REALITIES OF COVID-19 PANDEMIC IN NIGERIA: COPING WITH THE CHALLENGES AND CHARTING A WAY FORWARD

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O.S. Ilesanmi^1,2 and O.F. Fagbule³

1. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
2. Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria.
3. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Oyo State, Nigeria

Abstract

The impacts of COVID-19 have cut across both developed and developing countries alike. This has prompted different coping mechanisms for survival through these trying times. The reality of stigmatization in this period has negatively affected health-seeking behavior and public response to the outbreak. Challenges exist at both the community and the healthcare providing facilities. We present a review of best practices in coping with COVID-19. Our focus is on how to cope with the challenges and strategies to improve the response to the pandemic in Nigeria. It is required that safety measures be fully adopted and practiced by individuals and groups. Collaborative efforts are required by all stakeholders, government, healthcare workers, and private organizations to mitigate the negative effects of the pandemic, avoid stigmatization, and ease the return journey to normalcy.

Keywords: COVID-19, Infection prevention and control, Healthcare workers, Personal protective equipment, Pandemic

Overview of the COVID-19 Pandemic

The recent outbreak of the novel Coronavirus (COVID-19, SARS-Cov-2) has shaken the entire globe like a convulsing child¹. The impacts of the disease have cut across both developed and developing countries alike^2,3. At the early stage of the outbreak, many disregarded the existence of the infection. A few tried to shy away, while others were optimistic regarding the near end of the pandemic. Regardless of perceptions among individuals, the impacts of the COVID-19 outbreak have swept across the entire human race like a whirlwind with several challenges, although with varying levels of severity^2,3,4. The adoption of infection prevention and control (IPC) measures has helped maintain a minimal infection rate; however, these have also intensified the negative effects associated with this period^5,6. The innate ability for adaptation to prevailing conditions among humans has prompted coping mechanisms for survival through these trying times.

Globally, it is currently estimated that nearly 15 million persons have been confirmed as COVID-19 cases, with about 616,000 deaths⁷. Similar to others, the African region has not been exempted from the COVID-19 experience with as high as 736,587 cases and 15,424 fatalities⁷. A daily rise in the number of COVID-19 cases is being recorded in Nigeria, with a current estimate of 37,801 cases and 805 deaths as of 22nd July, 2020^7,8. In Nigeria, Lagos State is the epicenter of COVID-19 and makes up nearly a third of confirmed cases in the country. Other highly infectious areas include the Federal Capital Territory, Oyo, and Edo States⁸. A larger proportion of these infections occur at the community level, and this has encountered different perceptions and reactions⁹. We present a review of best practices in coping with COVID-19. Our focus is on how to cope with the challenges and chat strategies to improve the response to the COVID-19 pandemic in Nigeria.

Challenges at the Community Level and Proposed Solutions
Since time immemorial, epidemics of infectious diseases have been associated with stigmatization¹⁰. The outbreaks of typhus and cholera resulted in the stigmatization of Russian Jewish immigrants, among whom cases were initially documented. In the outbreak of the bubonic plague, which was credited to rats shipped from Hong Kong, residents of Chinese communities were discriminated against. The nomenclature associated with the outbreak of Hantavirus in the United States resulted in the discrimination of Native Americans in the region¹⁰. An adequate understanding of the nature and effects of stigmatization drove the race-free name determined by the International Classification of Diseases (ICD) and managed by the World Health Organization (WHO)¹¹.

Although it seems trivial, the criteria for naming diseases were established by the WHO because words can create racial discrimination and can result in grave consequences¹². Stigmatization has been a major theme during the COVID-19 outbreak. According to the Nigeria Centre for Disease Control, stigmatization is strongly associated with poor knowledge of COVID- 19 infection¹³.

The poor knowledge of COVID -19 has resulted in the poor use of safety measures in many communities. Presently, compliance with IPC measures, including social distancing, washing of hands, and use of face masks, is at an extremely low level in public places¹⁴. Due to poor adherence, a walk through public place is likely to create either of two impressions on one’s mind. Firstly, the likelihood of the near inexistence of COVID-19, and secondly, the casual reaction to the deadly infection among many. This could also result in stigmatization of persons practicing outlined safety measures.

The reality of stigmatization in this period has negatively affected health-seeking behavior and public response to the outbreak. Community-wide stigmatization could delay care-seeking among high-risk or infected persons, cause intolerance of specific population groups, or create dread of persons perceived to be infected¹⁵. A higher likelihood of stigmatization exists among quarantined individuals, and these persons are vulnerable to the risk of social rejection¹⁵. Due to the fear of being labeled as a carrier of the deadly disease, many individuals fail to seek care until symptoms become unmanageable or seek no care at all. This was similar to the experience during the 2003 SARS outbreak when health-seeking behavior was greatly reduced among persons of Asian descent¹⁰.