Probing Nigeria’s COVID-19 statistics – The Nation Nigeria
Nigeria, with 20,244 infections as at yesterday, seems to be recording more COVID-19 positive cases despite testing fewer persons in percentage terms than several African countries. It also appears to have a higher mortality rate from the virus. ROBERT EGBE examines the figures
ON Sunday, June 21, Nigeria recorded 436 new confirmed cases of the novel coronavirus and 12 deaths, bringing the total confirmed cases recorded in the country to 20,242.
Popular radio host, Dan Foster, was reported to be one of the casualties. The versatile American radio veteran succumbed to the virus at a Lagos hospital last Wednesday. His wife, Lovina, was reported to be on treatment at the Yaba Isolation centre, Lagos.
Two days before Foster’s death, there were more than 173,000 confirmed COVID-19 cases in Africa, and the number continues to rise.
Nigeria vs the rest of Africa
But, perhaps, unusually, a comparison of the COVID-19 statistics for Nigeria and that of seven other countries in sub-Saharan Africa indicates that Nigeria seems to be worse off in terms of the number of positive cases, recovery and mortality percentages.
Apart from Senegal and Zambia, countries with much smaller populations than Nigeria’s, Nigeria has conducted much lower number of tests (115760 as at June 21).
Although the government has often explained that it was focused on clusters of outbreaks rather than mass testing of the population.
“I would rather go a little bit slower and get it right than speed into a situation that we will end up regretting,” Nigeria Centre for Disease Control (NCDC) Director-General Chikwe Ihekweazu reportedly said last April.
But worthy of note is the much higher Covid-19 infection rate – more than double that of Senegal, nearly thrice that of South Africa, about four times higher than that of Ghana, six times that of Zambia, 10 times higher than that of Ethiopia, and 35 times higher than that of Uganda.
Furthermore, the recovery rate for those testing positive for the coronavirus in Nigeria is lower than that of all the comparison countries except Ethiopia.
Also, with the exception of Kenya, the case fatality rate (percentage of those testing positive who go on to die from Covid-19) for Nigeria (2.54) is higher than that of the other countries, and is actually more than twice as high as the rates for Ghana, Senegal, Zambia and Uganda. Note that Uganda as at 15th June 2020 had recorded no Covid-19-related death while the death rate for Zambia was less than 1 percent.
Is Nigeria worse off?
Why is Nigeria such an outlier in Africa in terms of Covid-19 infection rate, and rates of recovery and death from the coronavirus?
NCDC statistics for Nigeria as at June 15 could be stretched to imply that one out of every 5-6 Nigerian adults is carrying the coronavirus!
Like many African countries, Nigeria is mostly testing those who are already displaying some of the symptoms of Covid-19 and returnees from abroad. Our population age structure, health system, socio-cultural context and dynamics are not very different from those of the seven comparators with the possible exception of South Africa. All of these countries like Nigeria imposed lockdown measures in the second half of March 2020 and all started slowly lifting them in late May 2020. So, why then are our Covid-19 statistics so much worse?
Are Nigeria’s numbers inflated?
You probably read the WhatsApp messages or heard the rumours that made the rounds in April and last month. Anonymous sources raised the alarm that hospitals were inflating COVID-19 figures so as to get more money from the government. It was claimed that health officials were promised more cash to misdiagnose ailments and attribute deaths to the virus.
Hospital receipts were attached to the posts with the inscription “COVID-19”. If the claim were true, it would have explained the statistics. But it was not.
Responding to the outcry, the Lagos State Government explained why COVID-19 was on receipts of non-coronavirus positive persons. It was a coding system for subsidised healthcare following the pandemic, the state said.
On April 4, Lagos State Governor Babajide Sanwo-Olu announced that the state would bankroll medicare costs to cushion the effects of the lockdown to contain the spread of coronavirus pandemic.
“As additional ameliorating measure to complement the welfare packages previously announced, the Lagos State Government will, for the duration of the restriction on movement, take full responsibility for the medical bills of all patients at all Lagos State-owned secondary healthcare facilities.
”The patients to benefit are those that fall in the following category of Emergency/Casualty cases, including registration, laboratory tests, surgeries, and drugs.
“The patients that fall in the category of Maternity Cases, include normal delivery and Caesarean Sections (CS).
”What this means is that, at this time, patients with the above-listed conditions will not need to make any payments to access treatment and care at all our 27 General Hospitals across the state,” he said.
In implementing the scheme, health officials in the state adopted a coding system whereby ‘Covid-19’ was written on receipts issued to patients who benefitted.
But the reason for this was not adequately communicated to patients, many of whom raised the alarm.
