Nigeria acted late on COVID-19 fight –Enabulele, CMA president

Aidoghie Paulinus,  Abuja

The President of the Commonwealth Medical Association  (CMA), Dr Osahon Enabulele,  has said that the lockdown  measure  announced by the Federal Government  in the Federal Capital Territory, Abuja, Lagos and Ogun states to curb the 2019 novel Coronavirus in the country, was a decision taken too late.

In this interview with Sunday Sun, Enabulele said based on the current reality, one had expected the declaration of a purposeful total public lockdown for two to four weeks.

The former President  of the  Nigerian Medical Association  (NMA) also submitted  that had the government   applied the necessary measures on time,  the nation would have been better off as far as COVID-19 is concerned. Excerpt:

Apart from total closure of all entry points into Nigeria and the deployment of facilities and resources to combat COVID-19 which you called for, what else do you think the nation can do to urgently curb the spread of the virus?

While I appreciate the efforts put in so far by the federal and state governments, including Lagos State government, the Federal Ministry of Health and its agencies such as the Nigeria Centre for Disease Control (NCDC), as well as non-state actors, the private sector, corporate bodies, and all other citizens of Nigeria, I do believe that there is a lot more that should be done to urgently halt the spread of the virus in Nigeria. Well, the President of Nigeria, President Muhammadu Buhari, has just announced some measures to be taken by government, including a partial lockdown with restriction of movements in Lagos, Ogun, and Abuja. While I commend the government for this measure and others announced, I would have wished this came much earlier based on what we were seeing in other parts of the world and the way the cases of Covid-19 were being imported into Nigeria. About two weeks ago, or thereabout, I had advocated the urgent need for a phased and purposeful public lockdown. So, based on the current reality, one had expected the declaration of a purposeful total public lockdown for two to four weeks at this point in time, after adequate sensitization and preparation of the citizens and residents, provision of material and economic incentives to the people, with adequate security measures put in place. This kind of purposeful total public lockdown is to create opportunity to recruit and train more personnel and assemble necessary equipment. Importantly, it is also to allow for effective interruption of possible community spread, effective contact tracing, isolation and mopping up of primary cases and secondary contacts. This is especially because a lot of the high profile individuals who may have avoided screening at the airports, on their return from foreign trips, may have travelled round the country, interacting with various population groups. Well, now that Mr President has announced a partial lockdown, we should support the measure and hope for the best.  In any case, there are other measures that are needed at this time, including the need for proper coordination of efforts by the federal and state governments, as well as coordination of the contributions of non-state actors. I am happy that this was appropriately captured in the address of Mr President and I commend the government’s resolve to take on this. So, going forward, I expect a more effective coordination, synergy and strengthened integration and collaboration of federal and state efforts, in advancing the struggle against the virus. Government should indeed encourage more players in the private sector to support efforts aimed at containing the virus. Aside from the consolidation and improvement of current efforts, there should be accelerated recruitment of human resource for health to support the current available strength of human resource for health in Nigeria, with provision of better incentives and protective equipment, including Personal Protective Equipment (PPE). Perhaps, the time is ripe now to improve the current hazard allowance payable to medical doctors and other health workers, as well as a review of their retirement age. The public and private health facilities should be empowered to play appropriate and active roles in the containment of the virus, with provision of enough consumables and protective equipment, including PPEs.

There is urgent need for more well equipped isolation centres at federal and state levels, with adequate and appropriate numbers of medical equipment (such as Ventilators/Respirators, PPEs, e.t.c.), health personnel, particularly Anaesthetists and Intensivists, Pulmonologists/Chest physicians, e.t.c, to provide care for patients who may fall into the severely ill category. There is need to intensify public awareness and mobilization of citizens to actively participate in current efforts and strictly adhere to prescribed public health measures. In this regard, there is need for better and visible synergy between the Federal Ministry of Health, Federal Ministry of Information, National Orientation Agency and other relevant government agencies, and the media. The current public perception that the diagnostic screening for Covid-19 is elitist needs to be addressed, particularly on account of the news reports of VIPs skipping screening at the airports, the perceived screening of some public officers who may not have met the established guidelines, and the complaints by some ordinary Nigerians who wish to undergo screening, of slow or poor response to their request for diagnostic screening. I, therefore, advise that any irresponsible behaviour that puts public health in peril should not be tolerated. I also advise that diagnostic screening/testing should be made easily accessible to all Nigerians and residents who meet the guidelines, irrespective of their status. Indeed, the turnaround time for diagnostic screening, should be shortened to aid containment measures, while the diagnostic capacity for Covid-19 screening and screening of other emerging and re-emerging infections in Nigeria, needs to be urgently expanded.  As a start, diagnostic facilities should be provided in each Federal Teaching Hospital and Federal Medical Centre, or at least, two to three diagnostic centres in each geopolitical zone of Nigeria. Consideration should also be given to an urgent re-appraisal and restructuring of NCDC so as to fill observed gaps in their roles and performance. Importantly, I suggest that efforts be made to effectively decentralize and strengthen its roles and activities, in addition to the strengthening of the public health department in each state of the Federation, and the Federal Capital Territory. This is to allow for more effective and efficient delivery services to Nigerians, and improved performance of the centre.

