The Facts about Anambra's Covid-19 Index Case.
In a special Media Briefing held earlier today Monday, 13th April, 2020, the Anambra State Commissioner for Health, Dr Vincent Ugochukwu Okpala gives a factual account of Anambra's Covid-19 Index Case, how it was detected and how the state has managed the situation so far. Here are the excerpts from the Briefing...
Interviewer: Honourable Commissioner Please can you update Ndi-Anambra on the current status of preparations against the Spread of Covid-19 in Anambra State.
Commissioner of Health: In respect of preparedness of the State against the spread of Corona Virus in the State, the Covid-19 Action Team which His Excellency Governor Willie Mmaduaburochukwu Obiano chairs has done a lot to make sure this virus does not get into the state up until last friday. Now the activities that the state embarked upon started since January 29th 2020. We did a lot of work in infection prevention and CONTROL. We did a lot of work on surveillance, we did a lot of work in awareness campaign and we have been successful. His Excellency went an extra step to start putting in place strategies that will help in disease containment. These strategies were; the lockdown that we experienced, the school closures, the moves made by leaders of religious organizations, the advisory that discouraged handshaking and other forms of contact salutation. All those things that were put in place were to make sure that the virus doesn't come into Anambra State and to add to that the state went further to get ready for case management in case we have the bug come into the state and established Protective Care Centers not Isolation Centers. We have the center at Mbaukwu/Umuawulu that has 240 beds with the capacity to go up to 1000 beds. We have a center at Onitsha that has 58 beds with a world class ICU. We have centers at Ekwulobia, Umueri, Nnamdi Azikiwe University Teaching Hospital and Amaku. So this was where we were till friday last week.
Interviewer: NCDC announced on Friday that there is now an index case in Anambra State. Can you update us on the status of that case? What happened to him? Where is he? What kind of care is the State providing for the index case?
Commissioner: It is true that on Friday last week, NCDC sent a report that we have an index case in Anambra State. We were notified about that index case, we went through various rigors to identify that case. As a matter of fact, that notification came to us around 7-8pm and the team swung into action to identify the case. We knew where that case was as at the time of the announcement. We called the facility the patient was supposed to be in, I personally spoke with the doctors that were on call. Usually when a sample is taken from a patient by us and taken to the test center, we follow up the case up until the result comes out. So we followed this particular case, I called to find out how the patient was doing even before the result came out. I spoke to the doctor that was supposed to be on call in this facility and I was surprised when he said that he didn't know much about the patient. Usually there should be a hand out because when you sign out there should be a hand out to the next physician coming in. So I wasn't happy with the response I got but I took the name of the doctor he said that knew much about this case and he was not in the facility, so I called him until I found out that the patient had actually escaped from the facility and this doctor on duty did not know that the patient was not in the facility at that point in time. So we Started making calls and communicated his Excellency. Our goal at that point was to find out where the patient was. I spoke with the management of the hospital and there was no help coming from anybody. So we had to employ every available means to identify where this individual was at that point in time and it took us up until 3.21am in the morning. I was knocking at doors, entering facilities until with the aid of technology we were finally able to find out where he was.
Interviewer: Where is the Index Case Now?
Commissioner: Right now the index case is in one of our Protective Care Centers and now our centers have been prepared to take care of these cases as they arise. We have trained personnels. As of last week we have over 50 master trainers, Anambra citizens, health care personnel trained to take care of covid-19 patients.
Interviewer: Was that in collaboration with World Health Organization?
Commissioner: Part of it was actually joint partnership with world Health Organization and the European Union and these individuals were trained at the level of Master Trainers so they can actually cascade the training to others. The facility that this individual currently is in has ; ventilators, cardiac monitors, EKD machines, Central oxygen.
Interviewer: So you are saying that this patient is in good care.
Commissioner: Yes, I've been interacting with the patient on daily basis since we picked him up.
Interviewer: When was the last contact you had with this patient.
Commissioner: The last physical contact with the patient was last night (Easter Sunday), I was with the patient for 2hours.
Interviewer: So the rumours flying around Social Media that the patient has disappeared and in his house, so there is no truth in them.
Commissioner: That's a figment of people's imagination, there is no truth to that.
Interviewer: The patient granted some newspapers interview, he said the State Government wanted to kill him and since he was brought into the Protective Care Center ,no treatment was given to him and he was also starving.