Similarly, a doctor at the Infectious Diseases Hospital (IDH), Yaba, Lagos, told The Nation yesterday that there was no truth to the rumour.
“It is totally false. We do not get any extra allowances or financial incentives for inflating COVID-19 numbers,” the source said on condition of anonymity.
Claims of fabricated infections have also been made in America, for instance. Its source appears to be a misinterpretation of an interview of a Minnesota state senator Scott Jensen’s April 8 interview on Fox News about Medicare payments for COVID-19 hospitalisations in the American state.
A Canada-based website, www.globalresearch.ca published the interview with the headline US Hospitals Getting Paid More to Label Cause of Death as ‘Coronavirus’. It is worth noting that many analysts consider Global Research, despite its fancy name, as being prone to publishing conspiracy theories.
In an interview with FactCheck.org, however, Jensen said he did not think that hospitals were intentionally mis-classifying cases for financial reasons. But the damage had already been done and the misinformation spread around the world.
Federal Government not inflating figures
However, in a June 10 interview, a professor of virology, education administrator and former Vice- Chancellor of Redeemer’s University, Oyewale Tomori, reputed claims that the Federal Government could be brandishing ‘fake’ high numbers of COVID-19 new infections.
“The numbers are not only genuine but are also not high enough. The more we improve and increase our capacity for testing, the higher the number will be and the better for us to truly understand the magnitude of the problem we have in our hand. My prayer is that none of the doubters will join the number of COVID19 cases in Nigeria,” he said.
Could Nigeria casualty figures be caused by testing inadequacies? Or, conversely, could some of the other African countries’ better stats be caused by the same thing?
Test kits accuracy across the world has relatively high false negative/false positive rates (up to 10 percent in many countries where test sensitivity and stability studies have been conducted). The reliability and validity of the test results also depend on the handling of the test specimens, the storage of the kits and the technical expertise and thoroughness of the lab scientists conducting the tests and analysing the results of the tests. Could this be where Nigeria’s problems lie?
Calls on the matter to the NCDC Director rang out and texts to his phone were not replied.
Several African nations are trying to boost testing capacity using internal resources, with projects to set up field laboratories in remote areas and to develop rapid tests in Senegal and Uganda. But the World Health Organisation (WHO) has often raised questions, as has the NCDC about the efficacy of such tests. The WHO has often noted that such tests could incorrectly diagnose people, who might then return to their communities and unknowingly spread the virus.
For instance, researchers at Senegal’s Pasteur Institute of Dakar are working on a cheap and rapid test kit. They are working on a lateral-flow test, which uses a strip of paper impregnated with nanoparticles to detect viral proteins in saliva. The institute is partnering with the England-based biotechnology company Mologic to develop and validate the test. Senegal currently has about 4,800 confirmed COVID-19 cases.
But the WHO does not recommend the use of rapid antigen tests.
“Before these tests can be recommended, they must be validated in the appropriate populations and settings. Inadequate tests may miss patients with active infection or falsely categorise patients as having the disease when they do not, further hampering disease control efforts,” it wrote in a science advisory on April 8.
Nevertheless, last month the U.S. Food and Drug Administration granted its first emergency use authorisation for a rapid antigen test.
African cases in alphabetical order
Algeria – 11,771
Angola – 183
Benin – 765
Burkina Faso– 903
Burundi – 144
Cape Verde– 890
Central African Republic – 2,808
Chad – 858
Comoros – 247
Congo Brazzaville– 883
DR Congo – 5,826
Djibouti – 4,582
Egypt – 55,233
Equatorial Guinea– 1,664
Eritrea – 143
Eswatini – 635
Ethiopia – 4,532
Gabon – 4,428
(The) Gambia – 37
Ghana – 14,154
Guinea – 4,988
Guinea-Bissau – 1,541
Ivory Coast – 7,492
Kenya – 4,738
Lesotho – 4
Liberia – 626
Libya – 571
Madagascar – 1,596
Malawi – 730
Mali – 1,933
Mauritania – 2,984
Mauritius – 337
Morocco – 9,977
Mozambique – 733
Namibia – 55
Niger – 1,036
Nigeria – 20,244
Rwanda – 728
Sao Tome and Principe – 698
Senegal – 5,888
Seychelles – 11
Sierra Leone – 1,327
Somalia – 2,779
South Africa – 97,302
South Sudan – 1,892
Sudan – 8,580
Tanzania – 509
Togo – 569
Tunisia – 1,157
Uganda – 770
Zambia – 1,430
COVID-19 Situation in selected countries in Africa as at 15 June 2020 (12 PM GMT)
Probing Nigeria’s COVID-19 statistics – The Nation Nigeria