Coming To Terms With COVID-19 In One Of Nigeria’s Major Cities

First in a series of stories about how the coronavirus lockdowns and relaxations are playing out in different parts of Africa. 

A middle-aged man sells cloth face masks and face shields along a major highway in Ibadan southwest Nigeria. Photo by Paul Adepoju/Health Policy Watch

Ibadan, Nigeria – While Lagos and Abuja capital city continue to be the epicenter of the COVID-19 pandemic in Nigeria accounting for nearly half of confirmed cases, Oyo State is also generating a buzz. The state, just north of Lagos, has the third highest case count, and infections are steadily rising, even as lockdowns are relaxed more rapidly than elsewhere and students also return to school.  

This has triggered concerns that Oyo could become Nigeria’s Texas or Florida if public health policy measures aren’t followed carefully – right now they are not.  

The World Health Organisation (WHO), globally and regionally, have concluded that the COVID-19 pandemic may not end anytime soon and urged countries and governments across the world to safely reopen their economies without putting citizens, especially the vulnerable age groups to COVID-19. In Nigeria, the Oyo State capital city of Ibadan is emerging as one that is racing towards returning to normal, largely ahead of others.

It is the only state capital where students are already returning to school even as the number of cases continue to rise – about 1,000 cases away from clinging Nigeria’s second highest number of confirmed cases of COVID-19. 

But with a case fatality ratio of just 0.9%, the city’s leadership and a significant proportion of the general public consider the threat of COVID-19 not strong enough to halt students’ education, put families out of work or put the city’s life on hold.

Masks on Neck, Not the Face 

Friends and colleagues, Rabiu and Adeolu, sit on their motorcycles while waiting for passengers to transport to and from the market. When asked about their consciousness about COVID-19, they pointed to the face masks they wore, though improperly. Photo by Paul Adepoju/Health Policy Watch

As early as 6am, activities are already underway at the Agbeni market. Thousands of people roam the tightly packed streets of the market shopping for wares ranging from foodstuffs, building items and musical instruments to clothing and intimate apparel. The only evidence of the existence of the COVID-19 pandemic is an occasional sighting of individuals wearing masks – usually on the neck rather than the face as required by State health authorities – whose enforcement of the rules is even less evident than the masks.

Cases of COVID-19 in Nigeria, 29 July 2020

Although the city was never locked down, a 8pm- 6a.m. curfew was imposed from March 30 to June 20, as COVID-19 spread across west Africa and case counts in Nigeria went from just two confirmed cases on March 9 to 41,804 on July 28. In Ibadan, the first case of COVID-19 in the state was confirmed by the NCDC on March 21 and the case count rose to 2,668 on July 28.

The curfew had devastating impacts on the city’s nightlife and entertainment economy. Moreover, thousands of informal workers associated with this economy had their sole means of livelihood cut off abruptly – without the provision of  commensurate palliatives – unemployment, cash grants or even food aid. 

Just a few meters from the Oyo State Government Secretariat, activities have now been extended to 9pm at the popular Ultima Restaurant following the curfew’s relaxation.

The curfew had devastating impacts on the city’s nightlife and entertainment economy. Moreover, thousands of informal workers associated with this economy had their sole means of livelihood cut off abruptly – without the provision of  commensurate palliatives – unemployment, cash grants or even food aid. 

Just a few meters from the Oyo State Government Secretariat, activities have now been extended to 9pm at the popular Ultima Restaurant following the curfew’s relaxation.

During the curfew, a staff member told Health Policy Watch: “We had to suspend the evening shift which meant fewer workers; we also had to come to terms with the fact that we would have fewer customers. Although luckily for us we had our delivery service which saw increased adoption during the period.” 

Now, activities are returning to normal at the restaurant. Although a sign stating that only 10 people are allowed inside at any time is still at the entrance, customers are no longer asked to wait outside. Furthermore, instead of a handwashing station, the facility has shifted to temperature check and alcohol-based hand sanitizers. It has also been advising its customers to wear face masks – although not many adhere to the rule after gaining entry. 

A customer washes her hands before being allowed to enter a restaurant in Ibadan. Photo by Paul Adepoju/Health Policy Watch

“It will be easy for the city to move on if the people are abiding by guidelines that we are issuing, Ogunniyi Abiodun, public health expert at the Nigeria Center for Disease Control (NCDC), told Health Policy Watch. “Unfortunately, this is not happening as we would have loved it to be, which is why the number of cases continues to rise. But we will continue to appeal to the people and the government to base their decisions on the best available evidence.”

The Booming Business of COVID-19

Innovation has been at the heart of the COVID-19 response in the city as individuals and organisations embrace and deploy solutions that best suit their needs and are also within their budgets.

Not too far away from Ultima, a Domino’s Pizza outlet on Osuntokun avenue is co-located with an ice cream franchise. Together they have deployed a custom-built handwashing station that has a tap that users do not even have to touch – thus providing some form of protection against contracting the virus by touching frequently touched surfaces.

The hand washing station at Domino’s Pizza outlet located at Bodija area in Ibadan, southwest Nigeria. Photo by Paul Adepoju/Health Policy Watch

Social Distancing Not an Option

But most small and medium scale entrepreneurs in Ibadan lack the luxury of space enjoyed by franchise chains like Dominos – and therefore cannot effectively implement hygiene or social distancing measures. 

