Opinion: COVID-19: Kano, a city in critical situation

By Prof. Usman Yusuf

1. Though their hearts are heavy with grief and their eyes filled with tears, residents of this ancient city derive solace from their scripture which reminds them that: “We surely belong to Allah and to Him we shall return” Quran 2:156 and that “Every soul shall taste death” Quran 3:185.
2. Every other household in this city has either lost a relative, has someone lying ill from COVID-19, is awaiting test results of the virus or knows a family in similar circumstances. For me personally, some of these deaths are not abstract numbers but real people representing colleagues and friends lost to this unseen killer. 
3. Every day, all across the city, from the crack of dawn to the setting of the sun, there are silent processions of people bearing the remains of their loved ones felled by this virus for burial in cemeteries spread across the city. The family of one of my deceased friends told me that even though they have experienced death in the family before, death from COVID-19 was different. They described it as very painful, frightening, and lonely for both the deceased and the family.
4. They recounted how they helplessly watched their loved one gasping for air but could not go near him and when he passed away, they could not go near the body or accept visitors that would normally come to condole them. They are now home grieving alone while anxiously and prayerfully waiting for the results of samples taken from them to check if anyone of them has also been infected by the virus.
5. People in the city are living in a state of fear, uncertainty, and helplessness. An elderly resident summed it up this way: “I feel like the whole city is under a death sentence and we are just waiting for that knock on our doors from this silent unseen executioner here to take us”. 
6. The already struggling healthcare system in the city is on the brink of collapse as Private Hospitals are shutting down due to lack of capacity to manage sick COVID-19 patients and lack of Personal Protective Equipment (PPE) for staff. State secondary and Federal Tertiary hospitals are already getting overwhelmed and turning away patients due to lack of bed spaces, medical supplies, drugs, PPE and understaffing, 
7. Aminu Kano Teaching Hospital (AKTH), the only Tertiary hospital in the city is now like a ghost town, a visit to its Accident and Emergency is scary and heart breaking with patients lying everywhere many coughing and gasping for air while some already in coma are left unattended.
8. There is a very serious healthcare crisis now in the city that may claim more lives than COVID-19. There is no provision made anywhere in the city for the care of patients with ailments that are not related to Covid-19 like Malaria, Deliveries, Obstructed Labour, Diabetes, traumas etc. which are increasingly claiming lives.
9. There is a lot of anxiety and trepidation among all healthcare workers in the city who are acutely aware of the mortal danger they face daily from seeing patients without adequate PPE. Some of these selfless men and women have already tested positive for the virus and unfortunately, this number is likely to rise in the coming days thereby reducing the number of troops in the frontline to fight this enemy.
10. I have followed with great concern how some people and media outlets have been sucked into the false propaganda put forward by Governor Abdullahi Umar Ganduje and his surrogates who attribute the increasing death toll in the city to a “strange illness”. He is borrowing from the playbook of authorities in Wuhan China when they were trying to hide COVID-19 related deaths in the city at the beginning of this pandemic. 
11. Wuhan authority’s coverup crumbled when confronted with escalating death toll in the city. But at least they woke up and did something to reverse the situation, not so with Ganduje who is still in denial. People keep wondering what he stands to gain from these denials in the face of increasing deaths and sufferings of his people. 
12. The other day, I had to correct the anchor of Channels TV program: “COVID-19 Update” when I appeared at 6 pm on 28th April 2020 when she said on air that “Lagos is the epicenter of COVID-19 pandemic in Nigeria”. The reality is, with the rising daily death toll in Kano, the city remains the undeniable epicenter of the COVID-19 pandemic not only in Nigeria, but in the whole of Africa. 
13. What I find more worrisome is that the NCDC in its daily briefing is not even acknowledging the correct number of new infections and deaths in the city and is also not deploying adequate testing capacity and medical supplies to meet the worsening situation on the ground. 
14. NCDC on its website, clearly states that it has the capacity of doing 2,500 tests every day with 1,500 of these reserved for Lagos alone while the rest of the 35 States of the Federation and the FCT share 1,000 tests between them. There is no defensible scientific basis for this skewed and inequitable distribution of this vital national resource at this time of our national emergency.
