civineerArticle originally appeared on Sky Daily Online Newspaper.
Many people have expressed concerns on the closure of different state borders across Nigeria. Citing it as needless due to zero reported cases of COVID-19. While that sounds cogent superficially, something has slipped the attention of the government in those states. When the FCT and especially Lagos State announced its intention to lockdown their states, many people conducting business in those places rushed in troops to go back to their state of origins. None of them were tested when they arrived.
Could they have been exposed to COVID-19 and not infected, or just the latter? Could there be cases of pre-symptomatic or asymptomatic patients? Are there reported increase in death cases in those regions? Asymptomatic patients- unconfirmed COVID-19 carriers with zero symptoms and especially without travel history to the most affected countries won’t get tested in majority of countries. On average, 1 in 4 carriers are asymptomatic. Adding to the conundrum, pre-symptomatic transmission has been shown to responsible for up to 50% of the infected cases globally. Could we be having asymptomatic patients in many parts of Nigeria?
No. But who knows. Autopsy is neither done on corpses nor usually reported to the right authorities.
As I continued to wonder about the chances of our collective survival with this uncertain climate of the pandemic, I needed many answers. One is how quickly a vaccine can be developed for 7 billion people-which is about 18 months sadly. And the second is the how quickly can the lab test of COVID-19 be conducted and the results deduced.
Before I went further, I traveled back memory lane to understand how the virus was uncovered and tested. In October of 2007, 4 scientists working at The University of Hong Kong published a scientific paper in volume 20 of the journal of Clinical Microbiology Reviews titled Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Re-emerging Infection. It had a wary concluding title “should we be ready for the re-emergence of SARS?” They had uncovered the presence of coronaviruses (SARS-Cov-like viruses) in horseshoe bats, which possess wide susceptibility for genetic recombination and outbreak.
As the Chinese population continue to consume these bats, and studies are being investigated of the viruses in the lab, then outbreak is more than likely from either of those 2 sources. The scientists warned. No one took heed. About 12 years later, on 8 December 2019, a young man fell ill and visited a nearby hospital, representing the first reported case of COVID-19.
And on 7th January, the medical officials at Wuhan City in China were able to identify a new form infection. It was a new type of infection called 2019 novel coronaviruses, then. Although coronaviruses have been studied and known for a while since 2007, but not of this nature. The previous ones only affected animals. This, infected us.
Some German scientists working in Berlin developed the reagents and the laboratory procedure to test for the 2019 novel coronaviruses on 17 January 2020. By the beginning of February, the virus has hitchhiked to at least 21 different countries in all continents except Africa. The World Health Organization (WHO) quickly adopted the German procedure and spread to countries affected by the epidemic.
By February 11, a naming ceremony was held. The International Committee on Taxonomy of Viruses (ICTV) met and changed the name of this epidemic to SARS-Cov-2. Apparently, viruses are named according to their genetic structure in order to enable development of vaccines, medicines and diagnostic testing. Soon after the convention of the virologists, WHO renamed the disease to Coronavirus disease and gave it an acronym COVID-19. 19 representing 2019, the year it unfortunately exploded.
This naming pattern reminds us of the epidemic that erupted in 1981 and still exists today; HIV/AIDS. More than 25 million people have died from this. HIV is the name of the virus, but the disease the virus causes is AIDS. And so does it apply for SARS-Cov-2, the virus causing the disease, COVID-19.
Bill Gates largely touted as the predictor of COVID-19, with the oblivion of the research from Hong Kong in 2007, in a talk show with Trevor Noah mentioned our greatest weapon to fight it, aside social distancing, and what countries need to do, is “we need to prioritize the testing.”
Without this testing data, we cannot tell if this pandemic is living in us or not. And we cannot fight it, except by staying at home. We need testing stations in every state in Nigeria.
In South Korea, one of the 2 most successful countries to flatten the curve early, its Foreign Minister mentioned their most lethal weapon was social distancing in addition to how fast they administered the test and how they openly communicated with their citizens.
