ANALYSIS | X- Raying Kano’s response to COVID-19

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Considering the sheer size of its population, many fear Nigeria’s inability to break COVID-19’s chain of community transmission in Kano may pose a grave danger to the country’s war against the scourge

 

NCDC DG Chikwe Ihekweazu (first from left); Kano State Governor Abdullahi Ganduje (third from left) and Zouera Youssoufou is managing director and CEO of The Aliko Dangote Foundation

 

Long after COVID-19 emerged in Nigeria on February 27th, the absence of a case of the virus in Kano, officially the country’s most populous state, was a great surprise to many, considering its strategic location as the commercial nerve center of northern Nigeria and home to the country’s third busiest international airport. Thus, the disease’s arrival in Kano was but a matter of when and never if. And it is said, when Kano sneezes, other northern states catch cold.

Although Kano was one of the first Nigerian states to establish isolation centers and one of the first to close their borders, overall, the state government’s preparedness and response mechanism proved ineffective in preventing the spread of COVID-19 to Kano and subsequently, in preventing a chain of community transmission that has now seen the state overtook all other Nigerian states in numbers of COVID-19 cases – except Lagos. Fears abound of the possibility of Kano replacing Lagos as the epicenter of the COVID-19 pandemic in Nigeria, soon.

The sense of concern and trepidation surrounding the ability of Kano to contain the spread of the virus is informed by, amongst others, Kano city’s high population density; sociocultural and behavioral factors that have resulted in nonchalant attitude among many of the city’s residents towards the virus, some of whom do not even believe in the existence of the disease in its entirety. Other factors are Kano’s weak health and political governance systems.

Although it joined the COVID-19 race relatively late, the reality of Kano’s level of preparedness for COVID-19 became noticeable shortly after the state recorded its index case of the disease, which sparked chains of community transmission of the disease. This has seen Kano overtaken the Federal Capital Territory (FCT) as the state with second highest numbers of COVID-19 cases and currently threatens Lagos’ first position of being the state with highest numbers of cases in Nigeria.

In recognition of Kano’s double realities of high population density and indifferent attitude of majority of its citizens, analysts believe, if agressive proactive measures were taken by the Kano state and federal governments, long ahead of the spread of COVID-19 into the state, the current seemingly unchecked chain of community transmission, could have been avoided altogether.

It is worthy of note that unlike Lagos which was the epicenter of Nigeria’s battle with the Ebola Virus Disease, Kano never had to grapple with a contagion of epic proportion as the COVID-19 pandemic. Consequently, the state lacks the requisite infrastructure and human capabilities to deal with the contagion, which partly explains its weak preparedness and response capacity.

 

Weak state response, federal neglect

It must be acknowledged that no Nigerian state currently boast the capacity to independently contain and prevent the spread of COVID-19. Yet, states like Lagos and Kaduna have shown a much higher level of preparedness and proactiveness in their response to COVID-19 compared to states like Kano. The Lagos and Kaduna have remained outstanding in their response to the pandemic – no Nigerian states had shown such level of proactiveness and effectiveness in responding to the pandemic thus far.

Moreover, until when things began to get out hands, there was little federal presence in Kano’s effort to combat COVID-19, despite its evident weak preparedness and response capacity, high population density and high risk for community transmission of the virus due to its peculiar sociocultural landscape. Subsequently, Kano state was largely left on its own accord to deal with the pandemic. Thus, although the state government should take a larger proportion of blame for its weak response to the pandemic, that blame must be shared with the federal government as well.

Consequently, the state government’s response at the beginning of COVID-19’s spread into Kano leaves much to be desired. Although the state government had before COVID-19’s arrival in Kano, set up a taskforce to deal with the pandemic, events took a different turn when on April 17th, it was reported that three key members of the taskforce including its co-chair, secretary, and the state’s health commissioner had all got infected with COVID-19 and thus went into isolation. This development left the task force in disarray and significantly hampered Kano’s early response to the virus.

It was not until around late April when news of strange deaths began to surface and dominate the mainstream and social media and the #PrayForKano was trending on Twitter that the federal government began to pay attention to what was happening in Kano. As Nigerians began to link the strange deaths to possible community transmission of COVID-19 within Kano metropolis, the state government was quick to deny such link and brand the news of the mysterious deaths as “fake news” before it later announced it would investigate the unusual fatalities.

Relatedly, on April 27th, Governor Abdullahi Ganduje was reported to have accused the Nigerian government of having abandoned Kano to its own fate in the midst of the coronavirus pandemic. When asked by the BBC whether or not Kano was “getting any support from federal government agencies on the fight against COVID-19?” his response was: “Sincerely speaking, we are not getting deserved attention. If these equipment (testing centre) are under our control, we will do our best to make sure it works properly. But we are not getting the needed support and cooperation from Presidential Task Force on COVID-19.”

