Effects of Covid-19 on Nigeria

An analysis of the initial response, the media response and audience reaction, impact on education, impact on economy and life, works cited.

Currently, the whole world is in the midst of a global crisis, caused by the appearance of Coronavirus. The pandemic has affected every person, every family in its own way, forcing people to adapt and adopt new ways of living. Many people have suffered because of Covid-19 and some even lost their loved ones to the disease. The economic and social situation is unstable, and many organizations are still managing their crisis response in accordance with recent events. The spread of the disease is strictly country-specific, and to discuss the issue in more details, taking an in-depth look into its impact on a specific country proves to be more productive. In light of recent events, it can be useful to examine the impact of the coronavirus on life in Africa, its culture, habits, and worldviews. To view the people and traditions of Africa from a global perspective, an inspection of one of its major countries, Nigeria in particular, must be taken. This essay will focus on the spread and effect the Covid-19 pandemic had in Nigeria, its cultural impact.

As documented by the national public agencies, the spread of the Pandemic started around late-March to early-April in Africa and has been rising in numbers ever since. While accounting for only 5% total of the affected world population, the quick spread of the disease is nevertheless concerning (Mwai and Giles). Nigerian infected population totals about 46 thousand people, which is the third-highest number of cases in Africa (Mwai and Giles). With a lack of proper diagnosis available, many potential carriers are overlooked, worsening the situation and spreading the disease. This means that even the data acquired by the Centre for Disease Prevention and Control might not fully reflect the severity of the situation.

The death rate is fairly low, around 0.5 percent, which is explained by the average population being rather young (Mwai and Giles). Relative to other African countries, Nigeria is concerningly noted for not doing enough tests for the Coronavirus (Mwai and Giles). It also suffers from the same lack of available research data that plagues all other African countries and prevents them from properly estimating the risks. Covid-19 disrupts the flow of life for everyone in the country, imposing many restrictions and putting people at risk. On a brighter note, according to the World Health Organization, the rising trend for the Covid-19 spread is starting to subside, and the number of diagnoses cases is dropping. This occurrence is caused by the absence of new cases, which caused the number of infected people to slowly drop.

As a way to gain a better understanding of the topic and the timeline of the events, the initial appearance of the Coronavirus in Nigeria will be conducted. It was documented that the disease first appeared there on February 27, 2020. By April 11 of the same year, there were at least 318 confirmed cases and 190 deaths (Adegboye et al.). The researchers document that the virus had spread exponentially during the course of the first 45 days, and has been doubling in growth at the speed of about 9.8 days (Adegboye et al.). By analyzing the speed of the spread the researchers have found that while Nigeria follows the same general trends as all other counties, the number of cases there is significantly lower than in other parts of the world. This assessment allows one to understand that Nigeria was not affected by the Covid-19 as hard as it could have been. Since no specific measures need to be implemented, the main goal is to minimize the losses and stop the spread of the disease. The main priorities for counteraction are to stop disease transmission on a local level.

One of the most important facets of crisis resolution is mass media coverage. The information provided by the news and the internet is what keeps most people well-informed about the current events and the measures that might need to be taken. The portrayal of the issue by the media determines the media response, and can majorly influence the public perception. During the pandemic, presenting accurate, up to date information is crucial to the well-being of the people. Given all the reasons mentioned above, the examination of the media coverage of the Covid-19 in Nigeria is an important part of the discussion. A study employing a quantitative design examined the newspaper coverage of Covid-19 and the reaction to it, from January to March of 2020. The results have shown that the newspapers were dominated by news reports and opinion pieces, with all major publications reporting in the outbreak to some extent (Nwakpu et al.). The authors of the study conclude by stating that the media has helped the Nigerians sufficiently prepare for the pandemic and take precautionary actions (Nwakpu et al.). This analysis shows that timely reporting has helped decrease the impact of the coronavirus and stop the disease from spreading.

Because of the spread of the global pandemic, education has suffered major setbacks all around the globe. With a forced transition to online learning, many schools and educational institutions were forced to adapt to changing circumstances. Nigerian institutions are not an exception. The extreme conditions have exposed the troubling state of the education sector and the problems of the school system (Abari et al.). Underfunded institutions are struggling to provide quality education to many students forced to stay at home. The strain on the education system has revealed the severe problems with the funding and the quality of teaching. Many students were forced to skip school, and lost much progress due to the pandemic.

A scholar concerned with this topic notes that the pandemic has “emerged to break and collapse the walls that surround our education sector”, stating that the crisis offered a new, fresh look at the overarching problems the Nigerian education faces (Abari et al. 39). The author also says that the stakeholders in education must take this opportunity to reflect and embrace the digital shift to increase the quality of education and follow the global trends in the industry (Abari et al.). The only way to effectively remedy the system is to improve it in response to global trends and maintain a high quality of education.

The Coronavirus pandemic has had a major impact on the world economy and the lives of people. It is undeniable that an event of such a grand scale and severity affects all countries in the world, but the specific consequences of each place are unique. In Nigeria, the pandemic has put a big strain on the population and has left many poor people with no financial support. As noted in the Hope Ikwe’s paper, Nigeria does not have a well- developed welfare system to support the struggling individuals, leaving many to risk their lives for survival (Ikwe). With most people employed in the private sector, earning a living is difficult, especially at the time of crisis. The local and small businesses suffer the most, with many being forced to close or working with almost no profits. Corruption is another prominent issue of the Nigerian government, meaning that the finances distributed to aid the poor often simply do not reach them (Ikwe).

With such an unreliable system of governance and support, many people have to depend on each other and develop close-knit communities that help to ensure survival (Ikwe). Such support systems between people are a part of Nigerian and African culture, and their presence has been cemented by history. However, exactly this cultural arrangement presents the biggest danger during the Coronavirus pandemic (Ikwe). As the disease spreads between people in close proximity, it is becoming more and more dangerous to stay as a collective. The lockdown measures have saved many from dying of Covid-19, but left the people with virtually no support (Aronu et al.). Nigerian population has to adapt to an unfamiliar way of living, with almost no community or government aid. The changes are also very rapid, leaving many no time to adapt. The current events present a huge danger to the Nigerian way of life, becoming a concern for all people, regardless of age.

Abari, A. O., and N. O. Orunbon. “Building Bridges and Walls: Education and COVID-19 in Nigeria” . Research Journal in Comparative Education , vol. 1, no. 1, 2020, pp. 39-52, Web.

Adegboye, Oyelola, et al. “Novel Coronavirus in Nigeria: Epidemiological Analysis of the First 45 Days of the Pandemic.” medRxiv , 2020, Web.

Aronu, C. O., N. U. Otty, J. C. Ehiwario, and P. N. Okafor. “The Impact of the Lockdown Measure on the Confirmed Cases of the Novel Coronavirus (COVID-19) in Nigeria”. Journal of Scientific Research and Reports , Vol. 26, no. 6. 2020, pp. 110-9, Web.

Ikwe, H. (2020).The Impact of Corona Virus on the Socio-Economic Life of Nigerians. Culture e Studi del Sociale , 5( 1), Special issue, 383-388.

Mwai, Peter, and Christopher Giles. Coronavirus: How Fast Is It Spreading in Africa? BBC. 2020, Web.

Nwakpu, Ekwutosi Sanita, et al. “Nigeria Media Framing of Coronavirus Pandemic and Audience Response.” Health Promotion Perspectives , vol. 10, no. 3, 2020, pp. 192–199., Web.

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Coronavirus outbreak in Nigeria: Burden and socio-medical response during the first 100 days

Jimoh amzat.

a Usmanu Danfodiyo University, Department of Sociology, Sokoto, Nigeria

Kafayat Aminu

b University of Ibadan, Department of Sociology, Ibadan, Nigeria

Victor I. Kolo

Ayodele a. akinyele, janet a. ogundairo, maryann c. danjibo.

The coronavirus disease of 2019 (COVID-19) pandemic shocked the world, overwhelming the health systems of even high-income countries. Predictably, the situation has elicited social and medical responses from the public and governments, respectively. Nigeria recorded an imported case from Italy on February 27, 2020. Hence, this paper assesses the early socio-medical response to COVID-19 in Nigeria in the first 100 days after the index case. The paper employs analytical methods and collates data from various media reports and official sources.

The incidence of COVID-19 grew steadily in Nigeria, moving from an imported case and elitist pattern to community transmission. The case fatality stood at 2.8%. The country recorded an upsurge (52% of total cases) in the transmission of COVID-19 during the short period the lockdown was relaxed. This paper presents a concise response framework to highlight some specific multisectoral responses to the pandemic. A combination of social and medical responses to a large extent helped Nigeria curtail the spread of the virus.

The potential of overwhelming COVID-19 is still imminent in Nigeria as the country is attempting to hurriedly open the economy, which could sacrifice public health gains for temporary economic gains.


The coronavirus disease of 2019 (COVID-19) pandemic gripped the world with a shock, thereby overwhelming the health system of most nations. The World Health Organization (WHO) declared the novel human coronavirus disease (COVID-19) outbreak, which began in Wuhan, China on December 8, 2019, a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 ( WHO, 2020 ). With over seven million cases globally as of June 7 (2020): United States (over two million cases), Brazil (over 700,000 cases), Russia (over 500,000 cases), and in Africa, South Africa (over 54,000 cases) and Egypt (over 38,000 cases) bear the greater brunt. Following this WHO declaration, the Coronavirus Preparedness Group was constituted on January 31 in Nigeria (a country with 36 states and a Federal Capital Territory [FCT]). WHO categorized Nigeria as one of the 13 high-risk African countries with respect to the spread of COVID-19. Nigeria is also among the vulnerable African nations, given the weak state of the healthcare system ( Marbot, 2020 ). In Africa, there are still communities without healthcare facilities, apart from the scarcity of health workers ( Amzat, 2011 ). The projection is that Africa could bear the final burden of the COVID-19 pandemic if the countries do not institute effective measures to combat the pandemic.

Sociologically, the pandemic has caused global social disruption by limiting global social relations. The idea of “social distancing” negates regular social interaction, which is the bedrock of human society (Amzat and Razum, 2014). A contagious disease of global health importance also disrupts the usual norms of close physical contacts since the disease transmits through contact with individuals who already contracted the disease. COVID-19 deglobalizes the world in terms of human migration with airports shut, and social events (sports, festivals and the like) postponed indefinitely. The "stay-at-home" campaign and proscription of (large) social gatherings mean that social interaction has been limited.

Globalization, which signifies compression of time and space, aids the transmission of diseases on a global scale, facilitating the spread of COVID-19. The world has been witnessing global trade, movement of people, and the globalization of health (see Youde, 2020 ). The global transmission of diseases is one of the dysfunctions or latent functions of globalization, which offers both opportunities and catastrophes. The world is a global village; hence the health of individuals is intrinsically linked irrespective of distance. Beck, 1992 , Beck, 1999 and Giddens (2002) introduced the idea of risk society theory. The theory is concerned with the unintended and unforeseen side effects of modern life, which backfire on modernity (itself) ( Wimmer and Quandt, 2006 ). These side effects change human society: a health risk in Wuhan (China) becomes a pandemic, through human migration, affecting all countries of the world, with several thousands of deaths. As the world is being de-territorialized, facilitating trade, communication, and information, it is also prone to (health) risks. Beck (1992) noted that the world reflects the creation of health hazards, which jeopardize human living conditions at a global level.

According to the theory, modern advancements also come with a reproduction of risks: in this case, manufactured risks that lead to the gradual creation of risk society ( Giddens, 2002 ). "Manufactured risks" are exacerbated and controllable by human interventions. A risk society is “a systematic way of dealing with hazards and insecurities induced and introduced by modernization itself" ( Beck, 1992 :21). For Beck, "risk" is used in the contexts of hazard and vulnerability. The spread of COVID-19 has shown how the world is vulnerable to risks through social connectedness due to advancements in transport technology. This theoretical background about pandemic-induced disruption and risk explains the globalization of COVID-19. It is, therefore, not surprising that COVID-19 has engulfed the world with the resultant socio-medical impairments. Nigeria also faces the growing burden of COVID-19. In this context, this paper assesses the new burden and socio-medical response to COVID-19 in Nigeria, focusing on the first 100 days (February 27 – June 7, 2020). The paper relies on secondary sources and the objective analysis of official media reports.

The first month of COVID-19 in Nigeria (February 27 - March 27, 2020)

According to the Nigerian Centre for Disease Control (NCDC), the training of the rapid response teams across the 36 states in Nigeria was concluded in December 2019. On January 28, the NCDC further revealed that a Coronavirus Group had been set up to activate its incident system to respond to any emergency. Additionally, the NCDC worked with 22 states in Nigeria to activate their emergency operations centers to manage and link up with the national incidence coordination centers ( Ihekweazu, 2020 ). Although the government had strengthened the surveillance at the airport since January 2020, Nigeria recorded its COVID-19 index case that was imported from Italy, on February 27. This raised concerns about the effectiveness of airport surveillance and, by extension, the country’s general preparedness. The index case (an Italian) had visited some other states of the federation before testing positive for COVID-19. The pre-COVID-19 preparedness was grossly inadequate.

Nevertheless, the onset of COVID-19 sent waves of panic across Nigeria, like in every other country. Due to globalization, the health risk of communicable diseases could be pandemic ( Martin, 2005 , Tausch, 2015 ). Trade and travels facilitate the flow of people, who incidentally could move, carrying a health risk (in this case: the coronavirus). From one imported index case, many countries (including Nigeria) face tremendous health challenges with multiple cases and deaths. Since the first index case in Nigeria, the number of cases has been increasing (see Table 1 ), although at a snail pace due to public health interventions.

Timeline of Coronavirus Outbreak in Nigeria (February 27- June 7, 2020).

Source: Nigeria Centre for Disease Control ( NCDC, 2020 ; Worldometer, 2020 )

Upon the detection of the index case, the NCDC activated a multi-sectorial National Emergency Operations Centre (EOC) to oversee the national response to COVID-19. Subsequently, the Presidential Task Force (PTF) for coronavirus control was inaugurated on March 9, 2020. The PTF announced that travelers from 13 COVID-19 high-risk countries had been restricted from entering the country. The Port Health Services and NCDC monitor the self-isolation of returnees from the affected countries from then onward. The concern from several quarters was that the ban on high-risk countries would have taken immediate effect. By the time the ban took effect, the nation had recorded more imported cases. Unfortunately, most of those who arrived in the country did not comply with the 14 days self-isolation recommended by the NCDC.

