Bolstering COVID-19 surveillance in Lagos

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Nigeria, one of the African countries with high number of COVID-19 cases, is strengthening disease surveillance to help stem the spread of the virus. In Lagos, which accounts for almost half of Nigeria’s infections, the World Health Organization (WHO) is supporting the health authorities by mobilizing surveillance teams to help investigate and trace patients presenting COVID-19 symptoms at healthcare facilities. They dig through hospital rerecords every day looking for patients who may be showing COVID-19 and who may have been missed by hospital staff. Deployed in the 37 localities of Lagos state, they act as fresh eyes in medical centres and alert the state COVID-19 investigations teams once a case is identified. In Lagos 1408 health facilities are covered by the surveillance officers.

Dr Wesley Salifu, 27, a surveillance assistant in Lagos, takes a canoe to a riverine community in Ibeju Lekki area of Lagos. He is one of the 16 WHO consultants helping to find COVID-19 cases in health facilities in the state. Hundreds of health facilities are located far away from the Lagos metropolis. Dr Salifu visits at least six hospitals daily. To get to some far-flung communities, Dr Salifu is forced to take a rickety canoe or use a motorbike. The likelihood of hospitals in rural, wetlands like Ibeju Lekki missing possible COVID-19 cases is especially high, Dr Salifu says. “Because these areas are prone to malaria and common cold which have similar symptoms to COVID-19, it’s easy to mistake one for another.”

Surveillance assistant, Bola Adelakun, 26, visits a maternal health facility in Ibeju Lekki, Lagos. On arrival, hospital record officers present their registers to the officer so she can go through them. She also asks them what difficulties they face in finding or monitoring COVID-19 patients. Some of the problems are that many patients don’t wear face masks. The authorities encourage the use of masks, but health workers say many people are reluctant to follow prevention measures, while some do not believe that COVID-19 is real, hide symptoms and refuse to get tested. The average COVID-19 positivity rate in Lagos now stands at 24%, almost five times more than the global average of 5%.

Surveillance officer Adelakun collates her case findings at the Lagos Island Maternity Hospital. Since her deployment in June 2020, she has been able to find and monitor more than a dozen suspected and confirmed COVID-19 cases. Surveillance assistants and contact tracing teams often deal with data entry problems such as incorrect contact details provided by patients. Since active case search started in April, the numbers of COVID-19 tests as well as the numbers of confirmed patients have increased significantly in Lagos, according to Dr Clement Nwaeke, WHO Lagos National Surveillance Officer. As a frontline health worker who visits several hospitals daily, officer Bola says her work is interesting but admits it is risky. “I’m most scared when I get to a hospital ward and it is really crowded because I know there is a likelihood of infection in that kind of setting.”

At the Lagos State General Hospital, Marina, patients troop in and out at all hours of the day. The risk of health workers contracting the virus is high, and protective equipment like face shields, gloves and masks are essential needs. Several cases of the virus have been recorded in this hospital, officials say. Part of Lagos state’s caseload includes doctors, nurses and other frontline health workers.

Matron Kasali takes the blood pressure and the temperature of a patient at the Lagos General Hospital, Marina. Across hospitals and public spaces in Lagos, the blue and white coloured infrared thermometer has become a must-have instrument used to detect potential COVID-19 patients and book them for tests. As the country opens up its domestic airports after a March shutdown, authorities announced that strict prevention protocols, including temperature checks, will be followed before passengers can be allowed on flights.

Jemilat Keshinro, a records officer at the Lagos General Hospital, Marina, holds up the hospital card of a suspected COVID-19 patient. Often, some patients exhibiting COVID-19 symptoms refuse to be tested after healthcare workers at the hospital have advised them to do so, she says. The records department contacts the state’s rapid response team to investigate, track and test patients like that. Across Lagos’ five testing laboratories, over 59 000 samples have been tested so far.

Record officers are in charge of monitoring the numbers of COVID-19 positive cases noted at the hospital. At the General Hospital, Marina, suspected COVID-19 patients are usually sent for testing at the Infectious Diseases Hospital in Yaba area of Lagos State. In other cases, rapid response teams are invited to the hospital. Testing in Lagos was initially restricted to travellers returning from hotspot countries and their immediate contacts. Now that the state has slipped into the community transmission stage, anyone showing symptoms including cough, shortness of breath, fever, loss of smell, loss of taste, chest pain or catarrh can be tested, according to WHO guidelines.

Surveillance officer Adelakun and other surveillance assistants use spreadsheet applications to report and trace suspected COVID-19 cases. A separate team of state and local government officers will follow up on cases found with sample collection. The decentralisation of the COVID-19 response in Nigeria has enabled greater fluidity, allowing people at the grassroots to access the care they need. However greater manpower will be needed as COVID-19 infections increase.

Lagos state authorities say they are determined to safeguard the lives of health care workers who risk getting infected in the line of duty. Governor Babajide Sanwo-Olu announced that a COVID-19 allowance would be made available to emergency healthcare workers in the state. The governor also said health and life insurances have been procured for health workers. By 21 July 2020, a total of 720 health workers were infected in the state.

Surveillance officer Adelakun heads out of the Lagos State General Hospital, Marina. While the day’s work is done, the rounds will continue the next day. Lagos state government continues to ease restrictions on travel, businesses and schools and it is feared that COVID-19 cases will rise. Surveillance teams continue to play an important role in supporting the state in curbing COVID-19 spread. “All the teams are doing well, starting from the national level to the various state governments,” says Dr Clement Nwaeke, the WHO National Surveillance Officer. “WHO is always there by their side and the Local Government Areas are also helping out. What is needed now is sustaining the tempo of what we are already doing.”