Lacking appropriate waste management, Nigerian communities face a high risk of becoming trapped in vicious cycles of environmentally driven COVID-19 infections.
In the past decade, humanity’s technological advancement has brought enormous ease in day-to-day activities but advancement has not been without its challenges or drawbacks. The possibility of an epidemic escalating into a worldwide pandemic might have risen due to how easy it is to buy and sell commodities, and the frequency of cross-border transport. Today, there are growing concerns about the threats the upsurge of viral infections poses to the global population—one of such infections is the novel coronavirus disease 2019 usually abbreviated as COVID-19. The causative agent of COVID-19 is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The International Committee of Taxonomy of Viruses (ICTV) named the virus SARS-CoV-2 because it is genetically linked to the coronavirus that was responsible for the SARS outbreak in 2003. Coronaviruses are a large family of RNA viruses that can cause mild infections in the upper respiratory tract, like the common cold. They can also cause more serious lower respiratory tract infections like pneumonia, bronchitis or severe respiratory illnesses like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Although SARS and MERS have remarkably higher case fatality rates (CFR or the ratio of deaths caused by a particular disease to the number of confirmed cases of the same disease) than COVID-19, the total number of confirmed deaths (256,880 at 06 May) far exceeds that from SARS or MERS, because it is more infectious and easily spreads among people.
The specific standard for detecting, responding and reporting diseases might already be laid down by international organizations like the World Health Organization (WHO); however, there are still significant challenges when it comes to executing these global health processes, and in building sufficient health capacity in certain regions, developing countries especially. Nevertheless, a lack of foresight among African governments has brought most countries on the continent to a point where they lack the capacity to deal with COVID-19, one of the greatest threats to human health.
The Phases of Pandemics
Although the WHO outlines six phases of pandemics, during a pandemic, a disease typically spreads along three phases. These are: the initiation phase; the acceleration phase; and the actual pandemic phase (which is indicated by community-level outbreaks in at least one other country outside of an initial two countries located in one WHO region). Currently, different countries are in different phases of the COVID-19 pandemic. It is important to note that COVID-19 is a new development and, as such, studies on how the disease spreads and how people become infected are still being carried out. New facts about the virus keep emerging every day.
Regardless, experts have established that the coronavirus can be transmitted between people. Also, the initial theory of animal-to-human transmission now holds little merit—as research is still inconclusive on whether animals play a significant role in the spread of the disease. In contrast, it is established that COVID-19 infections can spread from contact with contaminated surfaces. Additionally, researchers believe that contact with the highly infectious droplets from a carrier’s sneezes or coughs has led to the development and extensive spread of COVID-19 in people—and within communities. In the US, the National Institute of Health (NIH) is evaluating the potency and safety of drugs like hydroxychloroquine through clinical trials. Similarly, studies to find potential drug treatments for patients with COVID-19 are happening all around the world.
COVID-19 in Nigeria
The fear of a widespread outbreak of COVID-19 in Nigeria is legitimate. Nigeria is the purported ‘Giant of Africa’ with the largest population on the continent, a population equivalent to nearly three per cent of the total world population. In February, Lagos State reported the first confirmed case of COVID-19 in Nigeria. Subsequently, there were reports of other cases of the virus in Ogun State and in Abuja. The figures have since grown steadily with confirmed cases of the disease across 35 states in the country. Amid fears of asymptomatic travellers spreading the disease in the local community, travel bans were issued and major international airports were shut. These measures ran alongside social distancing and stay-home orders issued by the federal government. All of these were steps in a good direction. However, Nigeria’s ability and, more importantly, preparedness to combat the deadly coronavirus disease especially now that the government is phasing out lockdowns, and while the world waits for vaccines to be developed, is doubtful. With the way Nigeria’s markets and public transportation systems are structured, the contamination of surfaces and transmission of infection within local communities remain very likely. This is especially concerning as scientists have found that COVID-19 can remain in aerosols for as long as three hours; on copper even longer, for four hours; on cardboard for 24 hours; and on stainless steel and plastic for up to three days.