The NCDC disclosed that all confirmed cases of COVID-19 in the country between February 27 and March 17 (the first 30 days) were imported by returning travelers. As of March 27, one month after the first case, ten states in Nigeria had 81 clinically confirmed cases. Three patients had fully recovered, and one death was reported. At this time, Lagos State had the highest number of cases (52; 64.2%). By April 5, the number of positive cases had increased exponentially to 232. The death toll had risen to five, and 33 persons had recovered while states with positive cases in Nigeria totaled 14.

Epidemiology of and Early Response to COVID-19 in Nigeria

Within the first 30 days, the NCDC observed that 70.0% of the individuals tested positive for COVID-19 were male, and 30.0% were female. Their ages ranged between 30 and 60 years. People aged 31-50 years were the most affected (39.0%). About 44.0% (101) of the cases were imported, some 41.0% (96) had incomplete epidemiological information; the sources of their infections were unknown. Thirty-five (15.0%) patients were known contacts of positive cases (NCDC, 2020) -- suggesting community transmission or cross-infection. Lagos State accounted for over 50% of the cases in Nigeria, followed by Abuja (20.3%) and Osun State (8.6%). Common characteristics of Abuja and Lagos include being the sites of major international airports and hubs of commercial and administrative activities in the country.

Similarly, Ejigbo, the epicenter of the infection in Osun State, has many of its indigenous people working in Cote d'Ivoire and other neighboring countries that are already battling with hundreds of COVID-19 cases. When COVID-19 forced some of them to return to Nigeria, many returned positive for COVID-19. From the first index and other imported cases, there has been a continuous spread across other states through inter-state travels.

During the first 30 days of COVID-19 in Nigeria, the disease distribution was elitist. The majority of those who tested positive were returnees from abroad ( NCDC, 2020 ). Air travel is predominantly elitist in Nigeria because of the high rate of poverty. The political elite also bore the early brunt of COVID-19 with three state governors and some political appointees testing positive for COVID-19. Due to the (initial) trend, the initial perception was that COVID-19 was a disease of the elite, who returned from international travels or had contact with the political bourgeoisie. Such perception, which has not dissipated, undermined control efforts. Sooner than expected, there was evidence of community transmission as COVID-19 broke the class boundary. It then became the responsibility of every Nigerian to take preventive responsibility.

COVID-19’s mode of transmission is still under scientific investigation; hence, people are advised to observe safety guidelines (such as safe handwashing, social distancing, or staying at home). These behavioral change imperatives transform the nature of social life and realities in Nigeria. The new social normal adversely impacts livelihood and survival chances, amidst grossly inadequate palliatives. Experiences and lessons from the worst-hit countries (e.g., the USA, the UK, Italy, France, and Spain) prove that no country can adequately prepare to contain the COVID-19 pandemic. Globally, only a few countries have achieved generalized testing. In most countries, significant challenges being faced due to the COVID-19 pandemic include inadequate healthcare personnel to manage the patients, insufficient medical resources (especially personal protective equipment [PPE] and ventilators), and inadequate facilities and treatment centers, among others.

Many health experts projected that Africa would face a hard time and struggle to keep the coronavirus outbreak under control once it is confirmed on the continent. The concerns were based on pervasive poverty, weak healthcare systems, and the diseases ravaging most parts of Africa. As of June 7 (2020), no country in Africa was coronavirus-free; the confirmed cases (in Africa) stood at 192,721, with about 5,200 deaths and 85,107 total recoveries ( Worldometer, 2020 ). Generalized testing is a significant measure for detecting cases; unfortunately, universal testing may not be possible in all parts of Africa (including Nigeria) due to inadequate resources. Nevertheless, every imperfect-but-best-possible-effort to stop the infection constitutes marginal gains and a step in the right direction until a cure is discovered.

The African Centre for Disease Control (Africa CDC) trained experts from Nigeria and 15 other African countries on the diagnosis of COVID-19 using Polymerase chain reaction (PCR), between February 6th and 8th ( Africa CDC, 2020 ). Therefore, most tests (In Nigeria) (as of June 7) have been through PCR tests in molecular laboratories, while studies to validate the integrity of the Rapid Diagnostic Test (RDT) kits are ongoing. There are also plans to add Gene-Xpert machines once they are available ( NCDC, 2020 ). Between February 27 and June 7, about 76,802 persons were tested in Nigeria (see Table 1 ). The number was described as paltry in a country with an estimated 200 million population ( Akor et al., 2020 ). COVID-19 testing is being done in runs; each run takes an average of six to seven h. For each person, the result takes between 20 and 48 h to be ready. Efforts are being made to reduce the timing to 12 h ( Akor et al., 2020 ). Due to limited testing and treatment resources, the Federal Government (FG) has targeted only those in pressing need of testing. Therefore, those to be tested are the following:

The number of molecular laboratories with the capacity to test for COVID-19 increased from five to 23 (as of June 7). Currently, private molecular laboratories are not being used for COVID-19 testing in Nigeria. Over three months after the index case was confirmed, more than one-third of the 36 states are without a testing laboratory. Samples are to be sent to Abuja or any of the available molecular laboratories if any case is suspected from the states without testing centers ( Michael, 2020 ). Although there is no cure for the COVID-19 infection, the NCDC revealed that the treatment of COVID-19 patients harmonizes with the guidelines from the African Centers for Disease Control. Additionally, the Federal Government is making efforts to eradicate the virus by directing the Coalition of Epidemic Preparedness Innovation [CEPI] to oversee three agencies (the Nigerian Institute for Medical Research [NIMR], the Nigerian Institute of Pharmaceutical Research and Development [NIPRD], and the National Agency for Food and Drugs Administration and Control [NAFDAC]) that will research and find a cure to the virus ( Ifijeh, 2020 ). NAFDAC has accepted some local herbal remedies for testing.

Table 1 shows the rate of recovery from COVID-19 as of June 7, 2020. Treatment of positive patients takes an average of one month. Most of the patients who succumbed to the infection in Nigeria reportedly had severe underlying health conditions, which became complicated by the coronavirus disease ( NCDC, 2020 ). Following international best practices, the NCDC has made a prescription for safe burial practices with minimal risk to the deceased's loved ones. COVID-19 requires competent laboratory diagnosis and stringent care procedures. Therefore, home management by primary caregivers (relatives) should not be an option, although the PTF is considering it due to limited resources and facilities. The virus is highly contagious; hence, it requires PPE, which is even inadequate for those in the front lines. If implemented, the option of home care might lead to an upsurge in the burden of COVID-19 in Nigeria.

The growing burden of COVID-19: The next 60 days (March 28 - June 7, 2020)

The number of new infections has been undulating since the outbreak started in Nigeria (see Table 1 ). The highest number of new cases in the first 100 days was recorded on May 30, when 553 of the total samples tested came back positive. Between March 28 and June 7, the country recorded an upsurge of the total number of confirmed cases (see Table 1 ). There is a positive relationship between the number of cases and the creation of more testing centers. Table 1 also shows an increase in the case fatality rate (CFR) and the number of discharged patients within this period. A walkthrough testing center was opened by the Oyo and Ogun state Governments ( Nigerian Tribune, 2020 , Editor, 2020 ). A possible reason for the high number is the stage of infection; the country had reached the phase of community transmission ( News Agency of Nigeria, 2020a ). Signs of community transmission were first publicized at a press briefing on April 1, and this later became more evident with 203 positive cases whose sources of infection remain indeterminate, according to the NCDC ( Oyeleke, 2020 ).

As of June 7 (2020), only one State out of the 36 and FCT has yet to record any COVID-19 cases. Lagos, Kano, and the FCT have the highest incidence, with 46.2%, 8%, and 7.6%, respectively. Lagos remained the epicenter of Nigeria’s COVID-19 crisis. The NCDC noted that a majority (80%) of COVID-19 patients have exhibited mostly mild symptoms, and some made a full recovery. Despite the capacity response, more deaths were recorded as the CFR increased from 1.2% (on March 27) to 3% on April 27, but dropped to 2.8% as of June 7 (see Table 1 ). The case fatality rate from COVID-19 in Nigeria has been described as the highest in West Africa ( Sobowale, 2020 ). Most of the fatalities were recorded among persons with underlying health conditions ( NCDC, 2020 ), predominantly chronic/non-communicable diseases that constitute a public health burden in Nigeria and Africa in general ( Okpetu et al., 2018 ).

Furthermore, 812 healthcare personnel (representing 6.5% of the positive cases) reportedly contracted COVID-19 in Nigeria ( Shaban, 2020 ). Some of these cases were from patients with a subclinical coronavirus infection who presented in hospitals with other conditions while hiding vital information from health workers ( Ayeleso, 2020 ). A shortage of personal protective equipment at some isolation centers is another reason why some health workers were infected ( Adejoro, 2020 ). An additional contributory factor is the unethical practices by some medical practitioners who run private hospitals in locations such as Lagos. Private hospitals were said to be secretly treating patients, who tested positive for COVID-19, without government approval ( Adelakun, 2020 ). The infection of healthcare personnel in Nigeria has created apprehension and could further strain COVID-19 control efforts in the country. In response to this, the Lagos State Government initiated a telemedicine platform, Eko Telemedicine, to cater to COVID-19-unrelated health problems in the state ( Adediran, 2020 ).

Public health education and response to COVID-19

Public health education and risk communication campaigns on coronavirus commenced in earnest with the reported index case of COVID-19. Both conventional and social media, including WhatsApp, Twitter, and Facebook, have assisted in disseminating updates on the virus (see Akinmayowa and Amzat, 2020 ). The NCDC provides regular updates on the outbreak with support from major telecommunication operators in the country. Additionally, there are sensitization activities across some streets in the country by the National Orientation Agency (NOA), non-governmental organizations (NGOs), faith-based organizations (FBOs), and other development partners. The NCDC regularly publishes guidelines on the prevention of coronavirus (social distancing, safe handwashing, maintenance of personal and respiratory hygiene, etc.) as well as a directory of helplines for each state ( NCDC, 2020 ).

Messages on the COVID-19 infection were equally translated into local languages to reach the general Nigerian population. The NCDC uses a communication campaign with the theme, #Takeresponsibility, on social media for a Nigerian audience ( NCDC, 2020 ). This is to emphasize the role of the individual both in the prevention of COVID-19 and the social upkeep of their health while the pandemic lasts. However, the extent to which public health education has influenced positive behavioral changes among Nigerians remain vague. Many people and faith-based organizations have continued to defy the directives on social distancing and public gatherings by organizing social events, while some worship centers also conducted congregational services. The government consequently adopted enforcement strategies through the deployment of police, military, and paramilitary organizations. However, this development also generated many problems due to the brutality of some security officers ( Kalu, 2020 ).

Experiences from the 2014 Ebola outbreak and Lassa fever should have helped the country prepare for the COVID-19 outbreak. The first strategy after the index case was contact tracing. Some of the challenges to the implementation of the contact-tracing strategy include lack of support and cooperation from the returnees who reportedly filled fake contact addresses and incorrect phone numbers in the forms at the point of entry ( News Agency of Nigeria, 2020b ). Consequently, the early days' initial bottlenecks included poor contact tracing and delayed closure of all entry points into the country.

Another vital response was a lockdown to prevent community transmission of COVID-19. There was a lockdown in two states (Lagos and Ogun) and the FCT for four weeks effective from March 30, 2020, with restrictions on inter-state travels throughout the country ( Muanya et al. 2020 ). Then a relaxed lockdown began on May 4, 2020, replacing the total lockdown with a curfew from 8 pm to 6 am while the interstate travel ban was still in place. Both the lockdown and the curfew exempted workers in essential services (health workers and security personnel) and those involved in the movement of essential commodities (food and drugs). The lockdown/curfew was put in place with the hope that people would adhere to the basic safety guidelines of social distancing, handwashing, and the use of facemasks in public places. Nigeria recorded a relative increase in the number of COVID-19 cases during the relaxed lockdown. From May 18 (two weeks after the relaxed lockdown) to June 7 (a total of 20 days), Nigeria recorded 6,527 positive cases, which represent a 52% increase in the number of all positive cases (see NCDC, 2020). The relaxed lockdown is a precursor to the gradual reopening of the economy, which could further lead to a COVID-19 upsurge if hurriedly implemented.

The consideration of a further lockdown has some dilemmas; there are both intended and latent consequences. The lockdown and stay-at-home directive exact adverse effects on peoples’ livelihood—with disproportionate effects on the vulnerable population, most of whom are daily income earners. The UNDP (2020) observed that the vulnerable population mostly works in the informal sector, which requires close person-to-person interactions for cash transactions and patronage. While the lockdown was critical for disease containment, it undermines the economic and social foundations for survival and the resilience structures of Nigeria's most vulnerable population ( UNDP, 2020 ). The projection is that millions more Nigerians will be pushed into poverty, and temporary and permanent unemployment, which will further expose them to the "hunger-virus." Lockdown-induced poverty and unemployment might, therefore, trigger an increase in other social problems, including general insecurity, kidnapping, and gender-based violence. The response to COVID-19 presents a dilemma involving a consideration of the trade-offs between public health interventions and socio-economic consequences. The economy can be reactivated through sound economic stimuli, and recovery policies, since the country has obtained COVID-19 recovery loans of US $288.5 million and US $3.4 billion from the African Development Bank (AfDB) and the International Monetary Fund (IMF), respectively ( IMF, 2020 ; AfDB, 2020 ). A hurried reopening would intensify the health crisis, nullify any presumed early economic gains, and delay the recovery process.

Generally, the response to the coronavirus outbreak in Nigeria could be described as medico-centric and reactionary. The federal and state governments only set up isolation centers after positive cases were confirmed in the country. For instance, there was no molecular laboratory in Ogun State, where the index case was identified; the patient was transferred to Lagos State for diagnosis and treatment. The same applies to other states (such as Akwa Ibom, Oyo, Sokoto, and Abia), where the governments acquired medical equipment to fight the outbreak only after positive cases had been reported. The inadequate proactive preparedness accounted for the initial panic wave created by COVID-19 in Nigeria. The pandemic also exposed the healthcare infrastructure's generally deplorable state—a significant reason for the medical tourism embarked on by the Nigerian elite. The greatest lesson of COVID-19 for Nigeria is the impossibility of taking foreign medical trips mainly to Germany, the UK, and the US for the treatment of COVID-19. It is a norm for most African politicians, who underfund and under-develop their health institutions, to travel abroad for healthcare. The federal and state governments are squeezing out funds to upgrade or set up some facilities to boost the COVID-19 response capacity.

