By Dr. Murtala Isa Umar :-
Kano has been recording spikes of the Covid-19 cases since it’s reported index case about 3 weeks ago with attendant recorded ‘strange deaths’. This has put Kano in the spotlight as one of the emerging global epicenters of the disease. Covid-19 has been observed to affect more adversely the elderly population, immunocompromised/those on immunosuppressive drugs and those with underlying medical conditions such as cardiovascular diseases, diabetes, respiratory disorders and cancers worldwide.
Kano is a melting pot of many sorts for the North, especially Northwest, and as such findings in Kano could be replicated in the surrounding states and probably the entire North.
Claims of denial of the disease in the North is widespread but I doubt if it’s related to ignorance. This disease is unprecedented.
Even though the writing has been on the wall that this may come anytime in many scientific literature, no living person with full senses and brain faculty could boast of witnessing this before. Even President Trump said ‘nobody thought this could happen’, until it was too glaring.
I think Kano has come to terms with the disease, like everybody else.
Strange Deaths
The deaths in Kano, which I believe are highly under reported, has been denied link with the Pandemic by many observers, government agencies and even by many medical experts. But based on my personal anecdotal evidences, which could be flawed, I feel there’s no way these deaths could be separated from Covid-19. These are,
- The observed deaths are reported to be more than 95% among the elderly population. Many say the deaths are natural. But we know natural deaths follow Normal Distribution within the population, meaning, natural deaths should affect both old and young and the paediatric populations. And we already know the vulnerability of the old in this pandemic.
Others believe the deaths recorded are as a result of the lack of access to care by those with noncommunicable chronic conditions occasioned by the Covid-19-associated shut down of many medical facilities with low capacity.
Here still, we could have also been observing deaths among those with diseases commong to younger population groups such as Type 1 DM, Acute Severe Malaria, Sickle Cell Disease (which Kano has high prevalence), Obstetrics-related deaths and a host of other conditions.
- Many patients and patient-relatives try to hide symptoms specified in the Covid-19 case definition for fear of stigmatization. Many patients know these symptoms through public campaigns by the NCDC and the social media.
In one major hospital alone, I observed and recorded 33 deaths in 48 hours and only 6 are below the age of 55. Considering our life expectancy of 48 years, I reckoned these deaths to be of the elderly.
Many patients in distress with clear symptoms reported to have tried to reach the NCDC and the state RRT with no success. Others that were lucky to get the hot lines were not responded to despite giving their addresses.
On personal basis, I receive average of 4 daily notifications of deaths of elderly parents, uncles and aunts of friends, colleagues and acquaintances.
These made it clear to me that there is clear high probable anecdotal causality and association between these reported deaths and Covid-19.
Many people like me with living elderly parents and or grandparents are apprehensive in Kano. My old man is close to 90 years and I keep worrying about him all the time. The only measure I could take was to convince him to stop fasting, encourage him to self-isolate and avoid seeing people, except necessary family members.
Probable Deadly Prevalence in Kano
In my careful observation, there are evidence to suggest an alarming rate of spread of Covid-19 in Kano within a short period.
In a short study I undertook among 26 households in Kano, 81% (21) reported at least one family member had at least 3 of the following symptoms, fever (which resisted conventional treatment) for 2 to 3 weeks, flu, cough, anosmia (loss of smell), ageusia (loss of taste), myalgia (muscle pain and weakness) and headache. This small study is limited by the lockdown and the social distancing guidelines and therefore may not be representative, but remains a guide.
The symptoms observed are those associated with high index of suspicion in Covid-19. Anosmia and ageusia were initially not included by WHO but due to rising evidence among experts, including Yan et al and Claire Hopkins in the Lancet, the CDC is forced to include them as early signs and symptoms of Covid-19.
Again, using comparative modelling projections, the city of New York Metropolitan Area has population density of about 500 people per square mile and the modelling used for the city projects that an asymptomatic Covid-19 infected person could infect 6 people per day with 50% relaxation of lockdown restrictions.
The highly dense 8 Kano city metropolitan local governments has a population density similar to that of Lagos of about 20,
000 people per square mile!
Using similar but conservative modelling projections with NY Metropolitan City, an infected asymptomatic individual with Covid-19 could and would infect 36 people per day.
Those with symptoms may infect less due to possible precautions and hospitalization or home stay.
This is similarly corroborated by a local modelling projection by Gambo and Abdulhamid (experts in mathematical and biomedical modelling) in Northwest University, Kano and reviewed by Professor (Emeritus) Peter McClintock, Lancaster University, UK
This makes me reach an initial conclusion that probably about 25 to 30% of our population in the metropolitan could be infected and further spreading the disease. This could translate to between 2 to 3 million people.
The Silver Lining
As with every situation, there’s always some hope in the horizon.
Kano, like other Third World population, may not observe the high Covid-19-related mortality as it’s being seen in the The First or Developed World like Europe and USA.
This is simply due to demographics.
Mortality is overwhelmingly seen in Covid-19 among the geriatric population, and many with comorbid conditions. In USA, the epicenter of the crisis, less than 1% of Covid-19-related mortality recorded are less than 50 years. This is similar with Italy, Spain and China. As at the end of April, less than 5 deaths are reported among the age group of 15 years and below globally.
In Nigeria, less than 8% of our population are 55 and above as compared to more than 55% in the USA. Even though 8% may be high in absolute numbers, it’s still far less than many Western countries.
This is therefore a call for us to specifically pay attention to our elderly population and focus our interventions towards them. These may include
- Isolating the aged population from the mainstream population
Treat promptly their underlying medical conditions
Encourage healthy living among them, including nutrition and supplementation with immune boosters
Institute and grant them access to geriatric care.
General Recommendayions
For us to get out of this crisis, government agencies, non governmental agencies and the public must act in concert to curb the spread of the disease especially to the most vulnerable group of the population.
Government, as a matter of urgency, should
- Ramp up testing to at least 3000 per day in Kano.
In the mean time, strengthen the department of Traditional and Alternative Medicines in the FMOH, in collaboration with NIPRD to quickly develop local remedies, at least known immune boosters available in our environment and make it available for our vulnerable population before we can develop local cure, as done by other African countries like Madagascar, Zambia and Uganda.
Remdesivir may come at a high cost for our population. This strengthen the need for Universal Health Coverage in our country, especially our vulnerable groups which are also the poorest.
Protect healthcare workers and their families from getting infected in order not to weaken the already fragile healthcare system in Kano. Government should also train and support community pharmacists as they have become the most vulnerable among the healthcare workers due to their easy access and prompt care.
Ramp up enlightenment campaign in Kano to ensure adherence to healthy interactions amid the pandemic since the lockdown seems impossible to enforce.
In this unprecedented crisis, all hands must be on deck and in concert for us to be able to somehow wriggle out of it before it consume all of us.
Dr Murtala Isa Umar, a Public Health Pharmacist, works with Aminu Kano Teaching Hospital and writes from Kano. He can be reached through
08037043441
murtalaumar@yahoo.com
@murtala_um
