Pandemic Diary #4 – Infectious Diseases Specialist

This week, Farida and Damilola spoke with an infectious disease specialist working in the COVID19 management team.

What is your current role in the COVID-19 response and what was your role before getting involved?

Primarily, I work as a clinician, I am a doctor; I see patients and that’s what I do on a day-to-day basis. For the response, I see patients and I work in the infection, prevention and control unit. I do training for doctors. I also help to assess health centre standards for COVID-19 management.

I specialize in infectious diseases.

From your background, it’s evident that you worked during the Ebola period.

Yes, I did.

Based on your experience managing both outbreaks, what are the major differences so far?

They are both RNA viruses, though Ebola is a type of hemorrhagic fever similar to Lassa fever. However, COVID-19 is a bit different because it is more of a respiratory virus so the route of transmission is different. Also the major difference between these viruses is that the Ebola virus outbreak was quite short, it basically lasted from July to October before Lagos was declared free. In addition, the confirmed cases in Nigeria were not up to 20 patients. However, with COVID-19 the confirmed cases are in the thousands with no end in sight for the response, so it’s more of a marathon.

Why was Ebola controlled in a shorter space of time?

When you look at the global response, we have never dealt with something like COVID-19 before in recent world history, of course, we had the Spanish flu in the 19th century. The problem is that we have never dealt with something on this scale. So it has been quite difficult.  

When you look at Nigeria, Lagos state had a tremendous advantage over other states because of the extreme experience we had with viruses like Ebola. So there was a more coordinated response but these are two different viruses and no one has experienced COVID-19 before, so we are all learning as we go.

Cool. How do you feel about the federal government’s imposed lockdown, as seen by the developed countries of the world?

It would be difficult to make a judgment call on that now. This is because all over the world people have been placed on lockdowns and there are many arguments on whether lockdowns are effective or are not. The U.S tried to lockdown but they currently have the highest cases of COVID-19 patients in the world. Now that they are trying to reopen, we can see a surge in cases. Sweden didn’t lockdown and the virus dealt with them rather badly. For Nigeria, based on the situation we were in at that time, I think a lockdown was inevitable. The effectiveness of the lockdown can be questioned. Did we achieve what we sought to achieve? I don’t think so but like I said, we wouldn’t beat ourselves too much over many of these things. We just rather move on, learn, and go.

On treating patients, what’s the mental effect it has had on you?

As physicians, we face one of the highest levels of mortality. It’s not very strange to see patients die; sad to say. The problem with COVID is that it has been difficult to predict. We see patients who get into critical situations and go home. Some get in similar conditions and die. The most disturbing aspect for me is those that talk until they die. You examine them breathing well and all of a sudden, like the snap of a finger, they are here and the next minute they are gone. I’m like, “What?! Is this the man I just spoke with?” So it’s been challenging, you know.  

I have been practicing medicine for years now so I have kind of built a fortitude against these things. However, you can’t be hardened. These things still consume us and we just try to move on to the next patient.

Any highs and lows so far?

Well, I will start with the lows; In the early days of the response, especially when we saw a lot of funds being spent on unnecessary PPEs and the guidelines weren’t being followed.  Personally, it was a hard time for me because I saw things sliding and I couldn’t do much about it. Change is difficult. It was only about two to three months after that we were able to win people over and people started coming around. I was happy that people were trying to conserve PPE like hazmat suits, as they knew they could do well with just a surgical gown. This aided in the preservation of limited PPEs.

Furthermore, I am happy with every patient that survives COVID, we have had a 98 year old survive, and for every patient I discharge, I reiterate the fact that they are very lucky to survive. It has been quite challenging, I have never been this stressed in my life. I am chronically tired, a lot of times I wake up but I doubt I have the energy to get up but I just have moved on. I pray we just get out of this phase because this has very challenging for all of us.

As an experienced doctor, we realize that you are used to this, however, have you heard of other doctors breaking down?

