The Chairman Medical Advisory Committee (CMAC) of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra state, Dr. Ugboaja Joseph, in this interview with Isaac Ojo, describes COVID-19 as an unfortunate and bizarre public health emergency that took the world unnoticed. He confirms that COVID-19 is real, and therefore, advises the public to adhere strictly to the laid down COVID-19 preventive guidelines such as staying at home, wearing face mask, and maintaining social distance. Excerpts:
Can we meet you Sir?
My name is Dr. Ugboaja Joseph, an obstetrician and gynecologist by training and currently the chairman, Medical Advisory Committee, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra state. I am also the director, clinical services, research & training as well as chairman, Task Force on COVID-19 of the hospital.
What do you feel about the current coronavirus pandemic ravaging the world?
It’s an unfortunate and bizarre public health emergency that took the world unnoticed. The virus is a novel one, and hence, not much was known about its pathogenesis and treatment. Therefore, new insights are gained everyday into its pathogenesis and transmission mechanisms, treatment methods as well as preventive strategies. Initially it was thought to cause deaths due to interstitial pneumonia and so ventilators were thought to be critical to the survival of patients. But emerging evidence shows that the virus causes blood clots in the lungs and other parts of the body, therefore reduces tissue oxygenation. This is why blood thinning drugs such as low dose aspirin have been added to the treatment plans.
Currently, Nigeria is in the community spread and so the number of cases is increasing everyday alongside the deaths. This calls for more stringent measures to curb the further spread of this deadly virus.
What is your responsibility as chairman NAUTH taskforce on Covid 19?
As the Chairman, NAUTH Task Force on COVID-19, our main mandate is to lead the response to the coronavirus pandemic in the hospital and environs. Being the only federal tertiary hospital in the state, NAUTH has an important role to play in the fight against coronavirus in Anambra State. These roles range from public and community awareness creation on the pandemic especially the preventive measures, the effective identification, isolation, testing and treatment of cases of COVID-19; collaboration with national and state agencies to curb the spread to carrying out research on aspects of the COVID-19 pandemic.
The taskforce has 6 teams/committees. These are the rapid response team, case management team, sensitization team, surveillance team, logistics and supplies team and team on collaboration and liaison.
The rapid response team is responsible for quick response in all alerts on possible cases of COVID-19 that is presented to any of our service points. They are trained on how to trace, move the patient to the isolation center, collect samples for investigation and commence management of the patient. This team includes doctors, medical laboratory scientists, nurses, hygienists and others. The case management team is led by the infectious disease specialists. The others in the team include the respiratory physicians, the pediatricians, the anesthetists, nurses, hygienists and others. This team is in charge of managing all the admitted cases in the Isolation unit both suspected and confirmed.
The sensitization team/committee led by the public health physicians and nurses has the mandate of sensitizing the hospital community and the general public on issues pertaining to COVID-19 infection. This committee has embarked on aggressive public sensitization on the dangers of COVID-19 and the need to adhere to the laid down preventive strategies. They have effectively engaged the media houses in and around Nnewi to facilitate this.
The surveillance committee is charged with monitoring the hospital environment to ensure that both staff and patients comply with preventive strategies especially use of face mask, hand hygiene and observance of social distancing.
The logistics and supplies team ensures that the PPEs and other materials needed in the fight against COVID-19 are available within the hospital through a proper forecasting, procurement and inventory system.
Finally, the committee on collaborations which is currently chaired by me is charged with the responsibility of attracting assistance to the hospital from public spirited individuals and corporate organizations. This committee has attracted several donations to the hospital. But by far the greatest donation to the hospital is that of a world- class COVID-19 Isolation and Treatment Center being constructed by Anambra Progressives, convened by Senator (Dr.) Ifeanyi Ubah. The building is almost 90% completed and will be handed over in about two weeks’ time. We remain grateful to the Anambra Progressives for this massive and timely gesture.
