LESSONS FROM COVID-19 EPICENTERSW I N N I NG S T RAT EG I ES F RO M T H E F RO N T L I N E

D a t e :

5TH June, 2020

T i m e :

3 PMNigerian Time (GMT +1)

V e n u e :

ZOOM

EMAIL: CONTACTUS@ACIOE.COM

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ACIOE Associates is an advisory services firm providing solutions in Strategy, Government Relations,Regulatory Affairs, Economic Development, Advocacy, Investment Facilitation, and Policy Analysis.

Our team provides advisory services on critical sectors, including Health, Agriculture, Social Impact, andGovernment relations.

We have supported governments (Federal and Subnational), development partners, and organizations aroundsustainable solutions to the challenging economic, political, and development issues within the countries weoperate.

ADVISORY | GOVERNMENT RELATIONS | REGULATORY AFFAIRS | INVESTMENT FACILITATION

F O R M O R E I N F O V I S I T

www.acioe.com

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• ACIOE provides daily COVID-19 updates on Nigeria’s social, political and economic

landscape. The daily updates also cover donations made by the private sector and

the COVID-19 statistics across Nigeria and key markets across Africa.

OUR

COVID-19SUPPORT

• Coordinating direct distribution of palliatives and hygiene products for underserved

commodities in Abuja, FCT.

• Providing regular updates for existing clients on the COVID-19 impact and recovery

efforts on specific health programs at the Federal and subnational levels.

• Providing thought leadership on the COVID-19 pandemic.

• Facilitating webinars on the key lessons and recovery efforts considering the

impact of the COVID-19 pandemic.

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OUR

COVID-19SUPPORT

• Facilitating partnerships between the private sector and the Nigeria Centre for

Disease control and Federal Ministry of Health

• Facilitating partnerships and the donation of essential supplies for front health care

workers across the 36 states in Nigeria.

• Engaging key stakeholders in public sector on the importance of ensuring

continuity amidst the COVID-19 pandemic.

TIME ACTIVITY RESPONSIBLE PERSONS

3:00pm – 3:05pm Welcome Address & Introduction ACIOE Associates

3:05pm – 3:15pm Overview of the COVID-19 Pandemic Response in Nigeria ACIOE Associates

3:15pm – 3:25pm Presentation on Lagos State COVID-19 Containment Approach Dr Abimbola Bowale (Case Management Lead, Lagos State Ministry of Health)

3:25pm – 4:00pm Panel Discussion – Strategic leadership of COVD-19 Containment

Strategy at Subnational level.

MODERATOR:

• Dr. Okunola Olumide (Senior Health Specialist, IFC)

PANELLISTS:

• Dr. Abba Z Umar (Honourable Commissioner of Health, Jigawa State).

• Dr Patrick Okundia (Honourable Commissioner of Health, Edo State)

• Dr.Tomi Coker (Honourable Commissioner of Health, Ogun State)

• Dr. Mohammed Kawu (AG. Secretary Health and Human Services

Secretariat in the Federal Capital Territory(FCT)

• Prof Akin Abayomi (Honourable Commissioner of Health, Lagos State)

4:00pm – 4:27pm Question and Answer (Q & A) Dr. Okunola Olumide (Senior Health Specialist, IFC)

4:27pm – 4:30pm Closing Remarks ACIOE Associates

Overview Of COVID-19 Situation In Nigeria.

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• The South West zone has a total of 1106 confirmed cases and

South East with a total of 9 confirmed cases by the 30th of

April,2020.

• The South West zone has a total of 5603 confirmed cases and

South East with a total of 115 confirmed cases by the 31st of

May,2020.

SOURCE: Nigerian Centre for Disease Control (NCDC)

8SOURCE: Nigerian Centre for Disease Control (NCDC)

9SOURCE: Nigerian Centre for Disease Control (NCDC)

• The average number of deaths

compared to the total confirmed

cases by the 31st of May,2020 was

2%.

A presentation by Lagos StateDr. Abimbola Bowale

(Case Management Lead, Lagos State Ministry of Health)

Panel discussion by Jigawa StateDr. Abba .Z. Umar

(Commissioner for Health)

17SOURCE: Nigerian Centre for Disease Control (NCDC)

Summary of Key Activities

• Establishment of 288 bed isolation centers (Level 1, 2 and 3)

• Quarantining and testing of1,348 Almajiris repatriated from 5 states

• Leveraging on Jakadan Lafiya (12,000 community focal persons) for contact tracing and reporting of suspected cases

• Provision of palliatives to over poor 100,000 families

• Establishment of molecular lab for covid-19

• Considering the establishment of zonal testing sites to enhance surveillance

• Deployment of 9-member medical and security teams in 22 points of entry

18SOURCE: Nigerian Centre for Disease Control (NCDC)SOURCE: Nigerian Centre for Disease Control (NCDC)

• The total number of

confirmed cases in Jigawa

State by the 31st May 2020

grew at a Cumulative

Average Growth Rate

(CAGR) of 120%

• The average number of

recoveries compared to the

total confirmed cases by the

31st of May,2020 was 22%.