Yes, we have had other doctors suffer a physical and mental breakdown which is quite worrisome. However, for me, I have not suffered either, although I get very tired. I wish everything could be over because it has been very stressful. Thankfully. we have not been as swamped like other parts of the world but we have also been strained. I have been close to breaking down but due to my reserve I am yet to suffer one

How has this affected your family life?

Interestingly, I got married in September 2014 which was smack in the middle of the Ebola response. My fiancé then, now my wife used to drop me off at Yaba; so she has been extremely supportive. There was also an outbreak of yellow fever at Bauchi in 2019. We went on vacation to the Yankari game reserve and all of a sudden, there was an outbreak. Immediately, I started case investigation and she was there with me.

Earlier in the response, there was the challenge of either going from home or staying in a hotel. And all she said was that it was also my house and we would get through the situation together.

End this for us on a happy note

We should thank everyone involved in the response. It’s been challenging for us in every single way. I think I want to salute everyone that has poured blood, sweat, and tears to get us to where we are today.  We just need to keep pushing until we get rid of it. We have been through this from the very first patient until now. We have seen all the ways we have evolved. We have become stronger, harder, tougher, better, and more skilled. We pray that God will shorten the days and we will go back to our normal lives sooner than later.

……….

We are grateful to this doctor for graciously granting this interview.

TWEETS #21

Sarcastic remark on claps for health workers

Wear a mask

America fattening the curve

Plea for correct wearing of masks

Paediatrics warns of spread between colleagues

Is there a new normal after this?

Canadian PM on plan to give health workers protective wear

Bereaved relative appeals for mask wearing.

Nigerian lawmaker describes loneliness of friend in isolation ward

Family appoints member to oversee plans for possible infection

Woman who lives with brother who tested positive details how masks and social distancing kept her negative as he recovered

ARTICLES #21

SA’s coronavirus cases continue to soar: Exceeds 200,000 mark

Coronavirus: How fast is it spreading in Africa?  

https://www.bbc.com/news/world-africa-53181555

Egypt reopens airports and welcomes tourists to pyramids after COVID closure

https://www.reuters.com/article/us-health-coronavirus-egypt/egypt-reopens-airports-and-welcomes-tourists-to-pyramids-after-covid-closure-idUSKBN2426VX

The effect of COVID-19 on food and income security in Africa

Egypt’s economy to decline due to COVID-19 impact: IMF

COVID-19: African countries reliant on tourism, oil exporters to be ‘hardest hit’: AfDB

How Pandemics Wreak Havoc—and Open Minds

https://www.newyorker.com/magazine/2020/07/20/how-pandemics-wreak-havoc-and-open-minds

The Covid-19 changes that could last long-term

https://www.bbc.com/future/article/20200629-which-lockdown-changes-are-here-to-stay

Madagascar re-imposes lockdown amid surge in virus cases

https://m.guardian.ng/news/madagascar-re-imposes-lockdown-amid-surge-in-virus-cases/

Malawi’s election cheer dampened by coronavirus surge              

https://af.reuters.com/article/idAFKBN24608L-OZAT

Malawi cancels Independence Day celebrations due to COVID-19

Ghana president self-isolates despite negative virus test

https://www.france24.com/en/20200705-ghana-president-self-isolates-despite-negative-virus-test

AU Commission sets stage for start of clinical Covid-19 vaccine trials

https://www.nation.co.ke/kenya/news/africa-cdc-to-start-covid-19-vaccine-trials-1447988

African Union Commission launches Covid-19 vaccine trial consortium

Covid-19 hit July 4th travel harder in some states, study finds

https://www.cnbc.com/2020/07/08/covid-19-hit-july-4th-travel-harder-in-some-states-study-finds.html

Hundreds of people celebrated the July 4 weekend at a Michigan lake. Now some have Covid-19

https://www.cnn.com/2020/07/12/health/michigan-coronavirus-torch-lake-sandbar/index.html

PRECIOUS-Gold ticks higher on worries over rising COVID-19 cases

https://uk.reuters.com/article/global-precious/precious-gold-ticks-higher-on-worries-over-rising-covid-19-cases-idUKL3N2EK04O

