran 3,160 Iran 50,468 UK 2,921 United Kingdom. 33,718 Netherlands 1,339 Switzerland 19,106 Belgium 1,143 Turkey 18,135 Germany 1,121 Belgium 16,770 Switzerland 565 Netherlands 14,697 Turkey 356 Canada 11,283 Brazil 327 Austria 11,238 Sweden 308 South Korea 10,062 South Korea 174 Portugal 9,034 Portugal 209 Brazil 8,076 Indonesia 181 Israel 7,030 Austria 158 Sweden 5,568 Philippines 136 Australia 5,360 Ecuador 120 In Africa, the top 20 most affected countries were as follows: By number of confirmed Cases By number of Deaths South Africa. 1,462 Algeria 86 Algeria 986 Egypt 58 Egypt 865 Morocco 47 Morocco. 735 Burkina Faso 16 Tunisia. 455 Tunisia 14 Cameroon 306 Cameroon 7 Burkina Faso 288 Mauritius 7 Ghana 204 South Africa 5 Senegal. 195 Ghana 5 Ivory Coast. 190 Niger 5 *Nigeria 184 * Nigeria 2 Mauritius 169 Mali 2 Kenya. 110 Angola. 2 Niger. 98 Sudan 2 Rwanda. 84 Senegal 1 Madagascar 59 Ivory Coast. 1 Guinea. 52 Kenya 1 Uganda 45 Togo 1 Djibouti 40 Guinea 1 Togo 39 Tanzania. 1 (From NCoV2019.live created by Avi Schiffmann) The breakdown of the Nigerian CoVID-19 figures (3rd April, 2020), as provided by the Nigeria Centre for Disease Control (NCDC), was as follows: Total Confirmed Cases: 190 Total Discharged (after recovery): 20 Total Deaths: 2 Confirmed Cases, State by State Lagos. 98 FCT. 38 Osun. 20 Oyo. 8 Akwa Ibom 5 Ogun 4 Edo 4 Kaduna 4 Bauchi 3 Enugu 2 Ekiti 2 Rivers 1 Benue 1 From the NCDC analysis, the virus has already spread to at least 13 of the states in the nation, and possibly more. Lagos (with 98), Abuja (38) and Osun State (20) are the epicentres. THE RESPONSE SO FAR From the outbreak of the pandemic and its first incursion into Nigeria, Lagos State, through the agency of its Incident Command Centre, led by the Governor, Mr. Babajide Sanwoolu, and the Ministry of Health, led by the Honourable Commissioner, Prof Akin Abayomi have, directly and in close alliance with the Nigeria Centre for Disease Control (led by the Director General, Dr Chikwe Ihekweazu), been working assiduously to treat confirmed cases, as well as to contain the disease and stop or slow its spread into the Nigerian population. The elements of this Containment strategy include screening of passengers coming into the country, especially those coming from countries where the disease is already widespread. People coming in from affected countries were routinely monitored during a prescribed period of self-quarantine. They proceeded to scale up human and physical capacity in the isolation centre, and to train staff from other parts of the country who, unlike Lagos, had not previously been tasked with dealing with such a major public health challenge. In the course of time, travel restrictions were imposed on the recognized ‘hot zones’ of CoVID 19. Confirmation of the presence of CoVID 19 to date has been through the taking of nasal swabs and running the test through a PCR machine. There are currently fewer than ten functioning units of the equipment in Nigeria, but there are said to be plans to scale up in short order. The major Isolation Centre in Lagos is located at the Infectious Diseases Hospital in Ebute Metta. A collaborative private initiative with Guaranty Trust Bank delivered a 100 Bed Isolation Centre, built in the space of one week, on the grounds of the Mobolaji Johnson Stadium in Onikan. There are contingency plans to build other Isolation Centres in Stadia and other public grounds as the need arises. A private initiative by a group of professionals by the name of Young Presidents Organization, led by Mrs. Fola Laoye, Dr Richard Ajayi and Dr Ola Brown has set up a field hospital on the grounds of Landmark Centre in Victoria Island and is shortly to commence operations. Some other states in the federation have created Isolation facilities for the use of their citizens. II CHALLENGES Personnel and Facilities: Given the limitations in the availability of doctors, nurses and other medical and paramedical personnel in the nation, and the limited numbers of medical facilities generally, there is fear that the system could be quickly swamped and overwhelmed if Nigeria were to experience the kind of surge in numbers of ill patients that has been seen in USA, Italy and the UK. Specially trained personnel such as Intensivists, Anaesthetists and Critical Care Nurses who are normally required to run the most advanced life-support equipment are in very limited supply in Nigeria as a whole, though Lagos State has higher numbers than all the rest in its public and private healthcare space. Equipment and Consumables: Preparations for response to the pandemic in other countries have included a push to ensure a plentiful supply of face masks and other Personal Protective Equipment (PPEs) for staff, and to ramp up the numbers of high-end equipment such as ventilators required for life support in critical situations. Not even the richest nations have quite the numbers of these item they have