Intrigues and Challenges Associated with COVID-19 Pandemic in Nigeria

Coronavirus disease 2019 (COVID-19) pandemic has emerged as a global health crisis, with 3,855,788 infected persons and 256,862 deaths worldwide as of May 9, 2020. In Nigeria, the first case of the pandemic was reported by the Nigerian Centre for Disease Control on February 27, 2020. Between the dates when the index case was reported and May 9, 2020, the nation has recorded a total of 4151 confirmed COVID-19 cases from 25,951 samples screened and 745 (18%) cases discharged with 128 deaths indicating a case fatality rate of 3.1%. Thirty-four (34) States and the Federal Capital Territory have recorded coronavirus disease. The most affected States in Nigeria is Lagos (epi-centre of COVID-19) with 1764 cases, followed by 576 cases in Kano states and only one COVID-19 case in Anambra State 42 days since the last report of index case. Demographically, a total of 2828 male subjects have been infected representing 68% and 1323 female subjects representing 32%. The age group 31 - 40 years is mostly affected accounting for 24%. The number of people with travel history is 210 (5%), 947 (23%) contacts, 2618 (63%) without epidemiological link and 376 (9%) with an incomplete information. Nigeria is currently witnessing community transmission of COVID-19. Some observed issues aiding community transmission of COVID-19 in Nigeria are: the distrust of some Nigeria citizens towards government on COVID-19 management, poverty, religious beliefs, ignorance on face mask sharing, low level of informed populace, misconceptions, stigmatization of infected individuals, poor health facilities, inadequate testing Centre, shortage of health workers, poor treatment among others. Effective people’s health preventive behaviour and community-based health policy and strategies to mitigate these challenges are therein suggested.


Introduction
The coronavirus disease (COVID-19) caused by Corona virus, belongs to a family of RNA viruses that manifest various symptoms such as fever, breathing difficulty, sore throat, sneezing, dry or productive cough, general weakness, pain and other mild respiratory disease in human [1] [2] [3]. These viruses are common in animals worldwide, but very few cases have been known to affect humans [4]. The World Health Organization (WHO) used the term 2019 novel coronavirus to refer to a coronavirus that affects the lower respiratory tract of patients with pneumonia-like disease that was identified and first documented in Wuhan, Hubei Province in China in December 2019 [5] [6] [7]. The WHO officially named the 2019 novel coronavirus as , since the organization felt calling the virus Wuhan coronavirus was discriminatory (WHO, 2020), while the current reference name for the virus is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [4]. In December 2019, some patients with pneumonia-like symptom of unknown origin were linked to a local Huanan South China Seafood Market in Wuhan, Hubei Province, China. In order to conduct an epidemiological investigation and to determine the etiological agent, the Chinese Center for Disease Control and Prevention (China CDC) dispatched a team of its health authorities to respond to the outbreak. A closure notice was served to the market and a day after the market was shut down and fumigated [1] [4] [8]. The WHO affirmed that the outbreak of the coronavirus disease epidemic at that time was associated with the Huanan South China Seafood Marketplace, however, no specific animal was linked to the outbreak [9]. Adhikari et al. [4] reported that the spread of the virus throughout China during the Chinese New Year, was attributed to a high level of human of movement among Chinese people during that festive period. The first genome of COVID-19 was published on 10 January 2020 by the research team led by Prof. Yong-Zhen Zhang [10]. So far, there are over 1000 COVID-19 genomes that have been published worldwide [11], including the first whole genome sequencing of COVID-19 in Africa from the index case in Nigeria. These sequencing has resulted in the identification of different strains of SARS-CoV-2 in circulation. However, while it is still too early to infer susceptible populations, it has been documented that observation from the early disease patterns demonstrated pandemic trend similar to Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses [4]. Demographics of the pandemic seem to be associated with age, biological sex, and other underlying health conditions that may serve as catalyst to the coronavirus disease [12]. COVID-19 was declared Pandemic (Public Health Emergency of International Concern) by the world health organization by early March, 2020 [13]. Barely two months later, 212 countries and territories had been affected globally including Nigeria. Some of these countries have witnessed plateau of the pandemic cases and new cases continue to decline. But most African countries are yet to reach the peak of the pandemic as cases of community transmission are on daily increase. In a recent study conducted by Ren et al., [24] and Roujian et al., [25], whole genome sequence results of SARS-CoV-2 showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843) revealing that SARS-CoV-2 was more distant from strain from SARS-CoV. However, the virus is phylogenetically closest to two bat-derived SARS-like coronaviruses-bat-SL-CoVZC45 (with 87.9% sequence identity) and bat-SL-CoVZXC21 (with 87.2% sequence identity) as reported in the study by Roujian et al., [25], and Ren et al., [24] [23]. The interaction between the SARS viruses and ACE2 has been proposed as a potential factor in their infectivity [28] [29]. Substitution of amino acid sequence at positions 723 and 1010 involving the replacement of glycine amino acid with serine and isoleucine with proline respectively in the ORF1ab encoded 2 (nsp2) and nsp3 has been reported to have been responsible for the changes observed in the SARS-CoV-2 [30]. However, the 100% similarity in the amino acid sequence of nsp7 and E-protein of SARS-CoV-2 found in Bat-SARS-Cov-ZC45 is believed not be a natural mutation, except it is genetically engineered through recombinant technology. Theory has been circulating that the coronavirus at the root of COVID-19 pandemic originated from the research laboratory. However, whether the unusual 100% similarity in the amino acid sequence of nsp7 and E-protein of SARS-CoV-2 found in Bat-SARS-Cov-ZC45 is a natural mutation or conjured and/or escape from laboratory, scientists all over the world are working hard to unravel the controversy.