As at January, tests result took longer than 24 hours to get globally. In the earlier days, as long as 72 hours. But South Korea’s research labs were able to develop a kit that enabled them provide results in less than 24 hours. With that global record then, numerous testing stations were set up in the country. The most notable ones being the drive-throughs, and for everyone passing through. Not just those showing symptoms. This sampling, goes against the global norm.
As of January 21st, only 11 South Koreans were tested, averaging 10 tests daily. As of March 23, South Korea has tested more people (316, 000) than any country and the closest country, Germany has done only half the number (167, 000) they did. Soon, after, countries like the US started prioritizing the tests and changing testing policies and protocols.
The day COVID-19 was declared a pandemic by WHO, March 13, the US were averaging about 6, 000 tests daily. As of April 7th, the US were averaging more than 150, 000 tests daily, Italy (35, 000) and South Korea (6, 000), so far representing the highest in the world. Remarkable change in testing policies and President’s Trump final acceptance of the presence of the disease. Although Nigeria’s daily testing capacity is increased to 1, 500 daily, same number of people are not tested daily. A different testing policy is in place here.
By April 6th, South Korea (466, 000), Italy (721, 000) and the US (1.92 million) have tested more people than anywhere in the world due to wide scale testing stations and outcome. The testing protocol for many countries including Nigeria is that not everyone gets tested until they tick a number of questions. Excessive symptoms, travel history to a country with severe cases, recent contact with people with such travel history and so many others. If you do not tick all the boxes, you cannot get tested.
How did South Korea achieve such speed and high number of people? Their protocol is to test everyone going through the testing stations.
As of April 8, the NCDC reported only about 5,000 people have been tested for the deadly virus in Nigeria. Even though the crisis centre of NCDC has reported to receive many phone calls, most of them were simply turned down.
As I started digging deeper about how the test could be expedited and set up across the country, I paused for a while to check on Dr Taoheed Abdulkarim. I met Dr. Abdulkarim, 33, back in 2014 in Kenya. We were both research scholars of the African Union Commission studying at the Pan African University, Institute for Basic Sciences, Technology and Innovation. Dr Abdulkarim is among the pioneer PhD graduates of the institute.
Having worked with a similar research equipment, ROCHE-896 in his research lab in Kenya, he explained how the tests for virus and other diseases differs principally because of what is tested. For most diseases, it is the DNA-think of it as the memory card of your genetic history- that we often hear of. For the virus, it is the RNA. Think of it as a messenger carrying the genetic information for a shorter period of time compared to your DNA.
Tests are conducted in quantitative realtime using a RT-PCR technique. The cell sample containing the RNA is taking from the upper respiratory tract (mostly through the nose) of the patient. The cell sample’s RNA structure is now compared with the RNA of SARS-Cov-2, searching for the maximum similarity. As the comparison is conducted using the RT-PCR machine, a computer screen shows a blank canvas. Curves start rising depending on the ones showing the most similarity to the RNA of the virus. Now if you are a COVID-19 patient and is tormented to watch the experiment take place, your prayer is for not any curve to rise. The higher the curves rise, the more RNA content and similarity it has. Once it rises to a certain threshold, you have tested positive.
This is basically what happens in any lab. As of April 7th, there are 9 labs in Nigeria that can conduct the test, owning to availability of the testing kits, speciality of the staff and biosafety level of the lab. A minimum of 3 safety level certification is required due to its deadly nature. Achieving this level of safety is not easy and the handling of this deadly virus is crucial.
So far, Taiwan is racing to test and get results in minutes. The US wants to do that in 2 hours or less. Abott, a German company has produced a 5 minutes portable device ID NOW for testing. It is already approved for Emergency Use testing. NCDC currently reports results in a little over 24 hours.
Whether or not blood sampling procedure, which offers the fastest way to conduct diagnosis, is determined, we can only stay-at-home to fight the insidious virus now.
Whether or not mass testing sites are set up across the country or not, and the testing triage is changed or not, we can only hope for the best of what the government is doing now.
Sadiq Abubakar Gulma tweets @sadiqgulma