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A day later, April 28th, a federal fact-finding mission from the Presidential Task Force on COVID-19 (PTF-COVID-19) met with Governor Ganduje and announced their presidential mandate to “reinforce and not reinvent the wheel” in Kano’s response to COVID-19.  The mission’s lead, Nasir Gwarzo was reported to have said President Muhammadu Buhari had given them a “marching order to be in Kano and find out what the state needs for containing the COVID-19 pandemic… (The) President said we must do everything possible to support, reinforce and mobilise support, even beyond the nation.”

 

Limited testing capacity

Despite the sheer size of its population, there was not a single testing centre in Kano at the beginning of the spread of COVID-19 into the state, unlike Lagos which had more than one testing centres and later got sample collection centres established by the state government. It was days into the outbreak in Kano that the Nigeria Centre for Disease Control (NCDC) established the first testing centre in Kano.

According to NCDC, Nigeria’s daily testing capacity for COVID-19 is 2,500, with 1,500 of these capacity being in Lagos state alone, while the remaining 35 states of the federation and the FCT have a combined capacity to conduct only 1,000 tests, daily. Ironically, the testing capacity of the NCDC’s lone testing lab in Kano was the minimum of over 40 and maximum of over 90 samples, daily. This was too little for a state like Kano.

Around April 22nd, the lone NCDC laboratory in Kano was reported to have ran out of reagents while a number of the lab workers were said to have been infected with COVID-19. Subsequently, the lab was shut down and underwent decontamination, which meant samples had to be transported to Abuja by road for testing leading to costly delay in confirmation of COVID-19 cases and subsequent tracing and testing of contacts of infected persons.

On April 26th, Nigeria’s minister of health, Osagie Ohanire, announced that the NCDC testing centre in Kano would resume operations on April 27th.  Same day, the establishment of a new testing centre was announced by the Bayero University, Kano (BUK) at the Aminu Kano Teaching Hospital (AKTH), whose maximum potential testing capacity was placed at 180 per day. Relatedly, on May 4th, the Aliko Dangote Foundation (ADF) announced the donation of a testing facility to the Kano state government, with the initial capacity to test for 400 samples daily which could be increased to 1,000 tests per day by as early as May 10th.

Experts believe ADF’s testing facility might prove a game changer in Kano’s response to COVID-19 since improved access to testing is at the heart of the campaign against the community spread of the contagion. Thus, the World Health Organisation director-general’s message to countries:  “Test, test, test. Test every suspected case, if they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too.”

 

Weak community engagement strategy

Long before COVID-19’s spread into Kano, analysts believe the success or otherwise of any prevention and containment plan for the disease in the state would be determined by the robustness and effectiveness of its community engagement strategy. As community gatekeepers, traditional and religious institutions play a strategic and unquestionably influential role in swaying people’s attitude and behaviors in Kano.

The fact that traditional and religious leaders didn’t feature prominently in Kano’s early preparedness plan for COVID-19 could be responsible for the huge misconception about COVID-19 that prevailed in the state even before the first COVID-19 case was confirmed in the state on April 11th. Consequently, videos of Kano citizens debunking the existence of coronavirus and its ability to spread to Kano were seen circulating on social media.  With aggressive community engagement, such acts deliberately meant to mislead and misinform the populace could have been avoided.

Shortly before Kano recorded its index case of COVID-19, a Kano-based nonprofit, the Resource Centre for Human Rights & Civic Education (CHRICED), had written a letter to the governor in which the group observed what they called “citizen apathy and unresponsive posture to the government’s social distancing directives”. CHRICED blamed this on a combination of lack of awareness and misinformation adding that many Kano citizens neither understood the dangers posed by COVID-19 and how it was transmitted nor what to do to prevent it.

“This information gap on COVID-19 needs to be urgently addressed using a comprehensive and robust communication strategy involving the government, civil society organizations, and community gate keepers. Such sensitization campaign will help stimulate the interest of citizens and get them to focus on the clear and present danger posed by this dreadful COVID-19 pandemic,” the group warned.

Certainly, a more proactive and holistic community engagement in Kano in the period leading to the outbreak of the COVID-19 pandemic in the state would have, to a large extent, helped changed the attitude of majority of Kano citizens towards the disease. The proactive enlistment of the support of community leaders to engage in robust community sensitization campaigns through mass media could have significantly changed people’s negative perception about COVID-19 in Kano. Thus, the current prevalent community transmission could have been averted.