Viral Shedding and Transmission
The European Centre for disease prevention and control [1] reported that during the course of the infection, the virus has been identified in respiratory tract specimens 1 -2 days before the onset of symptoms which can persist for up to eight days in moderate cases and for longer periods in more severe cases, peak of the infection is expected in the second week. The viral load close to symptom onset suggests that SARS-CoV-2 can be easily transmissible at an early stage of infection according to the Centre. The detection of Viral RNA in feaces from day 5 after symptom onset, up to 4 to 5 weeks in moderate cases, and more than one month after infection in paediatric patients has been reported [1]. While whole blood, serum, saliva and urine have also shown the presence of viral RNA. Prolonged viral RNA shedding has been reported from nasopharyngeal swabs for up to 37 days among adult patients according to ECDPC [1]. In a recently study by Li et al., [31], the novel coronavirus can persist in men's semen even after they have begun to recover, a finding that raises the possibility of transmission of COVID -19 sexually. Six (6) out of the 38 (15.8%) of the total participant whose semen were screened had results positive for SARS-CoV-2. This includes those still at the acute stage of the disease as well as those recovering from the disease. It has been documented that pre-symptomatic transmission (the time when the person becoming infected and symptom onset occurs) during the incubation period for COVID-19, which may take an average of 5 -6 days and may last up to 14 days [18]. During this period, some infected persons can be contagious.

K. O. Akinyemi et al.
Therefore, transmission from a pre-symptomatic case can occur before symptom onset [36] [37] and that some people can test positive for COVID-19 from 1-3 days before symptoms development [18]. Thus, raising the possibility of COVID-19 transmission by infected persons prior to development of significant symptoms.
There are few reports of laboratory-confirmed cases that are truly asymptomatic, and to date, there has been no documented asymptomatic transmission.
The WHO defines asymptomatic transmission an asymptomatic laboratory-confirmed case as a person infected with COVID-19 who does not develop symptoms [18]. Currently, an index case of COVID-19 in Benue State, Nigeria has not developed any symptom of coronavirus disease after 43 days in an isolation Centre without medication (http://www.vanguardngr.com/, theedi-tor@punchng.com, https://ait.live).

Epidemiology of COVID-19
Since the 31 st of December 2019 when the outbreak was announced to 7 th May 2020 between 6:00 and 10:00 CET (

Africa updates on COVID-19
The first COVID-19 case in Africa was reported in Egypt on the 14 th of February, 2020 followed by Algeria on the 25 th of February, Algeria is one of the 13 countries which WHO has identified as a top priority for preparedness measures due to their direct link or high volume of travel to China. Other African countries started reporting their index cases afterwards. Nigeria is the first sub-Saharan Africa country to report the COVID-19 confirmed case. Most of the identified imported cases in Africa arrived from Europe and the United States rather than from China [39]. Africa recorded her first fatality of COVID-19 in Burkina Faso on 18 th March 2020, a female patient aged 62 years old, with underlying diabetes condition [40]. The distribution of COVID -19 disease in Africa as reported by the World Health Organization regional office Africa from the 14 th February of the index case to 6 May 2020 is shown in Figure 1.
Testing for COVID-19 has been a challenge in the continent. In a tweet by the

Corona Virus Disease (COVID-I9) Pandemic in Nigeria
The index case of the coronavirus disease (COVID-19) was reported in Nigeria  Capital Territory (44) as shown in Figure 2 and    ble the agents of Anti-Christ to produce vaccine that contain microchips. These chips will serve as a means of identity (mark of the beast in the book of revelation) and at a later date will be used for buying and selling. This microchip was also tied to the current 5 G network (been promoted across the world by Huawei

Challenges, Myths and Intrigues of COVID-19 in Nigeria
Technology, China), as the required network for the function of the microchips that will be incorporated into the vaccine.

Some Identified Immediate Measures Put in Place by Government on COVID-19 Pandemic
The

Further Instituted Preventive Measures at the Ease of Lockdown in the Affected States Effective 4 th of May 2020
These measures are also applicable nationwide to individuals as well as businesses, employers and employees as follow: 1) Mandatory use of non-medical face mask/covering for all persons.
2) Overnight curfew from 8 p.m. to 6 a.m. This means all movements will be prohibited during this period except for essential services.

Scale-Up Actions to Curtail the Current Pandemic and Future Health Related Matters
The NCDC should not relent on the current efforts as Nigeria is yet to reach the

Recommendations
The following are some recommendations put forward for the response to the COVID-19 pandemic in Nigerian and other countries alike. This includes: 1) The need for Presidential task force on COVID-19 to intensify efforts to review data and emerging evidence and make the outcomes available to the community and religious leaders.
2) The health workers, security personnel's and other essential workers must be respected and protected.
3) The special population at risk and vulnerable groups, such as children, elderly and women must be monitored and protected. 10) The use data to inform and update the response strategy is equally essential.