Home treatment will increase infections, NMA, nurses warn
The Nigerian Medical Association and the National Association of Nigerian Nurses and Midwives on Sunday cautioned the Federal Government against treating COVID-19 patients at home.
The NMA and the NANNM, in separate interviews with The PUNCH, said the implementation of home treatment in Nigeria, where the majority of the infected people lived in crowded houses would create problems for the country.
The NMA specifically said patients, who would be treated in households with a large number of people might infect others, thus increasing COVID-19 cases in the country.
The Presidential Task Force on COVID-19, at its press briefing on April 30, had said the Federal Government was considering treating some COVID-19 patients at home.
The Nigeria Centre for Disease Control Director General, Dr Chikwe Ihekweazu, who disclosed this at the press briefing, said the country had only about 3,500 bed spaces for COVID-19 management.
“We are now trying to make more bed spaces available, but ultimately we might have to change our strategy and start considering homecare in certain circumstances where patients are able to provide rooms for their own management,” he said.
As of Saturday, there were 4,151 COVID-19 cases in Nigeria, with 3,278 of them still active and 745 discharged. No fewer than 128 people have died of the highly infectious virus.
WHO recommends use of ventilated houses
According to the World Health Organisation’s guidelines sent to one of our correspondents by the NMA President, Dr Francis Faduyile, all laboratory confirmed cases should be isolated and cared for in a health care facility.
The WHO explained that where isolation in a health facility was not possible for all cases, emphasis should be given to patients with severe and critical illnesses as well as mild illnesses such as “uncomplicated upper respiratory tract viral infection symptoms.
The WHO added, “If all mild cases cannot be isolated in health facilities, then those with mild illnesses and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home.
“For those presenting with mild illness, hospitalisation may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.”
It added in cases where care would be provided at home, a trained health care worker should conduct an assessment to verify whether the residential setting would suitable for providing care and whether the patient and the family were capable of adhering to the precautions that would be recommended.
The WHO also recommended that the patient should be in a well-ventilated room and that face masks or gloves should not be reused.
It added, “To contain respiratory secretions, a medical mask should be provided for the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded.”
The WHO also said the movement of the patient and shared spaces in the house should be minimised. “Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open) and use a mask when providing oral or respiratory care and when handling stool, urine, and other waste,” it advised care givers.
Dedicated linen and eating utensils recommended for home patients
It said dedicated linen and eating utensils should be used for the patient, adding that the items should be cleaned with soap and water after use and may be re-used instead of being discarded.
Our overcrowded homes will breed more infections — NMA president
Faduyile, in an interview with The PUNCH, said although the WHO guidelines were of global standard, he had a problem with how they would be implemented in Nigeria.
He stated, “We can’t just conform with anything from the WHO because many of those people infected are people living in rented apartments or houses that have a large numbers of people within the household. I doubt how beneficial it is for those persons to guard against infecting others in that area. I guess we will still have problem with the implementation of such a regulation in Nigeria.”
Plan to treat COVID-19 patients at home worries nurses
On its part, the NANNM expressed displeasure over plans by the Federal Government to treat coronavirus patients at home.
The President of the NANNM, Abdulrafiu Adeniji, in an interview with The PUNCH, said, “There is an adage that necessity is the mother of invention. Personally, I just see that it won’t have been the best but government doesn’t have any other way out. What the government is now saying is that the bed spaces in the hospitals are occupied.
“This is why we have been crying that Nigerians should learn lessons. With the little relaxation of the lockdown, people have been using the opportunity (to move about freely) and it’s a chance for the virus to spread among the people. Now, my prayer is that, even treating at home, the situation will not become so overwhelming that they would not be able to (handle it).
“Also, we have to be wary of some people that are not Africans who have predicted that corpses will litter the streets in Africa. Already, we don’t have enough respirators, test kits or personal protective equipment. Nothing is enough.”
No critical case will be treated at home, says LASG
But the Lagos State Government has said no critical case of coronavirus will be treated at home.
The state Commissioner for Information, Mr Gbenga Omotosho, in a chat with one of our correspondents on Sunday, noted that only 44 per cent of the state’s isolation centre capacity had been used.
He said, “As of Friday, there were 1,683 cases: 713 were on admission, 448 discharged and 33 deaths. The average duration of admission is 11 days.
“On severity of admissions, we have 59 per cent mild cases, 38 per cent moderate cases, two per cent severe cases and one per cent critical case.
“On the capacity of isolation centres, there has only been 44 per cent utilisation: Lagos Mainland (56 per cent); Lagos University Teaching Hospital (95 per cent) Onikan (68 per cent)
Landmark in Eti-Osa LGA (34 per cent); Lekki (44 per cent); Agidingbi, Ikeja (39 per cent) and Gbagada (0 per cent). So, there are 330 bed spaces still available out of the 600 bed spaces.”
Omotosho explained that the state Governor, Babajide Sanwo-Olu, would consult with the Federal Government if the state needed to resort to community care.
