Case count and the pandemic

It was a hard fought battle of will, but one guaranteed to turn out an upset. After digging in its heels for three months against being numbered among Nigerian states where Covid-19 has made landfall, Kogi State fell to the case count last week with two confirmed infections. That leaves Cross River only as at the time of writing this piece – among Nigeria’s 36 states and the Federal Capital Territory (FCT) – standing with zero record since the country’s index case was reported on 27^th February 2020. Kogi had tag teamed with Cross River until it was credited with two cases by the Nigeria Centre for Disease Control (NCDC) last Wednesday – a day that Nigeria recorded an unprecedented daily count of 389 cases.

Neither Cross River nor Kogi State was spared mud fight over the claim of being coronavirus free. Federal medical authorities and stakeholders even within the states accused both state governments of avoiding testing of samples as could show up their true status on the pandemic. Against that charge, the state governments held their ground on testing only when adjudged necessary. But then, the official case count itself wasn’t without controversy, as the two states alleged enormous pressure on them to declare fictitious cases of infection so to make up the national numbers.

Just before Kogi showed up on the infection list last week, doctors in the state accused the state government of shunning testing for the virus. “People are showing symptoms of Covid-19 – even though it may not be all the symptoms of the disease, but doctors suspect Covid-19; and because we were not able to carry out tests, we could not confirm (and) everything ends at the level of suspicion,” chairman of Kogi State branch of the Nigerian Medical Association (NMA) Dr. Kabir Zubair was quoted saying by Vanguard newspaper. The state government rejoined that it was ever ready to contain the virus and had made quantum provisions for testing of samples; but it did not commit to actual testing beyond its own designs. Health Commissioner Dr. Saka Haruna Audu was reported saying: “Kogi State remains committed to fighting Covid-19, a global pandemic, irrespective of reservations we may have over its handling in Nigeria. It is also important that we dismiss the notion that we are not inclined towards testing for the virus. What then will be the use of procuring over 5,000 test kits worth several tens of millions of Naira?”

Early in May, the Kogi government had declined to conduct test on a potential case who volunteered for testing, saying it suspected that plans were afoot to illicitly ‘import’ cases of coronavirus into the state. Information Commissioner Kingsley Fanwo in a statement said the government refused the request by an expatriate worker in the state to be tested for coronavirus infection because “the case does not fit into the spectrum of criteria set by the NCDC for actual or suspected Covid-19 cases requiring testing.” He added: “In view of the fact that Kogi State is one of only two states still Covid-19 free in Nigeria and having regard to recent pressures from some interesting quarters for Kogi State to find and declare cases of the disease, we are wary of an unholy conspiracy to declare Covid-19 in all states of the federation.” Incidentally, it was the same week that Kogi Governor Yahaya Bello ordered NCDC officials on a mission to his state to first go into 14-day quarantine at the state’s isolation facility and then get tested for coronavirus infection before getting to work, warranting that the mission be aborted.

Cross River State likewise has been steeped in heated controversy. Among others, doctors in the state canvassed that more testings be done to lay bare the true local situation of the pandemic. “The unacceptably low number of persons tested in Cross River suggests a lack of diligent, expansive and coordinated surveillance response, which is the hallmark of effective prevention and containment of Covid-19,” the state NMA chapter said in a recent statement jointly signed by its chairman, Dr. Agam Ayuk, and secretary, Dr. Ezoke Epoke.

“Much as Covid-19 is real and must be tackled with all vigour and collective will…there (is) need to tidy up the case counting”

Cross River government, however, insisted it was doing enough testing for the virus, and that the whole narrative was rather about pressure on the state to by hook or crook post figures of infection. Health Commissioner Dr. Beta Edu argued: “It is not compulsory or a must that Cross River must record a Covid-19 case; the pressure for us to have a case is really getting out of hand…People have come forward with text messages they received asking them to claim that they are Covid-19 positive and they will be paid for that. Every state in Nigeria must not have it, Cross River is peculiar.” She reeled out proactive measures the state took to stay ahead of the pandemic, adding: “Why is Cross River being criticised and castigated? Instead of so much castigation, we should be approached by the government to understand what we are doing differently.’’

When Kogi eventually fell to the case count last week, it did not submit tamely. Although Information Commissioner Fanwo was initially cautious, saying the state government was evaluating the situation and gathering the facts; his Health counterpart, Audu, was categorical that the status quo remained unchanged. “Kogi State till this very moment is Covid-19 free. We have developed full testing capacity and have conducted hundreds of tests so far that have come back negative. We have also continued to insist that we will not be party to any fictitious Covid-19 claims, which is why we do not recognise any Covid-19 test conducted by any Kogite outside the boundaries of the state except those initiated by us,” he said. Responding to journalists’ query on this claim at the daily media briefing by the Presidential Task Force on Covid-19, Thursday, NCDC Director-General Chikwe Ihekweazu retorted that the procedure of identifying positive cases was not one over which he had influence or control, and nothing in which he had any personal stake.

Case counting since the outbreak of Covid-19 pandemic in Nigeria has not been without disputation, and that isn’t from only Kogi and Cross River states. One notable instance that effectively left mud in the face of governing authorities is 58-year-old Susan Idoko-Okpe who was cited as Benue State’s index case of the pandemic, but who rejected purported results showing her testing positive and claimed she had spurned all related medications, yet remaining without symptoms for all of more than 50 days she was held in quarantine – against her will – until she was let off penultimate week. That was a messy case, if there was one.

The lesson to draw is that much as Covid-19 is real and must be tackled with all vigour and collective will that can be mustered, there may be genuine need to tidy up the case counting. The word in town lately is that many medical complaints taken by Nigerians to hospitals, whether public or private, get reckoned as Covid-19 related and billed accordingly – even where a complaint might be as disparate from respiratory issues as a bodily bruise. There is an echo of this in the unproven claims by Kogi and Cross River governments of pressure on them to declare fictitious cases. The unstated implication is that there is a way associated bills get underwritten from the national war chest against the pandemic; and if this is in any measure true, it means some operators within the governance and healthcare systems are exploiting the attention to containing this pandemic to fleece the common treasury.

This is something the Muhammadu Buhari administration should be interested looking into to staunch an underlying epidemic of corruption.