Covid-19: How early warning Lagos Health Commissioner gave helped us – Sanwo-Olu

Covid-19: How early warning Lagos Health Commissioner gave helped us – Sanwo-Olu

Sunday, April 12, 2020 2:29 pm


Governor Babajide Sanwo-Olu. Thisday photo

 …Says Prof Abayomi raised the red flag since 2019

 Governor Babajide Sanwo-Olu of Lagos has demonstrated great leadership in the way he has handled the covid-19 challenge. Moreover, as a team player, he gave due credit to who deserves it in this fight, in the person of Prof. Akinola Abayomi, Lagos State Commissioner for Health. He has revealed how an early warning by Abayomi made Lagos State prepare for coronavirus long before the pandemic put Nigeria in its dreadful itinerary!

In fact, Sanwo-Olu, the commissioner for health and others have been doing a yeoman’s job in the war against coronavirus. And Governor Babajide Sanwo-Olu’s squadron leader in this combat is  Abayomi, a Professor Emeritus of Medicine. As we published earlier on this platform, Profesor Abayomi, 68, is a specialist in Internal Medicine, Haematology, Oncology, Environmental Health and Biosecurity. He studied at the Royal Medical College of Saint Bartholomew’s Hospital in the University of London where he attained his first graduate degree in Medicine and progressing to obtain fellowships from both Royal College of Medicine in the United Kingdom and the College of Medicine of South Africa. He has also worked in several countries around the world in Internal Medicine and has been exposed to a variety of geographical variations of disease patterns within the discipline of Internal Medicine.

Prof Akin Abayomi, Lagos Commissioner for health

As we put it in our earlier report, “Abayomi also trained in ecosystem integrity, wilderness management and biosecurity and has a special interest in environmental health and passion for ecosystem integrity and the impact of environmental degradation on human health, practicing holistic organic agroforestry in combination with ecosystem conservation.”

It is therefore not a big surprise that Governor Sanwo-Olu singled Abayomi out for praise in an interview with Thisday on Sunday.

According to the Governor:Beside the leadership, I think we’re lucky in terms of institutional knowledge and also in terms of the crop of cabinet members that we’ve put together; and specifically, to talk about my Commissioner for Health (Prof. Akinola Abayomi).

We must give credit to the man, who professionally, had mentioned to me towards the end of last year (2019) urging that we should prepare for COVID-19, noting that there was trouble coming. In January, specifically, after we’ve cleared off the budgetary matters, the commissioner said to me that the pandemic was coming and it would get to us and what we needed to do was to activate a few things and I agreed with him.

As a professor, he was part of the team that dealt with Ebola. Among the things he said we needed to do was to upgrade the state’s health infrastructure like the infectious disease hospital and that we needed to set up a ‘control-and-command centre’ in anticipation of what was coming.”

Sanwo-Olu added: “We didn’t claim to have the knowledge of what would happen but I gave him the go-ahead, the cooperation and the approval to start preparing in earnest for the pandemic. By the end of January or the first week of February, we had set up an incident command, where I designated as the incident commander and the commissioner for health was designated as the deputy incident commander.

Well, at that point I had no idea what that designation meant but it was such a fanciful name that I wholeheartedly embraced. Be that as it may, things began to be a bit disturbing from the reports we were getting from international media on how China was grappling with the coronavirus pandemic. Every day, it became something that I was interested in and was schooling myself.

“During that period, it was discovered that many of the facilities were rundown and we needed to do some rebuilding – building up capacity and re-training personnel. From the end of January all through February, we started out rapidly fixing what needed to be fixed; renovating and making generators functional.

“Let me admit, there were moments I became worried even before the index case of COVID-19 was recorded in Nigeria -February 27, a Thursday. Ten days before the recorded case, the commissioner started calling every evening and each time I saw his call, I was awaiting the bad news that index case had been recorded.

“But he’d say, ‘No, no COVID-19 case yet but we need to buy this, buy that.’ I’d say, ‘okay, no problem’, until that particular Thursday, when he called me. It was around 10:30 pm. He said to me: ‘Mr. Governor, we have our first case!’ Of course, my heart just sank. Immediately, we activated everything we’d put on the ground. ‘Everything’ included that we needed to come clean; we needed to be transparent. We needed to tell the citizens and everybody where we are.

