It is arguable that the Lagos State Government has always been at the forefront of public health responses in Nigeria especially when it comes to outbreaks and diseases of global importance. How the State and Nigeria responded to the Ebola crisis in 2014 readily comes to mind, the World Health Organization describing it as a “spectacular success story”.1 It has been six years since Nigeria was declared free of Ebola but the events and stories of the disease remain fresh in Nigeria’s memories, an experience that would later serve as practice and preparation for a pandemic.
The index case of COVID-19 pandemic in Nigeria was recorded on 27th February 2020 in Lagos State.2 Since then, the number of cases in the country has increased, especially in Lagos State. As of 30th September 2020, there have been 58,848 confirmed cases and 1 112 deaths in Nigeria as a result of the disease. Lagos State has since reported 19,461 confirmed cases and 204 deaths as of 30th September 20202. Compared to Abuja which has the second highest number of cases (5709 cases – 9.7%), Lagos State bears 33% of the total confirmed cases and 18.0% of the total mortality compared to Edo State which has the second highest mortality (10.0%). These figures notwithstanding, Lagos State has a lower case fatality ratio (1.0%) compared to Abuja (1.4%) and Edo (4.1%).3
The Lagos State posture to disease outbreak is not unexpected as the State is the gateway to Nigeria, being the commercial and industrial centre of the country and the most populous state. While the State acted in concert with the Federal Government, health agencies, partners and institutions in tackling the pandemic, it exemplified imitable dispositions.
Surveillance, Monitoring and Enforcement
One of the strategies employed after the announcement of the index case was an incident management approach which involved a vigorous contact tracing that led to the identification and follow up of persons who had been in close proximity with the index case. This same approach was employed for each case that was discovered. Contact tracing was usually preceded by identifying the travel history of a case to either establish a connection with a known case or a suspected case from outside the country or to establish the presence of community transmission. Identification and announcement of the index case necessitated preparation for a total shut down of businesses and movement of people by the Lagos State Government. Excluding essential workers, the preparations afforded citizens of Lagos time to stock-up with food and necessary provisions for what was going to be a long haul. This was however not sustainable and led to staggered operations where only shops and stalls selling food and groceries were permitted to operate within certain hours (between 10:00am to 02:00pm every 48 hours) with the presence of law enforcements (the Lagos State Environmental Sanitation Enforcement Agency) who reinforced individuals’ compliance with COVID-19 directives.
Enforcement was done through ‘neighbourhood watch’ by Lagos State Taskforce which alerted the police about large gatherings, leading to arrests of offenders who were made to pay fines or embark on community service as a punitive measure.
Empirical evidence has shown that the use of remote technologies (telecare and telehealth) models is one potential solution to reach the underserved communities in developing economies.4 As part of efforts towards providing a wide coverage in Lagos State, telephone and web-based tool triage were adopted to respond to threats of COVID-19 pandemic.
Official hotlines were launched to increase public access to emergency response agencies and/or first responders with response to health-related issues. The twenty-four hour hotline helped triage people with respiratory symptoms and those concerned about contact with suspected cases. In some rural communities, the hotline numbers were written on large posters outside the primary health centres.
The Nigeria Centre for Disease Control used an online risk-assessment tool which led to an increasing number of persons getting tested and a greater compliance with preventive measures. One added advantage of this triage tool is that individuals were required to provide personal contact details (name, phone number and location) which helped to minimise the misuse of the service and ultimately enabling instant follow-up by a medical specialist irrespective of the assessment outcome (low, medium or high risk).5 In the private sector, several apps such as Wellvis COVID-19 triage tool have received commendation for its degree of usability providing users with a choice of language selection (English, French, Hausa, Igbo and Yoruba). This tool has been useful in reducing the number of inquisitive calls to the local hotlines, thus, allowing high-risk individuals’ quicker access to the authorities.6
To allay fears, dispel myths and rumours and keep citizens abreast of goings-on in the context of COVID-19, the Lagos State Government embarked on mass campaigns through social media, radio and television to create public awareness and educate the State’s citizenry. Regular updates were given through the State’s social media platforms and through the twitter handles of the Lagos State Commissioner of Health. Lagos State Government through its security outfit, deployed drones with loudhailers to enforce the social-distancing rule and to remind people to disperse and go home when gathered beyond the curfew hours (10pm-4am). The message is conveyed in English, Yoruba, Hausa and Igbo. The Lagos Rapid Response Squad drone initiative has been applauded by civilians as they believe the endeavour would help to reduce unnecessary police harassment and disperse people without the use of violence.
The importance of global interconnectivity resonates in the face of disease outbreaks that starts locally and necessitates the need for countries or regions to act proactively and decisively in preventing the spread of diseases. A veritable strategy lies in preparation, quick responses and coordinating mechanisms. It is not totally clear if the Lagos State Government utilized structures used during the Ebola crisis, but it is evident that to be effective, efficient and successful, future responses to outbreaks would need to rely on these structures.
1. World Health Organization. Emergencies preparedness, response. Successful Ebola responses in Nigeria, Senegal and Mali. One year into the Ebola epidemic. January 2015. [serial online] [cited 2020 Sept 30] Available from: https://www.who.int/csr/disease/ebola/one-year-report/nigeria/en/
2. Nigeria Centre for Disease Control. First Case of Coronavirus Disease Confirmed in Nigeria [serial online]. Abuja; 2020 [updated 2020 Feb 28; cited 2020 Sept 23]. Available from: https://ncdc.gov.ng/news/227/first-case-of-corona-virus-disease-confirmed-in-nigeria
3. Nigeria Centre for Disease Control. COVID-19 Situation Report. Situation Report 215. Wednesday, 30th September 2020; [serial online] [cited 2020 30 Sept 30]. Available from: https://ncdc.gov.ng/themes/common/files/sitreps/6038018661f9542c6577f2e4c06bf339.pdf
4.  Scott R, Mars M. Telehealth in the developing world: current status and future prospects. Smart Homecare Technology and TeleHealth [serial online]. 2015 [cited 2020 Sept 23];3:25-37 Available from: https://www.dovepress.com/telehealth-in-the-developing-world-current-status-and-future-prospects-peer-reviewed-article-SHTT
5. Nigeria Centre for Disease Control. Get Your COVID-19 Risk Assessment [serial online] [cited 2020 Jul 17]. Available from https://selfassessment.ncdc.gov.ng
6. Rao P. Nigerian digital healthcare start-up helps triage COVID-19 cases [serial online] [updated 2020 June 25; cited 2020 September 25]. Available from: https://www.un.org/africarenewal/magazine/june-2020/coronavirus/nigerian-digital-healthcare-startup-helps-triage-covid-19-cases