The Federal Government released a five billion Naira (US$ 12.5 million) special intervention fund and an aircraft to the NCDC for emergency responses. An additional ten billion Naira (US$ 25 million) was also released to Lagos State, the epicenter of the outbreak ( NCDC, 2020 ). The President also approved that pilgrimage transit camps be converted to isolation centers ( Olaniyi, 2020 ). The Federal Government also advised all state governors to establish a minimum of 300-bed treatment facilities, in anticipation of a further upsurge. These announcements were made after the number of positive cases had escalated. Many of the states underrated the pandemic potential of COVID-19, with some governors believing that God would not allow COVID-19 to be reported in their states. Only a few states (such as Anambra and Cross River) have been proactive by instituting some measures, the creation of isolation centers, compulsory use of facemasks, and a ban on public gatherings before any confirmed case had been reported.

Figure 1 presents a typical response framework based on an understanding of Nigeria's response so far. At the federal level, there is a Presidential Task Force (PTF) which coordinates the national plan against COVID-19. Each state of the federation also has a State Task Force. The task force's principal mandate is to draw up strategies, implement them, and mobilize stakeholders to insure a multisectoral response to the pandemic. Government officials mainly dominate the PTF, although there is an attempt to mobilize other stakeholders. For instance, faith leaders (FLs) have been substantially neglected despite the fact that Nigeria is a religious country (see Amzat, 2020 ). Despite the initial ban on religious gatherings, some FLs conducted congregation services. The FLs should have been appropriately engaged, instead of the blunt state directive that has not yielded the desired results. However, religious houses were hurriedly reopened in early June for regular services with the presumption of adherence to safety precautions during services. For some faith institutions that previously defied state directives, the possibility of compliance with safety guidelines is very low; hence, religious gatherings could be significant in explaining the next surge of the pandemic in the country.

Figure 1

COVID-19 Response Framework.

The PTF has been holding daily press briefings to enlighten people and address some pressing concerns. This includes deliberate efforts to debunk some myths or rumors about COVID-19. More efforts are still required to reach rural dwellers and non-literate communities ( Akinmayowa and Amzat, 2020 ). Rumor surveillance is very vital in curbing misinformation and myths ( Amzat and Razum, 2018 ). It is also necessary to “treat” some “covidiots," those who hold and spread myths or misconceptions about COVID-19. The “covidiots" also include those who refuse to observe precautionary measures because of such misconceptions. The medical response relies on the availability of testing kits, the creation of isolation centers, and PPE provision for health workers. The country also needs to motivate health workers to hold the front lines against COVID-19. There have been some controversies regarding the meager hazard allowance and life insurance provisions for the "frontliners."

Due to increasing evidence of community transmission, the PTF recommended case searching, involving house-to-house search, which has resulted in an increase in the number of cases detected, especially in Lagos ( NCDC, 2020 ). More case detection means more contact tracing. The process further involves social filtering, recognizing those with or without risks, and promoting safety measures. The ultimate result is to quash the host-agent link to reduce the incidence of COVID-19. The palliatives and economic stimuli are meant to minimize the adverse effects of a lockdown or restricted movement. As previously observed, the informal sector dominates the Nigerian economy; most of the participants are daily wage-earners. The government has been struggling to cushion the adverse economic effects through the distribution of food items that have been grossly inadequate and unevenly distributed. The country has no reliable database of vulnerable citizens; a national registration of citizens has not been effectively implemented. The vulnerable citizens face the “hunger-virus” amidst the coronavirus lockdown. Unfortunately, the pandemic has significantly threatened the country's economy due to the collapse in oil prices, lockdown, limited economic activities, and increased spending on health. While the framework has helped in the fight against COVID-19 in Nigeria, some loopholes still undermine it.

Conclusions: checking some loopholes in the state’s response

COVID-19 disrupts the globe: a typical case of unintended consequences of globalization. The flow of people aids the flow of infectious diseases (such as the Ebola virus disease and coronavirus). From a few imported cases, most nations are now battling with thousands of cases and deaths. In Nigeria, the country's existing health facilities and equipment (including ventilators and PPE) are grossly inadequate to handle the medical emergency due to COVID-19 ( Ibekwe, 2020 , Mac-Leva et al., 2020 ). Although the number of isolation facilities and capacity for intensive care units (ICU) in the country is growing, they are inadequate as many states are still struggling to set up isolation and treatment facilities.

Beyond the shortage of personal protective equipment (PPE), health workers also face high risks and challenges. They are always on the front line—taking care of the numerous COVID-19 patients increases their exposure to infection. As in the case of the Ebola virus disease, health workers often have a substantial share of the casualties ( Amzat and Razum, 2018 ). The fight against COVID-19 cannot be sustained and effective without properly motivating health workers. As the front line soldiers, all health workers should be covered by life insurance. Given the altruistic behavior of health workers, their protection should be paramount in the fight against COVID-19. It is also vital to provide PPE for health workers in the regular health centers, not only those staffing the isolation centers. Since COVID-19 presents with a symptom complex, i.e., like malaria and other diseases, individuals with unsuspected COVID-19 might report at health facilities where health workers and other patients might be exposed to COVID-19. Also, in the absence of PPE for the regular health workers, suspected COVID-19 cases might be rejected, which might lead to an upsurge in mortality from non-COVID-19 diseases.

There are concerns that the fragile health system might be unable to care for a high incidence of COVID-19 infection, which could lead to dreadful consequences in terms of morbidity and mortality. Many western countries (including Italy, the USA, and Spain) seem to have been overwhelmed by thousands of daily deaths. Again, the pressing concern is that the last burden of COVID-19 might be in Africa, and Nigeria could carry the most onerous burden if more effective precautions against the virus are not continuously enforced. The rush to fully reopen the economy might be a significant factor in a possible uncontrollable rise in cases after the first 100 days of COVID-19 in Nigeria. Evidence from the relaxed lockdown supports this fear if the economy is prematurely reopened without substantial precautions. Public health gains should be prioritized along with, if not prior to, economic gains.

Furthermore, there is a gross shortage of health facilities and health workers in rural areas where more than 60% of Nigerians reside ( Amzat and Razum, 2018 ). A rural COVID-19 outbreak might spell doom for any community in Nigeria as well as Africa. At present, the urban outbreak is overwhelming some countries, including South Africa. The African continent must be very proactive in preventive and public health campaigns.

While the lockdown has been helpful, it limits economic activities. In a typical resource-constrained society, it creates the "hunger-virus." A four-week lockdown was enforced to restrict the movement of people to curb the spread of the virus. The informal sector dominates the Nigerian economy. A lockdown prevents most people in this sector from economic activities, which will invariably increase poverty and unemployment while threatening human survival in general. Unfortunately, there was a gross shortage of palliatives in the form of foodstuffs and cash, which could have cushioned the effects of the lockdown. There is no proper coordination in the distribution of the meager palliative. This raises the question of equity in the allocation of resources. The millions of people not empowered before the pandemic constitute a considerable burden in the government’s efforts to distribute palliatives. Without adequate palliatives, civil resistance to the lockdown and other precautions is imminent, which is inimical to the public health strategy of curtailing the virus.

Finally, there is poor coordination among Nigeria's component units: the 36 states and the Federal Capital Territory (FCT). Initially, there was a controversy as to whether a state governor could independently lock down a state without recourse to the federal government (FG). Despite the controversy, Lagos State announced a partial lockdown before the federal government did the same with an initial 14-day lockdown of two states and the FCT. Some other states were hesitant to effect a lockdown while some were proactive, irrespective of state-FG power relations. The control efforts could have been better organized if the NCDC had established a link with state COVID-19 coordinators who would then advise the state governors. A multisectoral coordination and proactiveness enabled Nigeria to successfully fight the 2014 Ebola virus disease; the same approach would help in defeating COVID-19.

Nothing to declare.

Ethical Approval

Ethical approval for this study was not required following our institutions' policy since the work did not involve the use of human subjects or animal experiments.

Conflict of interest

The authors have no conflict of interest to declare.




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How well has Nigeria responded to COVID-19?

On January 23, 2020, the World Health Organization’s International Health Regulations (IHR) Emergency Committee advised that “all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.” On January 30, 2020, the WHO declared COVID-19 to be a public health emergency of international concern.

Siddharth Dixit

Siddharth Dixit

Associate in research - duke center for international development (dcid).

Yewande Kofoworola Ogundeji

Yewande Kofoworola Ogundeji

Associate director - health strategy and delivery foundation.

Obinna Onwujekwe

Obinna Onwujekwe

Coordinator, health policy research group, college of medicine - university of nigeria, nsukka, is nigeria prepared to respond effectively to pandemics.

In 2017, during the WHO’s Joint External Evaluation (JEE) of IHR core capacities (an independent, collaborative multi-sectoral effort to assess a country’s capacity to prevent, detect, and respond to public health risks), Nigeria scored poorly both in prevention and response.

Figure 1. Nigeria’s average score on preparedness to tackle public health risks

Figure 1. Nigeria’s average score on preparedness to tackle public health risks

Source: Authors, using data from World Health Organization (2017) .

These scores suggest that Nigeria is not prepared to respond to the current COVID-19 pandemic. This is most obviously evident from the low testing rates for COVID-19 in the country. Nigeria currently has the capacity to test only 2,500 samples a day, and just half of these are actually administered each day because of the shortage of human resources, testing kits, and laboratories, and case definition for testing that prioritizes symptomatic cases and their contacts. As of June 30, only 138,462 samples had been tested in Nigeria for a population of 200 million; in contrast, South Africa—a country of 58 million people—has already conducted 1,630,008 tests.

Nigeria had just 350 ventilators and 350 ICU beds for its entire population before the outbreak. In April 2020, the country acquired 100 more ventilators, but given the growing caseload, this will not be enough. There has been a continuous rise in the number of cases and deaths in Nigeria, and no flattening of the curve has yet been observed. (Figure 2)

Figure 2. Total confirmed cases in Nigeria as of June 22, 2020

Figure 2. Total confirmed COVID-19 cases in Nigeria as of June 22, 2020

Source: Worldometer .

The three states with the highest number of confirmed COVID-19 cases are Lagos (10,510 cases, 128 deaths), the Federal Capital Territory (1,870 cases, 33 deaths), and Oyo (1,380 cases, 12 deaths). These states account for about 54 percent of total confirmed cases, and 29 percent of deaths. However, many of the northern, southwestern, and southeastern states are now seeing an increase in the number of cases, and as of June 30, 2020 there are more than 100 reported COVID-19 cases in each of the states of Ebonyi, Enugu, Imo, Oyo, Ogun, Kwara, Edo, Delta, Sokoto, Katsina, Kaduna Kano, Jigawa, Bauchi, Gombe, and Borno.

What has the government done?

The Nigerian government has taken numerous health, social, and economic measures to cushion the impact of COVID-19 (Figure 3). However, some of the policy responses have weaknesses and, taken together, are not commensurate with the magnitude of the problem.

Figure 3. Timeline of important policy steps taken by the government of Nigeria Green circles indicate public health policies; blue circle indicate social and economic policies

Figure 3. Timeline of important policy steps taken by the government of Nigeria

Note: FCT: Federal Capital Territory, FMHADMSD: Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development, SMEs: Small and medium enterprises, NSR: National Social Register.

The major strategic responses by the federal government, their main shortcomings, and some ways to improve their effectiveness include:

Funding the COVID-19 response

According to the federal government of Nigeria, it will require $330 million to procure medical equipment, personal protective equipment, and medicines for COVID-19 control. The government has committed to investing some of this amount, and financial commitments were also made by private, bilateral, and multilateral institutions to raise the remaining funds. The Nigerian state oil company has pledged $30 million for the government’s COVID-19 efforts. The European Union has contributed 50 million euros to the basket fund to strengthen the Nigerian COVID-19 response. In addition, the private sector in Nigeria, after being called upon by the governor of the Central Bank of Nigeria, established The Coalition Against COVID-19 (CACOVID). It was launched on March 26, 2020 to help the government to control COVID-19 in Nigeria. CACOVID has raised over $72 million , which will be used for the purchase of food relief materials and to provide medical facilities and equipment in different regions of the country.

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The IMF approved $3.4 billion of emergency support to Nigeria to tackle the economic impact of the pandemic. In addition, in order to alleviate the macroeconomic situation triggered by the sudden fall in oil prices, the Nigerian government has borrowed $4.34 billion from the domestic stock market to finance its budget. The Nigerian government also plans to borrow another $2.5 billion from the World Bank and $1 billion from the African Development Bank.

In addition to mobilizing additional funding, the government should also increase the efficiency of its response to the pandemic. Making sure that regular health programs remain well-funded is even more important. For example, immunization financing must be maintained; drops in immunization will have profound long-term impacts. The crisis is also an opportunity for overall integration of health programs.

Nigeria will need more international assistance

At the federal level and in most states, evidence-based policies such as social distancing and “test and trace” approaches have been implemented. However, implementation has happened on a base of weak health systems, sluggish emergency response, weak accountability systems, and fragmented data and information monitoring systems. These weaknesses have led to implementation gaps. The federal government and the Central Bank of Nigeria have initiated programs to mitigate economic shocks. But, the financial packages rolled out will mostly provide relief to workers only in the formal sector. Similarly, social welfare schemes—such as food assistance and cash transfers—have been inadequate and inefficient.

The combined effects of COVID-19 and low oil prices have put Nigeria in a precarious financial situation. Given the low oil prices, the brakes put on economic activity due to the lockdown, and a weak global macroeconomic situation, the economic condition in the country could worsen and Nigeria will almost certainly require more efficient, equitable, and accountable use of domestic resources. There is also a potential scope for more international support than currently envisioned.

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COVID-19 and the Nigerian child: the time to act is now

Datonye Christopher Briggs, Tamuno-Wari Numbere

an expository essay on controlling covid 19 in nigeria

Received: 03 May 2020 - Accepted: 17 Jun 2020 - Published: 18 Jun 2020

Domain : Pediatrics (general),Global health,Health promotion

Keywords : Nigeria, child, COVID-19, pandemic, SARS-Cov-2, virus, impact

This article is published as part of the supplement PAMJ Special issue on COVID - 19 in Africa , commissioned by The Pan African Medical Journal .

