A systems approach to containment
March 11, 2020 1:16 PM   Subscribe

Why Nigeria knows better how to fight corona than the US Neoliberalism decimated African countries' public healthcare. And yet they know how to fight the coronavirus effectively
posted by Mrs Potato (21 comments total) 29 users marked this as a favorite
 
I would like to hear about what Nigeria is doing about coronavirus and would be very interested in related data. But this article has almost no information about that. How many cases, how are they testing, how are they isolating or quarantining, how are they tracing contacts, etc. etc? What did they learn from the Ebola epidemic, as in what concrete practices did they learn that they are now applying. The article asserts that there are lessons and practices and knowledge, but doesn't seem to follow through with much in the way of examples or information.

In contrast this article about South Korea's work on managing the epidemic has a number of concrete examples of the practices they are using: https://www.scmp.com/week-asia/health-environment/article/3074469/coronavirus-south-korea-cuts-infection-rate-without (not that it's perfect, I would still like more details, but it does give you an idea of what they are actually doing). Although I just learned that after a few days of declining daily cases, they had a reversal today with an increase in the number of daily cases.
posted by cron at 1:38 PM on March 11 [21 favorites]




The article asserts that there are lessons and practices and knowledge, but doesn't seem to follow through with much in the way of examples or information.

How Did Nigeria Quash Its Ebola Outbreak So Quickly?
What we can learn from the boot leather, organization and quick response times that stopped Ebola from spreading in this African nation

Scientific American, 2014

Crystal Simeoni is writing to her African audience, who all are aware of Nigeria's response to Ebola and the sacrifice of Dr Ameyo Adadevoh. We mourned.
posted by Mrs Potato at 2:03 PM on March 11 [15 favorites]




COVID-19 is not Ebola. I have the same questions as cron - is there anything specific that Nigeria has done to curb COVID-19? Currently there are two cases, the most recent disclosed on March 9. The previous case was an Italian visitor who was diagnosed on February 27. It is really too early to tell if the steps Nigeria has taken have effectively stopped the virus in its tracks. I hope they have!
posted by grumpybear69 at 3:05 PM on March 11 [11 favorites]


Yeah, going by the criteria of "not many positive cases!", everyone must agree that Trump and the rest of the Federal Government is doing a bang up job since the per capita for confirmed cases is so low in the US compared to other countries such as Italy and South Korea.
posted by sideshow at 3:15 PM on March 11 [1 favorite]


Thanks for these Mrs Potato
posted by glasseyes at 3:18 PM on March 11 [2 favorites]


Twirra having a meltdown over this nonsense, glasseyes.
posted by Mrs Potato at 3:41 PM on March 11


The airport was prepared for containment and testing temperature when teh news first hit. Propaganda has blurred the reality of the China Africa trade, and in a place like Lagos, a city of 20 million, the number of people going back and forth must be immense enough that the alert state would have occurred over a month ago. Here.
posted by Mrs Potato at 4:05 PM on March 11 [8 favorites]


...and now I know a wonderful neologism! Thank you, Mrs Potato.
posted by mwhybark at 4:15 PM on March 11


re: 10 minute coronavirus test(s)

It's almost certainly too early to have developed a diagnostic antibody to covid-19, but the nucleotide sequence is known, so the majority of 10 minute/ rapid tests (regardless of where they're being developed) is probably some variant of loop-mediated isothermal amplification with some kind of colourimetric readout from the amplified (non-infectious) DNA.

In theory, it works. In practice, the detection limit (ie., not sensitive) is rather high and this molecular approach tends to give an unacceptably high rate of false positives in most circumstances. False positivity can partially be offset at further expense of an even higher detection limit.

One can improve the detection limit through various means, but typically at the expense of true positivity.

The shelf life isn't great either, most isothermal polymerases are rather promiscuous and testing kits tend to slowly go "positive reading" before use/ in storage.

I wish everyone developing these all the best, though.
posted by porpoise at 5:05 PM on March 11 [7 favorites]


I'm not a scientist or a mathematician, but...to me, just a basic sense of the numbers here (like, the incubation period of this thing, how many countries have cases, how many are currently known to be infected, etc) tells me there's basically no way this won't spread to the entire world, if it hasn't already. I...have to feel like it's kind of a fantasy to think coronavirus can be contained at this point.

