Social media have, of late, been awash with news of COVID-19 patients protesting, fleeing isolation centres, or confirmed cases on the run in some states across the country.

Many reasons have been adduced for the development and they include stigmatisation, loneliness, poor feeding, poor state of isolation centres and neglect by medical personnel.

The situation may compromise Nigeria’s efforts to win the war against the global pandemic.

Refusing to show up

Nigeria’s efforts at containing the COVID -19 pandemic may be at risk following reports of COVID-19 patients fleeing isolation centres or confirmed cases refusing to show up for treatment.

As at last Thursday, May 14 when this report was filed, Nigeria had a total of 5,162 confirmed cases of coronavirus with 1,180 discharged and 167 deaths.

Sadly, reports abound of how COVID -19 patients flee isolation centres in some states while in some states, many of them are on the run after refusing to submit themselves for treatment. Others already on admission escape from the centres in protest against what they described as ‘poor treatment’ by the authorities.

An example is that of Gombe State where confirmed patients overpowered the security guard at an isolation centre and went on the rampage on the highway. According to the protesting patients, many of them had been in the isolation centre for two weeks without medical attention. They also claimed that the foods they serve them are substandard.

For these Nigerians, the action of the authorities made them to believe they were not actually sick. Specifically, one of the patients, a lady, claimed that even when they had headache, they had to give money to someone to help them buy drugs.

The patients went as far as blocking the highway to Borno and Adamawa states and mingled with members of the community who joined them in the protest, chanting that coronavirus was fake, and that they were just being used to make money.

Also in the epicentre, Lagos State, many of the patients who had tested positive for COVID-19 are on the run after refusing to submit for treatment.

Confirming this, the state Commissioner for Health, Prof Akin Abayomi, said many individuals who had tested positive for COVID-19 in the state were fleeing their residence and not submitting for treatment.

With active case of about 1,037 as of Friday, May 8, only 262 beds were occupied out of the 569 bed-capacity in Lagos. This means that about 800 COVID-19 positive patients were yet to be admitted.

Abayomi also narrated a situation where they test people, and cannot find them thereafter. “The ambulances will go into community, people will flee their homes, and they make it difficult for us to find them,” he said with alarm in his voice about the consequence of the cases mingling with people and spreading the virus.

At a briefing where he spoke, the Commissioner also said the percentage of admitted patients as of that Friday was about 26 per cent of the total active cases. Abayomi regretted that there was no time for health officials to hunt for the people on the run as positive patients are expected to make themselves available in their own interest.

To him, there is no reason patients should flee their homes for fear of isolation centres.

“Our isolation facilities are really comfortable, it is not like the Ebola days; we have made a lot of improvements. If you look at the testimonies of people that were discharged, you will see that the food is good, the attention is good, the wards are clean. Our staff members are very professional”, he said.

Recently, Oyo State government also raised the alarm about two COVID-19 patients who escaped from an isolation centre. The story is the same in Borno where a man and woman fled from an isolation centre. There were also cases of defaulters in Kano, Delta, Bauchi and Taraba states.

Meanwhile, the development is a source of worry to critical health watchers.

According to them, if the situation continues, Nigeria risks more problems in community transmission of Covid-19 and containment efforts will be more difficult.

Spreading infection

The Director, Institute of Public Health, Obafemi Awolowo University Teaching Hospital, Ife, OAUTHC, Prof. Adedeji Onayade, said patients who flee isolation centres will infect others who interact with them in the course of daily living activities.

Onayade, who linked their action to possibly psychological, poor living conditions and poor food, among others, called for more support and education for COVID-19 patients that though they are asymptomatic, they could spread the infection.

Explaining why medical experts may not be seen regularly by patients, he said: “The care in isolation ward is different from regular wards. Health care providers maintain minimal essential contact with patients in order to avoid infection.

“Patients who are used to doctors and nurses doing regular round in the wards may feel neglected. No visitors are allowed and they do not have privilege of any outdoor activities.”

Also in a chat with Sunday Vanguard, a molecular laboratory expert, Dr Casmier Ifeanyi, said isolation poses a lot of challenges to patients, Nigerians and the containment efforts as when patients break away from isolation centres, it becomes a major compromise on those things that can fuel community transmission.