• The ratio of deaths to

confirmed cases in Jigawa

State by the 31st of May

2020 was at an average of

2%.

Panel discussion by Edo StateDr. Patrick Okundia

(Commissioner for Health)

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Edo State Strategy in Fight Against COVID-19

Dr. Patrick OkundiaCommissioner for Health, Edo State Government.

The Situation Before:

•Been Practicing Medicine in Edo State for over 26 years.

•Primary Health Care System was practically None Existence.

•Secondary Health Care System collapsed:

1) 34 General Hospitals under HMB management.

2) 4 Flagship.

•Tertiary Health Care System:

1) 3 Federal.

2) 1 State (new): Took over the responsibilities of both Primary and Secondary.

•Private Health Institutions.

Previous Status:

•Suffered persistent neglect by successive Governments.

•Some just scratch the surface.

•Hope lost.

•Medical Tourism (internal and external).

•Shrinking manpower size.

•Quackery.

•Recurrent Strike actions.

•Training Institutions (School of Nursing and Midwifery) lost.

PRE-COVID19: Our Health System

• Identification of 4 Isolation centers

• Identification of 2 holding centers

• Renovation of 12 bedded isolation centre in SOH

• Construction of new 30 bed isolation centre in SOH

• Completion of 30 bed isolation centre in SOH

• Renovation of Ogbe Nursing Home as a holding centre

• Provision of tent in SOH as a triaging area

• Renovation of Ogbe Nursing Home continues

• Renovation and expansion of isolation centres in UBTH and

ISTH

• Continuation of Renovation and expansion of isolation

centres in UBTH and ISTH

• Completion of Ogbe Nursing Home

• Commencement of expansion and remodeling of SOH to 250

bed isolation centre

Our Preparedness

● Screening ongoing -94th fixed post, 75 mobile post

● Total persons screened to date 332,649 (66.52% of

500,000 target set for screening); 2,374 samples

collected giving a yield from screening of 0.71.

● 341 PCR confirmed cases from 2,743 samples (yield

12.4%)

● 3 high reporting LGAs - Oredo, Egor, Ikpoba-Okha

● 332 contact under follow up

● HCW infections 6.2%

● Bed space :SOHIC -300, UBTH -42, ISTH -9.

● Bed utilization :SOHIC 4.6%, UBTH 45.2%, ISTH

44.4%.

SITUATION REPORT

POST – COVID -19: New Realities

COVID-19 has been more of a blessing

to the Health sector in Edo State with:

1) Massive infrastructural

reforms in Health Institutions

across the State.

2) Training of healthcare

workforce who are now

more than ever

motivated.

3) Better reward

system for health

workers.

4) This has set a stage for the

much desired restructuring of

the health sector in Edo State

going forward.

Panel discussion by Ogun StateDr. Tomi Coker

(Commissioner for Health)

29SOURCE: Ogun State Ministry of Health

• The cumulative discharge rate for

Ogun state is 54%.

• The death rate is 3.2%

Panel discussion by Lagos StateProf. Akin Abayomi

(Commissioner for Health)

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SituationalAnalysis

Patient Breakdown

Isolation Bed Capacity

AgeVital Data

• Index-case from Ogun state, managed in Lagos– 27th Feb,

• Contact of index case – 9th March. Local case – 17th March

• Transmission –

• From week 0 to 4 – Mainly Imported cases over 80%• Week 5 to Week 8 – Contact of cases and community transmission – about 65%

• Geographical distribution of cases• Top 3 LGA – Eti-Osa, Lagos Mainland and Ikeja

• Population:

• Number of Tests:

• Number of Cases:

• Test Positivity Rate:

• Avg. Length of Stay:

• Case Fatality rate:

24 mln

22,620+

5,557

24.5%

12 days

1.1%

Six Facilities:• Mainland Hospital (IDH), Yaba - 115

• Onikan - 100

• LUTH - 60

• Gbagada - 118

• Landmark - 60

• Agidingbi - 44

• Lekki - 45

Yes29%

No 71%

Gender Proportion with Co-morbidities

30 20 10 0 10

Number of Confirmed Cases

20

≤ 10

11-20

21-30

31-40

41-50

51-60

>70

61-70

Ag

e-g

rou

p

Male Female

Male 62%

Female 38%

Case Severity

59%

38% 2% 1%

Mild Moderate

Severe Critical

Epidemiology

Weekly Cumulative ConfirmedCases

32 93 110 169309

746

1123

1860

2388

3520

4958

0 1 2 4

5557

2000

3000

4000

5000

WC 02/02WC 01/03WC 08/03WC 15/03WC 22/03WC 29/03WC 05/04WC 12/04WC 19/04WC 26/04WC 03/05WC 10/05WC 17/05WC 24/05WC 31/05WC 5/06

