PROPOSED NATIONAL STRATEGY FOR COVID19

We are a small group of young Nigerian professionals mostly from the oil and gas industry in Nigeria, with diverse backgrounds and experience.
We have come together to work on this because we feel an overarching national strategy to address covid19 in Nigeria, to ensure coordination and alignment for all the ongoing efforts, is what is most needed at this time. We searched and were unable to find one online. We are well into the 4th month of dealing with this disease now. We (Nigeria) should not remain in a “reactive” mode.

Our highest hope is that this proposal will prompt a more public discussion on the need for a single strategy on the national level and that as a result, a National Strategy will be developed that will be even better than what we have proposed here.
Such a strategy is more than just a Response Plan. We see a response plan as something that is primarily reactive. A strategy will consider our current realities, set goals for the country, and lay out a framework on how we will reach these goals.

It is also critical for this strategy to be published. This is so that the people can read it, understand it, and align with it. The people have to jointly work with the government and all related organizations for it to be successful. It will also allow inputs and ideas from our wealth of professionals.

WHY DO WE NEED A STRATEGY?
[img]covid19 Nigeria forecast.jpg[/img]

1. Based on the simple trend forecast above, we may have up to 700,000 covid19 cases across the country by the end of 2020. If we do not coordinate our response, using a national strategy, we may suffer a major loss of lives and productivity with the potential of effectively grinding the nation to a halt. We may also suffer severe damage to our national image. All this in spite of haven spent huge amounts of money.

2. If the number of covid19 cases continues to rise without a strategy in place to coordinate our response, the Government may have no choice but to resort to locking down the entire economy again, and for longer periods. This will lead to further huge economic losses for the country and all its citizens.

3. The continued growth of the covid19 cases, as forecast by the trendline, may further exacerbate the existing ethnic and communal conflicts currently ongoing in different parts of the country. This has the potential of increasing the level of armed conflict across the country, with even more severe consequences.

4. A published national strategy will allow the general public to understand and align with the strategy. This will be critical for success. It will also allow for proper public challenge of the strategy, to expose any shortcomings. This way, we will be taking full taking advantage of the wealth of qualified professionals we have around the country, who can add value to our plans.

5. A published strategy will enable good, pro-active resource planning. We can start preparing the things that will be needed well before they are critical. Individuals and organizations can look at the strategy and come up with where they can contribute, even without being prompted by the government.

PROPOSED STRATEGY

From our perspective, there are 3 areas we can focus on:
1. Get a medication or vaccine that helps eliminate it
2. Arrest or aggressively suppress (eliminate if possible) the spread using a combination of fit-for-purpose social-process solutions (e.g. lockdown, intense tracking, protective measures)
3. Try to minimize or effectively control its impact on our lives while we live with it.

#1 depends on the research taking place within and outside the country to find a cure/vaccine. This is largely down to funding, infrastructure, and technical research expertise. We (Nigeria) are rather far behind in this area, by our assessment. We chose not to focus on this option in our proposal. In this area, The Government simply needs to decide on what they will like to achieve (with respect to covid19 research) in Nigeria and adjust their expenditure to match their expectations.

Our proposed strategy, therefore, focuses on # 2 and 3.

Summary of Strategy for item 2: Arrest or aggressively suppress the spread

The objective in this area is to use a refreshed set of measures to aggressively suppress the rate of spread. While it may be extremely difficult to eliminate the virus, the next, more achievable level of success will be to suppress the rate of spread to such a level that the net number of covid19 cases does not grow over time (i.e. no net increase in the total number of cases in the country over a week, month or quarter).

