In a near replay of the July 20, 2014 Ebola Virus Disease episode when Liberian Patrick Sawyer imported the Ebola virus into the country undetected through the Muritala Mohammed International Airport, MMIA, an Italian national has imported the COVID-19 virus into the country through the same airport on February 25th 2020.
The Federal Ministry of Health and the Lagos State Ministry of Health had, in early hours of Friday February 28th, confirmed the case in Lagos. It is the first case of COVID-19 to be reported in Nigeria and in sub-Sahara Africa and the third in Africa after Egypt and Algeria since the outbreak occurred in China in December 2019.
Lagos state Commissioner for Health, Prof Akin Abayomi, told reporters during an emergency press briefing in Lagos on Friday, that the index case – a consultant with Larfarge Cement Company, Ewekoro, Ogun State - came into Nigeria on the 25th of February from Milan, Italy for a brief business visit.
According to Abayomi, the patient, a traveller, initiated his journey from Milan, Italy, on Monday, 24th February, transited through Istanbul on-board a Turkish Airline aircraft and arrived Lagos on Tuesday night, spent the night in an hotel near the airport and on Tuesday morning, he moved on to his business in Ogun State, a corporate entity.
"He carried out his business within Ogun State within the confines of the company. And on Wednesday he spent the night in their accommodation, a guest house. By the afternoon, he started to develop symptoms of high fever and body pains. He presented through the company medical facility, where investigation began. He gave a history of his origin of Italy, where we know there is a young outbreak."
Abayomi said it was astute of the medical personnel to keep him over night in an isolated environment.
"They contacted us at the biosecurity unit in Lagos for assistance and we immediately asked them to transfer the case to Lagos. He was brought to our high containment facility in Yaba on Thursday morning. Immediately, he arrived, he was put in strict isolation and appropriate tests were ordered.
Lagos responds promptly, begins contact tracing - Prof Akin Abayomi
"Within hours we received signals that the test in the laboratory was showing signs of positivity. At that point, we informed the Federal Minister of Health, the incident commander in the state, Governor, Babajide Sanwo-Olu and the Minister informed higher authorities in Abuja.
Noting that it was self important at that time to put together information for the public, Abayomi stated that the patient remains in strict isolation at the containment facility in Yaba and was doing well with supportive therapy.
In response to the development, the Lagos state government immediately started tracing persons that might have had contact with the index case from the airport through Lagos to Ogun State. According to Abayomi, this is important in order to start the isolation and containment of exercise that will break the cycle of transmission of the disease. He said Lagos has set in motion efforts to expand its isolation capacity.
"The important thing to know is that the patient is confined and we have started to identify his contacts all the way to the airline. That process started about 3.00am this morning. We would like to assure everybody that we are on this case to ensure that we can identify everybody that he must have come into contact with.
"His symptoms are subsiding and he does not have signs of respiratory disease which is a good thing, but he does have fever and body pains. If he had respiratory illness it is probably like that he may be more contagious than he is at the moment.
"At our infectious disease facility, we have ramped up capacity to isolate suspected cases. We are now sitting on an about 80-bed isolation facility because of the emergency funds that have been released by the incident commander. We need more capacity in case we have an increased number of cases in Lagos."
Abayomi said Lagos has a very aggressive public awareness campaign going on and has engaged in extensive training across the hierarchy of health professionals in Lagos.
"In addition we are building capacity to diagnose in Lagos and right now we can run the test in two centres in Lagos, one is in the biosecurity facility and the other at the Lagos University Teaching Hospital, LUTH. We are in constant contact with the Nigeria centre for Diseases Control, NCDC, and Minister of Health in Abuja."
Officials of the Port health services on ground at the airport were unable to detect that the Italian was carrying the virus because he manifested no symptoms. The Minister of Health, Dr Osagie Ehanire, explained that it was not a failure of screening. At an emergency press briefing in Abuja on Friday morning, he told journalists that most people who are infected with the coronavirus, may experience only mild illness and recover easily.
"It is not a failure of screening because coronavirus symptoms may not manifest within the first several days, so the person that is infected may not show any signs at all within the first few days or five days and then the symptoms begin. So if that person has traveled within that window, that person gets through anywhere and may not be noticed.
According to Ehanire: " The Italian went through the screening without symptoms and by the time he got to his house, I think a day or two after, he started to feel unwell and wisely enough he went to a hospital and there the doctors examined him and I believe they found that malaria was negative and they knew his travel history and they immediately referred him for a test in Lagos at LUTH testing centre and there it was discovered that he was positive for coronavirus and immediately put under isolation. In fact he has been put on isolation from the referral hospital in a special ambulance.
"As a matter of fact we need to commend the hospital for thinking ahead, not wasting time and taking necessary measures and commend Lagos state government for responding very appropriately. There was free thinking on the side of the hospital and on the side of the driver to transport him under those special conditions to the Federal infectious disease hospital in Lagos. He has immediately been put under very strict isolation, receiving treatment and the information I have this very morning is that he is stable.
"The symptoms for people will not be equally severe. And in fact there are speculations that up to 80 percent of people who get the coronavirus infection may show only mild symptoms or none and 20 percent will get very severe symptoms but all this is still under investigation. As we know this novel coronavirus even if it is new, it's behaviour is not very clear and there is a rapid flow of information coming up about it which is just beginning to enlighten the public. The scientists are working very hard to know more about it".
On tracing of the contacts, Ehanire said; "We are looking at all those people whom this man has been in touch with backwards from the day he was admitted. The first point of call whenever anybody enters the country is the Port Health services.
The Port Health services will be working with the airline to get the passengers manifest and find out where this gentleman was, and also where he sat and also those who sat around him and set up a monitoring system for all passengers and the crew members of that particular flight in order to get information to monitor their state of health within the next 14 days.
And further questioning of the gentleman will also reveal to us where he was and all the places he went. All we know now is that he came from Milan where he was before' it doesn't seem that he ever was in China. So he may have acquired it as a form of community infection from his own country."
Speaking on the issue of quarantining of travelers, Ehanire recalled that the World Health Organisation, WHO, has advised all countries that there is no need to put every single traveler into quarantine.
"There are some other countries who choose to do differently but we follow the guidelines of the WHO which say that screen all persons who are entering your country, check their travel history, if they are coming from a country that has a high rate of coronavirus, invite them for further questioning, give them a phone number to call and take their phone number and advise them in the interest of their own families and friends to stay in self isolation for 14 days and report any symptoms immediately.
"Not only that, if you do not call, we call you and find out how you are and if you have any suspicious symptoms we send an ambulance to get you. Our focus is on the multifunctional international airports in Lagos, Abuja, Port Harcourt, and Kano. Enugu Airport has been closed and I understand it will be opened very soon but we are also preparing for that possibility.
According to the Minister, the level of preparedness continues to improve in Nigeria every day. "Training is going on, the people that we call the port health workers are receiving training, they are visited by the NCDC to continue to sharpen their skills, preparedness, and knowledge. We are constantly looking at where there are weaknesses. Even the forms the passengers fill when they arrive we continue upgrading, immediately we discover that there is a gap some where we upgrade it and repair the gaps that are in there. So everything is been done to improve preparedness and improve ability to respond rapidly.
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