An Emergency Call To FGN And NCDC TO Review Covid-19 Diagnostic Strategy In Nigeria

The recent increase in the number of deaths and confirmed cases of COVID-19 in Africa, despite control measures such as lockdown in many countries, could be an early signal from the warning of World Health Organization (WHO) that Africa is likely to be the next epicenter of COVID-19 pandemic. If this comes to pass, no doubt, it will be a disaster with respect to the number of lives it will claim and devastating effects it will have on the already fragile economy of the continent.

Statistically, Nigeria is around 200 Million in terms of population and it plays critical role as the giant of Africa. This means many African countries are looking up to Nigeria in terms of effectiveness in the control of COVID-19 pandemic. This can be gleaned from the recent appointment of President Muhammadu Buhari by ECOWAS Heads of State as the champion of the fight against the pandemic in the sub-region.

Without going back to the actions Nigeria should have taken in controlling this global public health threat. The strategies taken at this moment might be disastrous if we fail to immediately review our diagnostic approach.
Officially, we have 1273 confirmed cases as at 26th, April 2020 but in reality, Nigeria has far more than that as unconfirmed cases. Many of these cases become unconfirmed because our molecular diagnostic approach can accommodate only 1,500 COVID-19 tests daily in 13 molecular diagnostic labs across the country. Undoubtedly, these unconfirmed cases (both symptomatic and asymptomatic) are indeed the potential reservoir for the spread of Coronavirus. This could be one of the reasons why COVID-19 has recently jumped-up from its lag phase to its early exponential stage despite all the control measures.

As a Molecular Biologist, it would have been stupid of me to disparage molecular diagnosis that has 99% accuracy not only on the detection of COVID-19 but also on the diagnosis of other infectious diseases. In fact, at this moment, it is the “GOLD STANDARD” for COVID-19 diagnosis. However, being a Gold Standard does not translate to being the best for us especially at this moment when prompt decision in terms of surveillance is expected to be taken on any confirmed case. Firstly, the equipment and reagents for molecular diagnosis are expensive and it requires trained experts. This has resulted in Nigeria having few diagnostic centres across the country. Secondly, it is not as fast as RDTs of which significant number of samples can be tested within short period of time.

In my opinion, Rapid Diagnostic Tests (RDTs) should be introduced immediately. Of course, we might say that none has been approved by FDA. Who cares? If, for instance, Allplex™ 2019-nCoV Assay developed in South Korea is already used in Europe and USA to control COVID-19 despite awaiting approval, what stops us from screening available RDTs in order to select the best? This procedure can be conducted by comparing the specificity and the sensitivity of several available RDTs on the isolated patients with that of the Gold Standard. This simple research that can be carried-out in a day will give us insights on the best RDT we can go for instead of waiting till unknown time when one will be approved. Alternatively, we can go for anyone that has been successfully used in other countries.

Basically, RDTs are simpler, cheaper, user-friendly and point-of-care in action. This means it will definitely improve our contact tracing because we will take diagnosis to their door step. In addition, COVID-19 has entered community spreading in Nigeria. This calls for RDTs that can be decentralized to virtually all the 774 Local Government areas within a shortest possible time with a view to addressing the spread of this virus.

According to Kang Kyung-wha, the South Korean Foreign Minister, “Testing is absolutely critical with a fast-travelling virus like this”. I urge the Federal Government of Nigeria and the Nigeria Centre for Diseases Control (NCDC) to urgently review the current diagnostic strategy with a view to introducing new set of RDTs that are simple, cost-effective, user-friendly and can be decentralized into the nooks and crannies of this nation. If this is not taken into consideration, we might be revolving round a cycle in terms of the daily number of cases.
If we are going to get it right, I guess this is the best time re-strategize our diagnostic approach.
God Bless Federal Republic of Nigeria.

By: Rasheed Osuolale Makanjuola
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