After a two week break from directly talking about the pandemic, it’s back on today’s agenda.
First, an introduction into how the coronavirus has managed to be both predictable and puzzling at the same time.
Let’s start with lockdown policies. We’ve seen them work in places like China and South Korea, whereas the story has been different in a country like Peru. The South American country is now the worst hit by the virus in the region, despite being first to restrict movement on the continent.
Then there has been the warm weather theory.
Earlier this month, a New York Times article cited research saying “heat and humidity had little to no effect on the spread of the pandemic.”
A week later, a Wall Street Journal piece discussed research saying that heat, humidity and sunshine inhibit the spread of the virus.
Africa, which has those three things in abundance has relatively less confirmed cases, but how do we explain virus hotspots in countries like Iran or Brazil?
How about a cure? Say Hydroxychloroquine? The official word from the WHO is that it is not deemed as a safe or effective cure. However, it continues to grab headlines with studies from France to China on how chloroquine could block the coronavirus from invading cells.
The studies haven’t been performed at the accepted standards - say with a control group or used human bodies. Still, the US president is currently on the drug.
It’s a confusing story all round to say the least - different scenarios and conflicting stories. The truth is many factors determine each person or country’s experience with COVID-19. There isn’t one thing that can explain it all.
Brazil is hot, but it also has a president that is against strict lockdowns.
The result is that different countries have their own unique situation. This uniqueness is also true across different states within Nigeria, and in this week’s newsletter, we will travel to three states to tell different stories.
Disclaimer: Cases and death figures used in this article are from the 21st May. State tests are from the 17th of May. Live numbers can be found here
This is probably one of the most interesting coronavirus stories in the country- really, it has drama.
Kogi, a state right in the centre of the country- the one one to share a border with ten other states - has 0 confirmed cases.
The states that surround it have a combined total of 742 cases. Aside from Lagos, 1 in 5 of Nigeria’s coronavirus patients are living next door to Kogi.
After the virus spread outside of Lagos and Abuja, it would have been one of the states most at risk.
How did it dodge the bullet?
Kogi joined a group of other fast-acting states at the end of March to close its borders and enforce lockdowns. Others include Lagos, Ogun, Abuja, and Rivers. Outside of that policy move, the state hasn’t done anything extraordinary to claim its 0 cases medal.
Of course, it might be a freak event. But it could also be related to Kogi’s current war with the Nigeria Centre for Disease Control (NCDC).
A battle that opens up a conversation on state powers with respect to Aso rock.
It all started on the 5th of May when an expatriate in Kogi alerted state officials that she had symptoms of the virus. The state moved quickly, sending Dr Saka Haruna, the Commissioner for Health with a team to assess her symptoms.
On arrival, she disclosed that she was feeling fine again.
Her temperature was normal, and she didn’t exhibit any other symptoms that would have qualified her for a test, so the Commissioner ended the matter there.
According to NCDC guidelines, there were no grounds to test her.
The expatriate pressed on. She allegedly escalated the situation to the NCDC to get tested, and this is what kicked off the mistrust between Kogi and the NCDC.
The Commission responded to the expatriate’s actions by saying the state “strongly suspect there are attempts to import the disease or declare fictitious cases in Kogi State.”
Three days later, a team from the NCDC arrived in the state - as they had in other states around the country. The Kogi state government, sour from recent events, ordered that they all be quarantined for 14 days or leave immediately. They left.
The Director-General of NCDC, Dr Chikwe Ihekweazu, responded by saying the NCDC can only provide help where help is wanted.
It’s an interesting story but did the NCDC not have the power to get cooperation from the state? One can’t say if Kogi residents were pleased with how the situation went. The few who spoke to reporters provided mixed views.
Well, the state government has taken matters into its own hands and acquired 5,000 of its own test kits. It conducted 111 tests which all came back negative.
The tests and results won’t be included in official NCDC statistics.
One can’t overspeculate, but Kogi’s situation seems to be one where we just don’t know how many true cases there are because the NCDC has not been able to test more than one person.
Some of you who have been tracking the figures would know that Kogi isn’t the only state with 0 confirmed cases - Cross Rivers shares the same achievement.
Does it have anything in common with Kogi?
Yes, it also threatened NCDC officials to a 14-day quarantine if they came to the state. However, it lifted this threat on Wednesday, the same time it removed its ban on religious gatherings. The NCDC has already arrived in the state, so let’s see if Cross River still maintains its 0 case status once testing starts.
The thing about the virus is that while cases can be hidden, it’s a lot harder to cover up deaths.
Three weeks ago, headlines and social media was bombarded with stories of “mystery deaths” in the state. All major international publications covered it - from the UK Guardian to the New York Times.
Nigeria, and perhaps even the rest of the world, feared that Kano would be another Italy or Ecuador.