However, the greatest asset to us in the fight against this pandemic is the presence of our Isolation Center with the full complement of trained members of staff that are willing and available to attend to these cases of suspected and covid-19 patients.
Though it is very small with only three wards, the staff is always on ground 24 hours a day to respond to alerts of COVID-19 and do the needful. The Isolation Unit is under the leadership of our very hard working and passionate DCMAC, Dr. Ezejiofor O.
What are the issues emanating from lack of testing kits?
In all cases of pandemic or epidemic, testing and subsequent isolation and treatment are key components of the response. The trend in the results of test when appropriately and adequately done gives the true picture in terms of the success or otherwise of the containment efforts. In Nigeria, testing is coordinated nationally by the NCDC through the public health laboratories and augmented by the efforts of the State Governments through the office of the state epidemiologists. Some institutions such as NAUTH also participate in the testing. The challenges with testing in a pandemic is enormous because of the number of people affected and the required logistic which usually include sample collection, transportation, laboratory analysis and documentation.
These processes require immense investment in equipment and personnel. Therefore, with the weak healthcare system in most African countries, it is not surprising that testing will pose a lot of challenges to them. In Nigeria, I feel the NCDC has done very well in the area of contact tracing and testing. Some state governments have also done very well but others need to test more.
What is the implication of having NCDC approved laboratory in Nnewi?
We were elated when the news of accreditation of Acunalysis laboratory for COVID-19 testing by NCDC came to us as that will save us a whole lot of spending on logistics of transporting samples to Irua, Edo state, reduce the waiting time for the result and allow earlier and quicker clinical decision-taking in suspected cases of COVID-19.
However, more than one month after, they are yet to commence testing. I don’t have the details of what the issues are, but we are earnestly looking forward to when they will commence COVID-19 testing following NCDC accreditation. There is no doubt that having a testing center close to us will ease most of the logistic difficulties we encounter in moving samples to Irua.
Why does it take more than three days for patients to get the result of their COVID 19 test?
Well, like I said earlier, there is yet no testing center in Anambra state and we still take samples to ISTH Irua for analysis. You must know that other institutions and states approach Irua for testing. So that usually will cause some delays.
What is responsible for the situation at hand where many frontline staff are testing positive to COVID 19?
The safety of the frontline staff in any case of epidemic or pandemic is of utmost priority because they are the ones who will salvage and rescue the situation. That is why at the inauguration of the NAUTH Taskforce of COVID-19, the Chief Medical Director emphasized that the safety of members of our staff is a topmost priority. The Taskforce and hospital management place a high priority on staff welfare and safety and has 3 approaches to it viz the provision of PPEs in adequate numbers and quality and other necessary materials and equipment such as hand sanitizers, water supply etc; Establishing clear COVID-19 preventive guidelines and policies including the triage and treatment algorithms and the constitution of a surveillance team to ensure that members of staff, patients and visitors to the hospital comply with these directives and punish offenders. Specifically in terms of the PPEs, the Chief Medical Director, Prof Igwegbe A.O, has been outstanding in ensuring that these are made available to our staff freely.
What is your advice is your advice to the public?
My advice to the public is to adhere strictly to the laid down COVID-19 preventive guidelines which include staying at home, wearing face masks, maintain social distance as well as practicing hand hygiene. Those of them who have symptoms such as fever or cough should present to the hospital early for testing and management. If they present earlier, chances of survival are highest. The people who are mostly at risk are people above the age of 60 years with some form of co morbidities like diabetes mellitus etc. this class of people should be extremely careful with respect of exposure to risk of contracting the disease. For the government, I feel they are trying but a lot more needs to be done in terms of creating awareness, enforcing lockdowns where and when appropriate, strengthening the health system by provision of PPEs and training of the health force as well as motivating the healthcare workers by paying reasonable hazard allowance and maintain life insurance for them. I believe that if all of us work together, we should be able to defeat this pandemic.