calculated as their need. New York State alone, with a population of eight and a half million people, has estimated that it would require up to 40,000 ventilators. In the United Kingdom, the workers in the National Health Service (NHS) are complaining daily about shortage of Personal Protective Equipment. The Lagos and Federal governments have taken measures to ensure a ready supply for local use. Unfortunately face masks that are useful both for medical staff and the generality of the public are not manufactured locally and have virtually disappeared from all local sources of supply. Hand sanitizers, due to market pressure, have been priced out of the reach of most citizens. The Fear Factor: There is an understandable fear of the pandemic among the populace, despite the efforts of government agencies to educate and calm citizens by teaching them how to carry out the basic hygiene measures for their protection. There is wide-spread dissemination of falsehoods and conspiracy theories concerning the origin and course of the disease. Some of these rumours even attribute sinister intentions to ongoing efforts to develop a vaccine and will definitely be a factor in limiting the citizens’ acceptance of such a vaccine, if they are not addressed. THE PRIVATE SECTOR RESPONSE The involvement of the private sector in the country’s response to the CoVID 19 challenge was led by the dramatic announcement that Guaranty Trust Bank was going to build a hundred bed capacity Isolation and treatment unit, complete with a well-equipped Intensive care unit. The unit was delivered and ready for action within one week of the announcement. The gesture, as well as the accomplishment, provided a great morale boost to the generality of the population of Lagos, and also helped to convey a sense of can-do. All of this fitted nicely into the calm professional manner in which the Lagos State in particular and its functionaries were pursuing the tasks of screening, targeted testing for case identification, contact tracing, isolation, and consistent surveillance of ‘persons of interest’. A spate of large donations from individuals and corporate organizations have been announced towards the efforts to combat the pandemic. The Dangote Foundation has announced its intention to build a large-capacity isolation centre in Kano. Various persons, including a former Head of State, have announced the donation of buildings for conversion to use as Isolation Centres. There has not been a lot said or heard about the involvement of the private medical sector in actual or potential service provision. It is known that some members of the organized private health sector have been receiving training in case the country at some point is faced with a ‘surge’ that threatens to overwhelm existing public resources. The role they may play in such a scenario has not been clearly mapped. It is most unlikely that their facilities could be converted to use as Isolation Centres, for the reason that there is a technical requirement that a facility that would be used for infectious disease must be appropriately constructed, equipped and certified for the purpose. Currently only government facilities such as the unit in Yaba, Irrua Specialist Hospital in Edo State and a few centres in the country are certified in this regard. However, collaboration could take place by way of private sector medical personnel volunteering or being ‘drafted’ where the need arises. Equipment such as ventilators and the personnel to operate them could also be ‘borrowed’ or ‘commandeered’ if the government considers that there is a desperate need in the nation. Evidence of good thinking in preparation for such a contingency would include compilation of a database detailing persons with relevant skills as well as an up to date inventory of relevant equipment in private hands. This is not in evidence at this time. It is quite possible that none of these measures will be called into play, but it is important to have the information well in advance. WHERE ARE THE GAPS? There is general agreement that the number of tests conducted so far across the nation – perhaps somewhat more than four thousand, is inadequate. With only a few exceptions, such as the President and the Vice President, only people who have been exposed to a confirmed case and who themselves have symptoms are subjected to, or able to access testing. The tests are the gold-standard cumbersome ones done with the PCR machine. The turn-around time for results is more than twenty-four hours, and may be as much as two or three days, and each machine can only run a limited number of tests in a day. No ‘point of care’ ‘rapid’ testing is being done at present. There is a fear that some people with sub-clinical infections who evade screening or quarantine could be missed entirely and may be disseminating the disease. There is certainly a need for a decentralized, scaled-up testing regime for a number of