Against the backdrop of an initial shaky response to COVID-19, thanks to three testing laboratories and even more sample collection outlets, COVID-19 testing has now become more accessible to citizens of Kano state
At the beginning of the COVID-19 outbreak in Kano, there was not a single laboratory with the capacity to test for the rampaging disease. Therefore, samples taken in Kano had to be transported to Abuja by road for testing. It was many days into the outbreak in Kano that the Nigeria Centre for Disease Control (NCDC) and Aminu Kano Teaching Hospital (AKTH) jointly established Kano’s first testing laboratory at AKTH.
Few days later, the laboratory in Kano was reported to have been shut down as a result of being contaminated while a number of the lab workers were said to have been infected with COVID-19. Once again, samples taken in Kano had to be transported to Abuja for testing leading to long delay in confirmation of COVID-19 cases and subsequent tracing and testing of contacts of the infected persons.
Many days later, the laboratory was reopened, having gone through a decontamination process. Same day, the Bayero University, Kano (BUK) announced the setting up of a new testing centre to serve not only Kano but also neighboring states like Jigawa and Katsina. In a related development, on May 4th, the Aliko Dangote Foundation (ADF) announced the donation of a mobile testing facility to the Kano state government, bringing Kano’s testing labs to three.
Hamza Fagge, focal person for laboratories at the Kano state taskforce for COVID-19, said the challenge of access to testing in the early days of the COVID-19 outbreak in Kano were due to lack of local testing capacity. Consequently, he said, samples transported to Abuja by road took between 3 and 10 days for the results to be returned.
The fact that samples had to be transported to Abuja by road due to the closure of airports in Nigeria came with a serious logistical challenge for Kano, since such samples had to be kept at certain minimum temperatures as they were being transported to Abuja, in the searing heart associated with the peak of the hot season in northern Nigeria, which lasts between March and May.
Moreover, the road travel to Abuja which was supposed to be a 5-hour journey had become a whole day journey, due to so many security checkpoints along the road which restricted movement and consequently posed a threat to the safety of the samples being conveyed. The fact that even when drivers conveying the samples arrived at the National Reference Laboratory in Abuja, they had to join a long queue of drivers bringing samples from other states didn’t help matters.
While speaking on the contamination and subsequent closure of the AKTH-NCDC testing lab, Nasiru Magaji, head of the AKTH-NCDC laboratory said, the contamination was not an unusual occurrence, especially in circumstances such as that of a new and highly contagious disease like COVID-19.
“Contamination is normal in our work especially when you are dealing with a new disease like COVID-19 which also leads to infections among health workers; some of our lab workers were infected. We therefore, had to close down the lab to cleanse it during which the NCDC sent a team to assist us in restoring its functionality,” Magaji told African Newspage.
Sufficient testing capacity
African Newspage’s findings reveal the three NCDC-accredited testing laboratories in Kano have a combined daily testing capacity of up to over 800 samples. When it was launched on May 3, the Dangote Foundation’s laboratory was reported to have a testing capacity of 400 samples per day.
Moreover, The BUK-owned lab is said to have a maximum daily testing capacity of about 300 samples (If operating at 3 shifts per day) while the NCDC-AKTH testing centre has a maximum daily testing capacity of 132 (If operating at 3 shifts per day). Whereas the Dangote lab is exclusively reserved for samples from Kano state, both the NCDC-AKTH and BUK laboratories also serve neigbouring states.
Magaji said since the resumption of work at the NCDC-AKTH laboratory after its decontamination, there had been a steady increase in their testing capacity; they were initially operating one shift per day (44 samples) while now they perform between three to four shifts per day.
“When we started work at the laboratory before the contamination, we were running only one shift per day which was 44 samples. When the lab was reopened after the decontamination, we began running two shifts and now we are running up to three shifts, daily. In fact, yesterday we ran four shifts. This is because our workers now better understand the process and, unlike in the past, are no longer nervous about the disease,” he said.
Like Lagos, Kano has also begun setting up of sample collection outlets which will help further ramp up the currently deficient sample collection system and increase the state’s daily testing capacity for COVID-19. There are already five operational sample collection centres within and outside of Kano metropolis, where citizens can now present themselves to be tested for the virus. There are also ongoing plans for more to be established across the state.
Lack of samples
Prof Isa Abubakar, director of BUK’s Centre for Infectious Diseases Research (CIDR) cum head of the varsity’s testing lab said although the PCR machine at the CIDR-BUK lab had the capacity to process more than 90 samples at a time and up to three shifts could be ran, daily; however, their major challenge was lack of samples.
“Our lab has the capacity for over 90 samples at a time which could be doubled if we run two shifts daily. We had even wanted to commence running three shifts three days ago unfortunately, there were not enough samples; we had only 20 samples! We had to go round to scout for samples within Kano and also reached out to the commissioners of health in Jigawa and Katsina to send us samples,” he said.
Prof Abubakar therefore said they were working to improve the system of sample collection by reorganizing it such that the collectors could work in batches and shifts, which, he said, would allow for round-the-clock sample collection. He also said there was need for the engagement and training of more sample collectors, so as to ramp up sample collection and subsequently improve access to testing in Kano.
The dearth of samples is a result of a weak sample collection system, one that is characterized by low numbers of sample collectors, inadequate sample collection tools, and lack of innovation in the system of collection. Consequently, when people call the NCDC call centre for their samples to be taken, in some cases, it would take up to two or even three days before they get tested.
Our findings reveal there are currently a total of only 100 sample collectors working across the state’s 44 Local Government Areas (LGAs). To address this gap in sample collection, the state and federal governments must work collectively to employ, train, equip, and deploy more sample collectors to the field.
Towards enhanced access to testing
Despite Kano’s now fairly high testing capacity, unfortunately, this capacity remains largely untapped as not more than an average of 300 tests are currently being conducted by the three testing labs, per day. This is less than 40% of Kano’s current testing capacity, therefore, much needs to be done to ensure the nonstop flow of samples to the testing centres.
The newly introduced innovative idea of the drive-thru sample collection outlets must be further leveraged to achieve an expanded sample collection system. There is also the need to ensure equitable distribution of samples among the three labs, based on their capacity. For instance, the NCDC-AKTH lab, the pioneer testing lab yet the smallest in terms of capacity seems to be receiving more samples compared to the two others, in relation to their capacities.
Consequently, results of samples taken could take up to a week before they are confirmed. Prolonging the determination of test results presents a serious danger to the campaign against COVID-19 as the delay in getting results of tested persons means many COVID-19 positive persons will end up infecting others with the disease before they know their status. Thus, there is need to ensure proper coordination between the three testing centers to guarantee equitable distribution of samples among them.
More so, our findings reveal the need for more reagents, manpower and Personal Protective Equipment (PPE) across the labs which further slows testing activities. Equally of high importance, is the need to ensure timely and adequate payment of hazard allowances to laboratory workers as a way of motivating them to do their work better, considering the high risk nature of dealing with COVID-19 samples.
This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.
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