Cross River: The whole COVID-19 thing sounded nonsensical and foolish:
As the global surge continues on the dreaded COVID-19 pandemic, Cross River State has proved to be the last state in Nigeria that experienced the outbreak of the virus. What has been the secret? The Cross River State Ministry Of Health has presented situation report on the level of implementation of the COVID-19 response protocol in the state
In a media chat, the Commissioner for Health in Cross River State, Dr. Betta Edu, spoke on the Covid-19 pandemic and the Cross River State experience as well as how the state has fared since the inception of the virus.
Early Preparation and Sensitization:
When we first heard about the virus and like all known cases of virus, we knew that will be widespread soon, hence there was need to commence proper sensitization. I recalled the first press briefing with journalists and the whole thing was just very funny. The Chinese were having it very hot especially in Wuhan. This was even before it was declared a pandemic. The virus had not even entered Africa let alone Nigeria when we started our campaign.
The general idea was to create the awareness of the virus and to inform the public about the protocols. We did this because like all known cases of viruses, the virus doesn’t move, people move with it, so telling people about the protocols was a way of putting the prevention in check.
We were not oblivious of the experiences of the Ebola virus where people carried false rumour of salt bath, pepper, some were said to have taken enema all in the name of preventing the virus. When all that failed, because it was bound to fail, the effect was outright dismissal of further speculative prevention in future.
It wasn’t surprising then to experience the negative attitude we saw in people when we raised the concern of the coronavirus. Many saw it from the point of a human induced problem; hence the solution should be available. Funny as it may sound, every effort has met rigid response from the virus and it was thus concluded that the world does not have an organized health response mechanism in play.
I am not trying to be theatrical here but the whole COVID-19 thing sounded nonsensical and foolish when people heard about this was because the name and all that surrounds the COVID-19 protocols sounded strange and impossible to believe like all viral diseases with strange protocols.
When the matter gradually escalated with medical professional stating the obvious about the pandemic, Nigeria reluctantly closed her border. We won’t forget in hurry how the border closure lingered longer than expected.
However, in the state, when the announcement of the lockout was made, many had dismissed the idea and branded the state as busy-body. But many begin to queue into the idea when information about how ruthless the virus has ravaged the world.
The once revered NCDC that made us very proud during the Ebola crisis seems lost, disoriented and disorganized. NCDC was reeling out numbers with reckless abandoned which many said were based on their perception of the virus.
At a point many lost faith in the integrity of the NCDC when incidences started popping up on the reality of the cases. Patients in quarantine centres were seen in videos on national television fighting, quarreling, complaining and causing possible breach of peace.
All the incident action plan pillars have continued to be active and constantly updated. The NCDC team on ground has been working with the state response team and they are satisfied with the response. For details of information about the response activities, contact the incident manager or go to the Cross River State Ministry of Health to get details. The website is also up and can give you all the update 24 hours. For social media-friendly people, our twitter handle can give you information on the go.
Risk Communication Pillar:
The Risk Communication Pillar has been on the road from one LGA to the next. The team is constantly informing our people and sensitizing them. The response team has worked with the Christian Association of Nigeria, Cross River State Chapter, to reach out to over 260 churches since the inception of the virus physically, while letters from the state Ministry of Health have been issued out to all places of worship in Cross River (both churches and mosques).
All thirteen (I3) pillars are running with daily EOC meetings between 8-10AM as well as daily situation room reports. This is fully supported by the National Rapid Response Team from NCDC which is currently in the state for support activities.
The state has started active case search in communities with border communities in Etung, Boki, Obanliku, Obudu Ikom and Akamkpa being the initial focus of the last week and is ongoing.
The presence of two Testing Centres in the State has led to an upscale in testing. The total positive cases in the state is 37 as at 26th July, 2020. The State-owned Lawrence Henshaw Memorial Hospital Testing Laboratory has carried out 165 Gene Expert test at the lab and has tested 16 positive cases with all results given to the client with same uploaded on NCDC dash board (both negative and positive results).
Unfortunately, there is a high public expectation that results from the LHMH should show overwhelming COVID-17 positive status. Those who hold this view believe that the results are being manipulated. Obviously, such people forget that unlike the UCTH that deals with critically ill clinical referrals, most persons being tested in the LHMH are well. They are mostly healthy people, some who simply walk or drive-in to confirm their status for travel reasons or those who even do so to clear personal doubts.
Secondly, most of the samples brought into LHMH are collected by random sampling in communities where active case search activities among healthy individuals have produced tests positivity of around 98%, a situation that is similar to conditions expected of a screening most tests. The stake holders must understand the difference and appreciate the results that will continue to come from both centers.
Asymptomatic positive cases by the latest guideline are managed on self isolation at home with follow up from rapid response team, while moderate cases will be managed at Adiaboh. As it is now well known to all stakeholders and partners, all critical cases are to continue to be managed in the UCTH Isolation center as the states only level 3 center.