It only takes one person, like, say, a member of the GOP who had confirmed contact with an infected person at a conference yet refuses to self-quarantine, in order to spread the virus far and wide. From what I know about this virus, it reoccurs in previously cured patients and it can be caught through your eyeballs, right? It's not so deadly to where infected people don't live to infect others- they can carry it for weeks without knowing? And it lives on smooth surfaces? For days?

In the US, we could make health care and testing and sanitization more accessible for everyone, make sure there's a federal sick leave policy, etc. What we are doing is trapping people on boats and talking about (surprise!) shutting down borders. The focus is 100% on containment, and in my opinion they're wasting time. The cat's out of the bag. We need to be prepared.

One of my parents, if they contract covid, they will die. Period. And one of my best friends is immunocompromised. I'm very personally invested in this, trying to contend with the reality of the situation, so I apologize if this whole comment is ...doomy.
posted by captain afab at 5:33 PM on March 11 [4 favorites]


Thanks for sharing this link, Mrs Potato.
posted by smoke at 5:52 PM on March 11


..... the number of people going back and forth must be immense enough that the alert state would have occurred over a month ago. Here.

The "Here" is a tweet from someone who describes themselves as involved in. "Screenwriting. Content Creation. Filmmaking. Apolitical. Kaizen. Galatians 2:20".. Zero mention of any medical expertise.

Sorry, I don't buy it. It's great that people are thinking positive, and I'm 100% sure that western media (and a lot of the west) has a neocolonialist/racist hardon for "doom! africa!" stories.

That still doesn't get anywhere near providing evidence for extraordinary claims like "number of people going back and forth must be immense enough that the alert state would have occurred over a month ago." and "Why Nigeria knows better how to fight corona than the US"

There are vectors entering every country every day that are asymptomatic (e.g. Lagos has about between 10,000 to 18,000 visitors every day through its airport!) , and covid19. is. not. ebola! Ebola has a quick incubation time, has very quick and VISIBLE highly lethal symptoms, and so, despite being a terrifying virus, poses an entirely different challenge to health systems than covid19.

This post, despite coming from a good place, is magical thinking, and is dangerous.
posted by lalochezia at 7:33 PM on March 11 [14 favorites]


As far as I can tell, Covid-19 is near the upper edge of dangerous for the modern world. Any more deadly (like MERS or Ebola) and it gets stamped out quickly. Any less and it's like the flu (which is incredibly dangerous, but kind of a normal dangerous like car crashes). This could be about 10x the normal flu, which is a lot, though nowhere near the 1918 flu, which hopefully isn't possible anymore.

I thought this Medium article was very in-depth. The title and intro are a bit extreme and off-putting, but the body seems to extensive and well-sourced.
posted by netowl at 9:51 PM on March 11 [4 favorites]


This post, despite coming from a good place, is magical thinking, and is dangerous.

Did you read the linked article? The author is an Atlantic Fellow for Social and Economic Equity at the London School of Economics, and I really didn't think it was that incendiary, or going too far.

Of course Nigerian officials are aware of the potential dangers of pandemics - they have to deal with them all the time, ranging from ebola, to some of the worlds last few cases of polio, to more common viral illnesses were vaccines aren't widely available like measles etc.

Nigeria's health system is structured around extremely limited resource, aggressive triage, complex social, cultural and religious norms. Prevention is a big focus of the health department. They don't have a madman for a president (at the moment); this isn't their first time dealing with a major and highly contagious pandemic; they are a country that is mostly hot, and high humidity - which has been shown to limit the spread; they do have far fewer points of entry to the country than they US; they don't have an aging population with the kind of co-morbidities often seen in older Americans.

I think people can disagree about the headline statement, absolutely. But, I'm sorry calling it magical thinking, and dangerous frankly comes off a bit dismissive, and yeah a bit racist to me.

Magical thinking is the church of cyprus claiming that holy water can't transmit the virus; dangerous magical thinking is Hindutva dipshits claiming for weeks that India had no cases because of the popularity of tumeric in Indian cuisine (!).

Do you know anything about Nigeria/Nigeria's health system? If not, I'd think about piping down.
posted by smoke at 10:46 PM on March 11 [9 favorites]


From what I know about this virus, it reoccurs in previously cured patients

maaaaybe but at this point I think it's at least as positive that a few people have gotten false negatives toward the tail end of the illness and then not actually been over it yet

and it can be caught through your eyeballs, right?

no idea about this one

It's not so deadly to where infected people don't live to infect others- they can carry it for weeks without knowing?

