Nigeria’S Race To Zero Covid-19 Cases: True Disease Burden Or Testing Failure?

Abstract

The 2019 coronavirus disease (COVID-19), caused by a novel member of the beta coronaviruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global public health hazard [1]. Since Nigeria’s index case on the 27 February 2020, the country has tested 1 818 957 persons, recorded 163 195 confirmed cases and 2058 deaths as of 31 March 2021 [2]. The positivity rate among the tested population was 9.0% and the case fatality rate was 1.3%. In April 2020, the Nigerian Government, through the Nigeria Center for Disease Control and Prevention (NCDC), activated its national Incident Control Center (ICC), the Surveillance and Outbreak Response Management System (SORMAS), and the mobile strengthening epidemic response system (mSers) amongst others for national coordination, surveillance and reporting of COVID-19 cases in the country [3]. Nigeria’s health care system is sub-optimal and plagued by a plethora of challenges as seen in many other low and middle-income countries [4]. Nigeria’s current health expenditure is 3.75% of its gross domestic product (GDP) [5]. With a Physician to population ratio of 4:10 000, Nigeria has one of the worst physicians to population ratio in the world [6]. The pandemic has further stretched the health created panic in health facilities and made obvious the dilapidated situation of the country’s infrastructures [3,4]. Another major constraint to the success of Nigeria’s COVID-19 control strategy was the high human poverty index (HPI). In Nigeria, an estimated 83 million people (40%) live below the poverty line [7], thus making COVID-19 a disease of hunger [8].