“I said to him we needed to call the health minister, the NCDC (Nigeria Centre Disease Control) and the President (Muhammadu Buhari). I pointed out that, before we wake up, if we didn’t push this message forward, Nigerians would have got wind of it. About 11:30 pm, we sat down to draft a message and we waited. We waited because the issue on hand is a national issue.

“It’s not something Lagos was keen on taking the shine. We believed that the federal government should take the lead in the matter. We agreed that the national government should make the official announcement.

“By the following morning, the whole airwave had gone agog with the news. The journey had just started. We were able to absorb that first case, because we were ready and we knew what was expected of us. I visited the facility, where the patient had been taken.

“And because the hospital is an infectious hospital, COVID-19 is new; it’s something we’ve not seen before. But we have other infectious diseases – tuberculosis, HIV and we were dealing with Lassa fever. As of that time, the fever had killed between 160 and 170 patients. Therefore, there was a need to separate the COVID-19 unit from the other infectious diseases’ unit.

“It was like a repetition of Ebola, which occurred a few years ago and it was in the same infectious disease centre that we handled that. Also, in that facility we have what we call the biosecurity lab. It’s a level-three biosecurity lab – first class! It was one of the best in Africa. It was built by Lagos State in conjunction with the Canadian government, the post-Ebola era.

In the same interview, Governor Sanwo-Olu revealed why, despite the numbers, fatalities still remain very low. “In truth, it’s a combination of many things. We don’t have a magic wand yet to wave the virus out of the land. At the moment, maybe we have a lot more patient-doctor ratio to the extent that we could treat the patients quicker and more effectively. Second, there’s something about us and that may boil down to the level of our immunity; we’ve developed some level of internal resistance.

“Could it also be because we’re in the tropics? On a lighter note, people also say that perhaps it’s because Nigerians are tough-skinned having been used to tough times. It’s certain that the health professionals are using a cocktail of medications, which I don’t know.

“The fatalities we’ve recorded were linked to underlying medical conditions the patients had. And hear this: Nigerians believe we pray a lot and we can’t rule out the efficacy of prayers. Think of the health professionals on the frontline, they must be praying each time they’re going in there to treat the patients. The positive outlook of the patients is also important.”

Below is the Thisday on Sunday interview, entitled:

Lagos is Prepared for the worst

It was late Wednesday afternoon and Governor Babajide Sanwo-Olu was far from retiring for the day. Ordinarily, he should have been tired from the series of meetings that won’t stop coming – time after time – he showed no signs of fatigue either. The essence of his many meetings was also predictable: addressing the Covid-19 pandemic from their different manifestations. Thus, the interview with THISDAY was not different. Without having to patronise him, Sanwo-Olu too knew his approval rating had gone up this period, because he isn’t doing badly. For a man, who had suffered scathing criticisms since assuming office – from deplorable state of Lagos roads to the backlash from restrictions placed on commercial motorcycles and tricycles, not also forgetting the recent Abule-Ado explosion – the Covid-19 challenge has only turned out the biggest test of his leadership. Confident and bursting with the kind of energy required of a Lagos governor, Sanwo-Olu said he’d been able to tame the virus, because he started preparing for it early, after his Commissioner for Health, Professor Akin Abayomi alerted him that the Wuhan, China health crisis would hit the whole world in no distant time. Although he’s so far left nothing to chance in the management of the emergency situation, Sanwo-Olu is however not oblivious of the fact that the battle against Covid-19 is one he cannot afford to lose and that much he reveals in this interview with THISDAY on Sunday. Excerpts:

Your show of leadership in the face of a global health crisis has been impressive especially, as COVID-19 ravages everything in its path. How challenging has it been for you to navigate through these times?

It’s been tiring times, to be honest with you. Before the outbreak of the coronavirus pandemic, nobody could tell a few months ago, a year ago, two years ago, this is how things would turn out. For everybody including myself, it’s been a strong learning curve. It’s been a very strong and difficult moment for all of us and I think there’s no business school, political school that could have given one enough tutorial on what we’re getting into.

But we’ve been lucky in Lagos. Beside the leadership, I think we’re lucky in terms of institutional knowledge and also in terms of the crop of cabinet members that we’ve put together; and specifically, to talk about my Commissioner for Health (Prof. Akinola Abayomi).