© Datonye Christopher Briggs et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Datonye Christopher Briggs et al. COVID-19 and the Nigerian child: the time to act is now. Pan African Medical Journal. 2020;35(2):82. [ doi : 10.11604/pamj.supp.2020.35.2.23286 ]

Available online at: https://www.panafrican-med-journal.com/content/series/35/2/82/full

Supplement (35:2)

an expository essay on controlling covid 19 in nigeria

Datonye Christopher Briggs 1,& , Tamuno-Wari Numbere 2

1 Department of Paediatrics, Rivers State University Teaching Hospital, Rivers State, Nigeria, 2 Department of Public Health, Rivers State Ministry of Health, Rivers State, Nigeria

& Corresponding author Datonye Christopher Briggs, Department of Paediatrics, Rivers State University Teaching Hospital, Rivers State, Nigeria

COVID-19 has overwhelmed virtually every sector in resource-rich countries of the world and has gradually but steadily enveloped almost all of Africa. While her leaders grapple with the vivid realization of the myriad effects of the virus, the African children should not be the ‘hidden victims’ of the COVID-19 pandemic because they are among the most vulnerable. This narrative highlights the effects of the pandemic on the economic, education, health, mental and socio-cultural well-being of the Nigerian child and suggests ways to mitigate it. The impact of COVID-19 pandemic on the Nigerian child are numerous. Policies should be set up urgently and interventions sourced to ameliorate the effect of the virus on the most vulnerable group in Nigeria.


The world as it is today is being overwhelmed by the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) virus that is responsible for the COVID-19 disease [ 1 ]. The World Health Organization (WHO) declared the new wave of infection with predominantly respiratory system symptoms a pandemic on March 11 th , 2020 with most countries reporting increasing numbers of morbidity and mortality rates [ 2 ]. The major drivers of the outbreak appear to be both symptomatic and asymptomatic persons infected with SARS-COV-2 from whom the virus can spread via droplets or direct contact with contaminated surfaces [ 3 ]. This forcefully and rapidly led to a systematic lockdown of most countries of the world [ 4 ]. Since the WHO had recommended a multi-prong preventive approach that includes physical distancing, hand washing with soap and water for at least 20 seconds and respiratory etiquette as mitigating measures, the lockdown eventually became a key method of restricting on-going community spread of the virus [ 1 ]. The resultant effects of these stringent public health actions have led to enormous economic losses, disruption of the ‘usual’ physical and social contacts, massive loss of jobs and means of livelihood and increase in mental health issues [ 5 , 6 ]. However, the effects of COVID-19 on the wellbeing of children across Africa is of concern and seems to lag.

Africa in the trend of events appeared to be the last continent hit by the pandemic. While the reports of new cases and death toll (epidemic curve) appears to be flattening and decreasing in other countries of the world [ 7 ], this cannot be said among the countries in Africa especially sub-Saharan Africa, where testing for COVID-19 is still a major challenge and healthcare facilities are in deplorable states [ 8 ]. Reports from China and other western countries demonstrate that children are largely unaffected and even for those diagnosed COVID-19 positive, severe disease and death is very unusual [ 9 ]. However, children are undeniably caught in the predicament COVID-19 is causing and their overall wellbeing risks being overturned due to the impact already ensuing in their families and immediate surroundings. Africa is less likely to consider the impact of COVID-19 on children early in the course of the response, as has been noted in earlier outbreaks [ 10 ]. Presently, with the rising incidence of newly diagnosed cases in Africa and more so in Nigeria, the well-being of children could pose a challenge as its leaders grapple with the most pressing needs which include food insecurity and economic burden of the pandemic [ 11 ]. The lockdown, therefore, makes children in these resource-limited settings and their families alike the hardest hit by both the virus and the ongoing response [ 12 ]. This narrative review highlights the likely impact of COVID-19 on the Nigerian Child under six sub-headings.

Impact on the economy: the slowing down in the global economy and lockdown of countries around the world as a result of COVID-19 has taken its toll on the global demand for oil. This drastic decline particularly affects a country like Nigeria whose sole Gross Domestic Product (GDP) and foreign reserves are dependent on foreign trade in oil. The odds, however, are not in the favour of Nigeria as the pandemic exerts pressure on the economy which was already contending with an earlier recession in 2016 [ 13 ]. Unfortunately despite an initial projected budget revenue allocation of 8.24 trillion naira, COVID-19 outbreak has had a negative toll on the oil price benchmark and also oil production respectively [ 14 ]. At the time of this review, it is about the second month after the first case of COVID-19 was reported in Nigeria and some state governors have already declared their inability to sustain payment of salaries to workers in the public sector [ 15 ]. With a high unemployment rate of 23.1%, almost half of the population are living below the poverty line ($2 a day) [ 16 ]. Children are thus affected indirectly because with the restrictions on international trade, closure of markets, delay and or non-payment of the non-essential workforce, the pandemic has contributed in no small measure to food scarcity and price inflation in the cost of staple food items in the country hence the level of hunger and poverty are on the increase [ 11 ]. The impact is greatest especially among children whose parents or guardians depend on daily income for survival which has been abruptly halted due to the on-going lock down parts in the country. With the already existing alarming rates of child-poverty in Nigeria [ 17 ], it is anticipatable that the impoverished would rather prefer the COVID-19 disease than to be hunger-stricken [ 18 ]. COVID-19, therefore, has already spun into action a vicious cycle of poverty, hunger and malnutrition in these already vulnerable or at-risk children. Without any urgent interventions, the situation could worsen because the pandemic risks undermining all the earlier efforts to reverse the trend of rising hunger in the country.

Impact on education: according to UNICEF about 1.6 billion children and young people are unable to be physically present at school due to the temporary closure of schools that have impacted over 91 per cent of students globally [ 19 ]. Although some schools can endeavour to provide online classes, this is unavailable to the majority of children and young people in Africa [ 20 ]. Since school closures, many families in Nigeria have found themselves unable to help their wards keep track with their education. Although learning platforms have been launched by UNICEF and Microsoft to aide affected children and young people continue their education at home in other parts of the world [ 19 ], this is largely unavailable in resource-limited settings like Nigeria where many students lack computers or high-speed internet services, making a considerable number of families unable to afford or sustain its use as a means for educating their wards [ 20 ]. The government in Nigeria, fully aware of these challenges have opted to have daily live teaching sessions on radio and television at scheduled time intervals in the entire country, albeit, there are many more children in semi-urban and rural areas without access to internet services and very limited electric power supply. These children are more disadvantaged and hence underserved because they have no access to formal education in this period. The impact of homeschooling on education, especially in families in Nigeria that lack an organizational structure remains to be seen.

Impact on health: the health hazards and human consequences of the COVID-19 is already known and the fact that it has nearly crippled the health workforce and outstretched the health care systems in resource-rich countries of the world is undeniable [ 21 ]. In most countries in Sub Saharan Africa including Nigeria, there was already an existent endemic ‘weak healthcare system’ with substandard personnel, infrastructure and funding in the pre-COVID-19 era [ 22 ]. Presently, due to the restrictions in movement and lockdown, commuting to the healthcare facilities when children are sick might be delayed. Also, the anxiety associated with exposing a child (and parent) to a potential site that brings them in close contact with the contagion during hospital visits may make parents less likely to present with their sick child early. Other possible challenges include the delay in receiving the urgent care needed if a child with asthma presents to healthcare centres as there is a substantial overlap between the clinical presentation of worsening asthma and COVID-19, and an increasing community spread also lessens the likelihood of obtaining a history of known contact with a confirmed case [ 23 ]. It has been reported that screening for COVID-19 is required if available in any asthmatic child who comes to medical attention with worsening cough or shortness of breath [ 23 ]. However, in settings where screening tests are not readily available, as is the case in most Nigerian healthcare facilities, undue delays could result in severe or life-threatening asthmatic episodes being misdiagnosed, mismanaged, abandoned or referred because of the fear of contracting the dreaded virus by healthcare workers who are inadequately protected. Similar instances could arise when children present with other viral or atypical types of pneumonia. Furthermore, there is the likelihood of widening the gap already covered by vaccination efforts and making more vulnerable children at risk of dying from vaccine-preventable diseases due to a disruption in immunization scheduled programmes in Nigeria. With an already low vaccine coverage rate of 32% in 2018, even brief interruptions of vaccination activities would only make outbreaks more likely to occur [ 24 ]. Presently Nigeria along with other sub-Saharan countries like Chad, Ethiopia and South Sudan are beginning to experience a resurgence of measles because the mass vaccination campaigns have been halted due to the COVID-19 pandemic [ 25 ]. Yet another impact will be the possible shortage of drugs/ supplies and challenges with diagnosing high risk/immunosuppressed children for HIV and tuberculosis. With the on-going restriction of movements, children on antiretroviral and anti-tuberculosis medications may face the challenges of stock outs and adherence issues due to the inability of the healthcare facilitates to prescribe medications for longer periods to cover the likely duration of the pandemic to avoid the risk of exposure to the virus [ 26 ].

Impact on mental health: it is plausible that prolonged physical and social distancing, lockdowns and closure of schools can harm the psychosocial wellbeing of children and young adults [ 27 ]. Mental problems ranging from stress to anxiety, depression and sleep disorders have been reported in children in epidemic settings [ 27 ]. Children also suffer from the effects of an abusive parent or guardian regularly because there is nowhere to seek help and avenues to let out their frustrations are very limited due to the closure of schools [ 28 ]. What happens to children who eventually become COVID-19 positive, get treated, recover and are reintegrated back into their schools and the society remains to be seen.

Sociocultural impact: there is also a likely increase in physical and sexual abuse, with children being at increased risk of indecent exposure to pornography, increase in teenage pregnancies, increased occurrences of armed robbery, bullying and outright hooliganism stemming from the prolonged lockdowns, worsening lack of food, inflation in prices of staple foods and poverty [ 29 , 30 ].

Impact on orphaned and vulnerable children: these include the street children, almajiris´, child refugees, children in conflict-torn regions, emancipated minors, those with disabilities, in orphanages and correction facilities. These particularly marginalized groups are in precarious situations because of the high rates of poverty, malnutrition, hunger and abuse [ 29 ]. Less attention may be given to these group of Nigerian children and they having to cope with COVID-19 pandemic, unaided, is very worrisome.

Suggested approaches to mitigate the effects of COVID-19 on the Nigerian child: the possible solutions would ultimately depend on the unique epidemiological context, political will, health care financing and the variations in health service provision patterns in Nigeria. While the government of Nigeria and stakeholders presently grapple with the COVID-19 pandemic as it unravels in varying dimensions daily, they should endeavour to act on each threat and have dynamic and creative strategic approaches to reduce the impact on the children in Nigeria. Children-specific approaches to mitigate the effects of COVID-19 would include: Implementing a coordinated response whereby paediatricians and other allied healthcare workers are set up to be ‘think tanks’ to formulate urgently evidence-based recommendations to: 1) Prioritize provision of meals to support the most vulnerable school-aged children across Nigeria in collaboration with the already existing school health programme schemes in the various states; 2) Prioritize education for every child in Nigeria and seek ways to reach the rural and semi-urban areas without access to television, radio or the internet; 3) Make guidelines on the management of paediatric patients during COVID-19 pandemic which should specifically address isolation facilities for children in healthcare institutions, triaging of children with signs of respiratory tract infections in out-patient-clinics, needed specifications and adjustments for attending deliveries of COVID-19 positive pregnant mothers, special care baby units and the breastfeeding and kangaroo mother care practices, routine immunization services and paediatric out-patient clinics. 4) Make guidelines on infection control specific to the paediatric population. 5) Make guidelines on support needs for the vulnerable and orphaned children including modalities to reach the malnourished and impoverished. 6) Prioritize providing ethical and psychosocial support services for children and families during and after the COVID-19 pandemic. 7) Advocacy with government and inter-sectoral collaboration to formulate appropriate child protection-focused programmes. 8) Provide a paediatric pandemic plan that will inform policymakers through promoting the understanding of COVID-19 and how it affects children: how next to be prepared in the future. 9) Other indirect ways to mitigate the impact in children seeking healthcare will include a surge capacity planning - the ability to scale up delivery of health interventions proportionately for the severity of the disease and population at risk: To urgently escalate COVID-19 testing which should include testing of children across all states. Reactivate her two-way referral system to ensure the more severe cases get tertiary care and probable cases are immediately isolated before the Nigerian Centre for Disease Control is notified and or referral to tertiary or known isolation centres. Massive training of healthcare providers on IPC protocols and ensure basic personal protective equipment are made available to the health centres. Engage the private and or general government hospitals by empowering them to review and manage regular medical and low-risk surgical cases to enable decongesting of the overburdened tertiary centres.


The authors declare no competing interest.

DCB conceptualized, designed the study. Both authors conducted literature searches. DCB prepared the initial manuscript. Both authors revised the manuscript for intellectual content. All the authors have read and agreed to the final manuscript.

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Research Articles

Covid-19 outbreak situation in nigeria and the need for effective engagement of community health workers for epidemic response.

The current Coronavirus Disease (COVID-19) outbreak has affected over 200 countries including Nigeria. It is one of the largest respiratory disease outbreaks affecting several countries simultaneously and a novel strain of Coronavirus (SARS-CoV 2) has been identified as the causative agent. Sequel to the advice of the International Health Regulation Emergency Committee, the Director-General of WHO declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and characterized it as a pandemic on 11 March 2020. The aim of the study was to describe the current situation of the outbreak in Nigeria and argued the need for effective engagement of community health workers for an appropriate response to COVID-19. We reviewed published articles on COVID-19 and daily epidemiological reports from the website of the Nigeria Centre for Disease Control (NCDC) from 27 February 2020 till 3 May 2020 (Epidemiology week 7 – 17) to describe the outbreak. We also reviewed ongoing responses by the government and other relevant agencies. Our findings revealed possible evidence of ongoing and increasing community transmission of COVID-19 infections, inadequate testing capacity and overwhelming of health resources. Our review also revealed infection of several health workers in the face of existing critical skilled health workforce shortage. With surging of new COVID-19 cases and a huge number of contacts to be traced, we recommended that the government needs to promptly bring community health workers on board, deploy rapid epidemic intelligence and scale up the use of mobile Apps for contact tracing. This will result in an effective and coordinated response to the ongoing outbreak, sustain routine health services especially at the community level, reduce morbidity and mortality, and preserve health indices gains already made in the health system.

Computational and Mathematical Methods in Medicine

Controlling the spread of covid-19: optimal control analysis.

Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). It was declared on March 11, 2020, by the World Health Organization as pandemic disease. The disease has neither approved medicine nor vaccine and has made governments and scholars search for drastic measures in combating the pandemic. Regrettably, the spread of the virus and mortality due to COVID-19 has continued to increase daily. Hence, it is imperative to control the spread of the disease particularly using nonpharmacological strategies such as quarantine, isolation, and public health education. This work studied the effect of these different control strategies as time-dependent interventions using mathematical modeling and optimal control approach to ascertain their contributions in the dynamic transmission of COVID-19. The model was proven to have an invariant region and was well-posed. The basic reproduction number and effective reproduction numbers were computed with and without interventions, respectively, and were used to carry out the sensitivity analysis that identified the critical parameters contributing to the spread of COVID-19. The optimal control analysis was carried out using the Pontryagin’s maximum principle to figure out the optimal strategy necessary to curtail the disease. The findings of the optimal control analysis and numerical simulations revealed that time-dependent interventions reduced the number of exposed and infected individuals compared to time-independent interventions. These interventions were time-bound and best implemented within the first 100 days of the outbreak. Again, the combined implementation of only two of these interventions produced a good result in reducing infection in the population. While, the combined implementation of all three interventions performed better, even though zero infection was not achieved in the population. This implied that multiple interventions need to be deployed early in order to reduce the virus to the barest minimum.