COVID-19: Govt to ban some countries from Nigeria        

COVID-19: Nigerian govt releases new guidelines for resumption of schools

https://www.premiumtimesng.com/news/headlines/402738-covid-19-nigerian-govt-releases-new-guidelines-for-resumption-of-schools.html

COVID-19 may be transmitted through air – NCDC

https://www.premiumtimesng.com/news/top-news/402746-covid-19-may-be-transmitted-through-air-ncdc.html

Gold rate rises to Rs 49,000 on surging Covid-19 cases

https://economictimes.indiatimes.com/markets/commodities/news/gold-prices-today-rise-to-rs-49000-on-surging-covid-19-cases/articleshow/76932493.cms

Coronavirus: Nations heading in wrong direction with Covid-19, says WHO

https://www.bbc.com/news/world-53393037

Egyptian journalist jailed on fake news charges dies of Covid-19

https://www.theguardian.com/world/2020/jul/14/egyptian-journalist-jailed-on-fake-news-charges-dies-of-covid-19-mohamed-monir

Covid-19 restrictions are shattering Argentina’s short-lived political truce

https://www.theguardian.com/world/2020/jul/14/covid-19-restrictions-are-shattering-argentinas-short-lived-political-truce

COVID-19: Linking loss of smell, depression, and anxiety

https://www.medicalnewstoday.com/articles/covid-19-linking-loss-of-smell-depression-and-anxiety

How COVID-19 is affecting HIV 2020 target – UNAIDS     

https://www.premiumtimesng.com/news/top-news/401786-how-covid-19-is-affecting-hiv-2020-target-unaids.html

Ocean investment could aid post-Covid-19 economic recovery

https://www.cnn.com/2020/07/13/world/ocean-investment-world-resources-institute-cte/index.html

German study finds low Covid-19 infection rate in schools

https://www.theguardian.com/world/2020/jul/13/german-study-covid-19-infection-rate-schools-saxony

Covid-19 immunity from antibodies may last only months, UK study suggests

https://www.cnn.com/2020/07/13/health/covid-immunity-antibody-response-uk-study-wellness/index.html

US military bases in Okinawa hit by Covid-19 as outbreak worsens

https://www.cnn.com/2020/07/13/asia/us-military-bases-okinawa-covid-19-intl-hnk-scli/index.html

Pandemic Diary #3: Frontline Driver, Lagos

First, explain the role you play in the COVID-19 response?

I primarily drive the ambulances used in evacuating confirmed cases from their homes to the isolation centre. Before we leave for any evacuation, we are given PPE like gloves, nose masks, and hazmat suits. While in motion, we put on our sirens to ensure swift arrival to the evacuation site. We drivers usually don’t get down from the car during an evacuation, the nurses and members of the evacuation team usually go into the house to evacuate the patient into the bus. Due to the nature of the virus, we do not use the air conditioners when we pick people that have tested positive to the coronavirus, this is to promote the circulation of air. Then they are transported to the Infectious Disease Hospital, Yaba.

Other than driving evacuation ambulances, what other role have you played?

Initially, when I got enlisted to join the response from my LGA, I was asked to help transport the samples from collection sites to the laboratory for testing.

How has the work affected your family?

The work has not been easy on my family, I have not been able to go home. I have been living at a hotel. Unfortunately, most Nigerians do not believe in COVID-19. Due to my exposure and experience, my family is very aware of the risk involved. Hence, they are very concerned about my safety.

Is it that they are frightened about your status?

Of course, they are. Usually, when I come home, they keep a distance from me *laughs*. I have not ever had symptoms that relate to COVID-19. Well, the thing is I have had the opportunity of conversing with medical doctors who have laid down precautionary measures needed to protect myself and boost my immunity against the virus. I have been encouraged to take vitamin C and fruits, to mention a few.

Since you work as a frontline driver, have you experienced any patient in a critical condition?

