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We're all stakeholders in fight against coronavirus pandemic
Okechukwu
September, 2020

Dr. Josephine Okechukwu as Director, Federal Capital Territory Administration (FCTA) Public Health Department is championing the fight against the corona virus pandemic. In this interview with Abuja Digest Victoria Agorom and Prudence Okonna, she spoke extensively on the issue as well as efforts to curb the virus in the Territory. Excerpts:

Abuja Digest Weekly:The nation and in fact the world over time are faced with public health issues such as the current corona virus pandemic. How would you analyze this ugly trend in the Nigerian context?
Okechukwu:Looking at what is happening now, it is not the first time we are having a pandemic. The whole world has been faced with pandemics sequentially. For our own generation, this is the first time we are witnessing it. So in relation to other diseases, once in a while in as much as we are having interactions with animals and other pathogens in our environment, we are bound to have crisis because there is an imbalance in the relationship that we have as human beings with other animals in the environment, which results in upsurge of some diseases.

Even before now we had been talking about the effect of global warming. I think this is part of the effect of global warming; the advent of many new diseases, from one case to another, which comes in epidemic form. It is not that the whole is experiencing an epidemic or a pandemic, but the issue is what type of organism? The difference is that the type of organism we are experiencing now is a new one that's the only new trend.

In Nigeria, we have been faced with several crises that come in epidemic form. Even before this corona virus issue, we were battling with Lassa fever in epidemic form. Initially it was very bad, and then it came down. Before now we talked about Ebola. So when we see that kind of upsurge coming up in the system it really affects humanity. For the problem we are having now, that is the Covid-19, it is quite unfortunate that it is happening. It came in and nobody knew what it was all about.

It started towards the end of 2019 around December but now eight months down the line it has created so much, that means there is still much that we need to do as human beings to make sure that everybody stays safe. There is a limit to what we can do though, but there is still something we can do because if we manage our environment and lifestyles well, these things might not occur. Notwithstanding that, we have to do what we can do to make sure that we control the spread of this disease.

Abuja Digest Weekly: Now, you are championing the management of this case in FCT, but as it is now the cases are still rising. Would you say that FCT has fared well in this regard?

Okechukwu: Like I said earlier, corona virus infection is a new infection that came into the whole world; nobody is happy or comfortable with what we are doing. As it is now, there are so many grey areas in Covid-19 that are yet to be unraveled by the whole world even by the greatest scientists. A lot of researches are going on around the world. So for us in FCT, we cannot say we are comfortable with what we are doing when we talk in context with what we are doing. We have not really achieved what needs to be achieved when we look at the spread. The first case was diagnosed on February 28, 2020, in Nigeria. Then from that time within the space of five months, we have cases in thousands. That is quite disturbing.

In FCT, the first case was on March 20, but now we recorded over 3,600 cases; so we are still having increasing number of cases. Secondly, we are not testing enough. We diagnose when we test, but if you are not testing them, you cannot find them. In our society, it is killing and creating so much havoc because we are not doing much from the perspective in the whole nation. We need to ramp up our testing capacity. If we must do the right thing, then everybody must be tested. So access to testing is a challenge. So in the communities, in the Area Councils, it should be made available to everybody. But FCT has done very well when compared to other states; we are like the best in the country. Even at that in our testing, we are not doing enough. Covid-19 should not be toyed with. Maybe we are just lucky that the strain in the country is a friendly one; our mortality is not as bad as it is in other countries.

As it is now, we do not know if we have gotten to our peak because we have not yet reached our peak; so there is still much to be done. For us to get to the peak there should be more access to testing. We are the best in treatment; we have enough facilities for treatment. So we are comfortable in that area in that we still have bed spaces available and we are still expanding. But the main thing now is providing testing for everybody that needs to be tested. At this stage of the pandemic we should not be talking about who is to be tested. There should be testing for everybody bearing in mind that so many people are asymptomatic, mainly the young ones, as identified from our data.

They are the ones who majorly disbelieve the existence of the pandemic; the ones who would not go for testing and if positive, the ones to refuse treatment. So, that area should be critically looked at. We have created so much awareness among Nigerians but the need to be further convinced that the disease is real; we need to change our mindset because in the next few months we do not know what will become of us in the case of corona virus.