Activation of1000 the ICS

Contact of Index case treated in Lagos

Update to COVID-19 Case definition

ACTIVE COMMUNITY CASE SEARCH

Index Case fromOgun State. Strategy: Containment, Isolation & Contact tracing

LOCKDOWN

EASE LOCKDOWN

DECENTRALIZED SAMPLE COLLECTION

Scenario Planning – Virus Infectivity

47,243

91,976

136,709

40,000

20,000

-

60,000

80,000

100,000

120,000

140,000

160,000

WC WC WC WC WC 16/04 23/04 30/04 07/05 14/05

WC WC WC 21/05 28/05 04/06

WC WC WC 11/06 18/06 25/06

WC WC WC 02/07 09/07 16/07

Scenarios of COVID-19 Infectivity for Lagos State

R = 1.55 R = 1.6 (Approx) R = 1.7

Current Position 5,557 Cases

Most likely scenario

after considering the

effect of interrupters

and herd immunity

Biosecurity Responsibilitiesof Government

A well informed populace

Pre-empt and prevent biosecuritythreats

Predict

Mitigate and adapt to insidious unavoidable environmental changes

Find and clearly identify a threat when it emerges

Stop it promptly

Restore calm and civil disruption &build resilience

Requires operational systems, policiesand regulations and Legislation to deterthreats and enable a rapid scale upshould an emergency occur despitepreventative measures

Trained workforce, Role of Academic Institutions, environmental and publicmonitoring and surveillance

Tertiarylabs,

health systems,

and emergency response inclusive oflaw enforcement.

• Each country has the moral responsibility to protect its people within the social contract from biological crises and threats, and protect the integrity of its ecosystem we depend on.

• Government agencies must be able to do the following:

Lagos State’s Preparedness forCOVID-19

As a result of the sequence of activities above, Lagos State was 60% ready for the COVID-19 outbreak

2018 20182016 –

202020182015 –

2017

BSL-3 Lab• Invested in a Biosafety

Level 3 Laboratory andBiobank in Lagos State

Staff Training

Trained key staff in Biosecurity and Biothreat reduction

Bio-Governance

Established the Biosecurity and Bio-Governance council

PolicyCompleted LagosState’sbiosecurity policy and roadmap

Infrastructure• Upgraded and expanded Isolation

capacity at Lagos Mainland hospital; the infectious diseases hospital.

Convened 5 Biosecurity conferences

Management of thePandemic

Since the outbreak of COVID-19, Lagos State has significantly strengthened its capacity to contain the virus by applying a dynamic approach to its planning process

Launch of the Incident Command System (ICS)

Further Upgrade of Facilities

Increased Installed Testing Capacity

Establishment and Training of Rapid Response Team

Epidemiology, Surveillance, Case Mgt., etc.

Engagement of Partners, Private Sector and Community

Management of Cases through Containment and Contact Tracing

Isolation Centres

Lockdown

1

2

3

4

5

6

7

8 To incorporation of Community Based Care

MoH in the lead

Now about 2,000 tests per day

Isolation for only severe-to-critical cases

Lagos State’s ResponseStrategy

Testing Strategy; PCR Testing based on clear case definition by public labs

Isolation Strategy:• Full Containment

in Public IsolationCentres.

1 – 99 Confirmed Cases

100 – 1,000Confirmed Cases

1,001 – 4,000Confirmed Cases

Above 4,000Confirmed Cases

Testing Strategy;• PCR Testing based on

clear case definition by public labs

• Decentralize sample collection

Isolation Strategy:• Full

Containment.

• Increase number of isolation centres

Testing Strategy; PCR Testing based on clear case definition by public labs

Testing Strategy;• PCR + Rapid Diagnostic Testing by

public & private labs

• Contribute to national testing effort

Isolation Strategy:• Full

Containment.

• Add privatefacilities forHigh care

Isolation Strategy:• Community-based care

• Isolation of only Severe-to-criticalcases

• Add Private facilities for all COVID care

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ACIOE Associates is an advisory services firm providing solutions in Strategy, Government Relations,Regulatory Affairs, Economic Development, Advocacy, Investment Facilitation, and Policy Analysis.

Our team provides advisory services on critical sectors, including Health, Agriculture, Social Impact, andGovernment relations.

We have supported governments (Federal and Subnational), development partners, and organizations aroundsustainable solutions to the challenging economic, political, and development issues within the countries weoperate.

ADVISORY | GOVERNMENT RELATIONS | REGULATORY AFFAIRS | INVESTMENT FACILITATION

F O R M O R E I N F O V I S I T

www.acioe.com