Median incubation of five days but the upper end might reach two weeks and it does seem to be transmittable for some time before the onset of significant symptoms.

And it lives on smooth surfaces? For days?

I keep seeing "may survive on surfaces for up to [outrageous length of time] but like the incubation period I think just hearing about the upper end of the distribution doesn't help much to get an idea of what's the usual case.
posted by atoxyl at 11:58 PM on March 11 [3 favorites]


My aim here is not to argue. This is not the time for such arguments. Tom Hanks has been tested positive in Australia. However, disaster preparedness and lessons from experience shouldn't be denigrated either.

The issue of possible underreporting of cases on the continent has been raised by international analysts. An expert with Senegal’s top disease control outfit says Africa has benefited from a robust preparedness for the epidemic.

Dr Amadou Sall, director of the Pasteur Institute in Dakar, also stressed the importance of lessons learned during the Ebola crisis that affected West Africa in 2014.

“I’m happy and proud [about] what Africa has done this time because usually we spend time running after epidemics when it is there but in this time we have been prepared,” he said.

“We put together a whole group of people that are going to be together working on referral of samples and confirmation, we’re going to do the [genetic] sequencing.

“And also very important we’re going to do research. Research is absolutely critical because three months ago nobody knew about this virus so understanding how it evolves in an African context is… absolutely important,” he added.

The underreporting concerns have usually been rebuffed especially on social media where users have rather accused Europe of bringing the disease to Africa.

Most confirmed cases in Africa were brought in by European travellers entering the territories or by Africans who have had recent travel history to Europe.


As at Wednesday March 11, the African case tally is as follows:

Egypt – 55
Algeria – 20
South Africa – 7
Tunisia – 5
Senegal – 4
Morocco – 2
Cameroon – 2
Burkina Faso – 2
Nigeria – 2
Togo – 1
DR Congo – 1


posted by Mrs Potato at 1:44 AM on March 12 [4 favorites]






Nigeria's health system is structured around extremely limited resource, aggressive triage, complex social, cultural and religious norms. Prevention is a big focus of the health department. They don't have a madman for a president (at the moment); this isn't their first time dealing with a major and highly contagious pandemic; they are a country that is mostly hot, and high humidity - which has been shown to limit the spread; they do have far fewer points of entry to the country than they US; they don't have an aging population with the kind of co-morbidities often seen in older Americans.
....
Magical thinking is the church of cyprus claiming that holy water can't transmit the virus; dangerous magical thinking is Hindutva dipshits claiming for weeks that India had no cases because of the popularity of tumeric in Indian cuisine (!).


I favorited your comment because the points, especially the paragraphs above, are germane and fair criticism of my original comment. Compared to magical thinking like you outlined above, the nigerian state response is, obviously, sensible. As you point out there are both deliberate policy, cultural factors and environmental conditions that will blunt the impact somewhat.

What I won't buy is the claim that because Nigeria has dealt with epidemics before they are super ready for a pandemic now - and by virtue of some small actions they will escape it!
They are probably more ready than many, but nothing I've seen (I'm willing to be shown!) that they have taken social distancing or containment anywhere seriously enough to halt the spread of this virus.

As the OP rightly pointed out, there are Europeans (and others!) bringing covid19 in through ports as we speak - and have been for months. I would be very skeptical of any reported numbers outside of places that are doing intensive testing (this includes most of the world!). We simply don't know how much this has spread.
posted by lalochezia at 8:01 AM on March 12 [3 favorites]


I would think that there are many lessons to be learned (good and bad both) from countries that have gone through major disease outbreaks in recent years. It’s not going to be a one to one match and the contexts are different as well, but the unwillingness I am seeing in the US (where I am living) to discuss, much less consider, other experiences is really apparent.

Nigeria and some other countries in Africa have recent experience dealing with new outbreaks. Much of Asia is coming out of the worst of the Coronavirus outbreak and dealt with SARS not all that far back. Etc. I wish we were applying the best lessons learned from those rather than closing borders and insulting allies.

(To be clear, I am sure that the public health experts here are informed by those examples, but it is obvious that the political leadership is willfully choosing to act contrary to the science.)

So I appreciate these links, thank you for posting.
posted by Dip Flash at 9:03 AM on March 12 [7 favorites]


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