We must give credit to the man, who professionally, had mentioned to me towards the end of last year (2019) urging that we should prepare for COVID-19, noting that there was trouble coming. In January, specifically, after we’ve cleared off the budgetary matters, the commissioner said to me that the pandemic was coming and it would get to us and what we needed to do was to activate a few things and I agreed with him.

As a professor, he was part of the team that dealt with Ebola. Among the things he said we needed to do was to upgrade the state’s health infrastructure like the infectious disease hospital and that we needed to set up a ‘control-and-command centre’ in anticipation of what was coming.

We didn’t claim to have the knowledge of what would happen but I gave him the go-ahead, the cooperation and the approval to start preparing in earnest for the pandemic. By the end of January or the first week of February, we had set up an incident command, where I designated as the incident commander and the commissioner for health was designated as the deputy incident commander.

Well, at that point I had no idea what that designation meant but it was such a fanciful name that I wholeheartedly embraced. Be that as it may, things began to be a bit disturbing from the reports we were getting from international media on how China was grappling with the coronavirus pandemic. Every day, it became something that I was interested in and was schooling myself.

 

During that period, it was discovered that many of the facilities were rundown and we needed to do some rebuilding – building up capacity and re-training personnel. From the end of January all through February, we started out rapidly fixing what needed to be fixed; renovating and making generators functional.

Let me admit, there were moments I became worried even before the index case of COVID-19 was recorded in Nigeria -February 27, a Thursday. Ten days before the recorded case, the commissioner started calling every evening and each time I saw his call, I was awaiting the bad news that index case had been recorded.

But he’d say, ‘No, no COVID-19 case yet but we need to buy this, buy that.’ I’d say, ‘okay, no problem’, until that particular Thursday, when he called me. It was around 10:30 pm. He said to me: ‘Mr. Governor, we have our first case!’ Of course, my heart just sank. Immediately, we activated everything we’d put on the ground. ‘Everything’ included that we needed to come clean; we needed to be transparent. We needed to tell the citizens and everybody where we are.

I said to him we needed to call the health minister, the NCDC (Nigeria Centre Disease Control) and the President (Muhammadu Buhari). I pointed out that, before we wake up, if we didn’t push this message forward, Nigerians would have got wind of it. About 11:30 pm, we sat down to draft a message and we waited. We waited because the issue on hand is a national issue.

It’s not something Lagos was keen on taking the shine. We believed that the federal government should take the lead in the matter. We agreed that the national government should make the official announcement.

By the following morning, the whole airwave had gone agog with the news. The journey had just started. We were able to absorb that first case, because we were ready and we knew what was expected of us. I visited the facility, where the patient had been taken.

And because the hospital is an infectious hospital, COVID-19 is new; it’s something we’ve not seen before. But we have other infectious diseases – tuberculosis, HIV and we were dealing with Lassa fever. As of that time, the fever had killed between 160 and 170 patients. Therefore, there was a need to separate the COVID-19 unit from the other infectious diseases’ unit.

It was like a repetition of Ebola, which occurred a few years ago and it was in the same infectious disease centre that we handled that. Also, in that facility we have what we call the biosecurity lab. It’s a level-three biosecurity lab – first class! It was one of the best in Africa. It was built by Lagos State in conjunction with the Canadian government, the post-Ebola era.

 

The infection rate has been relatively low in Lagos State. However, there are modeling indicating as high as 39,000 persons may likely be infected in the state. That’s scary, what’s your reaction to such high numbers?

You’re right. People will do all sorts of empirical modeling based on the trends of where the virus has emanated from and thus, they’re able to plot graphs. Yet, some of the things people didn’t understand is that we needed to look at where this thing is coming from. At the time COVID-19 got to Nigeria, it was only prevalent in developed countries, and of course, China where it originated.

If you do an economic comparison, you’ll realise that a lot of those jurisdictions have many average citizens that can afford international travels. Since it’s a disease that has to be ‘brought in’, the question is how many entry points can we possibly have? In France, for example, there are more than 20 international airports. Think of the UK and the US’ airports too, indicating that journeys can start in any part of the world and terminate in these entry points.