1. Introduction

The Novel Coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronaviruses that cause the coronavirus disease 2019 (COVID-19) and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020 [ 1 ]. The virus was discovered in December 2019 in Wuhan City of Hubei Province, China [ 2 , 3 ]. SARS-CoV-2 belongs to the order of Nidovirales, a family of Coronaviridae, and subfamily of Orthocoronavirinae [ 4 ]. Coronaviruses are a group of enveloped viruses with a positive-sense, single-stranded RNA and viral particles resembling a crown from which the name was derived [ 3 ].

The COVID-19 is a highly infectious disease that can be spread directly or indirectly from an infectious person to a healthy person through the eye, nose, and mouth via droplets produced when coughing or sneezing [ 2 , 5 , 6 ]. The exact source of the disease is uncertain. However, rodents and bats have been suspected by many researchers [ 5 , 7 ]. The SARS-CoV-2 can survive up to 8-10 hours over porous surfaces (like paper, wood, sponge, and fabric) and a little more than 8-10 hours on nonpermeable surfaces (glass, plastics, metals, etc.) [ 2 ]. It has an incubation period of usually 2-14 days [ 2 , 8 ]. Its symptoms are similar to that of common cold or flu. Also, others include fever, dry cough, shortness of breath, and pneumonia [ 5 ]. The severity of the illness can vary in different people from mild to severe symptoms based on their age and health status [ 2 , 5 , 6 ]. Almost 80% of COVID-19 patients are either asymptomatic or have mild symptoms and usually recover from the disease within 2 weeks. However, high mortality is recorded among the aged people and people with underlying chronic diseases, 2% of COVID-19 sufferers are under 18 years of age, out of which, fewer than 3% developed severe conditions [ 2 ]. COVID-19 has a low mortality rate that ranges from 2%-3%, which is significantly less than 10% of the severe acute respiratory syndrome (SARS) in 2003 and 35% of Middle-East respiratory syndrome (MERS) in 2012 [ 2 , 3 , 5 , 9 ]. Due to its high infectivity, COVID-19 spread exponentially to virtually every part of the world within three months [ 1 , 10 ].

As of April 2020, almost every country of the world has recorded at least one positive case despite speculation that the virus does not thrive in regions with hot weather. Entire Europe (especially, Italy and Spain) has become the epicentre of the outbreak, while the United States of America, Asia, and Australia record hundreds of new infections daily, with thousands of disease mortalities recorded [ 10 ]. In Africa, Nigeria recorded her first case on February 27, 2020, but as of April 26, 2020, just within 60 days, the figure has risen to 1364 infections with 45 deaths so far [ 11 ]. It is sad to note that most of the mortalities of COVID-19 especially in developing countries are attributed to poor medical facilities and medical personnel.

There is no specific treatment or vaccine available for COVID-19 probably because it is a new disease, and vaccine development usually takes up to 18 months [ 9 , 12 ]. There is no approved medicine that eradicates the virus; however, treatment is mainly supportive [ 2 , 9 , 13 ]. It is because of these realities that governments across the world have resorted to nonpharmacologic measures. For instance, the Nigerian government has sensitized its citizenry on the need to adopt safety measures such as wearing of disposable surgical face masks, regular hand-washing with plenty of soap under running water, and the use of alcohol-based hand sanitizer in the absence of soap and water among others as recommended by the WHO [ 1 , 10 , 11 ]. Also, many governments worldwide are spending billions of the United States’ dollars as well as soliciting aids from well-spirited individuals and organizations towards combating the COVID-19 pandemic. Furthermore, many countries have imposed compulsory self-quarantine and restricted movements of their citizenries (lockdown/sit at home), closure of businesses, and borders as preventive measures [ 1 , 10 ]. These interventions have succeeded greatly in curtailing the transborder spread of the SARS-CoV-2 from country to country. Nevertheless, the emerging major problem in the spread of COVID-19 is human-to-human transmission in a heterogeneous community. Sadly, the implementation of these interventional policies of governments (e.g., total lockdown of movement, businesses, and fear of quarantine/isolation) has thrown up another new challenge in the fight of the disease because of hunger and poverty especially in developing countries in sub-Saharan Africa where governments lack social securities. Therefore, there is the need to find cost-effective ways of halting the COVID-19 pandemic with minimal economic and social disruptions to avert impending catastrophic economic rupture.

Scholars are approaching this pursuit from two broad but complementary aspects of sciences: the medical and natural sciences. The medical scientists are busy trying to identify the source(s) of the disease, quicker ways of detecting the disease, treatment, and vaccine production [ 1 , 12 , 13 ]. The natural scientists are busy trying to proffer interventional measures through the development of mathematical models that will control the disease transmission especially now that there is no vaccine or known treatment.

Mathematical models have over the years proven to be reliable and efficient tools employed in formulating control strategies towards suppressing and mitigating the effects of infectious diseases, epidemics, and pandemics such as Ebola, SARS, and MERS [ 14 – 16 ]. For COVID-19, some mathematical models have been produced which aim at halting the spread of the disease and forecasting its transmission through simulations. Some scholars focused on calculating the basic reproduction number, [ 8 , 17 – 19 ], and failed to consider the effect of public health education, quarantine, and isolation on the transmission of COVID-19. In the work of Imai et al. [ 9 ], they assumed COVID-19 is highly inconsistent in terms of the number of new infections just like SARS. They also investigated the consistency of their model with realities of the outbreak size using the set of simulated epidemic paths. Their findings affirm that without the implementation of holistic control measures, human-to-human transmissibility of COVID-19 is enough to sustain the pandemic and postulated that COVID-19 will have a diminutive generation time if the majority of COVID-19 cases have mild to moderate symptoms. Shen et al. [ 20 ] credited the high case detection rate and quick response by China and the world at large, to experiences from fighting the previous coronaviruses. Their findings postulate that COVID-19 may be a weak species in the coronavirus family, using the national epidemic of Wuhan in China with a fatality rate of 11.02% (9.26-12.78%) which is less than to those of SARS (14-15%) and MERS (34.4%) with a total of 8042 (95% CI: 4199-11884) infections and 898 (368-1429) death, respectively. Chen et al. [ 5 ] in their research simulated the potency of transmission of COVID-19 from bat (probable) source to humans using their Bats-Hosts-Reservoir-People transmission model [ 6 ]. They calculated the basic reproduction number using the next-generation matrix approach, and their results revealed that COVID-19 has higher transmissibility than MERs in the Middle East countries. Rabajante [ 21 ] reveals that more havoc and transmission/spread of COVID-19 is being perpetrated within the period an infected person is exposed. Rabajante [ 21 ] stated that such an infected person can transmit the virus, especially in a social/public gathering in a remote community within 14 days infectious period. Using the early models of COVID-19, Rabajante [ 21 ] recommends the maximum observance of control measures in any public/social events. Tang et al. [ 3 ] updated their previous model to a time-dependent model. They took into cognizance new interventional advances made in the COVID-19 fight. Their updated findings reported that the best control measure is persistent and constant strict self-isolation. They predicted that the pandemic will peak if the public health measures are adhered to. He et al. [ 6 ] studied the transmission of COVID-19 with binomial distributions in their discrete-time stochastic epidemic model. Their model parameters were derived from fitted reported data of China from January 11 to February 13, 2020. Their basic reproduction number affirms the positive contributions of various control measures recommended by WHO. While the result of numerical simulation suggests that the disease will peak around February 2020 with contact rate as a paramount factor in the control of COVID-19.

Bordered on how best to control the disease with minimal risk (optimization theory), assessing the consequences of some interventional measures and the risk involved especially now that antiviral treatment and vaccines are not yet available, it is crucial to investigate the optimal control of some control measures. Optimal control is the generalization of the classical calculus of variation in optimization theory. It involves minimizing the cost function and converting a given optimal control model into a Hamiltonian function and apply the Pontryagin’s maximum principle. Optimal control has been successfully applied to infectious diseases like HIV, Ebola, Tuberculosis, and SARS. For a disease like COVID-19 that spreads fast, the timing of implementing control measures is important. Unfortunately, very few researchers like [ 22 , 23 ] considered an optimal control analysis of the COVID-19 transmission and suggest that more researches should be directed in this regard. Djidjou-Demasse et al. [ 22 ] in their work employed the concept of optimal control theory to explore the best control strategy to implement while awaiting the vaccine. They deduce that the only end to COVID-19 is when humans develop immunity. They weigh the options of humans developing natural immunity after infection or after they have been vaccinated. Their findings reveal that vaccination will best minimize the cost of loss of human lives, while maximal implementation of control strategies will peak the pandemic in four months after onset. Their results forecasted the possibility of having an efficient vaccine to be in 18 months. Moore and Okyere [ 23 ] attributed the rapid spread of COVID-19 to poor medical amenities. Their optimal control analysis focused on the controls: personal protection, treatment, and environmental spraying (environmental hygiene) as time-dependent control functions. Their numerical simulation reveals that optimal implementation of all the control measures greatly reduces exposed and infectious individuals in the population.

From the foregoing literature, interventions have been invested in, advocated for, and implemented by various stakeholders and still ongoing in the fight of COVID-19. These have cost a huge sum of money and time, casualties in businesses, economies, lives, etc. Unfortunately, the world is still recording high mortality and morbidity due to the disease. The few mathematical models that abound on COVID-19 suggesting diverse interventional control measures are yet to explore critically the optimal control analysis of those control parameters. This is necessary to ascertain their contributions in the dynamic transmission of COVID-19 for guidance in formulating better policies on the fight against COVID-19.

The model by Gumel et al. [ 16 ] forms the motivation for this study. Gumel et al. studied the impact of quarantine and isolation on the transmission dynamics of SARS. They assumed that everyone quarantined progress to isolation. The control measures in their work were assumed to be time-independent control measures. However, there is a possibility that some people will not develop symptoms after the quarantine. So they return to susceptible class to avoid being infected in the isolation centre. Also, it is well known that behavioral change played a very important role in the spread of diseases. Public health education contributed to people’s behavioral changes towards infectious diseases such as Cholera [ 24 ] and Ebola virus disease [ 25 ]. It will help the health personnel to reach out to people and influence them to adopt new behavioral changes and practice personal hygiene. Thus, this study seeks to ascertain the effectiveness of public health education, quarantine and isolation in reducing the infection of COVID-19, and the time taken to achieve that. It will establish the optimal control strategies required and the proportion of exposed individuals that will be quarantine to curtail the disease. It will seek the effect of time-dependent control variables and control constants on the transmission dynamics of COVID-19. The effect of constant controls will be explored using sensitivity analysis which will be used to identify the most sensitive model parameter that will be targeted. Pontryagin’s maximum principle will be applied to the optimal control model.

The rest of the paper is organized as follows: Section 2 is the model formulation for the COVID-19 with control measures. The model analysis for the COVID-19 is discussed in Section 3 with a sensitivity analysis of the model parameters. The formulation of an optimal control of the COVID-19 model and its analysis is done in Section 4 , while Section 5 is the numerical simulations and its discussion. Section 6 is the conclusion.

2. Model Formulation

In this section, the formulation of a deterministic model for COVID-19 is presented. The model by Gumel et al. [ 16 ] used for the control of the SARS outbreak is extended for the control of COVID-19 in this study. The total population, , at time, , is divided into subpopulations: Susceptible, ; Exposed, ; Quarantined, ; Infectious not hospitalized, ; Hospitalized/Isolated Infectious, ; and Recovered, . We further extend their model by incorporating public health education and the possibility of persons in the Quarantined, , who test negative for COVID-19 to return to the Susceptible, . The quarantined compartment comprises persons who come from high-risk regions and contacts of those who tested positive for COVID-19. These persons are kept for the incubation period of the virus. They are tested for the virus within this period. Those who test negative returned to Susceptible, , while those who test positive are taken to the compartment of Hospitalized/Isolated Infectious, . Those who miss quarantine but test positive are in the Infectious not hospitalized, , compartment from where they either recover because of their strong immunity or enter the compartment of Hospitalized/Isolated Infectious.

The human population at any given time, , is given by

In the Susceptible compartment, , a proportion of humans are recruited into the population at a constant rate, , through immigration/birth of no risk population and through a proportion, , of quarantine individuals that return to susceptible compartment after 14 days without symptoms at the rate, . People exit the susceptible compartment either through infection induced by the disease with the force of infection, . Infection is acquired via direct contact with infectious human contaminants or droplets. The public health education/awareness campaign, reduces the force of infection, , and it is time-dependent. The force of infection is given as where and are the modification factors for the exposed, quarantined, and hospitalized/isolated individuals. The parameters, and , are associated with the hygiene consciousness of the quarantine and the hospitalized/isolated individuals, respectively. The exposed compartment, , gains population through infection induced by the disease at the rate of and from a proportion, , of the recruitment of people immigrating from a high-risk population of COVID-19 at the rate of . A proportion, , of the exposed individuals exits through quarantine at the rate , and the remaining proportion, , of the exposed individuals escapes the quarantine and progresses to the infected compartment at the rate, due to ignorance or fear of being quarantined. We assumed that some of the immigrants in were either infected and at presymptomatic stage or had no infection [ 26 ]. This implies that not all individuals in will develop symptoms. Thus, individuals in who did not develop symptoms after the incubation period will progress to , while those who developed symptoms will progress to . This implies that a proportion, , of the quarantined individuals exits back to susceptible class after 14 days of no symptoms and reexamination at the rate, , while a proportion, , of the quarantined individuals that test positive progresses to Hospitalized/Isolated compartment at the rate . Also, the infectious not hospitalized individuals are isolated at the rate, , and can recover due to a boost in immunity at the rate, , and progress to the recovered compartment or die of the virus at the rate, . For the Isolated/Hospitalized compartment, , they gain population from a proportion, , of quarantined humans that become infectious during the 14 days quarantine period and the infectious not hospitalized individuals that are isolated. People exit the hospitalized/isolated compartment through recovery at the rate, , or death-induced rate, . Furthermore, the compartment of recovered, , gains population from the infectious not hospitalized individuals that miss isolation but recover due to boost in immunity, and from the hospitalized/isolated individuals at the rates of and , respectively. The recovered individuals are assumed to develop permanent immunity to COVID-19, and all the compartments exit their compartments through natural death rate, . The description of the parameters used in the COVID-19 model is given in Table 1 . The system diagram for the transmission of COVID-19 is shown in Figure 1 .

an expository essay on controlling covid 19 in nigeria

From the schematic diagram in Figure 1 , the model equations are derived as follows with as the initial conditions.