Abuja Digest Weekly: You have emphasized the need for more testing as it is now in FCT. Where can one go for testing?
Okechukwu: We have the National Reference Lab in Gaduwa. We also have the Defence Headquarters, Thisday Dome, Federal Medical Centre, Jabi and we are trying to decentralize testing now. The University of Abuja Teaching Hospital and many other places including the Area Councils have been mandated to collect samples. There are also Gwagwalada Township Clinic, Kuje and Kwali Primary Health Centres. In AMAC (Abuja Municipal Area Council), a site has been designated at Apo near the Area Council Secretariat. So every secondary health care facility has been told to create a space for samples collection. More sites are coming up at these facilities. Maitama, Kuje and Nyanya General Hospitals will be among the centres; so they are going to start in earnest. The main thing now is collecting samples and we have trained our health workers on how to collect samples. And we also take samples in response to calls from individuals that we still go to people's houses for samples collections---in response to their calls. So for us in FCT, we are doing a lot in that aspect. But some Area Councils need to step up their samples collection sites because what we are doing now is testing across board. We are expanding, trying to increase access to testing. Our laboratories are doing well. But people have to take ownership; all the stakeholders have to come on board and all the health facilities have to come on board because there is this stigma that is attached to Covid-19 even among health care workers. It should not be so.

Every health facility should begin to collect samples so that we can move forward. What we need to do is to ensure that everybody is protected. The use of personal protective equipment should be strictly followed among the health care workers. Even the patient needs to be protected because the phobia is that any patient who has corona virus will infect others, but you do not know who has corona virus until you get tested. The main thing is to ensure that everybody gets tested, just like HIV (human immuno-deficiency virus). What we are talking about is that when you are tested, you know your status, you are safer and also the people around you.

Abuja Digest Weekly: Are there plans to increase the campaign on testing as community transmission is on the increase?
Okechukwu: Of course yes, because that is the next strategy we are looking at. We cannot just sit back and say all is well. We plan to create more awareness and sensitization on the issue as community transmission is on the increase and people need to be tested and we tell them the sites wherever their samples can be collected.

We will also share the phone numbers so that they can call and we go to their homes to collect samples. The issue is not just testing; our main challenge now is the refusal for treatment. We have backlog of people that need to be sent to treatment centres. There is refusal of treatment among the young ones majorly; we do not have to wait before we begin to have complications. So we are going to create more awareness about testing and getting treatment and we are looking at commencing home treatment for the ones that are mild, especially for people that are less than 50 years old and are asymptomatic. Because the transmission level of this virus is very high, you can get one positive person in a family where others

are negative and the next 24 or 72 hours the rest become positive and you would not even know the next complication that will set in. We want to stop that. What we are doing is that everybody that is positive should have access to treatment. There is drug treatment and it is available. There is no cure for it (corona virus) now but there are drugs that we use to alleviate the symptoms and people get well overtime.

And luckily for us, the virus clears out of the body within two to three weeks. But what we need to emphasize is early diagnosis and prompt treatment because once this is done, the person gets well within the shortest period of time. So there is going to be massive awareness creation and sensitization of people about the disease because it is like all that we have been talking is short-lived in people's memories. So we need to refresh people's memories and tell them the prevention, getting tested, treatment and the sites where these are available. We are going to use the media, we are going to go to the communities and then do massive campaign.

Abuja Digest Weekly: The volume of work is quite enormous. Do you have enough hands to execute this?
Okechukwu: When we talk about pandemic, it does not reside only in one person's domain. It is supposed to be collaboration; everybody should be on board. It is the responsibility of everybody and when we talk about awareness creation, if everybody has any information, they should feel free to share the information. It is not domiciled only in health care workers. Everybody should be part of this fight against Covid-19. That means whatever service anybody can render, whether in the church, mosque or market place, offices or anywhere across board, everybody should join. So it has gone beyond the health sector; that it is their sole responsibility. Everybody has to fit in. So, in terms of human capacity, there is no amount of human resources that can be enough in the health system especially as regards this disease. Covid-19 is very overwhelming to win. No country has enough human resources. As I am speaking, even China, UK or US, the health system is being overwhelmed. So other people are coming in to support. But thank God that we are not experiencing such now in this country, but if we manage our system well, we can do well with it. For now we have trained personnel that are doing the work and, just like I said earlier, everybody must be on board to talk about this Covid-19 and support.