Contact tracing, case identification and surveillance activities:
There is a total of 234 persons on contact tracing at different parts of the state. All positive cases have been contacted and their contacts enlisted while contact tracing and sample collection for contacts is ongoing. The rapid Response team from NCDC has been supporting the rapid response team on ground to reach out to contacts. In Ogoja where an index case died in a health facility, more than 156 contacts are being followed up for the required period and samples collection is ongoing. The affected facilities have been decontaminated and the relevant sections or whole facilities sealed off in line with IPC protocols.
In Ikom, fourteen (14) contacts are being followed up. There is contact tracing going on at various parts of the state with the highest contacts being followed up around Calabar and Ogoja metropolis. The greatest challenge faced with contact tracing is stigmatization. Some members of public do not want the team to come into their houses or street with the COVID-19 branded vehicles or PPEs. Their belief is that these items raise eyebrows of persons around them. Landlords are threats to their tenants and the reverse is also true.
Most of such people prefer to bring listed contacts to LHMH for testing while others among them prefer to meet with LGA rapid response team for secret sample collections. All these present undue challenges and further delay results.
Activation of the designated Isolation Centre:
All stakeholders must appreciate the fact that different states have slightly different protocols for managing COVID-19. Presently over 9 states in the Federation have adopted home-self Isolation for COVID-19 patients based on several factors considered by the state including resources available to run Isolation centers in their various states.
All three Isolation centers in the state are up and running. However, persons will be taken into the isolation centers based on criteria for management as prescribed in our state protocols. The Adiabo Isolation center has been opened for over a week now with the first set of health workers deployed to the center, awaiting clients. Two persons who visited the center without confirmed test results were sent to LHMH for testing and follow up.
The center at Ogoja has all its full complement of staff deployed there and they had already admitted a client at the center this week with contact tracing ongoing. Previous admissions there were held as suspicious cases and all were discharged home in good health.
The UCTH is the center for critical cases which cannot be managed at Adiabo or in GH Ogoja. As we have written in our report and advocated in several fora, there is need for the expansion of the UCTH center to accommodate more critical cases during the pandemic. we hope the Federal ministry of health that has direct jurisdiction over the University of Calabar Teaching Hospital can immediately respond to this request, while as a state we will continue to support all centers within our limited resources.
Providing free treatment and care of confirmed cases in Government Isolation Centres:
The Cross River State Government within its limited resources will continue to support treatment at the various treatment centers in the state. However, it is important to note that all centers supported must give report for utilization and also provide acknowledgment of support given to the facility.
Establishment of a coordinated Emergency Operation Centre:
There is an Emergency operations center supported by the Cross River State Government, US government and NCDC. Meetings hold at this center from 8-10am everyday with all relevant key stakeholders. At these meetings issues bothering on the state response to COVID-19 are discussed and resolutions taken on different aspects of the incident Action Plan implementation. The State situation report for COVID-19 response is updated daily on our website and on our twitter handles.
Persons seeking updates can go to these places to access same. Further questions can be transmitted through the toll-free lines. The call lines are opened 24/7 and response will be given to request as soon possible. Members of the public are enjoined to utilize this medium to get their complaints or concerns across to the Taskforce or come to the state Ministry of Health. Issues will be addressed as we move along. The website is https://crsmoh.cr.gov.ng/
As it stands, Cross River State has decentralized COVID-19 Response to Local Government Areas and we have tasked Chairmen on immediate Action
Covid-19 is not a dead sentence but you see the world we live in. People are generally very difficult to manage some love being forced to do what is best for them. With the contentions of nose mask finally put to rest and its overwhelming importance. Many still have the difficulties of using the nose mask.
It may sound funny but this is the reality we are faced with. Let me even shock you the more, people complained about test centres in Cross River State. Government should set it up and all that. How many have visited the place? It’s a walk in and drive in centre and it’s free but then who wants to be stigmatized? Go to Ethiopia for instance, to run a Covid-19 test, you pay as high as $100.
If we can discipline ourselves and surrender ourselves to testing, it will make things easier not when we expect everything from Government. You see, people’s general believe is that they don’t have the virus yet to even prevent themselves from contracting the virus is a problem. Having identified this problem, we are setting up a special court against no mask no movement.
One of the outstanding innovations in the response against COVID-19 world over was the grand innovation of the locally manufactured face mask by the Governor of Cross River State, Senator Ben Ayade who started the no mask no movement in Nigeria. Following this drive, over 1.5 million masks have been distributed free to Cross Riverians across the state.
The Cross River State Government had set up task force to ensure the use of mask which was later adapted to a mobile Taskforce, when people could tell the stationary location of the Taskforce and would only use face mask around those areas. Advocacy and sensitization have continued to fill the air pleading that Cross Riverians should use their face mask in the interest of public safety but this indeed a teething problem.
Look, there is life after COVID-19 and there is still in the Covid-19 era, we don’t have to be careless and carefree. In medicine, preventive health is more commendable and always advocated for and this is what we stand for and seek to achieve.
Like I noted earlier, this pandemic has indeed revealed the world’s nakedness in healthcare delivery. We are not there yet in terms of readiness, planning and execution of our healthcare delivery system. There is need to harnessed every potentials, efforts and resources to secure the future in healthcare especially in prevention. To this end, we have to be up and doing in sensitizing the public and properly educating the public as well. Don’t forget, Health is Wealth.