 Looking at the number of cases recorded as far as the 2019 novel Coronavirus is concerned, are you not scared that Nigeria will record considerable number of casualties in no distant time?

Both government and the governed need to join hands together to prevent this. As at 9:30p.m, March 29, 2020, Nigeria is reported to have 111 confirmed cases of Covid-19. I believe if we all work conscientiously with effective tracking of all secondary contacts, we may be able to prevent the kind of explosion in the number of individuals with Covid-19, as was witnessed in some countries abroad. The recoveries so far made, particularly with cases managed at the Infectious Disease Hospital,Yaba, Lagos, gives a ray of hope that with some more commitment, backed with the necessary strategic actions and provision of the necessary resources, we may be able to stave off the deleterious effects and complications of the Covid-19 pandemic.

You were on an inspection tour of the isolation centres in Lagos and Abuja. Are you satisfied with what you saw?

Satisfied? Hmmmm! I will rather say it was a medley of impressions. Yes, it is true that as part of the Commonwealth Medical Association’s resolve to support national efforts to control the pandemic in affected countries of the Commonwealth, I and members of the CMA team paid assessment visits to some of the designated facilities and isolation centres in Nigeria, amongst which where the isolation centres at the Infectious Disease Hospital (Mainland Hospital) in Yaba, Lagos, and the University of Abuja Teaching Hospital, Gwagwalada, Abuja. We also had interactions with frontline health workers and members of the public. We were fairly satisfied with what we saw at the Infectious Disease Hospital, Yaba, Lagos; University of Abuja Teaching Hospital (UATH), Gwagwalada; and the National Hospital, Abuja. We appreciated the commendable management protocol at the Infectious Disease Hospital, Yaba, Lagos, as well as the commendable efforts of the respective managements of the University of Abuja Teaching Hospital (UATH), Gwagwalada; and the National Hospital, Abuja, in scaling up their level of preparedness to manage potential cases of Covid-19. Equally commendable was the patriotic and exemplary commitment exhibited by the medical doctors and other health workers, particularly those in the frontline, despite some evident resource inadequacies and inadequate hazard allowance. We were, however, not satisfied with the inadequate number of isolation centres, as well as  the state of the existing isolation centres which lacked adequate numbers of some essential requirements and health personnel, particularly those needed for management of Covid-19 patients who may fall into the severely ill category. Equally unsatisfactory was our observation of the uncompleted nature of the NCDC designated isolation centre within the precincts of the University of Abuja Teaching Hospital, Abuja. We noted that the centre was still undergoing construction, weeks after the first case of Covid-19 was confirmed in Nigeria, and particularly at a time when the number of confirmed cases in Abuja and Nigeria is on the rise. We acknowledged the role so far played by the NCDC but, however, observed some complaints about the sometimes frustrating slow pace of response by some NCDC officers to distress calls and request for services by Nigerians, including those who suspect they may have been exposed or infected. This may be evidence of the overburdened state of NCDC, perhaps occasioned by some inadequacies in manpower and other essential ingredients. There were equally complaints of inaccessibility of diagnostic screening for Covid-19, with some perception of an elitist approach to diagnostic screening.

Some have said that the government’s inability to put the necessary measures in place on time led us to where we are now. Do you agree? 

This may not be far from the truth.

What do you think was responsible for that?