Ifeanyi explained that people are only taken into isolation when they test positive and once they mix other residents in the community, they will spread the virus.

Blaming the situation on the poor state of isolation centres in the country, he said there have been several complaints about poor feeding and treatment in the centres.

“These are human beings; it is natural that they will protest because you are garaging them. It has been alleged that many of the people there are not receiving treatment at all”, the expert said.

“Some say they are only given Vitamin C.

“If the complaints coming from there are anything to go by, something is definitely not right.

“Then, there is something begging for an answer. What is the protocol that we are using to manage these people in isolation?

“If there is a protocol, then it is time we review it because it seems not to be meeting with the expectation of the people we take in there.

“If we do not want to place them on any therapy at all, we should be seen to be giving them a regimen that will help their immune system to overcome the infection so that they do not progress and the prognosis will be good.”

Citing a COVID-19 patient that died recently under isolation, Ifeanyi explained that although the deceased was doing well when he was taken to isolation, nobody bothered to check on him until when it was expected that in three days time he will be leaving the centre.

He said the patient died because he went into a mild respiratory crisis without treatment.

“That simply means that even though, the disease type he had was mild, he was progressively becoming very morbid and nobody knew.”

To prevent people from fleeing the centres or die, the expert called for the review of the isolation management protocol by incorporating routine medical laboratory testing across isolation centres in Nigeria.

According to him, the incorporation of the routine laboratory testing would help managers have information on patients’ haematological parameters and basic biochemical parameters.

“Laboratory is not only to test for disease; the duty of laboratory includes diagnosis, treatment and management of patients and prevention of disease”, Ifeanyi stated.

“In the four prongs, you cannot put the lab aside. Most of the isolation centres that do not have the laboratory component should start making plans for a laboratory component there, so that, as we do a supportive regimen or a symptomatic management, we will have a laboratory component giving us an in-depth knowledge as to the health status of patients.”

He argued that COVID-19 patients cannot be garaged without daily evaluation; provision of good foods and there would not be news of people escaping or refusing treatment.

“How can you take people in, garage them and you don’t provide foods, not evaluate them from day to day, you don’t provide supportive, you are just there waiting for symptoms to manifest for you to treat them? That protocol is faulty”, Ifeanyi said.

Corroborating his views, President of the Nigerian Medical Association, NMA, Dr Francis Faduyile, appealed to patients to understand that the containment of COVID-19 was not entirely at the purview of government but all Nigerians.

“Government cannot be putting a military man or a police man to ensure that individuals behave rationally”, he said.

“We call on the populace that even if you are infected, you must try as much as possible to protect others from being infected and that is where we are going to do more advocacy works and give information to the people.”

State of isolation centres

The NMA leader said the status of individuals may not be met due to the state of isolation centres that are mass produced.

“Since it is a mass isolation centre it might be difficult to have all the necessary things for you to have a comfortable stay but to the down trodden, that could mean an improvement of where they were staying.”

According to him, to contain the virus, everyone must sacrifice at least two to three weeks of his lives.

“We are appealing to individuals in the isolation centres that feel that it is not up to their standards, they should please sacrifice, stay there for two three weeks and go back to their comfortable accommodation”, Faduyile said.

“It is not right for us to start fleeing isolation centres when we know we can increase transmission of the disease,”

On her part, a public health expert, Dr Imei Okon, said state governments should invest in isolation centres to encourage patients to stay.

Okon said the development would definitely impact on the country’s containment efforts because the moment a patient flees from treatment facility, he or she has broken protocol and this can escalate positive cases.

“In the interest of everybody, government should try to make isolation centres conducive”, she said.

“We have a team set up by the Federal Government to give accreditation to isolation centres.

“They are currently moving round to ensure standards and that will stop patients from moving around in search of conducive environment.”

Okon advised Nigerians to stop stigmatisation of people that test positive to Covid-19.

“Nigerians should know that it is not a death sentence, anybody that is positive should come out and take treatment”, she said.

“It doesn’t take long for you to recover and continue with your normal life.

“In the interest of the community, let us all work together to end this outbreak so that we can all be alive to tell the story just like we did with Ebola”. (Text, excluding headline, courtesy of Sunday Vanguard)

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