But Nigeria is racing against time in prevention of this COVID-19 knight fork that will force the country to choose between either of the unpalatable catastrophes that one would not wish his enemy: medical catastrophe and socio-economic catastrophe. Which one is worse between the two, is a matter of perspectives.
In chess game, a fork is a strategy whereby a single piece makes two direct attacks on opponents' pieces simultaneously. It’s also called a double attack. This is one of the most effective ways to capture opponent's material because it becomes difficult to save pieces that are under attack. The real master of fork is the knight. The knight's ability to jump into unexpected places, makes knight fork a constant threat throughout the game. With this background, we shall delve into how COVID-19 pandemic prevention is forcing the Nigeria to choose between difficult choices in Africa's most populous country.
The W. H. O. recommends a 2-prongs approach in tackling COVID-19: social distancing and contact tracing. Adhanom Ghebreyesus Tedros, W.H.O. official, says that epidemiological testing — where the contacts of infected people are identified, tested in turn and isolated as needed — is the ONLY WAY to fully break the chains of transmission.
In Nigeria, the choices before the government cannot be harder. Locking down the country means killing of livelihood of majority of citizens. Citizens are being forced to abandon their means of livelihood, at the background of fragile economy and uncertainties resulting from low oil price. This has already led to many businesses going into come, a situation that will persist several months post-COVID-19 era. Opening up the country may overwhelm the health system and lead to preventable loss of lives from COVID-19.
This is a perfect example of Knight Fork. The type of COVID-19 preventive measures is the knight, while the opponents pieces being threatened are i) countrywide full-blown COVID-19 epidemic which will easily overwhelm the marasmic health system, if the country is not locked down and ii) destruction of kwashiorkor economy which will eventually tear the entire support frame of the citizens' livelihoods, if the country is locked down.
So how will the country prevent this impending COVID-19 knight fork by putting preventive measures in place? The country may have to choose to live with widespread social disorder accompanied by economic collapse or risk a full-blown epidemic with health system collapse. The good news is that, like in chess, the options are not always limited to two. A counter attack can be launched to salvage the situation. It’s not all the time that a defence must be mounted when under attack. Sometimes, another attack is launched to force the opponent to retreat and stop his impending attack. This strategy is called a counterattack.
Aggressive contact tracing is the required counterattack strategy to employ is the situation. Based on testing criteria adopted in Nigeria, it’s difficult to establish significant community spread of COVID-19. It means it’s not yet all doom and gloom and it’s not too late to stop the knight fork that will force us to choose between medical catastrophe and socio-economic catastrophe.
Aggressive contact tracing, with minimal disruption in the country’s socio-economic landscape is a much-needed panacea. Josh Michaud of the Kaiser Family Foundation posited that the whole point of contact tracing is to ensure that people who have the virus are separated from those who don't. That includes imported cases and the contacts who might be incubating the disease. If you get them to self-quarantine before they are infectious, then you've essentially stopped the transmission of that disease from that transmission train. If you do that with enough contacts, then you've effectively interrupted community transmission. Contact tracing is not perfect. No matter how aggressive it is being pursued, as not all contacts can be reached and contacts maynot adhere with guidelines. However, if it’s just 85% of contacts that are isolated for 14 days, there will be significant decrease in community transmission.
The Way Forward
The Nigeria government is doing a fantastic job so far, notwithstanding the growing figures of positive cases. No stronger evidence of this than accolades from the W. H. O. boss himself. However, in-depth analysis of detected cases reveal a big gap in existing control measures. Local transmission number is going up, while imported cases number is flattening out. This boils down to ineffective contact tracing. Not all imported cases have been tracked, and not all contacts of imported cases have been traced. So local transmission is having the whole floor. Examples are abound.
Not too late to adopt another strategy. We start by getting list of those that arrived in that arrive in the country in the last six weeks via flight manifest. Tracking can be done via their international passport number. It’s a complex method but it can be done. Thereafter, tracking of all contacts of imported cases and existing cases will be done. Maintaining air-tight interstate border is crucial to ensure suspected contacts are kept within a state.
Relaxing lockdowns will boost the economy, especially if combined with tight closure of interstate borders. Flight should be used for medical supplies and food supplies that require interstate journeys. This will allow proper control of leakages. If Lagos state and Abuja borders have been well-closed, most other states wouldn’t have recorded more than a case or two. Dusk to dawn curfew can be maintained to minimize mingling among elites – major carriers of the virus.
Use of cloth facemask should be made compulsory for all outdoor movements, in order to reduce shedding of virus in asymptomatic carriers. CDC recommendation of wearing of cloth facemask where other social distancing measures are difficult to maintain should be adopted. 6-feet social distancing remains important in slowing the spread of the virus. Simple cloth facemask can slow the spread of the virus and help people who may have the virus and do not know it from transmitting it. Cloth facemasks made at home from common materials at low cost can be used as an additional, voluntary public health measure.
This means Nigeria can still avoid this impending double attack. But Nigeria is racing against time in prevention of this COVID-19 knight fork that will force the country to choose between either of the unpalatable catastrophes that one would not wish his enemy: medical catastrophe and socio-economic catastrophe. Which one is worse between the two, is a matter of perspectives.
Dr Sunkanmi Adesina is a Medical Doctor and a Public Health Policy Analyst. He writes from Ibadan, and he can be reached via his personal email: [email protected]