Commissioner: One of the reasons we might be having this problem is that His Excellency wants all patients to be taken care of in the most humane way and that is why we have chosen to call our facilities Protective Care Centers opposed to the medically recommended name "Isolation Centers". We don't want our patients to be stigmatized, we don't want our care centers to be stigmatized too, we are solidly against that because this condition is treatable. The survival rate is very high. Globally the case mortality rate for this disease is at 6.1% and in Nigeria it is at 3% so looking at the cases around the country Lagos, people are surviving. So we should not stigmatize each other when it comes. As part of that humane treatment, we left the patient with his telephone and access to his family and friends so he could feel comfortable. He wants to interact but it shouldn't be a source of nuisance and distraction to the management team because if he does, certain privileges would be withdrawn, but right now we are not going to do that. From the time we had his result to the time we engaged the team, it took around 9 hours. I personally led the team that took him to the Protective Care Center. I was in the center till 7- 7.39 am. He said he wanted to eat and I asked him what he wanted and he said he's diabetic he wanted porridge plantain. And I asked what kind of protein do you want in it, he said fish. I was there when the food arrived at 7.30 in the morning. I told him whatever you want, let us know.
Interviewer: What about contact-tracing? How far have you gone with that?
Commissioner: From the time we picked up the index case, the thing that came to our mind was Case Management: treat this patient in a standard manner and then go after contacts for the containment of the disease. We have since then made contact with 29 potential contacts and these contacts are from the facilities that the patient visited, family and friends, business associates and that job continues. As of yesterday we have 29 contacts we have contacted and we have also decontaminated those facilities in question based on NCDC and WHO guidelines. The facilities that the patient had access to.
Interviewer: Is there a testing center in the state?
When it comes to testing, when we get a call for a test to be conducted as a result of symptoms or we have a health care provider call in on behalf of a person that wants to be tested, you call the Anambra State Public Health emergency operation center numbers that have been made available and not NCDC. If you call NCDC they will still refer you to us, we get an average of 150 calls per day. When we get that call we engage you and ask a few questions. We have a case description guideline. We didn't develop that, NCDC and WHO did but every country has now designed theirs to fit their system.
We go through case description, for someone showing symptoms there are a set of questions ... Have you been exposed to someone that has been diagnosed for Covid-19, not a suspected case or are you coming from a place that has wide transmission? The team goes there, interacts with the individual. If he meets what we term 'case definition' then we take samples of such individual to a test center. But if they don't meet the case definition, we explain to them they didn't meet the case definition. The reason is this; we don't test at will, if we collect those samples and take them to a test center, that center could be at Irua in Edo State, it could be in Ebonyi State. If we fill out the form they will still ask more questions to ensure the case meets "case description." So that's why at our level we do a lot of 'checking' to ensure we are not going on a wild goose chase.
When they run a test, we get the result between 24-48 hours. It doesn't matter if the test Happened in Edo State or Lagos. Once we hand over that sample to the test center we loose control. If the result comes out negative, NCDC sends the form and ticket to the negative section. If it comes out Positive they announce it themselves, we don't control if they will announce it or not and that is why things are centrally coordinated. So that is it about testing. Yes, we have been working hard to get a test center in Anambra State. It will save us the 6hrs going and coming from Irua. The NCDC regulates establishment of test centers and we have gone far with them but I want Ndi-Anambra to know that right now we don't have a problem with testing. Anybody that qualifies to be tested have been tested and will be tested and as at that index case we had 13 tests that returned Negative the 14th case was the one that returned Positive.
The new testing method that will come into the state is the use of the Gene Machine to do tests. This is a machine used for tuberculosis patients. We have about 10 testing centers for that. The manufacturers of these machines have developed a cartridge that could also aid in testing for Covid-19 and the result comes out in 15 Minutes. We are in contact with them and have placed an order for it like 3 or 4weeks ago and we were supposed to get it in the next one week but they came back to us saying that America and UK have to be satisfied before they can start shipping to other places. So they promised to get it down by ending of April and beginning of May.
My advice to Ndi Anambra is this;
let me break it down to the barest level. The virus in question does not have wings and doesn't move about. It is people that move the virus. So, if we stay still, the virus stays still and dies but if we move, we move the virus.
Now that we have an index case it has become paramount that we stop moving about. That is the only way we can battle this and it's good a thing people are beginning to understand this. If we were at 60% we have to move compliance rate to 99.9 %. Other countries are regretting not strictly adhering to directives and in the US, they have over 20,000 deaths. We don't want that to happen to us here in Anambra. We should stick to what science has proven to work. We need to observe all the measures put in place and stop moving the bug around. If we do that we will win this battle.