3. Model Analysis

For the sake of model analysis, the controls, , are considered as constants, that is, . Investigation of some properties of model analysis will be carried out in order to understand the impact of the constant control parameters on the transmission dynamics of the COVID-19.

3.1. Positivity and Boundedness of Solutions

3.1.1. invariant region.

The solutions of the model are uniformly bounded in a positive invariant region,

The total population at any time, , is given by ( 1 ) and

Solving equation ( 5 ) using Groonwall’s inequality gives . This means as , . Hence, the nonnegative solution set of the model equations ( 3 ) enters the feasible region, , which is a positively invariant set.

3.1.2. Positivity of the Solutions

The following theorem proves that the solution of the model is nonnegative for .

Theorem 1. Let the initial solutions satisfy . The model has nonnegative solutions which are contained in the feasible region, .

Proof. From the first equation of ( 3 ), Solving ( 6 ) gives . In the same way, This shows that the solution set is nonnegative for all , since exponential functions and initial solutions are nonnegative.

3.2. Existence of Disease-Free Equilibrium State

From equation ( 3 ), and are represented as follows:

The model equations ( 3 ) become

The disease-free equilibrium state, , is established when there are no infective immigrants into the population (i.e., ) and when there is no disease in the community (i.e., ).

The equilibrium state for the model equations ( 9 ) is at the state when , and these are solved simultaneously to give the disease-free equilibrium state. , as

3.3. Basic Reproduction Number

The basic reproduction number, , is a threshold quantity that predicts the spread of disease in the population. It is an average number an infective will infect people in a wholly susceptible population. If , the infection will die out. If , the infection will persist in the population. The approach of Next-generation method by Driessche and Watmough [ 27 ] is used to compute .

The rates of new infection and the transfer from in and out the infected compartments are given by

The partial derivatives of and at the DFE, , yield

The basic reproduction number, , which is the spectral radius of the matrix, , is given as where

If , we have a perfect quarantine with no infectious not hospitalized individuals, i.e., . The reproduction number with perfect quarantine, is where .

If , there is no exposed individual in quarantine, the basic reproduction number, , is given by where .

3.4. Existence of Endemic Equilibrium State

The equilibrium state for the COVID-19 model ( 9 ) is obtained by solving

Solving these simultaneously, these equations give

Substituting as and simplifying yields the following quadratic equation where

If , we have and , in equation ( 19 ) where .

So, equation ( 19 ) will become

This implies from equation ( 21 ) when ,

corresponds to disease-free equilibrium (DFE) state, , in equation ( 10 ), while represents the endemic equilibrium state, when .

Substituting into gives the endemic equilibrium state, where

When , we have from equation ( 19 ) that

Substituting as equation ( 25 ) into , we have

Equation ( 24 ) gives the endemic equilibrium state when while equations ( 25 ) and ( 28 ) give the endemic equilibrium state when provided that equations ( 25 ) and ( 28 ) satisfy the inequality,

3.5. Sensitivity Analysis of the Model Parameters

It is important to know the relative contribution of different model parameters responsible for the transmission and prevalence of any disease. This will help to identify where to focus interventions that will reduce the mortality and morbidity due to the disease. In this study, the sensitivity analysis is examined to identify crucial model parameters that will reduce the burden of the disease and also quantify the impact of each input parameter on the value of an outcome. The initial disease transmission is directly related to the basic reproduction number, . Therefore, we perform a sensitivity analysis on to identify the most critical parameters that will curtail the spread of COVID-19. We use forward normalized sensitivity index of to measure the relative change in , to the relative change in the model parameter . This is also defined using partial derivatives if is a differentiable function of the model parameter, , as is defined in Chitnis et al. [ 28 ]; Sanchez and Blowe [ 29 ] by where is the sensitivity index of with respect to parameter, .

We compute the sensitivity indices for each parameter in . For instance, the sensitivity index of for is given as

Table 2 shows the sensitivity indices of for other parameters in and their parameter values. The parameter values are taken from the literature on COVID-19, SARS, and MERS.

From Table 2 , the sensitivity indices with negative signs indicate that the value of decreases when they are increasing, while the sensitivity indices with positive signs show that the value of increases when they are increasing. The sensitivity analysis shows that the most sensitive parameters are in the descending order of and so on. These parameters will halt the spread of COVID-19 by reducing and increasing . It implies that the control parameters, , will reduce the spread of COVID-19 if they are increased. This is also shown in Figure 2 for the impact of and on . This implies that increasing the rate of implementation of interventions such as awareness, quarantine, and isolation in the exposed and infected not hospitalized population will halt the spread of COVID-19. In reducing we may consider the behavioral change in the transmission rate for further research.

an expository essay on controlling covid 19 in nigeria

4. Optimal Control Analysis

The control effort, , represents the public health education effort in educating people about the importance of social distancing, stay at home, and hand-washing in halting the spread of COVID-19. The control effort, , represents the effort used to quarantine the exposed individuals, and the control effort, , represents the effort used to isolate the infected individuals. The public health education effort involves educating the public through social media, television, radio, and traditional rulers in the community on how to observe social distancing and hand washing. The efforts used to quarantine the exposed individuals and isolate infected individuals include recruiting and training of the health workers on how to wear personal protective equipment (PPE), tracing the contacts of those exposed to the COVID-19 through home visits and phone calls, counseling, provision of an ambulance to convey the infected individuals to the isolation centre, general/COVID-19 tests, provision of isolation centres for treatment, and other related logistics.

Our goal is to minimize the cost function given as subject to the system of differential equations ( 3 ). All control efforts, , are assumed to be bounded and Lebesgue measurable time-dependent functions on the interval , where is the final time. The control effort set is defined as

The parameters, , , and , are the balancing cost factors for the public health education effort, , the quarantine efforts, , and the isolation effort, , respectively. The terms, , , and , represent the costs associated with public health education, quarantine, and isolation, respectively. Based on the literature for the optimal control of epidemics, the cost of the controls is assumed to be nonlinear and quadratic [ 32 , 33 ]. If , then 100% effort is applied in public health education, quarantine, and isolation, respectively, at time, . Conversely, if , then no public health education for the people, no quarantine is carried out for the exposed (latent) individuals, and no isolation for the infected not hospitalized individuals.

The control time-dependent parameters will be considered in this section. Our goal is to find an optimal control for public health education effort, , quarantine effort for exposed individuals, , and isolation effort for infected individuals, , such that

The necessary conditions that an optimal solution must satisfy are obtained by applying the Pontryagin’s Maximum Principle to the COVID-19 model of equation ( 3 ). This principle converts system ( 3 ) and equation ( 32 ) into a problem of minimizing pointwise Hamiltonian, , given as: where , denote the associated costate variables for the state variables .

Using equation ( 35 ), we state the following theorem.

Theorem 2. Given an optimal control and solutions of the corresponding state system ( 3 ) that minimizes over , there exist costate variables , , that satisfy the following systems of equations where is defined in equation ( 2 ) and final time conditions Also, the optimality conditions, , and are given by

Proof. Differentiating the Hamiltonian function, , at the respective solutions of equations ( 3 ) and the optimal control with final time conditions, the differential equations governing the costate variables are obtained as follows: This gives the costate system in equations ( 36 ). The optimality conditions are given in the interior of the control set as Solving for as , as , and as , yield

Thus, using the bounds of the controls, , , and , the optimal control efforts in the compact form are given by equation ( 38 ).

The equations ( 3 ), ( 36 ) with optimality conditions ( 38 ) and the initial conditions, , and final time conditions ( 37 ) gives the optimality system.

Owing to the priori boundedness of the state variables, the costate functions, and the resulting Lipschitz structure of the ODEs, the uniqueness of the solutions of the optimality system is obtained for the small-time interval, . Hence, the bounded solutions to the optimality system are unique for .

5. Numerical Simulations and Discussion

5.1. numerical simulations.

We carried out numerical simulations to investigate the impact of public education, quarantine, isolation, and the proportion of exposed individuals that will be quarantined. This is implemented using the parameter values and initial conditions from the literature on COVID-19, SARS, and MERS [ 31 , 34 ]. The initial conditions for the state variables are as follows: , , , , , and , while , . The balance costs in the objective function are , , and . The other parameter values are given in Table 2 . The optimality system is solved using the forward-backward sweep scheme. The details of the scheme are presented by Lenhart and Workman [ 35 ]. Many researchers have computed different values of the basic reproduction number for the person to person transmission, reservoir to person transmission, environmental transmission, and some of their results have been compared with other types of coronaviruses, SARS, and MERS, and their results show almost similar results [ 5 , 36 ]. Hence, we focus our numerical simulation on the impact of a different combination of control interventions with their different control profiles on the transmission dynamics of COVID-19.

6. Discussion

A six compartmental model for the transmission dynamics of COVID-19 with quarantine, isolation, and public health education as time-dependent control measures is examined using the work of Gumel et al. [ 14 ] as a guide. The model is for human-human transmission that involves imported cases and community spread. The model is proven to have an invariant region. This region is where the model is well-posed and makes biological sense to be carried out for the human population. The basic reproduction number, , is when none of the exposed individuals are quarantined compared to when all of the exposed individuals are quarantined. This means that a single infected person can transmit the infection to approximately two other persons when there is no quarantine, while there is a possibility of stopping further transmission of infection when quarantine is implemented. However, there is a chance that some of the exposed individuals evade quarantine due to fear of stigmatization and death. Therefore, public health education/awareness will help to correct their misconceptions and encourage them to accept the control measures. Furthermore, people that have recovered need to share their experiences in quarantine and isolation centres with members of their community to enlist the cooperation of the entire community. When there is no isolation of the infected not hospitalized individuals in the population, the basic reproduction number, . This means that one infected not hospitalized person will infect approximately three persons in the population. The presence of isolation will help to reduce the number of infected not hospitalized individuals in the population. The simultaneous implementation of the three interventions reduces the number of infected individuals compared to the implementation of two interventions in the infected population (Figure 3(a) ). This implementation takes about 64% input of awareness for 80 days, 58% input of quarantine for 95 days, and 100% input of isolation for 98 days before they drop slowly to their lower bound (see Figure 4(a) ). This does not achieve zero infection in the population which implies that more interventions are needed to eradicate the virus. On the other hand, the combined implementation of public health education and quarantine measures produces a better result for the exposed population (Figure 3(b) ). It takes about 100% input of public health education for 90 days and 100% input of quarantine for 95 days to trace 2000 contacts in the exposed population (Figure 4(b) ). It means that public health education/awareness should reach all the hooks and corners of the population. People need to be aware of the virus, and also, the creation of adequate awareness of COVID-19 among the population will facilitate contact tracing and quarantine of high-risk individuals. It will also help to identify those who do not qualify for quarantine but tested positive for COVID-19 to be isolated. This will reduce further transmission of COVID-19 in the population.


Furthermore, time is of importance in implementing these interventions (see Figure 5 ). The number of exposed and infected individuals in the time-dependent interventions is 3,602 and 695 compared to 10,690 and 2,531 in the time-independent interventions, respectively. This implies that 7,088 and 1,836 individuals will not be exposed and infected, respectively, if interventions are implemented timely. These interventions are good to implement early which is the first 2-10 days of the outbreak. This will keep the burden of COVID-19 low. The virus will remain in the population for a prolonged time if there are no adequate interventions in place, but it will eventually drop over time (see Figure 6 ). With the interventions such as public health education/awareness, quarantine, and isolation, the number of exposed and infected individuals will reduce drastically within a short time but not to zero, leaving a residue of infected individuals with the potential to cause a further outbreak. This implies that COVID-19 will not be eradicated even with timely implementation of interventions unless a vaccine is developed.


When the proportion of the exposed individuals that are quarantine is increasing, it reduces the number of exposed individuals and infected individuals in the population (see Figure 7 ). When no exposed person is traced and quarantined in the population, the virus will remain in the population even when public health education/awareness and isolation interventions are present. When 30% of the exposed individuals are traced and quarantined immediately, the number of exposed individuals and infected individuals reduces to 2500 and 290 persons, respectively. The number of exposed individuals and infected individuals is about 1200 and 90 persons when 50% of the exposed individuals are quarantined. Again, quarantining 80% of exposed individuals will result in about 700 exposed persons and 20 infected persons in the population. This does not eradicate the infection in the population. To achieve zero infection in the population, we postulate that, additional interventions such as mass testing, and vaccination need to be incorporated. These were not done in this work and would be the focus of further research. This is in line with the new directive by WHO for research.

an expository essay on controlling covid 19 in nigeria

7. Conclusion

In this paper, a new deterministic mathematical model of COVID-19 was formulated with quarantine, isolation, and public health education as interventions. The model was also used as a prototyped to extensively investigate the contributions of these control measures to ascertain their individual and combined contributions in curbing the transmission and spread of COVID-19. The model analysis includes the establishment of the Invariant region and positivity of the model, the existence of disease-free equilibrium, and computation of the basic reproduction number . It was found that the basic reproduction number, , is when none of the exposed individuals are quarantined compared to when all of the exposed individuals are quarantined, . This means that a single infected person can transmit the infection to approximately two other persons when there is no quarantine, while there is a possibility of stopping further transmission of infection when there is quarantine. It was also shown that when there is no isolation of the infected not hospitalized individuals in the population, the basic reproduction number, . This means that one infected not hospitalized person will infect approximately three persons in the population. The presence of isolation will help to reduce the number of infected not hospitalized individuals in the population. The simultaneous implementation of the three interventions reduces the number of infected individuals compared to the implementation of two interventions in the infected population. Furthermore, it is observed that the time-dependent interventions reduce the number of exposed and infected individuals by 7,088 and 1,836, respectively. With the interventions such as quarantine, isolation, and public health education, the number of exposed and infected individuals will reduce drastically within a short time but not to zero, leaving a residue of infected individuals with the potential to cause a further outbreak. This implies that COVID-19 may not be eradicated even with the timely implementation of these interventions. Therefore, further interventions are needed to stop the spread of COVID-19.

Data Availability

The data used in this article are included within.

Additional Points

Recommendation . Governments should ensure prompt implementation of quarantine, isolation and public health education in the COVID-19 fight in order to suppress its infectivity and mitigate the disease burden. Further Research . Incorporation of mass testing and/or vaccination in the current model to ascertain its potential to eradicate COVID-19 in the population.

