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.

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