15. Testing remains one of the key measures to curb the spread of this disease. WHO Director-General, in March 2020 reiterated this point when he said “We have a simple message for all 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,”.
16. The truth is that in Nigeria, we are not testing anywhere near enough. With a population of close to 200 million, less than 10,000 people (15,759 samples) have so far been tested while South Africa with a population of 59 million has tested over 160,000 people and Ghana with a population of 31 million has tested close to 70,000 of its people. Even small countries like Djibouti with a population of less than 1 million (988,000) has tested over 8,000 people. It is common knowledge in the scientific community following this pandemic that, maps that do not show any cases of COVID-19, are an indication of a lack of testing rather than the absence of the virus in that community.
17. I have always believed that Kano City alone has more cases of COVID-19 than the whole nation put together due to the epidemiology of the disease, the city’s population density, socioeconomic and cultural factors, and weakness of the health system and political governance. 
18. Lack of testing has been the main reason we have not been seeing the true picture of the disease in the city leading to increased mortality among the elderly particularly those with preexisting illnesses. Accurate, real-time actionable testing data is crucial in the fight against this virus and it also helps policymakers in making sensible decisions. 
19. As we mourn our loved ones and friends, we ask that their humanity be respected and acknowledged. Now is the time for thoughtfulness, honesty, transparency and compassion for one another not half truths and propaganda.
20. Kano’ situation is critical and I call on the Federal and State Governments, Donor Agencies, the International Community, people of means and all Nigerians to do all in their power to help the city.
IN SUMMARY(a). Kano city is the epicenter of COVID-19 Pandemic in Africa.
(b). It is a city in mourning with a rising daily death toll.
(c). The residents of the city are living in a state of loss, fear, and uncertainty.
(d). The state Governor is not showing any credible leadership and is still in denial.
(e). NCDC is not accurately accounting for the number of infections and deaths in the city.
(f). NCDC is not deploying enough resources for testing and contact tracing to the city.
(g). The healthcare system in the state is on the brink of collapse with private hospitals shutting down and secondary and tertiary hospitals getting overwhelmed.
(h). Healthcare workers are still not provided adequate PPE despite the Presidential directive to do so.
RECOMMENDATIONS(1). The decision of Mr. President to have Federal Government Presence in Kano is commendable, however, the PTF needs to move its operations to Kano which is the epicenter of this pandemic and be giving the nation a daily update on the situation in the city.
(2). Urgent Federal Government assistance to the people and hospitals in the city like:
(a). Foodstuffs to people and Medical supplies to all hospitals 
(b). Mobilize more healthcare workers from the Uniformed Services and elsewhere in the nation to the city.
(3). The President will need to have an independent way of verifying that his directives are followed through and that people and hospitals are receiving what he directed.
(4). Because of the serious National Security implications of what is happening in Kano, I urge our lead Security Agency, the DSS to be proactive in getting accurate data to the President on the following: 
(a). Status of the healthcare systems and needs in the state, 
(b). Number of people testing positive daily
(c). Number of daily COVID-19 related admissions to hospitals
(d). Number of people lying ill at home with the disease 
(e). Number of burials daily in each of the city’s cemeteries 
(f). Mood of the people in the city
(g). Inputs from Traditional, Religious and Community leaders
(5). I call on all Ministers and political appointees from Kano as representatives of the President, to be seen in Kano commiserating with the Emir, Governor, and people and be heard on local radio stations consoling people. 
(6). I call on Federal legislators from Kano state to be heard on local radio stations talking to their people.
(7). I call on the President to urgently reach out to foreign leaders for help with the following because we neither have the luxury of time nor access to these medical supplies in the international open market:
(a). COVID-19 Test kits
(b). PPE for healthcare workers
(c). Gowns, Face masks, Goggles
(d). Drugs and Medical consumables 
(e). Ventilators
Usman Yusuf is a Professor of Haematology-Oncology and Bone Marrow Transplantation.