Similarly, consider the economy in Europe. You will notice that inter-country trips can be made by road at cheaper rates. Movements in these places are fluid. Our own modeling doesn’t, as a matter of fact, have to follow theirs. So, we sat down and looked at the realities on the ground here. Where are our entry points? It’s (coronavirus) not a domestic disease. It’s ‘imported’ into Nigeria. Apart from Abuja, Lagos has at least 70 per cent of international travels. We can count the number of international flights into Lagos. That’s number one.

Number two and mind you, I’m talking about first-time carriers, what’s the average earning power of the people, who are travelling? Apart from the middle, upper-class people, who travel, the top set of people are the ones who actually go on repeated travels all the time. It’s not a model in which you see people earning less than $1000, who need to do international travels to the UK.

On that evidence, I saw that it was the same set of people who are moving in and out and it’s not a large percentage of our population. Thus, I said to myself that if we could quickly block that entry, we would be able to stop the spread of the virus. However, these aren’t facilities under the control of the Lagos State government. We’re subnational. That decision (to block the entry points) had to be taken by the federal government.

Thus, in terms of the modeling, I knew that people were using the economic indices of where those cases were coming from to reference the likely cases that occur here. But it’s not that simple taking into cognizance the number of entry points of other places compared to ours. Beyond the first level of control, is the strategy to curtail the level of transmission.

But why did the Lagos State government refuse to reveal the identity of the first index case?

The patient has a right to privacy, which also includes his medical records unless a patient decides to make public his or her own medical issues and records. Medical practitioners have ethical responsibility to respect the privacy of their patients in terms of their medical records and related issues. Among the patients discharged from the isolation centre, there were those willing to talk about their experiences but didn’t want their identity revealed and there were those willing to be identified publicly.

Despite the numbers, fatalities still remain very low. What’s the secret behind the treatments of the patients?

In truth, it’s a combination of many things. We don’t have a magic wand yet to wave the virus out of the land. At the moment, maybe we have a lot more patient-doctor ratio to the extent that we could treat the patients quicker and more effectively. Second, there’s something about us and that may boil down to the level of our immunity; we’ve developed some level of internal resistance.

Could it also be because we’re in the tropics? On a lighter note, people also say that perhaps it’s because Nigerians are tough-skinned having been used to tough times. It’s certain that the health professionals are using a cocktail of medications, which I don’t know.

The fatalities we’ve recorded were linked to underlying medical conditions the patients had. And hear this: Nigerians believe we pray a lot and we can’t rule out the efficacy of prayers. Think of the health professionals on the frontline, they must be praying each time they’re going in there to treat the patients. The positive outlook of the patients is also important.

 

Clearly, no leadership could have envisaged and prepared for this kind of challenge. So, what are your takeaways from this?

One thing that shouldn’t be overlooked is sincerity. Sincerity is important. You must be able to reflect what’s inside of your heart. The first thing is, we want to give our people the best possible care that we can offer them. Two, we want to encourage our staff not to look back and to know that we’re with them all the way. Three, We needed to see how we’ll use leadership as a tool to ensuring that we redefine governance.

Where we need to use leadership as a tool to redefine governance, I said to myself if nothing one needs to transparently continue to communicate with the public. Even if we’re drowning, we need to give hope and assurance by just saying to people, ‘You know what, the situation is bad but we’re going to get better.’

When you don’t say anything all sorts of things cross people’s minds and there’ll be nobody to dispel any wrong notions. So, I decided that I have to be out there to let people know what we’re doing. It’s only when we’ve told our people what we’re doing that they can hold us accountable. Not saying anything will suggests we don’t have a plan.

Since we have a plan, our message is that everything is going to get well. We’ve provided various facilities, medical equipment and we can do better in those things. We need to tell the people what we have done, what we’re doing and what we need to do; and the places we need to get to and a real way to do it is to show leadership and transparently come forward and speak to the people.

The people need to believe in you. We just need to continually carry the people along. Every day meetings are being held and I ask the team to let me know what needs to be communicated to the citizens. You know, what doesn’t get measured doesn’t get done. So, we said to ourselves, we’re going to tell people we’ll do this and that, then, we go out to do just so. That’s the essence of governance. It’s been an eye-opener for me. With all sense of modesty, it’s also been a lot more than one can imagine.

Has the lockdown really been effective the way it should be?