The world is a global village. At the time Coronavirus (SARS-CoV-2) broke out in China in December 2019, with subsequent affectation of other countries, I had expected countries that were yet to be affected at the earlier stage, including Nigeria, to have patriotically put in place, proactive measures to prevent importation of Covid-19 cases into their respective countries. The delay in releasing funds to the appropriate government ministries and agencies in Nigeria for the control of the pandemic, the delayed closure of Nigeria’s borders and international airports, as well as the delay in constructing the NCDC designated isolation centre within the premises of the University of Abuja Teaching Hospital, Gwagwalada, and whose construction is still ongoing at this moment, are all cases in point. Another attributable reason may have been this impression that because Nigeria successfully managed the Ebola crisis with global plaudits, then the erroneous assumption may have been made that Covid-19 would be no big deal for Nigeria to manage. All these may have contributed to the observed inertia and slow responses at the earlier stage of this war in Nigeria.  The foregoing notwithstanding, I believe things are much better now with government and all other stakeholders more conscious of the reality and better prepared to combat the challenge of Covid-19. I hope that the current commitments will be sustained and improved upon as the war rages on.

Are you satisfied with government’s response to the virus so far?

I acknowledge the efforts so far made by the Federal Government of Nigeria and various state governments in containing Covid-19, including the release of some funds to address the challenge. I equally appreciate the efforts of the Federal Ministry of Health and its agencies, professional associations, including the Nigerian Medical Association, medical doctors and other health workers (particularly those in the frontline), the private sector, and all other citizens of Nigeria. However, it is my well-considered view that a lot more can still be done, particularly by governments and the National Centre for Disease Control whose response to some individuals suspected to have been exposed to SARS-CoV-2, has been said to be sometimes frustratingly slow.

Federal and state governments have accused the Nigerian Medical Association (NMA) of not showing concern. What is your take on it?

I want to believe this is not true. If it is, then it is a most unfortunate accusation which is totally uncalled for at this critical time when there should be greater synergy. This is certainly not the time for a blame game. It is a time that calls for purposeful, responsive and integrative leadership, with the opening up of transparent communication channels, greater cooperation, integration and collaboration. From my vantage position as President of the Commonwealth Medical Association with superintendence over the National Medical Associations in the Commonwealth of Nations, including the Nigerian Medical Association, I seriously doubt this allegation.  This is because of my concrete knowledge of the several efforts so far made by the Nigerian Medical Association and its various state and FCT-Abuja branches. While I suspect it may be due to a communication gap between government and the NMA, I wish to respectfully appeal that rather than getting enmeshed in blame games, those making such accusations should show responsive and collaborative leadership by opening up the communication channels and reaching out to the NMA to reconcile the issues and seek its collaboration for the good of the people. Whatever communication gaps exist, should be urgently plugged.

Financially, do you think the government is prepared to tackle the spread of the virus?

From the resources available in Nigeria and the support of non-state actors, particularly in the private sector, I am convinced that the financial wherewithal is available to address the challenge. I wish to appreciate all private sector players who have so far made financial and material donations to this cause. I advise government to encourage more donations from private and corporate bodies to support government’s efforts at controlling the pandemic at national, subnational and local levels. What is needed at this time is a bi-partisan and patriotic support for what, undoubtedly, is a national cause.

There are reports of closure of inter-state borders. Is that necessary?

It is part of the expected containment measures to limit local and community transmissions of the disease. The states have perhaps learnt from the effect of the delayed closure of Nigeria’s borders and international airports, which may have led to the importation of some of the Covid-19 cases. However, it is not enough to enforce closures. It must be purposefully and strategically done to achieve the expected objectives. There must also be enough period of sensitization and preparation of the citizens for such actions, with economic incentives provided, or else there may be some complications. Importantly, there is great need for proper synergy between the Federal Government and the various state governments, in the implementation of such policy decisions. Happily, Mr. President assured in his broadcast to Nigerians, yesterday, that observed inconsistencies in approach by federal and state governments will be eliminated.

Why is Dr Osahon Enabulele shying away from 2020 Edo governorship election?

I am not shying away from the 2020 Edo State governorship race. For your information, I once contested for the governorship seat in Edo State about 13 years ago, precisely in April 2007. Myself and the current National Chairman of APC, Comrade Adams Aliu Oshiomhole, were co-contestants in that rigged election. So, it is nothing strange to me. However, I believe there is a time and a season for all human endeavours.

For now, I am contented with my clinical practice as a chief consultant family physician, and my local, national and global leadership preoccupations through which I have been making my modest contributions to local, national and global developments.

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