reasons, one of which is to get a sense of the actual size of the existing burden of illness, in order the better to deal with it. In addition, there will be a requirement, as time goes on, to establish a protocol about the testing of medical personnel who treat infected patients. It is dangerous but necessary public service, as illustrated by the fact that over 60 doctors have already died in Italy, and there is an ongoing effort to scale up testing of medical personnel treating COVID-19 patients in the UK. THE PRESIDENT SPEAKS On Sunday 30th March, President Muhammadu Buhari finally made a national address to outline his government’s plans to fight the CoVID 19 war. Lagos, Ogun and Abuja would be put in lockdown for two weeks in the first instance, he announced. The Steering Committee which he had earlier set up under the headship of the Secretary to the Government, was hard at work, drawing up strategy and policy to combat the menace. He wanted all resources, including donations from the private sector, centralized. He tried to end on a note of resolution and hope. He would do what he could to soften the economic difficulty of the lockdown, especially for the poor and underprivileged. Curiously, he talked about keeping the school feeding programme going, even where there were no schools open. LOCKDOWN Lagos is now in the grip of lockdown. It is an eerie, unaccustomed feeling to see and hear neighbours trying to make a life of sorts within the confines of their homes. Some people have compared it to the experience of ‘awaiting trial’ prisoners encountered on a recent visit to the Ikoyi Correctional Centre. OUTLIERS IN COVID-19 RESPONSE What is ‘best practice’ response to the COVID 19 pandemic? As illustrated by statistics of cases, deaths and recoveries earlier given, some countries are clearly coping better with CoVID -19 than some others. It may be helpful to look at some examples. China: The official COVID-19 figures for China to date (3rd April, 2020) are 83,269 confirmed cases, 3,322 deaths and 76,745 recovered. China, in the heat of the COVID-19 crisis did a number of things, some of which could only be done in an authoritarian society that is also at the cutting edge of modern Science. It put huge swathes of the country in a total lockdown for a protracted period. It massively scaled up physical capacity and knowledge to deal with the problem. The rushed and efficient building of the mega-hospitals, and the cadres of the People’s Liberation Army arriving in huge transport aircraft to shore up the medical personnel in Wuhan were the images people saw on television, but behind the scenes, Chinese scientists were sequencing and analyzing the genome of the virus, inventing test kits that gave results in a short time, trialing treatment options, and rushing to be first out in the field with an effective vaccine. There is some criticism that China almost certainly withheld information from the world about the scale of the CoVID-19 problem, and that the figure of 3322 deaths is a massive underestimate. All the same China is gradually re-opening for business while the rest of the world is shutting down. The Chinese model deserves a look, for whatever it is worth. South Korea: The current figures (3rd April, 2020) for South Korea are 10,062 cases, 174 deaths, and 1,749 recoveries. The key defining feature of the South Korean response has been massive testing among the population. Covid-19 arrived in the country in January 2020 and up till the middle of February, there were only 30 cases. Then came ‘Patient 31’ tagged the ‘super spreader’, a lady who got infected, went to Church twice and visited a hospital and a restaurant, spreading the virus round. Within ten days, there were more than 2300 cases. South Korea reached a peak daily count of 909 deaths on February 29. For a brief period, it was the second most infected country after China. The country rallied by starting a massive programme of testing within the population, introducing ‘drive-through testing’ to the world. They shared information openly, aggressively innovated to cut down testing times and developed testing kits that were quickly approved for use. They protected their medical personnel with personal protective equipment, giving them confidence to work. They carried out aggressive contact tracing using GPS and a mobile app. They put in place social distancing with routine use of face masks by the population, but did not carry out a full lock down, leaving many business activities able to proceed with caution. The country’s recovery is still work in progress, placing at number 15 on the ‘deaths’ list, number 15 on the ‘cases’ list, and close to the top on the ‘recovered’ list. Germany: Germany, like some other European nations, has been hit hard by CoVID-19. In the middle of March, it announced ‘radical measures’ to protect its population. These included nation-wide closure of bars, clubs, theatres, casinos