Yes o!!! I have seen patients that have had to be revived or stabilized with oxygen masks. For example, there was a patient in critical condition that we had to evacuate. Fortunately, we arrived early and were able to revive her with oxygen while for others, when they get sick with COVID-19, they assume that they can self-medicate which can be dangerous at times. I try as much as possible to inform confirmed patients, to seek professional medical help instead of taking unnecessary medication from local dispensaries. The biggest dilemma facing Lagosians in general regarding treating medical conditions is the misuse of medication. For example, one may have a common cold and proceed to use medicines for headaches while the actual condition worsens. This is exactly what is happening with the COVID-19 response in Lagos.

Have you seen anybody that has died during evacuation?

Yes a few about 3 to 4 deaths.

Silence

Have the deaths had any effect on your mental health?

Not at all, I am not affected. As I said earlier, the major issue affecting most people is the lack of awareness and information on preventive measures needed to prevent being infected with the virus. Like me now, after a long day, I always take my medication, supplement with fruits, and get enough rest.

Give me a breakdown of a typical day for a frontline driver.

First, I work Sundays to Saturdays. Luckily, I do not sleep a lot, “Kerosene ni mi” (I am kerosene). I am ready for duty anytime around the clock, my roommate can attest to that. For example, a few days ago I was called by a doctor to evacuate a critically ill patient from a hospital to an isolation centre. Even though the rain was pouring heavily, I was able to evacuate the patient successfully.

What advice will you give the public?

My advice to the public is that no one is above the virus and immediately you discover you have been exposed to a confirmed case or notice any symptoms, do endeavour to visit your local health care centres or hospitals. Another thing is that for some people the fear of the virus is responsible for their deaths. In one of our female wards, a patient died after hearing of her roommate’s death. On a positive note, few of my colleagues have been infected and have survived, So COVID IS ONLY A DISEASE AND NOT A DEATH SENTENCE.

TWEETS #20

Person loses relative, says corona is real

Cousin who died alone

Mum lost battle with COVID19

Prudent alarmism saves lives.

We are sick and tired, the virus is not

500 Delta Airlines employees test positive with 10 dying

Grieving family requests hot coffee thrown on faces of those not wearing masks in lieu of flowers.              

ARTICLES #20

NHS faces staff shortages ahead of second wave

https://www.independent.co.uk/news/uk/politics/coronavirus-uk-winter-second-wave-nhs-hospital-staff-shortage-a9588041.html

Many people report delirium      

https://www.nytimes.com/2020/06/28/health/coronavirus-delirium-hallucinations.amp.html#click=https://t.co/PXDjEKwvzg

MIT Robots disinfect Greater Boston Food Bank 

Who gets the vaccine first?

https://www.wired.com/story/lets-say-theres-a-covid-19-vaccine-who-gets-it-first

How humanity unleashed a flood of new diseases

Fragile healthcare system in Peru is being tested.

A world without detention centres

https://english.alaraby.co.uk/english/comment/2020/6/19/coronavirus-emptied-detention-centres-they-should-remain-closed-forever

A story of two national COVID19 responses

https://english.alaraby.co.uk/english/comment/2020/6/19/a-tale-of-two-covid-19-responses

How British Columbia prevented new outbreaks

https://www.theglobeandmail.com/canada/british-columbia/article-a-lesson-learned-early-how-bc-has-avoided-major-covid-19-outbreaks/

Coronavirus: UK’s Covid-19 alert level reduced from four to three

https://www.bbc.com/news/uk-53106673

Coronavirus: Brazil becomes second country to hit one million cases

https://www.bbc.com/news/world-latin-america-53092196

CureVac Begins Human Trials of Optimized mRNA COVID-19 Vaccine

COVID-19: UN health agency warns of ‘new and dangerous phase’ as cases mount

https://news.un.org/en/story/2020/06/1066732

Coronavirus: Palestinian Authority closes two West Bank cities after virus spike

https://www.middleeasteye.net/news/coronavirus-palestinian-authority-closes-two-west-bank-cities-after-virus-spike

Coronavirus: Spain to allow UK tourists without quarantine          

https://www.bbc.co.uk/news/uk-53122825

Chile reports more than 7,000 virus deaths under new counting method

https://m.guardian.ng/news/world/chile-reports-more-than-7000-virus-deaths-under-new-counting-method/