Abuja Digest Weekly: How do we flatten the curve of the pandemic?
Okechukwu: We have to get to the peak before flattening the curve. We are yet to reach the peak and no one can predict now when we are achieving our peak or flattening the curve. Initially we were thinking that we have reached the stage where we can flatten the curve; meanwhile we were still peaking. As it is now, we do not even know if we have reached our peak because we are having new cases every day and when we analyze our data it is like cases triple every month. So we need to get to our peak. Everything is just guesswork. No country will tell you when they will get to their peak because many countries are having their second wave now. So that peak, is it really real?

For us, we need to get to our peak and we cannot get there except we are tested. When we test, we know the number of people that truly have the virus before flattening the curve and then the decline. As it is now, I do not know and I do not think anybody can have that prediction because there are so many things that are still unknown and to be unraveled about this virus.

Abuja Digest Weekly: Finally, based on your position, what are the challenges that you are facing as you execute your numerous duties, more so in a pandemic such as this?
Okechukwu: As the Director of Public Health Department, it is quite a challenge being there because as you come in, the first thing you are having is

an epidemic; the next thing is a pandemic. Initially what we were battling with was Lassa fever. While trying to find our feet and arrange our system, corona virus came on board and since then, it has been very overwhelming---which is an understatement because nobody was prepared for this. As it is, no country was prepared for corona virus infection or well prepared, if not they would have been able to control or curtail the transmission of the infection and that is a huge challenge.

This virus is very tricky. There are many things we do not know about it and being a pandemic, in the health sector this the first time we are getting involved in the management of a pandemic. But to God be the glory, for us in the FCT we have done very well. I have a formidable team because when this first came up, we responded very well. We gathered ourselves together; everybody came in to join the fight against the virus. We have a team for emergency response. We formed pillars and every pillar has been very fantastic. We have a workforce that really joined hands to ensure that we have this level of success. One, the Minister of FCT has been fantastic. He has this passion for this work.

Initially, the anxiety to stop the transmission was there with full force to curtail community transmission. We did all we could and the end we still had community transmission and nobody should be blamed. All we did was to make sure that we did our best. The infection has gone down to the community, fine, but he (Minister) remained very supportive. Every support that needs to be given to the health sector was given. The health sector was quite supported in all ramifications. When we look at what we have achieved---so many treatment centres, we have over nine treatment centres in FCT now and they have been equipped, they are functioning---somebody is responsible for that and the FCT Permanent Secretary, the Secretary of Health and Human Services Secretariat and so many people that are the stakeholders, have supported.

But our main challenge is like you plan to do something, you are succeeding but you do not know when you will see the light at the end of the tunnel. For us to see the light now in what we are doing in managing the virus, we need to get to somewhere before we can say we are comfortable. Now, many health care workers are overwhelmed with the workload, stress is setting in and many of them are breaking down. So if I have to talk about my challenge, it is one of the key issues. Everybody for the past five months, we have never had a day of rest, we work round the clock, so we have gotten to our elastic limit that people are breaking down.

And then many of our health care workers are coming down with the virus and this is creating apathy and anxiety in the system. But it's good that we have not lost anybody. We go through it and we come out stronger. Then we need to really face the financial aspect. Finance is key to any effective management of such pandemic. If the government can bring out more money to support this fight, it will really go a long way. There are still so many areas that need to be funded for us to have something to fall back on to identify the areas that need attention.

Another challenge is people accepting that the disease is real; some still believe it is a scam or a political tool to destabilize the country. Nigerians have to understand now that the fight against corona virus is for everybody; our lives are our responsibility. Wearing of face mask is a must and I want to tell everybody to distance themselves from anybody that is not wearing face mask.

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