It has, to be sincere. You know the Lagos gridlock. Traffic issue in Lagos is something we still need to solve. Here’s why the lockdown helped in halting the spread of the coronavirus pandemic. So, we’re tracing some individuals, because somebody in an aircraft has tested positive for COVID-19, leading to trying to identify all the people who sat close to the confirmed COVID-19 patient.

So, some mapping is required to know those likely to contract the virus because of their seats’ proximity to the confirmed case: where do these people live? What do they do? Where are they going? The surest way to get these people is to visit them and take their samples. Initially, it was taking us three to four days to track people in the early days. The logistics were heavy. That’s number one.

Number two, we also realised that they’ll probably be infecting the community and one effective way is to slow down the movement of people. It’s only when you move there is the likelihood that people who don’t know you from anywhere, in a bus or somewhere else can get it. An ‘innocent’ sneeze or cough can do a lot of damage to other passengers in the bus.

But when people are restricted to their homes, the spread can be contained to a great extent. That’s the whole idea of the lockdown apart from making mobility easy for those involved in contact tracing, it’s a solution that’s proven as it can be seen in Wuhan province (China). We’re fighting an invisible enemy that turns on its head our cultural and traditional values like warm-hearted greetings and gatherings that dwell much on physical contacts.

Let’s look at the impact of the COVID-19 crisis on the economy, governance and the social life of Lagos.

It’s heavy. It will be heavy. All of our indices are somersaulting. It will be heavy. First, we should look at what kind of economy are we running. At the federal level, we’re running a mono-economy with foreign earnings largely dependent on crude oil. As of today, the oil price has plummeted from $60-something to $20-something indicating that our earning power economically as a nation has crashed and we’re just getting out of the first quarter.

We’re also an import-dependent economy. If we’re export-oriented, maybe our staying power will also show, at least, we’re producing. We’ve improved on food production and local consumption in the last three to four years better than what it used to be. There are many rice farms, mills. Just imagine we now need the dollar to import rice. We’ve stopped the importation of tomato puree. We have many agro-allied companies.

However, power hasn’t been efficient in the country. These are some of the drivers that ought to help the cost of production even in that economy so that when you break down your cost of power you can pass that onto your customers. At the state levels, where are our IGRs? Where do we source all the money? Income taxes aren’t sure at this point. Now that many firms have shut down completely or partially, we don’t know the effects in terms of rationalisation; we don’t know the effects on employment and the lack of it.

Consider VAT (Value-Added Tax): you can only exert tax on what’s consumed. Consumption has drastically reduced. Once you don’t have revenues coming, it becomes also difficult for the government to be able to progressively deliver some of the economic agenda, be it development, capital expenditure or even recurring expenditure like (payment of) salaries. It’s really going to affect us.

In view of this, all of us have to think out of the box. All of us have to think through this time and we need to tighten our belt. The government now needs to be very proactive and prudently put limited resources to the best use. In Lagos, we’re designing ways to further reduce cost of governance. We’re now obligated to think more creatively on how to solve the challenges and problems confronting us in the wake of the coronavirus pandemic.

On the social side, how are we going to deal with it? As it is, we have to maintain social distancing; you shouldn’t touch me and I shouldn’t touch you. This new reality is absolutely alien to our culture as a people. This will require some re-engineering of our psychology to grapple with the fact that a friend is here and you can’t give him a warm handshake. You can’t hug him. People must understand this new reality; our new social culture demands some level of physical distancing.

More important, we need ourselves to be there for each other. We can expect some mental issues to come out of this new norm that we all find abnormal. Think about falling into depression in this period. Well, I also heard that this new norm has its own good side too: we heard that some families are reconciling with one another, husbands and wives who have to endure long-distance relationships have now come together.

Parents are getting to understand their children better. We should also be mindful that there’ll be some social tension in homes sometimes resulting in domestic violence and it’s sad to admit that there had been reports of domestic violence. These are issues we need to manage and communicate across all strata in whatever forms. We must do everything to get our lives back.

For example, we’ve developed a tourism strategy. I’m sure I’m leaking my strategy. This year, it can be envisaged that hardly will people go for summer; the financial strain brought about by COVID-19 and the post-coronavirus fear. Therefore, the question we need to ask ourselves is: what are the things we need to do jazz up the social life of people after the lockdown? We’ll think through this and see how we’ll create a local economy; revamping the beaches, promoting memorabilia, boot camps for children, etc. We must create that economy. Once it’s a naira economy, it’s good for us. Let’s make our local currency strong.