One of the popular landmarks in Ibadan is the Cocoa House at the center of Ibadan’s Dugbe Business District. Completed in 1965 at a height of 105 metres and was once the tallest building in tropical Africa. Opposite the historic building is a line of small shops being used by small business owners. In one of them, Tijani Balogun and four other phone repairmen are attending to customers with damaged mobile devices – a brisk business even in hard times. 

In the small room that is just about one-meter wide, customers watch as their mobile devices are disassembled and damaged parts are replaced. While admitting that the threat posed by COVID-19 to both customers and artisans is imminent, Tijani said it is a risk worth taking considering there is no better option.

“I don’t see any option for us to make daily living and maintain social distancing. Five of us are even struggling to keep up with the annual rent fee. Are we going to say that only one of us should use the shop each day?” he asked.

Presented with the shop serving as a potential petri dish for COVID-19, Tijani said customers without face masks cannot be denied services because of his competitors next door that will gladly welcome them.

“I’m not sure if I will get it (COVID-19) or not but I’m sure that I can die of hunger if I don’t attend to my customers that will pay me and give me money to feed myself and my family,” he said.

Phone repair technicians working together in a small shop in the Dugbe area of Ibadan attend to customers without wearing face masks. Photo by Paul Adepoju/Health Policy Watch

Government Plans Stricter Enforcement of Mask Rules  

Inasmuch as establishments are being compelled to have measures in place to protect workers and visitors, individuals are also expected to prioritise wearing of face masks and are aware that they could be denied entry to public places if they don’t have one on. But a loophole has also emerged – presenting a face mask at the door and removing it after gaining entry.

A cross section of defaulters that spoke to Health Policy Watch in Ibadan metropolis described the wearing of masks as necessary but uncomfortable when they wanted to talk or in need of fresh air.

“Even when I’m the only one in my car, they would not allow me to enter public premises without having a face mask on. So I just have to hang it for them to see and remove it afterwards,” Abiodun Ilori, a civil service worker said.

An overview of COVID-19 response in Ibadan suggests that more enforcement and a clearer attribution of responsibilities would be required to improve the outcomes of current efforts. 

Currently most of the onus for compliance rests on business outlets that can be shut down or receive hefty fines if they contravene government’s guidelines. 

So in general, stores, restaurants and workplaces that can afford to take measures, are attempting to comply with requirements, at least with regards to social distancing and hygiene. But since citizens themselves face no direct repercussions if they fail to wear masks or observe hygiene and distancing rules, abiding with directives has still remained largely optional. 

At a KFC outlet in Ibadan, only one person out of four wore the face mask properly. Photo by Paul Adepoju/Health Policy Watch

Realising this, the state government recently announced that from August 2020, it would start arresting and prosecuting residents caught not wearing masks in public. During the weeks leading up to the commencement of the enforcement measures, the government said it will attempt to “sensitize, persuade and ensure compliance”. 

A similar enforcement approach is being deployed in Lagos which is about 120 kilometers away from Ibadan and is the epicenter of Nigeria’s COVID-19 pandemic. 

Health System Tested by COVID-19

Beyond the enforcement of prevention measures, access to COVID-19 tests is also expanding – although efforts to strengthen the diagnostic capacity have also put health systems to the test.

Even though access to testing is still unequal, community testing is expanding as volunteers are being mobilised from one part of the city to another including open markets

More and more health clinics  serving local communities are also opening test collection centres.  And there are ventures to expand testing in non-traditional sites too. For instance, the state government-owned Lekan Salami Stadium at Adamasingba in Ibadan has recently opened a testing center, under a public-private partnership with health tech startup lifebank, Nigeria Institute for Medical Research, Citizen for Citizen (an NGO) and laboratories at University of Ibadan’s College of Medicine.

The state government-owned Lekan Salami Stadium at Adamasingba in Ibadan is also being used as a COVID-19 testing centre. Photo by Paul Adepoju/Health Policy Watch

Prior to COVID-19, the major responsibilities of hospitals under the state’s healthcare system included care of patients living HIV, malaria, maternal health and immunization. With the advent of COVID-19, existing health infrastructures are being converted to aid the response – as has happened in countries elsewhere. 

A newly constructed maternity hospital at Olodo area of Ibadan became the state’s largest COVID-19 isolation centre while the Chest Clinic at Jericho area of the city, which was the hub of tuberculosis diagnosis and treatment prior to the pandemic, was also converted into another isolation center. 

Itunu Adelowo, Director of Operations at the African Development and Empowerment Foundation described the roles being played by the state’s health system as evidence of the need for much bigger investments in, and empowerment of, health systems. 

“When we say invest in ending maternity mortality, COVID-19 has shown that the acquired capacity for fighting maternal mortality could be deployed in tackling health emergencies. As poor as the health system was before COVID-19, it remains a major pillar supporting COVID-19 response. Now imagine what can be achieved when we have a well funded, structured and enabled health infrastructure,” Adelowo told Health Policy Watch. 

“It will be easy for the city to move on if the people are abiding by guidelines that we are issuing, Ogunniyi Abiodun, public health expert at the Nigeria Center for Disease Control (NCDC), told Health Policy Watch. “Unfortunately, this is not happening as we would have loved it to be, which is why the number of cases continues to rise. But we will continue to appeal to the people and the government to base their decisions on the best available evidence.”

Life goes on in a second hand clothes market in Ibadan – Photo by Paul Adepoju/Health Policy Watch

Image Credits: P Adepoju/HP-Watch, Nigeria Centres for Disease Control.