He insisted that the state had not got to that level.
“That has its own protocols. An expert would ask certain questions to know the severity of the case. No critical case will be treated at home. Most of the cases we have are mild. If you have a mild case, after say 12 to 13 days of treatment, it should clear off. The health commissioner even said none of our patients needed a ventilator and that is because people report early. Those who died did not report early,” he added.
Meanwhile, another traditional title holder in Kano, the Dan Iyan of Kano, Alhaji Yusuf Bayero, is dead.
Until his death, Bayero was the District Head of Dawakin Kudu in Dawakin Kudu Local Government Area of the state.
The Secretary of Sallaman Kano at the Emir’s Palace, Alhaji Muhammadu Muhammad confirmed the death of the deceased to The PUNCH in Kano on Sunday.
He said the monarch, who died in the early hours of Sunday, was the first District Head of Ajingi Local Government Area.
Bauchi 150 deaths caused by hypertension, childbirth, others, not COVID-19 – Gov
The Bauchi State Governor, Senator Bala Mohammed, has said massive deaths in Azare town, the headquarters of the Katagum Local Government Area of the state within the last two weeks, were not caused by COVID-19.
He, however, said that from records available, within the last one month, no fewer than 150 people had died from hypertension and other diseases.
Sunday PUNCH had reported that Azare, the headquarters of the Katagum LGA, was said to have recorded massive deaths within the past 14 days.
While a former member of the House of Representatives for the Azare Constituency, Ibrahim Baba, in a letter to the President, Major General Muhammadu Buhari (retd.), claimed that over 100 people died of coronavirus in one week, another politician, Musa Azare, put the number, in his letter to the state governor, at 301.
However, the Bauchi State Government debunked the claims saying only one person had so far died of COVID-19 in the state.
But speaking at a press conference on the development which had caused panic in the state, Mohammed said that the state government was on top of the matter.
He said: “We have also reviewed the rumour about Azare, that it has become a morgue, it is not true.
“We have even got the statistics of the deaths for the last 30 days, about 150 died in Azare and an average and eight deaths per day. Most of them we have the causes of their deaths arising from hypertension, childbirth and other diseases.”
14 Abuja doctors, nurses go into isolation as three patients test positive
At least 10 doctors and nurses working at the Gwarinpa General Hospital, Abuja, have been asked to go into self-isolation after a patient who was being prepped for surgery tested positive for Covid-19, The PUNCH reports.
Another four doctors in Wuse District Hospital have also gone into isolation following exposure to two Covid-19 patients in the hospital, the Association of Resident Doctors of the Federal Capital Territory has said.
It was learnt that the patient at the Gwarinpa hospital had been admitted at the hospital for intestinal obstruction and was to be wheeled into the theatre last Thursday.
During his admission at the hospital, about 10 doctors and nurses on duty had contact with the patient directly or indirectly
However, before the surgery could begin, he started coughing profusely thereby causing a scare among health workers.
A health worker, who spoke to The PUNCH on the strict condition of anonymity, said, “A patient visited our hospital sometime last week and he was examined by a doctor. He was diagnosed with intestinal obstruction and was placed on admission pending a surgical operation. He was given drugs and fluid.
“He was supposed to do the surgery on Thursday but he started coughing profusely so we began to have suspicions. He was questioned about his health status and then he revealed later that his brother had just tested positive for COVID-19.
“He was isolated at the ward and a Covid-19 test was administered on him. The next day, his test came back positive. The Nigerian Centre for Disease Control has evacuated him while the hospital has been decontaminated.”
The official told The PUNCH that the hospital management asked about 10 doctors and nurses to go into self-isolation.
“The management has asked us to go into self-isolation. We will be tested later in the week,” she said.
Meanwhile doctors employed by the Federal Capital Territory last year are being owed salaries between three to seven months, the Association of Resident Doctors, FCT, has said.
The doctors also complained about suspicious deductions from the salaries of old doctors after they were registered on Integrated Payroll and Personnel Information System.
This is contained in a communiqué issued after a virtual council meeting on May 7, 2020 and signed by Dr Mustapha Ibrahim, the General Secretary of ARDFCTA.
The doctors said they would have embarked on a strike on May 1, 2020 but decided to put it on hold.
The document read in part, “The council noted with dismay the haphazard nature in which the April, 2020 salaries was paid by the IPPIS with no prior sensitisation or explanation despite the April 30 deadline for all matters connected therewith be resolved.
“Most newly employed members were still omitted in the payment of April, 2020 salaries bringing the total months owed them to between three-seven months. There is an established community transmission of COVID 19 in the FCT with four of our members already exposed following the confirmation of two cases at Wuse District Hospital.
“Despite Management’s assertion of provision of adequate PPE across all the general hospitals, it was noted by council that some of this PPE are still been hoarded by some units as members do not readily access these apparels when attending to suspected cases.
“Exposed members are subjected to a lot of psychological trauma during this period of self-isolation.”