gyms and other places of gathering, including Churches and even brothels. These were in addition to the closure of schools and borders. By then Germans had begun to fall ill and die in numbers, and the country was climbing high on the list of affected nations. Flight restrictions were introduced and gathering of more than two people were banned. There was a massive effort to increase antibody testing in the population. Chancellor Merkel controversially announced that she expected that a full 70% of the German population would ,over time, test positive – not for illness, but for previous exposure to it, presumably conferring some immunity. Some authorities disputed this. The figure of 70% is significant. The ‘Reproduction Number (R0) of the corona virus SARS-CoV-2 is between 1.5-3.5 meaning each infected person passes the virus to more than two people, who then pass to another ‘more than two’ and so on. This is not as contagious as measles. If 70% of a population actually have immunity to the virus, hypothetically, either through direct exposure or vaccination, the population may acquire ‘herd’ immunity. Some public health experts have disputed that this could ever happen without vaccination. In any case, the Germans are talking about the possibility of issuing ‘Immunity Passports’ to people who test positive for antibodies, enabling them to return to work or school. III HOW BAD IS IT GOING TO GET – BEFORE IT GETS BETTER? International experts have been predicting for several weeks now that there will be a ‘Third Wave’ of COVID-19 infections targeting African nations, and that the scale of death and suffering will dwarf what was experienced in the first wave in Asia, or the second wave in Europe and America. It is still the received wisdom in international ‘Aid’ and ‘Donor’ circles, and no less a figure than Bill Gates has expressed foreboding on account of Africa’s weak health systems. Some international experts are still scratching their heads for explanation as to why the Nigerian figures of cases and deaths are not – yet! – going through the ceiling. At a conversation of local and international experts on Sunday 30th March on Arise Television network, one expert opined that Nigeria was doing well because of the experience Lagos State in particular had acquired dealing with Ebola. Dr Yele Aluko – a US based interventional cardiologist now Chief Medical Officer, Americas Advisory Health Sector, Ernst & Young LLP, had seen the ‘models’ predicting what should be happening about now in Nigeria, how the curve should be rising steeply, and how everybody should be having their work cut out in a desperate effort to ‘flatten’ it. He suspected the actual infection figures were higher than what was being reported because not a lot of testing was being done. Still it had to be acknowledged that even within the confirmed cases, the mortality was low, and pattern of the illness was not extremely aggressive as in Italy or Spain. Could that be because the median age of the Nigeria population was 18.4 years and not 45.5 years as in Italy, with younger, fitter people being affected, and their immune systems responding better to infection? Or was there some other reason, yet to be identified? SAFE, RATHER THAN SORRY It is obviously better to be ‘safe, rather than sorry’. It is safer, in planning terms, to expect a surge as the predictive ‘models’ have said, and lay down the infrastructure, resources, and most crucially, THE THINKING to deal with the worst case scenario, rather than assume that the current mild pattern and low numbers will continue. One of the greatest dangers to public health, as to social health in Nigeria, is the extreme indiscipline of its elite, especially the political elite. ‘Legislators’ have been known to come in through the borders and refuse to be screened. ‘Billionaire’ businessmen, surrounded by unctuous uniformed policemen, would come in from foreign parts, and refuse to be quarantined. In that climate, there is a danger that there has already been a Nigerian version, or several Nigerian versions, of the South Korean ‘Patient 31’ – infected persons who have escaped scrutiny to wreak havoc in the hinterland and whose ravages are yet to be discovered. It is always good to operate on a worst-case scenario basis. Every evolving scenario then becomes a gain. BEYOND THE LOCKDOWN Midway through the lockdown, it is appropriate to ask – What Next? It is doubtful that the local population in the affected areas have the resilience for a protracted lockdown. The well-intentioned ‘social intervention’ measures by government agencies at state and federal levels are not likely to give the large number of Nigerians who live on incomes earned from day to day sufficient sustenance to endure a protracted stay at home. The top-driven ‘Abuja’ initiative is particularly suspect in this regard. How involved are the locals – the CDAs, the local formal and informal