How Healthcare workers’ battle to save Nigeria from COVID-19, Lassa fever, against all odds

It rained rather heavily that evening, ushering in the cool breeze. At this point, most Nigerians had a breath of fresh air as they were happy that the heat would subside. No one had the ominous feeling that the deadly COVID-19 also known as Coronavirus had crept into the country.

In the morning of February, 27, Lagos reported its first case- a 44-year-old Italian man who slipped into Nigeria from Milan. He was able to pass the airports undetected.

However, before the Italian’s arrival, Coronavirus had made its way into the African coast, stopping by Egypt two weeks before it got into Nigeria. One scary attribute of Coronavirus is the ability to manifest in unexpected circumstances and rear its ugly head in unwanted spaces like the proverbial hydra with many heads.

A hairy like substance when viewed in a lab, the virus is responsible for over 240,000 dead people worldwide.



It is mainly transmitted through droplets generated when an infected person coughs, sneezes, or exhales. These droplets are too heavy to hang in the air, and quickly fall on floors or surfaces.

You can be infected by breathing in the virus if you are within close proximity of someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or mouth.

Oluwaseun Ayodeji Osowobi who is one of over 380 survivors in Nigeria says it's an experience no one wishes on anyone- enemy or friend.

"The virus kicked my system. It made me very weak. I was dizzy every second, I was throwing up. I lost my sense of taste but my sense of smell heightened so I could smell everything like water, food, even soaps. Everything was just disgusting to me. It was a very tough period, a very tough moment for me," she said in an interview. This is alongside high fever, heavy dry throaty coughs and an incredible appetite loss.

Sadly, while Nigerian health workers are battling to curb the spread of the virus, they also have to contend with nipping the spread of Lassa fever in the bud.

Lassa fever, a silent killer in Nigeria since 1969

The earliest case of Lassa fever in Nigeria can be traced back to 1969 in the town of Lassa, in Borno State, Nigeria. However, a fresh case broke out in 2007. Records about the fever only began to account for cases from January 2017.

Lassa fever is an acute viral haemorrhagic illness of 2-21 days duration that occurs in West Africa. The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces.

The disease is known to be an endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, but probably exists in other West African countries as well.

"About 80% of people who become infected with Lassa virus have no symptoms. 1 in 5 infections result in severe disease, where the virus affects several organs such as the liver, spleen and kidneys," the World Health Organization reports.

The host is a rodent of the genus Mastomys, commonly known as the “multimammate rat.” Mastomys rats infected with Lassa virus do not become ill, but they can shed the virus in their urine and faeces.



The mastomy rats are dangerous for two reasons. First, it is probably the most common mouse in equatorial Africa, especially in human households and eaten as a delicacy in some places.

Secondly, once the mouse has become a carrier, it will excrete the virus throughout the rest of its lifetime through faeces and urine creating ample opportunities for transmission to humans.

The gestation period is in the dry season, stretching from May to June. They breed year-round. This fact is synonymous with Lassa fever’s reoccurrence year after year.

Till date, no vaccine has been produced and while clinical trials point out Ribavirin as an effective cure if given early, no evidence shows if it actually works.

Majority of the earliest cases of Lassa fever died. Only one of those early laboratory-confirmed cases was documented to have survived with supportive therapy alone, according to a report in the African Health Sciences journal.

The patient was a 59-year-old female farmer who hails and resides in Ebonyi State, Nigeria. She was admitted with a one-week history of fever, shaking chills, severe headaches, anorexia and body weakness. On the day of presentation, she had two episodes of vomiting but no hematemesis. She admitted to taking meals of game that often included rat meat. Before presentation, she visited a district hospital where she was treated with intravenous quinine and chloramphenicol and at presentation she was on oral antimalarials (artemether-lumefantrine) and ciprofloxacin without improvement. She was a known hypertensive diagnosed three years ago; and had been compliant with her anti-hypertensives.

She was placed on oral antimalarials, antibiotic, and antihypertensive as well as intravenous fluid infusion. On the 8th day of admission, her loin pains and headaches reduced. Slowly she began to come around. The patient was discharged on the 18th day of admission. On follow-up visits two and four weeks after discharge, she remained well.



Like Coronavirus which is partly airborne and advocates social distancing and hand washing to prevent, the same goes for Lassa fever. Thus, health workers are advised to prevent contact with the patient’s blood, body fluids and contaminated surfaces or materials such as clothing and bedding. This health advisory means health workers are vulnerable to the virus- but if they do not attend to the sick, who will?

For Dr Eghosa Omoruyi of First Hospital & Maternity LTD, Karu, Abuja, this double-edged fight is not something to envy. He narrates his earliest meeting with a Lassa fever patient and how he navigated the tide. “In the past, I've encountered just a patient suspected to be having Lassa Fever. So we referred the case to the designated testing and treatment centre in Edo state, and thankfully the patient tested negative to Lassa fever,” he revealed.

For safety purposes, doctors are advised to treat Lassa fever and COVID-19 with a high index of suspicion.

“Sadly, that is the unenviable lot of frontline health workers and other Nigerians right now. We are faced with two daunting viral diseases: one a pandemic and the other an outbreak. The NCDC has been really proactive in ensuring both diseases are kept at bay. We may not be seeing the much desirable results now but I'm very much hopeful that in the end, we will triumph,” he added.

A poor health care system

In 2019, the Nigerian Medical Association said there were only 40,000 doctors in an estimated population of 196 million.

Data from the World Health Organization reveals that Nigeria's physician-to-patient ratio is four doctors per 10,000 patients and patients often wait hours to be seen. This is the reality in the fight against two viruses, no cure and an ailing Primary Health Care system.