Similar to Italy, there were reports from the Nigerian Medical Association in Kano that 42 doctors and 28 nurses had tested positive. A sign that things could be bad.
Still, there is some uncertainty around what led to the spike in deaths.
Some, including Sabitu Shaibu, the deputy head of the state task force on COVID-19 argued that the rumoured 640 deaths were mostly from natural causes and below the average death rate of the state.
The lockdowns and not necessarily the virus could have also had something to do with it.
Isa Abubakar, the director of the Centre for Infectious Diseases and Research at Kano’s Bayero University, highlighted how some hospitals had closed as health workers without protective equipment wanted to avoid contracting the virus.
As a result, people with conditions, either unwilling or unable to seek medical care, died at home.
Despite these theories, coronavirus being the main suspect can’t be ruled out.
Underlying all of this uncertainty is a lack of accurate information. What happened in Kano was a problem of underreporting before the news stories broke on the 28th of April.
Leading up to that day, Kano was reporting an average of seven cases per day. The situation seemed calm in Nigeria’s second most populous state (even this statistic is in contention).
However, Governor Ganduje had already started raising the alarm. Two days before, he reported that there were 74 new cases in the state while the NCDC reported four.
As soon as the mysterious death stories broke, the presidential task force and the NCDC sent a team to get the situation under control. They bolstered testing capabilities and equipment in the state.
The state’s only testing lab was not functioning at the time of their arrival, but now there are three - one less than Lagos.
Testing and the number of cases started to rise dramatically.
Daily cases went from an average of seven to averaging 60 in the four days from the 28th of April. In just over two weeks, Kano went from 80 cases to almost 700 - taking its rightful place as the second-highest state in the country.
With better testing and reporting from the NCDC, fears surrounding Kano have subdued. It’s still worrying that it has 36 deaths, though - four less than Lagos which has over triple the number of cases. A fatality rate of 4% vs 1% in Lagos.
Assuming there aren’t any major reasons why Kano citizens are more susceptible to deaths than Lagosians then the numbers suggest that Kano may have more undetected cases.
The state is still playing catch up, and it will be a few more weeks before we get a better understanding of it’s coronavirus situation compared with Lagos.
Borno, with 24 deaths (10% fatality rate) is another state to watch.
Last month, Stears Business created a State Response Index (SRI), which scored Nigeria’s 36 states and the FCT based on their policy responses to the pandemic.
On the whole, the states with the most cases have the highest SRI scores. For example, Lagos with almost 3,000 cases has a score of 9 out of 10, adopting almost all policy measures that we covered. These include movement restrictions, isolation centres (300 beds), assistance for the poor, and test labs.
There are a few outliers, though - states with a relatively high number of cases but a low score on the policy response index.
One obvious case is Katsina which has 281 cases - the fourth highest in the country - and a Stears SRI score of only 4. The only six states with a lower score have a range of 7 to 32 cases, which could excuse their lax policy responses.
To achieve a score of 4, Katsina closed its land borders, joined other North-West states to fund extra security, received cash transfers from the federal government, and imposed restrictions in certain local governments.
Despite almost 300 cases, the state has no test labs, it did not enforce a strict lockdown, and doesn’t have up to 300 isolation beds.
Arguably, the most vital policy measure to reduce the spread of the virus is imposing lockdowns, but the state opted for a different approach. It imposed restrictions across local governments but had fewer rules restricting movements within local governments.
Out of 34 local governments, seven had restrictions within their areas. These have been eased over time, and free movement within these local governments will restart from Monday.
This strategy means that there might have been less economic harm from a lockdown, but the spread of the virus has not been fully curtailed.
Unsurprisingly, Katsina has the second-highest cases per test in the country.
Yobe has a rate of 64% with 32 cases from 50 tests, but the relatively low number of tests makes the figure less informative.
As of last Sunday, Katsina had conducted 663 tests, and almost 40% came back with a positive result. In Lagos, the rate is 17%.
It’s difficult to draw too many conclusions from these figures because of Nigeria’s relatively low test rates, but Katsina’s imbalance between cases and a comparable weak response from the government is one to keep an eye on.
As cases across the country rise, there is a risk that more states break the thousand mark, where it seems things are trickier to handle. The NCDC boss complained on Thursday that Lagos is short of isolation beds.
What hope would states like Katsina have if the virus spreads further?
Well, from the Kano example, the NCDC currently seems capable of responding to situations when needed (as long as the state doesn’t force them to isolate for 14 days first).
Such gaps like test labs and isolation centres could be dealt with.
One final thing to remember - with data, it’s always important to consider the information that you don’t have.
We can only assess Katsina’s situation because they have reported enough numbers to analyse. With the likes of Kogi, Cross River, and other states with only a few cases - Anambra and Benue - the real situation could be worse than the states we pay attention to.