A lot of thoughts, opinions and perspectives have been shared on how “Nigeria definitely has more cases of COVID 19, but we will not know because we are not testing enough,” and that is a narrative we should be careful about.
Two caveats: We must continue to advocate for Universal testing as the ideal step. We must recognise that we may be experts at outbreak preparedness, readiness, response and recovery, and yet the picture attached applies.
Still think otherwise? See this ghsindex.org
Still think otherwise? See this ghsindex.org
Universal testing is the ideal solution, where every one is tested, infected people are isolated & the pandemic is ended. But in the absence of that, the watchwords test, isolate, contact trace & physical distance have to be implemented using known principles like case definition
From all indications, Nigeria has performed <1,000 tests. These were performed using algorithmic case definition - the right decision for the country currently. Many espouse that if we were testing more, we would definitely have more cases. Sounds like truth, but has drawbacks
There are a number of ways of estimating the burden of an infection during an outbreak, outside testing.
1. Exportation of cases (prior to travel restrictions)
2. Number of new cases per day meeting case definition etc.
1. Exportation of cases (prior to travel restrictions)
2. Number of new cases per day meeting case definition etc.
Yet estimating the burden of infection for respiratory viruses is one of the most difficult, and relies very heavily on serious to severe illnesses.
A few useful resources on burdens of infection can be found here:
1. The Burden of Influenza: a Complex Problem link.springer.com/article/10.100…
1. The Burden of Influenza: a Complex Problem link.springer.com/article/10.100…
2. Estimation of Coronavirus Disease 2019 (COVID-19) Burden and Potential for International Dissemination of Infection From Iran annals.org/aim/fullarticl…
3. Estimating disease burden of a potential A(H7N9) pandemic influenza outbreak in the United States bmcpublichealth.biomedcentral.com/articles/10.11…
3. Estimating disease burden of a potential A(H7N9) pandemic influenza outbreak in the United States bmcpublichealth.biomedcentral.com/articles/10.11…
4. Estimation of the COVID-19 burden in Egypt through exported case detection thelancet.com/journals/lanin…
COVID19 has been reported to be asymptomatic in 20 - 50% of those infected (bmj.com/content/368/bm… and eurosurveillance.org/content/10.280…) and among those with illness, around 81% showed mild illness (cdc.gov/mmwr/volumes/6…).
This means that around 2 in 10 cases will be serious to severe. When you have 2 in 10 infected individuals facing severe respiratory illness, the health system will feel the pulse Nationwide.
So for example, if Lagos has 1,000 infected people who are “undetected,” we expect that 200 of them will have serious to severe illness that will require admission and respiratory support.
Even if these numbers are weighted for a younger population, we are not seeing such mass admissions at hospitals, from any State reports. See Week 1 Global Sit Rep to see that undetected cases will be glaring over any 10 day period who.int/docs/default-s…
On the basis of case definition, current hospital admissions and verbal reports from Disease Surveillance and Notification Officers in sampled States, there is no evidence at the moment to suggest a significant upturn in respiratory illness related admissions.
I know that we have a history (including present cases) of being disappointed by the people who we have entrusted with leadership, but the technical leadership during these difficult times has been excellent. Even some of the political leadership has been commendable.
However, ignoring the science and opting for a new-found expertise in armchair epidemiology is everyone’s right, but it really helps to seek understanding.
Our testing, is proportional to the cases that meet case definition, and so are the results. Nothing suggests that the current case definition needs a review as at today. So a large number of cases are not going undetected as many would like to allege.
Happy to see evidence to the contrary of course.
If we miss many infected people, you will not be the one to say it. We will all feel it in the pulses of health facilities in those localities & reports from everywhere. Of course a few will fall through the cracks, reinforcing ultimate need for Universal testing.
Wear54gene, Jack Ma & a few other private sector entities are pulling weight to support NCDC to ramp up testing. Let us keep pushing for that to happen. In the meantime, let us keep sharing accurate information on COVID19, and try to stay at home if you can. We will beat this!