 

Weak compliance, enforcement of lockdown

It would be recalled that the Kano state government had since March 25th ordered the complete closure of all land and air routes linking the state to other parts of the country with effect from March 27th, to prevent the spread of the virus to the state.‎ Although Kano was one of the first Nigerian states to close their borders, even before a case of the virus was confirmed in the state, the fact that Kano is today fast becoming epicenter of the COVID-19 pandemic in Nigeria could be easily linked to the poor sense of compliance and enforcement of COVID-19 precautionary measures in the state.

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Whereas the state was proactive in closing schools, borders as well as asking Kano citizens to adhere to social distancing measures and maintain high personal hygiene, the state largely failed to enforce these preventive and precautionary measures. In CHRICED’s April 10th letter to the state governor, the group had drew the government’s attention to Kano citizens’ almost total non-compliance to its social distancing directives aimed at mitigating the spread of COVID-19 in the state.

“From our observations, large social gatherings including weddings, naming ceremonies, and congregational prayers have continued with active participation of some your government’s key officials; and with no understanding of the disastrous consequences these could hold for public health in Kano State. Also, across many play grounds, youths continue to engage in daily games of football, even though the rest of the world has put a stop to sporting activities due to the ravages caused by this COVID-19 pandemic.

“The transport services, particularly the tricycle (Keke) riders continue to violate the social distance order by overloading passengers. These trends portend very serious implications for public health and safety in Kano State, the most populous state in Nigeria, which could have a higher burden to cope with should preventive measures be undermined and allowed to fail,” the group had cautioned.

Moreover, local media in Kano was awash with reports of people sneaking into the state despite the border closure through various land entry points. There were also reports of various acts of bribery and extortion of citizens seeking to illegally enter Kano by security agents manning checkpoints at strategic entry points, which sabotaged and compromised the government’s border closure policy. It’s very possible that many COVID-19 positive persons might have found their way into Kano during this period.

On April 14th, after Kano has recorded its index case of COVID-19, the state government ordered a complete lockdown of the state effective from April 16th. With the total lockdown of the state, all non-essential movements within and without the state were banned, congregational mosque and church services were also banned. Markets and super markets were all closed down, while public and private sector organisations including Ministries, Departments and Agencies (MDAs), banks and telecom companies all got shut down.

Whereas compliance with the lockdown measures was good in many parts of Kano metropolis, the story was different within many neighborhoods were people continued with their routine activities such as congregational prayers and sitting together in groups while youths engage in street footballing matches. After a video of a large crowd of youths watching a football match in Kano went viral on mainstream and traditional media, on April 21st, the police announced the arrest 30 youths for engaging in footballing activities within Kano metropolis.

 

Inadequate palliative measures

Since the total lockdown of Kano, citizens of the bustling metropolis majority of whom are daily wage earners who live hand-to-mouth kind of existence had been living under difficult conditions, as access to feeding increasingly became a serious challenge. The success of lockdown measures in places like Kano would to a large extent be determined by the ability of the government, organized private sector, NGOs and philanthropists to ensure palliative support reach the poor.

Indeed, for majority of Kano’s residents, the choice between staying at home and going out to earn a living during the COVID-19 lockdown is that of a choice between the devil and deep blue sea. Ultimately, like an unnamed Lagos resident told CNN, “I prefer to die from Covid-19 than hunger,” many Kano residents would rather go out and eke out a living and therefore risk contacting the virus than staying at home to die of hunger!

Notably, the Kano state government had on April 23rd launched the distribution of food items to 50,000 households of the poorest of the poor across Kano’s 44 Local Government Areas, to cushion the effect of COVID-19 lockdown measures on its citizens. Yahuza Bello, chair of Kano COVID-19 taskforce’s fund raising committee said four households in each of Kano’s 11, 000 polling units across 484 political wards would receive “a bag of rice, a carton of spaghetti, macaroni, dawavita, four litres of oil, semovita, pasta, indomie and cash gift of N2,000.”

In a state of 16 million people, many of whom live in abject poverty, Kano’s palliative measure was but a drop in the ocean – it was too insignificant to encourage the poor to stay at home. Subsequently, as a result of lots of cries among the citizens on the hardship they were going through as a result of the lockdown, the state government had to appeal to President Buhari, who had on April 26th placed Kano on a 2 week federal lockdown, to allow the state government to relax the lockdown.

“We are making this appeal on behalf of our people who are presently running out of food items. We would love the federal government to relax the lockdown for a period of time to enable people stock their homes, especially now that majority of us are fasting. It will also ease the economic hardship in the state,” Governor Ganduje was quoted to have said.