Minister of State for Health, Dr Olorunnimbe Mamora, said the healthcare system in the country was not perfect.

“We do have a health system that can cope but that is not to say it is perfect. We still need to do a lot of health system strengthening,” the minister said in an interview. Nonetheless, Mamora stressed the need for the Federal Government to pay more attention to the outbreak of Lassa fever which has killed scores of people in the country.

So far, Nigeria has over 2000 confirmed Coronavirus cases while Lassa fever has neared a thousand confirmed cases in 27 states of the Federation.



While some would like to believe that the Nigeria Centre for Disease Control is well equipped for these outbreaks, staff strength is lacking in an agency which is Nigeria’s only hope. If the NCDC is required to cater for about 180 million people with just a little over 200 staff members, we may be fighting a war that may never be won.

Eghosa says health workers have been stretched beyond what they can imagine.

“Before the pandemic, Nigeria had always been pitiably short in supply of Doctors. From the recent analysis, the ratio has been 1 Doctor to over 3000 patients on the average. Other allied professions are in a similar situation. The pandemic has now compounded the problem. Health workers have been stretched too thin,” he stated.

"At the moment, NCDC with staff strength of over 200 people has responsibility for nearly 200 million people. That is a lot to manage. However, we leverage on our Nigeria Field Epidemiology and Laboratory Training Program and similar structures for outbreak response," An August 2019 tweet by the health agency read.

A2j:

At the moment, NCDC with a staff strength of over 200 people has responsibility for nearly 200 million people. That is a lot to manage. However, we leverage on our @NigeriaFELTP and similar structures for outbreak response. #PreventEpidemicsNaija

— NCDC (@NCDCgov) August 1, 2019

Currently, only 213 staff work with the Nigeria's Centre Disease for Control, according to information gotten from the website in the about section. With Lagos leading the toll with over 1000 Coronavirus cases, NCDC has a lot of sick people to cater to especially in a country like Nigeria where public officials prefer medical tourism.



A phenomenon that has cost the country about $1billion annually, as reported by the Minister of State for Health, Dr Osagie Ehanire.

Ever since wealthy Nigerians imported the deadly virus home, the cases have received a spike. Notable landmarks began from March 18th when Lagos began to report an average of 4-8 cases daily.

Recalcitrant Nigerian travellers

While the doctors battle two incurable viruses over scarce N95 masks and behind closed doors, they have to deal with recalcitrant Nigerian travellers who are determined not to die alone. Several of the imported cases of the Coronavirus in recent weeks have attempted to get into Lagos mostly via air, sea or neighbouring cities. This is despite returning from a high-risk country with full knowledge of Nigeria’s carelessness in contact tracing.

There are two notable cases of travellers resorting to lying about their conditions. The first is a 57-year – old, male, brought into the Accident and Emergency Department of the University of Ilorin Teaching Hospital on the night of Wednesday, April 1st, 2020. The patient was in the company of one of the hospital’s Professor of Internal Medicine (a specialist in infectious diseases); with a history of abdominal discomfort/stooling, following ingestion of rotten pineapples.



He was initially admitted and managed as a case of food poisoning. The patient later died in the early hours of the following day, 2nd, April, 2020, the tertiary hospital said.

UITH said it was not informed about the deceased’s travel history until after his corpse had been released to a relative for burial.

Another case was a 55-year-old hypertensive and diabetic patient presented to Lagos University Teaching Hospital’s emergency unit on 2nd, April, 2020, with “malaise, tremors, and fever.”

He was diagnosed with acute chronic kidney disease and sepsis.

The source, a caregiver, said the man did not disclose his travel history and had died “a few hours” after his admission to the Federal Government-owned facility. Apparently, the man just returned from Holland and his family felt to keep his travel history mute out of fear. The implication for both cases is the quarantine of more health workers and possible, death of medics which are not enough in Nigeria as it seems.



Eghosa says lies about travel histories have become a new reality, so also is safety at work.

“Unfortunately, this is becoming a trend. For whatever inexcusable reasons, patients now lie about their local and international travel history; and this not only misleads the caregiver, it also puts the lives of everyone around such individuals at huge risk,” he stressed.

With the issue of dishonest travellers concealing their travel histories, and poor manpower, the NCDC might be overstretched beyond what it can take. The repercussions of this battle may eventually require more unemployed or underemployed personnel to join the health agency to speed up testing- a major feature in the NCDC’s work in identifying a case of either virus.



The call has already been made by the NCDC boss, Chikwe Ihekweazu. Stating some of his worries about the process, he revealed that the challenge is how efficient the public health workforce would be in collecting samples and sending them in.

"We have the capacity but not the staff. We eye 2,000 tests in Lagos, 1,000 in Abuja and a 1,000 in every part of the country. Our priority is to increase the scale of testing. We are developing innovative tools to track all of it," the NCDC boss stressed at one of the Presidential Taskforce meetings on COVID-19.



With the reality of community transmission in Nigeria, the country may experience a population explosion of infected personnel never seen before. Eghosa refusing to speculate on the failure of healthcare workers in curbing both viruses counters the claim with a message of hope.

“So yes it is a war that can and will be won. But each of us, ranging from the frontline health workers to the folks at home, all have a huge role to play individually and collectively. We have repeatedly been walked through the drills by the NCDC and FMOH via various news outlets and educational programs on the importance of Basic Personal Hygiene, Social Distancing, Stay At Home Order, Use of Facemasks and other Personal Protective Equipment.

“All of these in combination are what law-abiding citizens are to make a habit of if we must win. At the other end, scientists are working tooth and nail to see how fast we can to getting a cure or a vaccine. Until then, we are all we have to mitigate this Global menace,” the doctor concluded.