To successfully achieve this, we propose the following:
a. Develop guidelines that will be shared and distributed on a local govt ward level across the country. The guidelines will be easy to read (e.g. paper bills with lots of graphics) to inform people on (i) the basic covid19 prevention steps (ii) Exactly what to do if you suspect you are ill with mild symptoms (iii) Exactly what to do if you feel ill with serious symptoms (iv) How to raise any concerns/observations about covid19 in your neighborhood.
b. In a minimum of 3 local govt headquarters in each state, set up a small local covid19 response team that will assist with basic response, logistics, and information sharing in a coordinated manner.
c. Reduce the testing cycle time to 3 days across the entire country. This is the time between when a patient gives a blood sample, and when they receive their results. This is to further minimize how much patient is able to spread the disease once they are positive.
i. To be able to achieve item (c), we propose to develop a testing center in each state of the country. From the STRATEGY TO SCALE UP ACCESS TO CORONA VIRUS TESTING IN NIGERIA document available on the NCDC website, we expect to have full testing coverage of all states in Nigeria by end-sept 2020. This strategy does not aim to have a testing center in each state. Having at least one center in each state will reduce the logistics challenge of getting samples to a testing center and help reduce the cycle time. This is especially where there are border restrictions between states.
d. Increase the total number of tests that can be completed in a day. This may mean increasing testing throughput by using “pooling” testing methods being used in Ghana and South Africa. But available data shows that for every country that has been able to successfully bring the disease under control, increasing testing was absolutely key.
e. In each state, working with the Local Govt Areas, identify high population density areas within cities, and provide centralized sanitization facilities for them, in addition to focused treatment and test sample collection.
f. In each state, identify 3 major hotels that will be used as Isolation Centers for most serious cases. Govt will go into agreement with hotel ownership for some form of compensation. Quite a number of hotels are operating well below normal capacity at this time. This will go a long way to address the issue of bed spaces for serious cases.
g. Negotiate with local caterers to provide food for people with serious symptoms who have to be in a treatment center. The food will be paid for by the Govt. This will be a way of boosting employment during the period. Most caterers are working at very low capacity right now.
h. This strategy will require funding. The funding can be achieved by a combination of input from Federal, State, and LGA, in addition to Private-Sector and International NGOs. Many private-sector brands will be proud to associate themselves with the legacy of successfully overcoming covid19 in Nigeria.
i. Aim to have these in place within 2 months from now. We can reasonably forecast how many covid19 cases we will have 2 months from now, and how many are likely to show serious symptoms. We can use this as a guide on the total number of patients we should be planning for by that time. Our estimate is that the number of cases in 2 months will be approximately 100,000.
j. Using this method, the relatively low number of cases (relative to many other world regions) in Nigeria can be more quickly identified, isolated, and treated. With a focus on this for about 4 months, the chances of bringing the disease fully under control are very high, by our assessment.

Strategy for item 3: Minimize long-term impact

The objective will be to:
- Prevent any future exponential increase in the number of cases in any part of the country
- Maintain covid19 management measures from Option 2 at a stable or reducing monthly cost over time
- Continuously reduce the cost of personal covid19 testing and treatment over time.

To achieve this, we propose the following:

a. Identify and equip a minimum of 2 covid19 medical centers in each state capital. Equipment and processes will be aligned to a national standard. Funding for these centers can be a mix of sources, both private and public. Each center will have a published protocol for receiving, treating, discharging covid19 patients, and will collaborate closely with the testing centers in the state.
b. Carry out a quick study of all covid19 (current and recovered) patients to identify a common trend. With this information, the country can identify and focus on the percentage of the population that are likely to develop serious symptoms. We can then preemptively provide extra protection for those people to reduce their chances of getting infected.
The fact that this approach is not being used in other countries does not mean that we should not look into it. There are still reasons to believe that our natural response to covid19 is unique, compared to other regions of the world. We should study this more carefully to use it to our advantage.
c. Continuously monitor new infection levels in every high-activity local govt across the country. Set a threshold outside of which an immediate response will be activated. This is with the assumption that work on option 2 has been able to yield a stable number of infected persons across the country.
d. Issue nation-wide standards for face masks and hand-sanitizer production, in collaboration with the Standards Organization of Nigeria. Actively encourage local manufacture of face masks and hand-sanitizers to completely meet all our needs from local production. All manufacturers will be expected to adhere to the new national standards.

With this strategy, we expect that Nigeria will be able to bring the covid19 spread under control within 6 months. At this time, we expect that it will be extremely difficult to eliminate the disease without a cure/vaccine. After bringing it under control, our efforts to minimize the impact of living with covid19 will help make it such that we can operate in a state of equilibrium while the disease remains within our borders.