Having secured presidential approval for its request to relax the lockdown, on May 2nd, Kano state announced the relaxation of the lockdown between 10am to 4pm on Mondays and Thursdays of every week. Whereas many were skeptical about the relaxation of the lockdown in a state which was fast becoming the epicenter of the COVID-19 crisis in Nigeria, the decision could have been the most realistic considering the plight of the masses of Kano. Otherwise, the people would have revolted which could have led to total breakdown of law and order.

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Although the government had urged citizens to adhere to preventive measures as they go about their businesses during the specified hours on Mondays and Thursdays, it’s very likely that people would adhere to these measures due to prevailing nonchalant attitude of Kano citizens towards such government declarations. Therefore, the government must come up with a clearly defined strategies for enforcing these precautionary measures. Otherwise, it is going to be business as usual and the government order will remain mere a pronouncement! 

 

‘Mysterious’ deaths

Since the commencement of the implementation of the lockdown policy in Kano, the state has recorded an unusual spike in deaths of especially citizens above the age of 60. In a period of just week, over 600 dead bodies were reported to have been buried by undertakers across the multitudes of graveyards spread across the bustling metropolis. The spike in mortality rates were initially blamed on complications such as malaria, hypertension, and pneumonia, sparked by the usually high daily temperatures being recorded in Kano at the peak of the summer season.

“Over the past week there have been reports of mysterious deaths in our great Kano state and I’m here to assure everyone that investigations are already ongoing. Autopsies are still being carried out but so far there’s been nothing to suggest that they are linked with Covid-19,” Abdullahi Umar Ganduje, the governor of Kano state, was reported to have said after the deaths have become a major issue of discussion on social media in Nigeria.

However, after the conclusion of its fact-finding mission on the ‘strange’ Kano deaths, the presidential mission which investigated the deaths through verbal autopsies, had in its preliminary report released on May 4th, said majority of the deaths were caused by COVID-19. “We have five cogent reasons to say that the mass deaths recorded in Kano are associated with the Coronavirus,” Gwarzo, the mission’s team lead told journalists on Sunday.

Other factors that could have been responsible for the Kano mass deaths was the near breakdown of the healthcare system in Kano as a result of the closure of all private healthcare facilities and diagnostic centres, as an attempt to limit the spread of COVID-19 in the state.  Consequently, health workers at public healthcare facilities in the metropolis were overwhelmed; many healthcare workers were reported to have either turned patients away or even totally absconded from their duties. The health workers’ attitude was motivated by their fear that the patients might have been infected with COVID-19 as well as lack of Personal Protective Equipment (PPE) in the healthcare facilities.

While the health workers’ attitude might appear to be irresponsible, dealing with potential COVID-19 patients without protective gears would have been out rightly suicidal. Consequently, 34 medical doctors in Kano were reported to have contracted the virus in the line of duty while one died from COVID-19 complications. Going forward, the state and federal governments must, as a matter of urgent responsibility, ensure health workers are equipped with all necessary PPEs; otherwise we would continue to witness desertions which will ultimately lead to the total collapse of the already weak response efforts in Kano.

 

Save Kano, save Nigeria

The best time for Kano to prepare for the COVID-19 pandemic was three months ago; having obviously failed to prepare for an effective response to the disease which is responsible for the current high-level of community transmission of the virus and COVID-19 related deaths in the state, the state and federal governments must evolve a comprehensive joint strategy for responding to what many experts fear might be a looming catastrophe.

“With the preliminary report, most of the recent deaths recorded and tests carried out point to coronavirus. Hence, before the final reports which are expected in the next one week or few days, it is necessary for people of the state to wake up from their slumber and understand that this is a serious issue at hand,” Gwarzo had warned on Sunday.

For, unless something drastic and urgent is done to break the chain of community transmission in Kano, the number of cases we are witnessing today might after all just seem like a child’s play. One of the major cause for worry with the COVID-19 situation in Kano is that the virus has since spread into vulnerable groups such as the almajiris, some of whom have been confirmed to have tested positive for the virus, after they had been deported to their states of origin such as Bauchi and Kaduna.

The war against COVID-19 in Kano can only be won if all stakeholders work collectively in the interest of the people of Kano. Whereas the state and federal governments have the major responsibility in the fight against the pandemic, Kano’s too many high-net-worth individuals, traditional and religious leaders as well as faith-based, community-based, and civil society organizations must also take active role in the war. Indeed, the success or otherwise of the campaign against COVID-19 in Kano will have repercussions across Nigeria and possibly beyond.

 

 

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.

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