Conflicts of Interest

The authors declared there are no conflicts of interest.


We want to appreciate Dr. Sunday Madubueze for proofreading the manuscript and the respective departments for their support. We also thank the reviewers for their comments that improve this paper.

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Mini review article, covid-19: emergence, spread, possible treatments, and global burden.

an expository essay on controlling covid 19 in nigeria

The Coronavirus (CoV) is a large family of viruses known to cause illnesses ranging from the common cold to acute respiratory tract infection. The severity of the infection may be visible as pneumonia, acute respiratory syndrome, and even death. Until the outbreak of SARS, this group of viruses was greatly overlooked. However, since the SARS and MERS outbreaks, these viruses have been studied in greater detail, propelling the vaccine research. On December 31, 2019, mysterious cases of pneumonia were detected in the city of Wuhan in China's Hubei Province. On January 7, 2020, the causative agent was identified as a new coronavirus (2019-nCoV), and the disease was later named as COVID-19 by the WHO. The virus spread extensively in the Wuhan region of China and has gained entry to over 210 countries and territories. Though experts suspected that the virus is transmitted from animals to humans, there are mixed reports on the origin of the virus. There are no treatment options available for the virus as such, limited to the use of anti-HIV drugs and/or other antivirals such as Remdesivir and Galidesivir. For the containment of the virus, it is recommended to quarantine the infected and to follow good hygiene practices. The virus has had a significant socio-economic impact globally. Economically, China is likely to experience a greater setback than other countries from the pandemic due to added trade war pressure, which have been discussed in this paper.


Coronaviridae is a family of viruses with a positive-sense RNA that possess an outer viral coat. When looked at with the help of an electron microscope, there appears to be a unique corona around it. This family of viruses mainly cause respiratory diseases in humans, in the forms of common cold or pneumonia as well as respiratory infections. These viruses can infect animals as well ( 1 , 2 ). Up until the year 2003, coronavirus (CoV) had attracted limited interest from researchers. However, after the SARS (severe acute respiratory syndrome) outbreak caused by the SARS-CoV, the coronavirus was looked at with renewed interest ( 3 , 4 ). This also happened to be the first epidemic of the 21st century originating in the Guangdong province of China. Almost 10 years later, there was a MERS (Middle East respiratory syndrome) outbreak in 2012, which was caused by the MERS-CoV ( 5 , 6 ). Both SARS and MERS have a zoonotic origin and originated from bats. A unique feature of these viruses is the ability to mutate rapidly and adapt to a new host. The zoonotic origin of these viruses allows them to jump from host to host. Coronaviruses are known to use the angiotensin-converting enzyme-2 (ACE-2) receptor or the dipeptidyl peptidase IV (DPP-4) protein to gain entry into cells for replication ( 7 – 10 ).

In December 2019, almost seven years after the MERS 2012 outbreak, a novel Coronavirus (2019-nCoV) surfaced in Wuhan in the Hubei region of China. The outbreak rapidly grew and spread to neighboring countries. However, rapid communication of information and the increasing scale of events led to quick quarantine and screening of travelers, thus containing the spread of the infection. The major part of the infection was restricted to China, and a second cluster was found on a cruise ship called the Diamond Princess docked in Japan ( 11 , 12 ).

The new virus was identified to be a novel Coronavirus and was thus initially named 2019-nCoV; later, it was renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ( 13 ), and the disease it causes is now referred to as Coronavirus Disease-2019 (COVID-19) by the WHO. The virus was suspected to have begun its spread in the Huanan seafood wholesale market in the Wuhan region. It is possible that an animal that was carrying the virus was brought into or sold in the market, causing the spread of the virus in the crowded marketplace. One of the first claims made was in an article published in the Journal of Medical Virology ( 14 ), which identified snakes as the possible host. A second possibility was that pangolins could be the wild host of SARS-CoV-2 ( 15 ), though the most likely possibility is that the virus originated from bats ( 13 , 16 – 19 ). Increasing evidence and experts are now collectively concluding the virus had a natural origin in bats, as with previous such respiratory viruses ( 2 , 20 – 24 ).

Similarly, SARS and MERS were also suspected to originate from bats. In the case of MERS, the dromedary camel is an intermediate host ( 5 , 10 ). Bats have been known to harbor coronaviruses for quite some time now. Just as in the case of avian flu, SARS, MERS, and possibly even HIV, with increasing selection and ecological pressure due to human activities, the virus made the jump from animal to man. Humans have been encroaching increasingly into forests, and this is true over much of China, as in Africa. Combined with additional ecological pressure due to climate change, such zoonotic spillovers are now more common than ever. It is likely that the next disease X will also have such an origin ( 25 ). We have learned the importance of identification of the source organism due to the Ebola virus pandemic. Viruses are unstable organisms genetically, constantly mutating by genetic shift or drift. It is not possible to predict when a cross-species jump may occur and when a seemingly harmless variant form of the virus may turn into a deadly strain. Such an incident occurred in Reston, USA, with the Reston virus ( 26 ), an alarming reminder of this possibility. The identification of the original host helps us to contain future spreads as well as to learn about the mechanism of transmission of viruses. Until the virus is isolated from a wild animal host, in this case, mostly bats, the zoonotic origin will remain hypothetical, though likely. It should further be noted that the virus has acquired several mutations, as noted by a group in China, indicating that there are more than two strains of the virus, which may have had an impact on its pathogenicity. However, this claim remains unproven, and many experts have argued otherwise; data proving this are not yet available ( 27 ). A similar finding was reported from Italy and India independently, where they found two strains ( 28 , 29 ). These findings need to be further cross-verified by similar analyses globally. If true, this finding could effectively explain why some nations are more affected than others.


When the spread of COVID-19 began ( Figure 1 ), the virus appeared to be contained within China and the cruise ship “Diamond Princess,” which formed the major clusters of the virus. However, as of April 2020, over 210 countries and territories are affected by the virus, with Europe, the USA, and Iran forming the new cluster of the virus. The USA ( Figure 2 ) has the highest number of confirmed COVID-19 cases, whereas India and China, despite being among the most population-dense countries in the world, have managed to constrain the infection rate by the implementation of a complete lockdown with arrangements in place to manage the confirmed cases. Similarly, the UK has also managed to maintain a low curve of the graph by implementing similar measures, though it was not strictly enforced. Reports have indicated that the presence of different strains or strands of the virus may have had an effect on the management of the infection rate of the virus ( 27 – 29 ). The disease is spread by droplet transmission. As of April 2020, the total number of infected individuals stands at around 3 million, with ~200,000 deaths and more than 1 million recoveries globally ( 30 , 34 ). The virus thus has a fatality rate of around 2% and an R 0 of 3 based on current data. However, a more recent report from the CDC, Atlanta, USA, claims that the R 0 could be as high as 5.7 ( 35 ). It has also been observed from data available from China and India that individuals likely to be infected by the virus from both these countries belong to the age groups of 20–50 years ( 36 , 37 ). In both of these countries, the working class mostly belongs to this age group, making exposure more likely. Germany and Singapore are great examples of countries with a high number of cases but low fatalities as compared to their immediate neighbors. Singapore is one of the few countries that had developed a detailed plan of action after the previous SARS outbreak to deal with a similar situation in the future, and this worked in their favor during this outbreak. Both countries took swift action after the outbreak began, with Singapore banning Chinese travelers and implementing screening and quarantine measures at a time when the WHO recommended none. They ordered the elderly and the vulnerable to strictly stay at home, and they ensured that lifesaving equipment and large-scale testing facilities were available immediately ( 38 , 39 ). Germany took similar measures by ramping up testing capacity quite early and by ensuring that all individuals had equal opportunity to get tested. This meant that young, old, and at-risk people all got tested, thus ensuring positive results early during disease progression and that most cases were mild like in Singapore, thus maintaining a lower death percentage ( 40 ). It allowed infected individuals to be identified and quarantined before they even had symptoms. Testing was carried out at multiple labs, reducing the load and providing massive scale, something which countries such as the USA did quite late and India restricted to select government and private labs. The German government also banned large gatherings and advocated social distancing to further reduce the spread, though unlike India and the USA, this was done quite late. South Korea is another example of how a nation has managed to contain the spread and transmission of the infection. South Korea and the USA both reported their first COVID-19 cases on the same day; however, the US administration downplayed the risks of the disease, unlike South Korean officials, who constantly informed their citizens about the developments of the disease using the media and a centralized messaging system. They also employed the Trace, Test, and Treat protocol to identify and isolate patients fast, whereas the USA restricted this to patients with severe infection and only later broadened this criterion, like many European countries as well as India. Unlike the USA, South Korea also has universal healthcare, ensuring free diagnostic testing.


Figure 1 . Timeline of COVID-19 progression ( 30 – 32 ).


Figure 2 . Total confirmed COVID 19 cases as of May 2020 ( 33 ).

The main mode of transmission of 2019-nCoV is human to human. As of now, animal-to-human transfer has not yet been confirmed. Asymptomatic carriers of the virus are at major risk of being superinfectors with this disease, as all those infected may not develop the disease ( 41 ). This is a concern that has been raised by nations globally, with the Indian government raising concerns on how to identify and contain asymptomatic carriers, who could account for 80% of those infected ( 42 ). Since current resources are directed towards understanding the hospitalized individuals showing symptoms, there is still a vast amount of information about asymptomatic individuals that has yet to be studied. For example, some questions that need to be answered include: Do asymptomatic individuals develop the disease at any point in time at all? Do they eventually develop antibodies? How long do they shed the virus for? Can any tissue of these individuals store the virus in a dormant state? Asymptomatic transmission is a gray area that encompasses major unknowns in COVID-19.

The main route of human-to-human transmission is by droplets, which are generated during coughing, talking, or sneezing and are then inhaled by a healthy individual. They can also be indirectly transmitted to a person when they land on surfaces that are touched by a healthy individual who may then touch their nose, mouth, or eyes, allowing the virus entry into the body. Fomites are also a common issue in such diseases ( 43 ).

Aerosol-based transmission of the virus has not yet been confirmed ( 43 ). Stool-based transmission via the fecal-oral route may also be possible since the SARS-CoV-2 has been found in patient feces ( 44 , 45 ). Some patients with COVID-19 tend to develop diarrhea, which can become a major route of transmission if proper sanitation and personal hygiene needs are not met. There is no evidence currently available to suggest intrauterine vertical transmission of the disease in pregnant women ( 46 ).

More investigation is necessary of whether climate has played any role in the containment of the infection in countries such as India, Singapore, China, and Israel, as these are significantly warmer countries as compared with the UK, the USA, and Canada ( Figure 2 ). Ideally, a warm climate should prevent the virus from surviving for longer periods of time on surfaces, reducing transmissibility.


On gaining entry via any of the mucus membranes, the single-stranded RNA-based virus enters the host cell using type 2 transmembrane serine protease (TMPRSS2) and ACE2 receptor protein, leading to fusion and endocytosis with the host cell ( 47 – 49 ). The uncoated RNA is then translated, and viral proteins are synthesized. With the help of RNA-dependant RNA polymerase, new RNA is produced for the new virions. The cell then undergoes lysis, releasing a load of new virions into the patients' body. The resultant infection causes a massive release of pro-inflammatory cytokines that causes a cytokine storm.

Clinical Presentation

The clinical presentation of the disease resembles beta coronavirus infections. The virus has an incubation time of 2–14 days, which is the reason why most patients suspected to have the illness or contact with an individual having the illness remain in quarantine for the said amount of time. Infection with SARS-CoV-2 causes severe pneumonia, intermittent fever, and cough ( 50 , 51 ). Symptoms of rhinorrhoea, pharyngitis, and sneezing have been less commonly seen. Patients often develop acute respiratory distress syndrome within 2 days of hospital admission, requiring ventilatory support. It has been observed that during this phase, the mortality tends to be high. Chest CT will show indicators of pneumonia and ground-glass opacity, a feature that has helped to improve the preliminary diagnosis ( 51 ). The primary method of diagnosis for SARS-CoV-2 is with the help of PCR. For the PCR testing, the US CDC recommends testing for the N gene, whereas the Chinese CDC recommends the use of ORF lab and N gene of the viral genome for testing. Some also rely on the radiological findings for preliminary screening ( 52 ). Additionally, immunodiagnostic tests based on the presence of antibodies can also play a role in testing. While the WHO recommends the use of these tests for research use, many countries have pre-emptively deployed the use of these tests in the hope of ramping up the rate and speed of testing ( 52 – 54 ). Later, they noticed variations among the results, causing them to stop the use of such kits; there was also debate among the experts about the sensitivity and specificity of the tests. For immunological tests, it is beneficial to test for antibodies against the virus produced by the body rather than to test for the presence of the viral proteins, since the antibodies can be present in larger titers for a longer span of time. However, the cross-reactivity of these tests with other coronavirus antibodies is something that needs verification. Biochemical parameters such as D-dimer, C-reactive protein, and variations in neutrophil and lymphocyte counts are some other parameters that can be used to make a preliminary diagnosis; however, these parameters vary in a number of diseases and thus cannot be relied upon conclusively ( 51 ). Patients with pre-existing diseases such as asthma or similar lung disorder are at higher risk, requiring life support, as are those with other diseases such as diabetes, hypertension, or obesity. Those above the age of 60 have displayed the highest mortality rate in China, a finding that is mirrored in other nations as well ( Figure 3 ) ( 55 ). If we cross-verify these findings with the population share that is above the age of 70, we find that Italy, the United Kingdom, Canada, and the USA have one of the highest elderly populations as compared to countries such as India and China ( Figure 4 ), and this also reflects the case fatality rates accordingly ( Figure 5 ) ( 33 ). This is a clear indicator that aside from comorbidities, age is also an independent risk factor for death in those infected by COVID-19. Also, in the US, it was seen that the rates of African American deaths were higher. This is probably due to the fact that the prevalence of hypertension and obesity in this community is higher than in Caucasians ( 56 , 57 ). In late April 2020, there are also claims in the US media that young patients in the US with COVID-19 may be at increased risk of stroke; however, this is yet to be proven. We know that coagulopathy is a feature of COVID-19, and thus stroke is likely in this condition ( 58 , 59 ). The main cause of death in COVID-19 patients was acute respiratory distress due to the inflammation in the linings of the lungs caused by the cytokine storm, which is seen in all non-survival cases and in respiratory failure. The resultant inflammation in the lungs, served as an entry point of further infection, associated with coagulopathy end-organ failure, septic shock, and secondary infections leading to death ( 60 – 63 ).