French stadiums to allow fans in from July 11 – government

https://www.eurosport.com/football/ligue-1/2019-2020/french-stadiums-to-allow-fans-in-from-july-11-government_sto7781096/story.shtml

Pope hails Italy virus doctors, nurses as heroes at Vatican

https://www.washingtonpost.com/world/europe/pope-hails-italy-virus-doctors-nurses-as-heroes-at-vatican/2020/06/20/1d5cbf10-b2ea-11ea-98b5-279a6479a1e4_story.html

How COVID-19 and the climate are transforming the real estate sector

https://www.weforum.org/agenda/2020/06/what-effect-has-covid-19-had-on-the-real-estate-sector/

Novartis halts malaria drug trial against COVID-19 amid participant shortfall

https://www.thejakartapost.com/life/2020/06/20/novartis-halts-malaria-drug-trial-against-covid-19-amid-participant-shortfall.html

Costa Rica halts reopening as coronavirus infections rise

https://www.reuters.com/article/us-health-coronavirus-costa-rica/costa-rica-halts-reopening-as-coronavirus-infections-keep-rising-idUSKBN23Q37L

Zimbabwe’s health minister charged in COVID-19 graft case

https://www.washingtonpost.com/world/africa/zimbabwes-health-minister-arrested-in-covid-19-graft-case/2020/06/20/8d71f362-b2e3-11ea-98b5-279a6479a1e4_story.html

Data fog: Why some countries’ coronavirus numbers do not add up

https://www.aljazeera.com/indepth/features/data-fog-countries-coronavirus-numbers-add-200607065953544.html

Nearly 1,500 deaths in one day: UK ministers accused of downplaying Covid-19 peak

https://www.theguardian.com/world/2020/jun/19/over-1000-deaths-day-uk-ministers-accused-downplaying-covid-19-peak

COVID-19 spreads in cramped Rohingya refugee camp

https://www.aljazeera.com/news/2020/06/covid-19-spreads-cramped-rohingya-refugee-camp-200620110652714.html

What is an immunity passport and could it work?

https://www.weforum.org/agenda/2020/06/immunity-passport-quarantine-work-covid-19/

Three months, 14 swab tests: A 29-year-old Indonesian’s coronavirus ordeal.

https://www.aljazeera.com/blogs/asia/2020/06/months-14-swab-tests-29-year-indonesian-coronavirus-ordeal-200617232447617.html

Coronavirus live updates: Staggering jobless claims persist; global deaths near 450,000.

https://www.cnbc.com/2020/06/18/coronavirus-live-updates.html

Premier League: One positive coronavirus test in latest phase of mass testing.

https://www.skysports.com/football/news/11095/12008446/premier-league-one-positive-coronavirus-test-in-latest-phase-of-mass-testing

Jakarta Post: New coronavirus cases in New Zealand rattle public confidence – The Jakarta Post.

https://www.thejakartapost.com/news/2020/06/18/new-coronavirus-cases-in-new-zealand-rattle-public-confidence.html

COVID-19 infections surge in six US states.           

https://www.aljazeera.com/news/2020/06/covid-19-infections-surge-states-200618083951837.

WHO urges caution on ‘breakthrough’ coronavirus drug dexamethasone, citing early data.

https://www.cnbc.com/2020/06/17/coronavirus-update-who-urges-caution-on-dexamethasone-citing-early-data.html

Brazil faces the coronavirus disaster almost everyone saw coming.

https://www.washingtonpost.com/world/2020/06/15/brazil-faces-coronavirus-disaster-almost-everyone-saw-coming/

Trump Says Coronavirus Will ‘Fade Away’ Even Without Vaccine.

https://www.bloomberg.com/news/articles/2020-06-18/trump-says-coronavirus-will-fade-away-even-without-a-vaccine

WHO gives up on hydroxychloroquine for COVID-19, stops trials.

https://arstechnica.com/science/2020/06/who-gives-up-on-hydroxychloroquine-for-covid-19-stops-trials/