The Environmental Drivers of COVID-19
The field of environmental epidemiology suggests that the risk and eventual transmission of a disease can have different outcomes under different environmental conditions. Generally, this means that environmental factors (such as levels of sanitation and good hygiene) play very crucial roles in the transmission, morbidity and mortality rate of any disease. Bearing in mind Nigeria’s demographics, the novel coronavirus will likely vary in how it affects different communities. Over a specified period, the level of exposure people have to contaminants in the environment becomes key to determining and validating the overall health of the population.
To fight off the coronavirus disease, the body needs a high level of immunity. However, in Nigeria, more than 30 per cent of the population live with one or more chronic conditions. The elderly and people across other age groups with an underlying chronic condition (such as diabetes, cancer, or pulmonary and cardiac diseases) have low immunity and are more susceptible to the virus. Moreover, the indiscriminate use of chemicals (e.g. herbicides) in the environment is already a public health concern in Nigeria. Nigeria has also been experiencing a rise in malnutrition, especially in the North. All these factors increase the chances of having weakened immune system and means our communities face long-term vulnerability to diseases and increased susceptibility to COVID-19.
In a densely populated country like Nigeria, person-to-person transmission—a common way COVID-19 spreads—means the likelihood of a rapid spread is high. Presently, the state with the highest incidence of coronavirus in Nigeria is Lagos State. This may be because Lagos State regularly experiences a high influx of human traffic, making it the ‘epicentre’ of the disease.
Clean water is an even more understated challenge. One of the key prevention strategies for the coronavirus disease is constant hand washing. And while around 70 per cent of households in Nigeria can boast of constant supply of water, less than 50 per cent of households have access to clean water. In many communities, individuals still have to travel long distances to get potable water. Schools, markets and even some government offices do not have water stations where people can fetch water, let alone practise constant hand washing.
Avoiding contaminated surfaces is another way to prevent the transmission of the virus, and our waste management can either be an opportunity to contain the virus or a gateway to disaster. But with dumpsites at capacity and even spilling over to the roads in some instances, is the government doing enough to ensure a safe environment for its people? Are hospitals and health facilities treating COVID-19 patients in Nigeria implementing proper disposal of treatment materials? Without appropriate waste management, we could easily become trapped in a vicious cycle of environmentally driven infection.
Researchers are still trying to establish if there is a relationship between educational status, poverty levels and the rate of exposure or susceptibility to communicable diseases. This is useful if we are to understand how social factors determine the strength of people’s immune systems and where and among which communities the government needs to focus its energies during a pandemic like COVID-19. In other words, do higher education levels or incomes mean, on average, a stronger immune system? Are less educated people fundamentally at higher risk? The Nigerian answer to this question would be that having a large number of highly educated people may not be a crucial factor in slowing or stopping the spread of diseases in a population. Having adequate environment-friendly public facilities is significantly more important. The notion that higher education means better hygiene itself is flawed because it doesn’t consider how social factors influence higher education. For instance, in many institutions of higher learning in Nigeria, access to good toilet facilities is low. As a result, a large proportion of students are forced into unhygienic practices like throwing ‘shotput’, and such ‘waste material’ can be washed into water bodies. This kind of practice can lead to an outbreak of communicable diseases and poses the risk of spreading bacterial and viral infections in the environment. In fact, scientists have discovered that stools of more than 50 per cent of hospitalized patients infected with COVID-19 tested positive for the SARS-CoV-2 RNA. Although, it is still uncertain whether the virus found in faeces of an infected person is capable of causing COVID-19 in another person, there are fears of potential faecal-oral transmission.
The Necessary Steps
Nigeria not only needs to build stronger public health infrastructure, which will give a boost to the planning, delivery and evaluation of health activities and practices. The government must also not overlook or underestimate the environment. This means improving and enforcing waste management policies and sanitary practices across all states. It also means ensuring that government facilities at all levels include basic amenities like regular water supply, electricity and public toilets. It means channelling investments into epidemiological research to improve our preparedness against the threats of infectious diseases; as well as funding and promoting health education to enable individuals make informed decisions on procedures to follow in curbing the spread of infectious diseases. These are crucial steps if we are to ensure lower exposure to pathogens, lower morbidity and mortality rates, and better survival outcomes⎈
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