Figure 3 . Case fatality rate by age in selected countries as of April 2020 ( 33 ).


Figure 4 . Case fatality rate in selected countries ( 33 ).


Figure 5 . Population share above 70 years of age ( 33 ).

For COVID-19, there is no specific treatment available. The WHO announced the organization of a trial dubbed the “Solidarity” clinical trial for COVID-19 treatments ( 64 ). This is an international collaborative study that investigates the use of a few prime candidate drugs for use against COVID-19, which are discussed below. The study is designed to reduce the time taken for an RCT by over 80%. There are over 1087 studies ( Supplementary Data 1 ) for COVID-19 registered at clinicaltrials.gov , of which 657 are interventional studies ( Supplementary Data 2 ) ( 65 ). The primary focus of the interventional studies for COVID-19 has been on antimalarial drugs and antiviral agents ( Table 1 ), while over 200 studies deal with the use of different forms of oxygen therapy. Most trials focus on improvement of clinical status, reduction of viral load, time to improvement, and reduction of mortality rates. These studies cover both severe and mild cases.


Table 1 . List of therapeutic drugs under study for COVID-19 as per clinical trials registered under clinicaltrials.gov .

Use of Antimalarial Drugs Against SARS-CoV-2

The use of chloroquine for the treatment of corona virus-based infection has shown some benefit in the prevention of viral replication in the cases of SARS and MERS. However, it was not validated on a large scale in the form of a randomized control trial ( 50 , 66 – 68 ). The drugs of choice among antimalarials are Chloroquine (CQ) and Hydroxychloroquine (HCQ). The use of CQ for COVID-19 was brought to light by the Chinese, especially by the publication of a letter to the editor of Bioscience Trends by Gao et al. ( 69 ). The letter claimed that several studies found CQ to be effective against COVID-19; however, the letter did not provide many details. Immediately, over a short span of time, interest in these two agents grew globally. Early in vitro data have revealed that chloroquine can inhibit the viral replication ( 70 , 71 ).

HCQ and CQ work by raising the pH of the lysosome, the cellular organelle that is responsible for phagocytic degradation. Its function is to combine with cell contents that have been phagocytosed and break them down eventually, in some immune cells, as a downstream process to display some of the broken proteins as antigens, thus further enhancing the immune recruitment against an antigen/pathogen. The drug was to be administered alone or with azithromycin. The use of azithromycin may be advocated by the fact that it has been seen previously to have some immunomodulatory role in airway-related disease. It appears to reduce the release of pro-inflammatory cytokines in respiratory illnesses ( 72 ). However, HCQ and azithromycin are known to have a major drug interaction when co-administered, which increases the risk of QT interval prolongation ( 73 ). Quinine-based drugs are known to have adverse effects such as QT prolongation, retinal damage, hypoglycemia, and hemolysis of blood in patients with G-6-PD deficiency ( 66 ). Several preprints, including, a metanalysis now indicate that HCQ may have no benefit for severe or critically ill patients who have COVID-19 where the outcome is need for ventilation or death ( 74 , 75 ). As of April 21, 2020, after having pre-emptively recommended their use for SARS-CoV-2 infection, the US now advocates against the use of these two drugs based on the new data that has become available.

Use of Antiviral Drugs Against SARS-CoV-2

The antiviral agents are mainly those used in the case of HIV/AIDS, these being Lopinavir and Ritonavir. Other agents such as nucleoside analogs like Favipiravir, Ribavirin, Remdesivir, and Galidesivir have been tested for possible activity in the prevention of viral RNA synthesis ( 76 ). Among these drugs, Lopinavir, Ritonavir, and Remdesivir are listed in the Solidarity trial by the WHO.

Remdesivir is a nucleotide analog for adenosine that gets incorporated into the viral RNA, hindering its replication and causing chain termination. This agent was originally developed for Ebola Virus Disease ( 77 ). A study was conducted with rhesus macaques infected with SARS-CoV-2 ( 78 ). In that study, after 12 h of infection, the monkeys were treated with either Remdesivir or vehicle. The drug showed good distribution in the lungs, and the animals treated with the drug showed a better clinical score than the vehicle group. The radiological findings of the study also indicated that the animals treated with Remdesivir have less lung damage. There was a reduction in viral replication but not in virus shedding. Furthermore, there were no mutations found in the RNA polymerase sequences. A randomized clinical control study that became available in late April 2020 ( 79 ), having 158 on the Remdesivir arm and 79 on the placebo arm, found that Remdesivir reduced the time to recovery in the Remdesivir-treated arm to 11 days, while the placebo-arm recovery time was 15 days. Though this was not found to be statistically significant, the agent provided a basis for further studies. The 28-days mortality was found to be similar for both groups. This has now provided us with a basis on which to develop future molecules. The study has been supported by the National Institute of Health, USA. The authors of the study advocated for more clinical trials with Remdesivir with a larger population. Such larger studies are already in progress, and their results are awaited. Remdesivir is currently one of the drugs that hold most promise against COVID-19.

An early trial in China with Lopinavir and Ritonavir showed no benefit compared with standard clinical care ( 80 ). More studies with this drug are currently underway, including one in India ( 81 , 82 ).

Use of Convalescent Patient Plasma

Another possible option would be the use of serum from convalescent individuals, as this is known to contain antibodies that can neutralize the virus and aid in its elimination. This has been tried previously for other coronavirus infections ( 83 ). Early emerging case reports in this aspect look promising compared to other therapies that have been tried ( 84 – 87 ). A report from China indicates that five patients treated with plasma recovered and were eventually weaned off ventilators ( 84 ). They exhibited reductions in fever and viral load and improved oxygenation. The virus was not detected in the patients after 12 days of plasma transfusion. The US FDA has provided detailed recommendations for investigational COVID-19 Convalescent Plasma use ( 88 ). One of the benefits of this approach is that it can also be used for post-exposure prophylaxis. This approach is now beginning to be increasingly adopted in other countries, with over 95 trials registered on clinicaltrials.gov alone, of which at least 75 are interventional ( 89 ). The use of convalescent patient plasma, though mostly for research purposes, appears to be the best and, so far, the only successful option for treatment available.

From a future perspective, the use of monoclonal antibodies for the inhibition of the attachment of the virus to the ACE-2 receptor may be the best bet. Aside from this, ACE-2-like molecules could also be utilized to attach and inactivate the viral proteins, since inhibition of the ACE-2 receptor would not be advisable due to its negative repercussions physiologically. In the absence of drug regimens and a vaccine, the treatment is symptomatic and involves the use of non-invasive ventilation or intubation where necessary for respiratory failure patients. Patients that may go into septic shock should be managed as per existing guidelines with hemodynamic support as well as antibiotics where necessary.

The WHO has recommended that simple personal hygiene practices can be sufficient for the prevention of spread and containment of the disease ( 90 ). Practices such as frequent washing of soiled hands or the use of sanitizer for unsoiled hands help reduce transmission. Covering of mouth while sneezing and coughing, and disinfection of surfaces that are frequently touched, such as tabletops, doorknobs, and switches with 70% isopropyl alcohol or other disinfectants are broadly recommended. It is recommended that all individuals afflicted by the disease, as well as those caring for the infected, wear a mask to avoid transmission. Healthcare works are advised to wear a complete set of personal protective equipment as per WHO-provided guidelines. Fumigation of dormitories, quarantine rooms, and washing of clothes and other fomites with detergent and warm water can help get rid of the virus. Parcels and goods are not known to transmit the virus, as per information provided by the WHO, since the virus is not able to survive sufficiently in an open, exposed environment. Quarantine of infected individuals and those who have come into contact with an infected individual is necessary to further prevent transmission of the virus ( 91 ). Quarantine is an age-old archaic practice that continues to hold relevance even today for disease containment. With the quarantine being implemented on such a large scale in some countries, taking the form of a national lockdown, the question arises of its impact on the mental health of all individuals. This topic needs to be addressed, especially in countries such as India and China, where it is still a matter of partial taboo to talk about it openly within the society.

In India, the Ministry of Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH), which deals with the alternative forms of medicine, issued a press release that the homeopathic, drug Arsenicum album 30, can be taken on an empty stomach for 3 days to provide protection against the infection ( 92 ). It also provided a list of herbal drugs in the same press release as per Ayurvedic and Unani systems of medicine that can boost the immune system to deal with the virus. However, there is currently no evidence to support the use of these systems of medicine against COVID-19, and they need to be tested.

The prevention of the disease with the use of a vaccine would provide a more viable solution. There are no vaccines available for any of the coronaviruses, which includes SARS and MERS. The development of a vaccine, however, is in progress at a rapid pace, though it could take about a year or two. As of April 2020, no vaccine has completed the development and testing process. A popular approach has been with the use of mRNA-based vaccine ( 93 – 96 ). mRNA vaccines have the advantage over conventional vaccines in terms of production, since they can be manufactured easily and do not have to be cultured, as a virus would need to be. Alternative conventional approaches to making a vaccine against SARS-CoV-2 would include the use of live attenuated virus as well as using the isolated spike proteins of the virus. Both of these approaches are in progress for vaccine development ( 97 ). Governments across the world have poured in resources and made changes in their legislation to ensure rapid development, testing, and deployment of a vaccine.

Barriers to Treatment

Lack of transparency and poor media relations.

The lack of government transparency and poor reporting by the media have hampered the measures that could have been taken by healthcare systems globally to deal with the COVID-19 threat. The CDC, as well as the US administration, downplayed the threat and thus failed to stock up on essential supplies, ventilators, and test kits. An early warning system, if implemented, would have caused borders to be shut and early lockdowns. The WHO also delayed its response in sounding the alarm regarding the severity of the outbreak to allow nations globally to prepare for a pandemic. Singapore is a prime example where, despite the WHO not raising concerns and banning travel to and from China, a country banned travelers and took early measures, thus managing the outbreak quite well. South Korea is another example of how things may have played out had those measures by agencies been taken with transparency. Increased transparency would have allowed the healthcare sector to better prepare and reduced the load of patients they had to deal with, helping flatten the curve. The increased patient load and confusion among citizens arising from not following these practices has proved to be a barrier to providing effective treatments to patients with the disease elsewhere in the world.

Lack of Preparedness and Protocols

Despite the previous SARS outbreak teaching us important lessons and providing us with data on a potential outbreak, many nations did not take the important measures needed for a future outbreak. There was no allocation of sufficient funds for such an event. Many countries experienced severe lack of PPE, and the lockdown precautions hampered the logistics of supply and manufacturing of such essential equipment. Singapore and South Korea had protocols in place and were able to implement them at a moment's notice. The spurt of cases that Korea experienced was managed well, providing evidence to this effect. The lack of preparedness and lack of protocol in other nations has resulted in confusion as to how the treatment may be administered safely to the large volume of patients while dealing with diagnostics. Both of these factors have limited the accessibility to healthcare services due to sheer volume.

Socio-Economic Impact

During the SARS epidemic, China faced an economic setback, and experts were unsure if any recovery would be made. However, the global and domestic situation was then in China's favor, as it had a lower debt, allowing it to make a speedy recovery. This is not the case now. Global experts have a pessimistic outlook on the outcome of this outbreak ( 98 ). The fear of COVID-19 disease, lack of proper understanding of the dangers of the virus, and the misinformation spread on the social media ( 99 ) have caused a breakdown of the economic flow globally ( 100 ). An example of this is Indonesia, where a great amount of fear was expressed in responses to a survey when the nation was still free of COVID-19 ( 101 ). The pandemic has resulted in over 2.6 billion people being put under lockdown. This lockdown and the cancellation of the lunar year celebration has affected business at the local level. Hundreds of flights have been canceled, and tourism globally has been affected. Japan and Indonesia are estimated to lose over 2.44 billion dollars due to this ( 102 , 103 ). Workers are not able to work in factories, transportation in all forms is restricted, and goods are not produced or moved. The transport of finished products and raw materials out of China is low. The Economist has published US stock market details indicating that companies in the US that have Chinese roots fell, on average, 5 points on the stock market as compared to the S&P 500 index ( 104 ). Companies such as Starbucks have had to close over 4,000 outlets due to the outbreak as a precaution. Tech and pharma companies are at higher risk since they rely on China for the supply of raw materials and active pharmaceutical ingredients. Paracetamol, for one, has reported a price increase of over 40% in India ( 104 – 106 ). Mass hysteria in the market has caused selling of shares of these companies, causing a tumble in the Indian stock market. Though long-term investors will not be significantly affected, short-term traders will find themselves in soup. Politically, however, this has further bolstered support for world leaders in countries such as India, Germany, and the UK, who are achieving good approval ratings, with citizens being satisfied with the government's approach. In contrast, the ratings of US President Donald Trump have dropped due to the manner in which the COVID-19 pandemic was handled. These minor impacts may be of temporary significance, and the worst and direct impact will be on China itself ( 107 – 109 ), as the looming trade war with the USA had a negative impact on the Chinese and Asian markets. The longer production of goods continues to remain suspended, the more adversely it will affect the Chinese economy and the global markets dependent on it ( 110 ). If this disease is not contained, more and more lockdowns by multiple nations will severely affect the economy and lead to many social complications.

The appearance of the 2019 Novel Coronavirus has added and will continue to add to our understanding of viruses. The pandemic has once again tested the world's preparedness for dealing with such outbreaks. It has provided an outlook on how a massive-scale biological event can cause a socio-economic disturbance through misinformation and social media. In the coming months and years, we can expect to gain further insights into SARS-CoV-2 and COVID-19.

Author Contributions

KN: conceptualization. RK, AA, JM, and KN: investigation. RK and AA: writing—original draft preparation. KN, PN, and JM: writing—review and editing. KN: supervision.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The authors would like to acknowledge the contributions made by Dr. Piya Paul Mudgal, Assistant Professor, Manipal Institute of Virology, Manipal Academy of Higher Education towards inputs provided by her during the drafting of the manuscript.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00216/full#supplementary-material

Supplementary Data 1, 2. List of all studies registered for COVID-19 on clinicaltrials.gov .

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Keywords: 2019-nCoV, COVID-19, SARS-CoV-2, coronavirus, pandemic, SARS

Citation: Keni R, Alexander A, Nayak PG, Mudgal J and Nandakumar K (2020) COVID-19: Emergence, Spread, Possible Treatments, and Global Burden. Front. Public Health 8:216. doi: 10.3389/fpubh.2020.00216

Received: 21 February 2020; Accepted: 11 May 2020; Published: 28 May 2020.

Reviewed by:

Copyright © 2020 Keni, Alexander, Nayak, Mudgal and Nandakumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Krishnadas Nandakumar, mailnandakumar77@gmail.com

This article is part of the Research Topic

Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response


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