community groups, the local governments – all of whom must own the process and the responsibility? Is it focused on the lock-down states, is it a ‘Northern’ largesse, or is it a general freebie? Like Primary Health Care, Social Welfare is local. And, incidentally, the containment of Ebola – which still stands as the high point of Nigeria’s public health achievement, was essentially funded from Lagos resources – even if some of it was ‘refunded’ later by the federal government. Will the graph of the ‘Nigerian Model’ as it grapples with CoVID-19 come up with a mild bump, or a sky-high surge? The President could have maximized the utility value of the inconvenience of total lockdown if he had imposed the lockdown on the whole nation, instead of three locations. The virus would then have been forced to show its face wherever it was lurking, with a good chance of case identification and definitive contact tracing. A reconsideration of the issue may still be in order! Beyond the lockdown, for the foreseeable future, social distancing, perhaps with a compulsory wearing of face masks in public spaces, is likely to be the next step. Gradually offices may open under new public health rules, and some commerce may resume incrementally. Even in the best possible scenario, it should be another month or two before schools resume, depending on where the evidence goes. Of course, if there is a massive, overwhelming surge, all calculations are off. Whichever way it goes, the process must be led by the Science. WHERE IS THE SCIENCE? There is a general acknowledgement that more testing needs to be done than the one thousand or so that have been done across the nation, and the process needs to be decentralized and made more accessible. According to Francis Faduyile, President of the Nigerian Medical Association, he, in a recent meeting with the Minister for Health, pointed out the need for massively more testing, noting that the logic of testing based on recent contact with a case and the presence of symptoms would miss out asymptomatic carriers, especially those who were able to evade quarantine. The next question is – Test? What Test? Testing divides into two lots – testing for presence of illness (virus RNA or antigen test) and testing for evidence that a person has had the illness and may have developed immunity to it (antibody test). There is a proposal in the UK to do widespread antibody testing in the community to get a sense of the exposure and immunity level in the population, although there is a recognized need to improve the accuracy and specificity of existing testing kits. Angela Merkel’s government’s mooted plan to issue ‘Immunity Passports’ that could authorize people to get back to work is also based on antibody testing. Nigeria requires an intensification of existing testing targeted at identifying ‘cases’, but it will also need at some point soon to know what is really happening inside the community by testing for antibodies. To Pamela Ajayi, CEO of Synlab/Pathcare, the problem with test kits, especially the ones from China, is that the science is still evolving, and many of them are not yet very reliable. A powerful argument. But not a reason not to move that way. Work is ongoing in the world’s research laboratories as we speak. In Wuhan, in Seoul, in Munich, in Oxford, at Imperial College, London. People are struggling with solution-points to the real-time problems of COVID-19 – faster, more reliable tests, treatment that works, vaccination. Nigeria should be part of that work and not just be waiting to consume the product. Nigeria did a first earlier on this journey by sequencing the genome of COVID 19 virus, using material from the Index Case. But Nigeria cannot stop there. The nation cannot continue to freewill on the product of other people’s work. Not everything can simply be bought, in the manner in which we are used to buying private jets or secondhand MRI machines with padded contracts. In a crisis, nobody sells what they need for themselves. The classic example was at the height of COVID 19 when India, the ultimate salesman of generic drugs, refused a request to sell some drugs to China because it needed the drugs for its own citizens. MENTAL HEALTH Being quarantined for suspected COVID-19 infection, being diagnosed ill with COVID-19, having a relation ill with COVID-19, having a relation die with COVID-19 and being unable to be with them in their last hours for safety reasons – all of these scenarios carry mental health implications that will not go away just because they are unrecognized and unacknowledged. The existence of a preexisting mental health condition such as Depression or Anxiety may affect the outcome for a person ill with the virus. There is as yet no ‘received wisdom’ about how to design a system that identifies who is likely to need help, and to input the help in a safe and impactful way. It is a novel virus, and every affected society is just