COVID-19: Independent appraisal, analysis on the Kano situation

Kano has been recording spikes of the COVID-19 cases since it’s reported index case about 3 weeks ago with attendant recorded ‘strange deaths’. This has put Kano in the spotlight as one of the emerging global epicenters of the disease. Kano is a melting pot of many sorts for the North, especially Northwest, and as […]

Kano has been recording spikes of the COVID-19 cases since it’s reported index case about 3 weeks ago with attendant recorded ‘strange deaths’. This has put Kano in the spotlight as one of the emerging global epicenters of the disease.

Kano is a melting pot of many sorts for the North, especially Northwest, and as such findings in Kano could be replicated in the surrounding states and probably the entire North. I think Kano has come to terms with the disease, like everybody else.

Strange deaths

The deaths in Kano, which I believe are highly under reported, have been denied link with the pandemic by many observers, government agencies and even by many medical experts. But based on my personal anecdotal evidences, which could be flawed, I feel there’s no way these deaths could be separated from COVID-19.

Many people like me with living elderly parents and or grandparents are apprehensive in Kano. My old man is close to 90 years and I keep worrying about him all the time. The only measure I could take was to convince him to stop fasting, encourage him to self-isolate and avoid seeing people, except necessary family members.

Probable deadly prevalence in Kano

In my careful observation, there is evidence to suggest an alarming rate of spread of COVID-19 in Kano within a short period.

In a short study I undertook among 26 households in Kano, 81% (21) reported at least one family member had at least 3 of the following symptoms, fever (which resisted conventional treatment) for 2 to 3 weeks, flu, cough, anosmia (loss of smell), ageusia (loss of taste), myalgia (muscle pain and weakness) and headache. This small study is limited by the lockdown and the social distancing guidelines and therefore may not be representative, but remains a guide.

The symptoms observed are those associated with high index of suspicion in COVID-19. Anosmia and ageusia were initially not included by WHO but due to rising evidence among experts, including Yan _et al_ and Claire Hopkins in the _Lancet_, the CDC is forced to include them as early signs and symptoms of COVID-19.

Again, using comparative modelling projections, the city of New York Metropolitan Area has population density of about 500 people per square mile and the modelling used for the city projects that an asymptomatic COVID-19 infected person could infect 6 people per day with 50% relaxation of lockdown restrictions.

The highly dense Kano city metropolitan local governments have a population density similar to that of Lagos of about 20,000 people per square mile!

Using similar but conservative modelling projections with NY Metropolitan City, an infected asymptomatic individual with COVID-19 could and would infect 36 people per day.

Those with symptoms may infect less due to possible precautions and hospitalisation or home stay.

This is similarly corroborated by a local modelling projection by Gambo and Abdulhamid (experts in mathematical and biomedical modelling) in Northwest University, Kano and reviewed by Professor (Emeritus) Peter McClintock, Lancaster University, UK.

This makes me reach an initial conclusion that probably about 25 to 30% of our population in the metropolitan could be infected and further spreading the disease. This could translate to between 2 to 3 million people.

The silver lining

As with every situation, there’s always some hope in the horizon.

Kano, like other third world population, may not observe the high Covid-19-related mortality as it’s being seen in the first or developed world like Europe and USA. This is simply due to demographics.

In Nigeria, less than 8% of our population are 55 and above as compared to more than 55% in the USA. Even though, 8% may be high in absolute numbers, it’s still far less than many Western countries.

This is therefore a call for us to specifically pay attention to our elderly population and focus our interventions towards them. These may include:

1. Isolating the aged population from the mainstream population
2. Treat promptly their underlying medical conditions
3. Encourage healthy living among them, including nutrition and supplementation with immune boosters
4. Institute and grant them access to geriatric care.

General recommendations

For us to get out of this crisis, government agencies, non governmental organisations and the public must act in concert to curb the spread of the disease especially to the most vulnerable group of the population.

Government, as a matter of urgency, should:

1. Ramp up testing to at least 3,000 per day in Kano.
2. In the meantime, strengthen the department of traditional and alternative medicines in the FMOH, in collaboration with NIPRD to quickly develop local remedies, at least known immune boosters available in our environment and make it available for our vulnerable population before we can develop local cure, as done by other African countries like Madagascar, Zambia and Uganda.
3. Remdesivir may come at a high cost for our population. This strengthens the need for Universal Health Coverage in our country, especially our vulnerable groups which are also the poorest.
4. Protect healthcare workers and their families from getting infected in order not to weaken the already fragile healthcare system in Kano. Government should also train and support community pharmacists as they have become the most vulnerable among the healthcare workers due to their easy access and prompt care.
5. Ramp up enlightenment campaign in Kano to ensure adherence to healthy interactions amid the pandemic since the lockdown seems impossible to enforce.

In this unprecedented crisis, all hands must be on deck and in concert for us to be able to somehow wriggle out of it before it consumes all of us.

 

Dr Murtala Isa Umar, a public health pharmacist, works with Aminu Kano Teaching Hospital and writes from Kano  [email protected]