What’s the cost of managing the coronavirus crisis?

Even today as I speak with you, spending has been signed on some expenses, because I’m committed to a 24-hour turnaround time. There can’t be bureaucracy in all of this. However, I’ll give you some idea around that. Last year, when we started the preparation of the IPCs (Infection Prevention Control), I said to myself in the budget that let’s even wrap up before our expenses in health. It’s only what you’ve earned that you can spend.

We raised some bonds last year, which we were lucky that early in the year, we had some headroom with the bond, which we’ve started spending for our health facilities. About five health facilities are concurrently being renovated. If not for the lockdown, we’d have opened two health facilities as well in Epe and Badagry. We’ve, therefore, started spending a bit on health, because of the fund we had from the bond’s proceeds.

Once the health commissioner told me they needed to activate the IDH (Infectious Diseases Hospital), I was more than willing to give approval; everything is being monitored though. Vehicles, new equipment, training, welfare, etc. are part of all interventions we’re engaging in currently. There are about 10 isolation centres that people don’t know exist with 60-bed, 80-bed capacity.

All of our health workers stay in these facilities when they can’t go home. We’ve anticipated that even in the event that we have an ‘explosion’ in the number of confirmed cases, we can put people in Epe, Animosho, Ibeju-Lekki. As we speak now, we’ve had to pick 67 Nigerians stranded at the border. They’ve been lodged at our facilities in Badagry. We’ll test them and quarantine them for 14 days. They’ll be fed.

We had 17 students from the Seme border a couple of days ago. We took very good care of them. When we confirmed that they tested negative to COVID-19 we allowed them to join their families. For Lagos State, it’s really not about the money now. It’s more about how quickly can we get post-COVID-19. How quickly can we get our people, who turned negative to go back home? The main goal of governance at this stage isn’t financial. It’s really about how do you help your citizens; how do you get your people out of this unfortunate situation.

To be transparent, people are supporting Lagos tremendously, starting from the federal government of Nigeria; they’ve given us some recurrent money and some new funding post-COVID-19. What we’re going to do at the House of Assembly in order to obtain a big expenditure framework. We have to be fully prepared for this kind of infectious disease.

We’re going to be building infectious diseases research and training facilities – purpose-built. We’re going to build a 300-bed isolation facility and office complex. We’re looking at building three to four-storey building at the Yaba facility. That’s the plan. We can’t over-prepare for catastrophe like this. Then, we’ll go back to see how we’ll revamp our entire health structures.

What are the total bed-spaces at the moment?

In Yaba, we have about 120 beds. We just commissioned the Onikan isolation centre; it has 110 beds. That’s 100 regular beds, four wards – two for male patients and two for female patients. Then, we have the 10-bed ICU ward. We have at Gbagada, kidney and renal centre; it’s going to take 180 beds. Aside from that, there are another 10 at Gbagada; there could be a spillover and that’ll take 250 (beds).

Inside IDH Yaba, there’s a ground zero that can occupy 250 beds as well. All these are in addition to the 10 other facilities I earlier talked about. They’re private facilities that we’ve temporarily acquired; some of them have 50, 60, 80 and 40 beds. That one will give about 200 or 250 beds. If it happens that these places are stretched, we have two other plans. We can activate a tent at the Agege stadium. We can activate another tent at Surulere’s Teslim Balogun Stadium.

Within 10 days we can put these tents. We have over 2000 beds bought already in the event that they’ll be needed. We just have to prepare for the worst and hope for the best. To echo the WHO’s secretary-general’s words, you can never say you over-prepared for a pandemic. When you’re faced with a pandemic that defies race, boundaries, skin colour, gender and economic status, you’ve got to build that capacity. We’ve even built capacity in terms of ventilators. We have in all of our hospitals that we’ve tracked – about 80 ventilators. But for COVID-19, we have about 40.

Are you likely to ask for additional financial aids given the extent of what Lagos needs to fight this invisible but common enemy?

To be fair, we still have sufficient funds. The federal government has been very magnanimous and a lot of citizens have supported us. These individuals will be thanked privately and publicly at a future date for what they have done to help us.

-Continue reading the full interview from the source: Thisday on Sunday

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