trying to find its way around it. But it is necessary that people with the requisite skills are challenged to commence discussion, design and appropriate professional input straight off. TRADITIONAL MEDICINE TO THE RESCUE? It is a staple of Psychology that when confronted with desperate circumstances, people reach for ‘remedies’ that have no proven value. Anyone who has had the experience of working in a hospital and interacting with people suffering from terminal cancer will have noted that where ‘logical’ interventions offer no promise of relief, the mind begins to think magically and is ready to do even the most absurd things and pay through the nose in the faint hope that this recourse may bring salvation. That being as it may, it is also true that Science advances by Serendipity, which means that laboratory researchers are familiar with the experience that when they are conducting experiments searching for ‘a’, they sometimes stumble on ‘b’, which turns out to be a far more important ‘discovery’ than they could ever have hoped for. They then spend the rest of their lives expanding and developing ‘b’ and its knock-on products. They get lionized. Sometimes they win the Nobel Prize. There is a lot of accumulated ‘knowledge’ hidden in the wide array of plants and herbs that grow wild or are cultivated in our environment. This ‘knowledge’, sadly, is not documented, not backed with evidence, and is often advertised by hearsay. There has been a lot of effort over the past several years, led by people such as Dr Bunmi Omoseindemi in Lagos, to document and codify this ‘knowledge’ and remove the inverted commas from it so that it may cross over into the mainstream of Science. There is a potential treasure trove hidden there – cures or palliation for old illnesses, perhaps even remedies for ‘new’ afflictions such as COVID-19. The Ooni of Ife has become a passionate advocate for the value and relevance of this ‘hidden wealth’. Perhaps this is the right time for the ‘Herbalists’ to interface with the Pharmacologists and search for active ingredients in old remedies of roots and herbs and verify and quantify their efficacy. Finding anything that works will not only help the CoVID-19 response of Nigeria, potentially, it could also make Nigeria extremely wealthy. But it will not ‘travel’ by mere word of mouth. CONVERSATIONS, OPPORTUNITIES AND TAKE-AWAYS Is there any opportunity to be gained from this adversity? Can the CoVID- 19 challenge make Nigeria a more resilient, more innovative nation? Stella Okoli, MON, CEO of EMZOR Pharmaceuticals is elbow-deep in the effort to respond. She’s facing a challenge cranking up the products she wants to deploy. Packaging is the issue, she says. Packaging, you ask? Yes, packaging. Sometimes the bottleneck is not the thing itself but the one you cannot see from outside. She intends to face it down. To Mazi Sam Ohuabunwa, President of the Pharmaceutical Association of Nigeria, the solution is that government must increase funding for medical innovation through National Institute of Medical Research. When it is pointed out to him that the private sector itself carries a big responsibility to innovate in order to maintain its competitive edge, and that Pfizer International’s budget for R&D in 2019 was $8.65 billion, he agrees that a part of every forward looking company’s retained earnings should be devoted to R&D, even though government still needs to come in with strategic support. He is not aware of what has developed concerning the Innoson offer to produce ventilators, or the recent statement from Bayero University on the same matter, but he believes someone should be following up on these things. Personal Protective Equipment for medical staff? There is a firm producing PPEs in Aba even as we speak, he affirms. Perhaps some of the donated funds may be used to scale this? It is a question, and not a statement. Nobody is sure who is doing ‘the Strategy thing’ in Nigeria. A BRAVE NEW WORLD BEYOND COVID-19, OR MORE OF THE SAME? Someday, hopefully soon, the scourge of COVID-19 will be well and truly over. There may be sporadic incidents here and there, but most people will be immune, whether through vaccination or Angela Merkel’s much disputed 70% positive antibody based ‘herd immunity’. Will this bizarre pandemic have changed social, economic and even political relationships for good, or will it be back to business as usual? Will America remain at the top of the economic heap, or will China have taken over? Or is there still some imponderable lurking around the corner, like some erratic power-hungry despot firing off a nuclear missile in a moment when he thinks the world powers are too weak to respond? Perhaps Africa, and specifically Nigeria, will have taken the opportunity to come of age, shaking off the ‘modelling’ of adversity and deprivation foisted on it by ‘experts’, and carving a new can-do, dynamic ‘Nigerian model’ for itself? Perhaps!