At midday on March 17, a week after the World Health Organisation declared the novel coronavirus a pandemic and 20 days after Nigeria reported its index case, Chikwe Ihekweazu — a consultant epidemiologist now leading Nigeria’s war against the spread of COVID-19 — called a meeting of top medical experts to appraise the country’s preparedness.

Mr Ihekweazu’s agency, the National Centre for Disease Control, was going to need a great deal of assistance in a very short period of time. As cases of coronavirus began to rise in Lagos, apprehension flared across the country of almost 200 million.

Of immediate concern was Nigeria’s decrepit health infrastructure, which has been so bad that even the president could not trust it to treat an ear infection.

During an appraisal of Nigeria’s readiness, the meeting heard that Nigeria had an estimated 350 intensive care units, according to officials present. Experts estimated Nigeria’s hospitals with Intensive Care Units (ICU) infrastructure at 71, with each having between one to 20 beds.

“The total number of ICU beds in the country was put at 350,” a source present at the meeting told PREMIUM TIMES, saying the meeting was held in “top secret” to avoid aggravating Nigerians about insufficient treatment mechanisms available in the country.

“Mr Ihekweazu and the rest of us present at the meeting swallowed a bitter pill,” the official said. “The situation was so helpless that the only thing we could do is to pray that Nigeria’s cases do not rise to the level we have seen in other countries.”

At the time the meeting held, Nigeria had eight confirmed cases out of 53 people tested, officials said. But as of March 30, 111 cases have been reported with one person confirmed dead from the virus. However, officials said Nigeria had enough personal protective equipment (PPEs) to last for 30 days.

Now, medical experts at the NCDC told PREMIUM TIMES they feared a time when doctors across the country would be faced with a situation where they would need to decide whose lives should be prioritised for the few available ventilators.

The 71 facilities that NCDC experts found are ICU-equipped contain both public and private hospitals across Nigeria, officials said.

For weeks, President Muhammadu Buhari declined to address Nigerians on the crisis, isolating himself from other leaders who have been at the frontline of containing the virus around the world.

When he eventually addressed the country in a pre-recorded speech on March 29, he did not mention ICUs or ventilators throughout his 20-minute speech. Instead, the president only announced a lockdown of Lagos, Ogun and Abuja for 14 days — and even that decision has been questioned by legal experts as unconstitutional.

PREMIUM TIMES obtained the information as senior administration officials, including health minister Osagie Ehanire and Mr Ihekweazu himself, have been avoiding questions around the country’s available ICU capacity.

Throughout last week, Messrs Ihekweazu and Enihare, as well as health ministry spokesperson, Enefaa Bob-Manuel, all declined PREMIUM TIMES’ request for comment on the briefing.

Popular demand

As the fight to contain COVID-19 becomes increasingly intense, countries across the world are racing to expand their ICUs in anticipation of many people who are likely to fall critically ill and overwhelm existing health capacity.

COVID-19, a highly infectious disease, has been adjudged by medical experts as potentially deadly for people with respiratory and other underlying health conditions.

Demand has risen worldwide for the supply of ventilators, a computerised device that pumps air in and out of the lungs. It has long been a crucial component of an ICU.

President Donald Trump spent last week urging U.S. manufacturers to ramp up production of ventilators, with the country tapping into its strategic reserve to cater for the sick in New York, Los Angeles and other densely-populated American cities.

On Friday, after General Motors announced it might not be able to produce more than 8,000 ventilators between now and April ending, the president invoked defence production laws to compel the major manufacturer to produce thousands more for Americans.

Mr Trump estimated that the U.S. may need additional 100,000 ventilators in about 100 days.

He had previously maintained his reluctance to use his defence production powers, and his breakaway underscores how crucial ventilators are in protecting lives amidst the pandemic.

Across Europe, demand for ventilators has skyrocketed, with existing tens of thousands of ventilators being deemed insufficient to address growing cases. The situation has prompted some countries to ban exportation of the critical resource in a bid to preserve their own population.

‘Hopeless situation’

As of March 30, Nigeria has confirmed only 111 coronavirus infections amongst its nearly 200 million people, a far cry from the thousands of cases recorded in the U.S. and European countries where ventilators have become a highly prized commodity.

However, analysts believe the few cases are due to insufficient testing. While other countries are testing thousands per day, Nigeria has tested less than 500 people so far. On Friday, Mr Ihekweazu admitted during an appearance on Arise TV that the country lacks sufficient kits to ramp up testing of citizens.

The situation has seen the NCDC carry out tests for political, business and entertainment elite across the country, even when they have not shown symptoms. Meanwhile, ordinary citizens are asked to shelter-in-place until they show serious symptoms.

But, looking at countries with a superior health infrastructure, including thousands of ICUs and ventilators, scrambling to cope with coronavirus cases in their jurisdictions, experts in Nigeria are worried of dire days ahead.

“Let us be realistic here: Nigerians should expect tough times ahead, and that is even downplaying the severity of what we are likely to face,” Shuaib Musa, a medical doctor in Kaduna, told PREMIUM TIMES.

Mr Musa said even the 350 ICU beds that the NCDC estimated for Nigeria would have only a few left that are vacant.

“If you have up to 10 or 20 ICU beds that are not currently occupied by critically ill patients suffering from other health conditions other than COVID-19, then the country is even lucky,” the medical expert said.

Mr Musa said in the entire Kaduna State, only the 44 Reference Hospital and the Nigerian Air Force Base have a few functional ICU beds, which he strongly doubted would be made available to non-military citizens.

“From my findings as a medical doctor in this state, Ahmadu Bello University Teaching Hospital either has no functional ICU beds or barely functional ones,” Mr Musa said.

Mr Musa said when serious testing commences, Nigeria would likely record thousands of COVID-19 cases and demand for ventilators would rise.

“We cannot treat them with our existing infrastructure and the money released by the president the other day is only a drop in the bucket,” the doctor said.

Nneka Chukwumah, a medical expert at the University of Benin Teaching Hospital, told PREMIUM TIMES the outbreak could overwhelm Nigerian hospitals in the coming weeks.

“The hospitals we had before the outbreak were poorly equipped,” Ms Chukwumah said. “But considering what other countries have been going through, we would simply say Nigerian hospitals would not be able to cope.”

Ms Chukwumah, a dental consultant, said Nigerians are being given a false sense of assumption that the infections are still below 100 in Nigeria.

“They have not been testing,” she said. “The numbers would have been far higher, otherwise.”

She said the prevailing approach could cast Nigeria as an unserious country.

“By now, all hospitals should have had the rapid test kits at least,” she said. “This would allow doctors to test on the spot once a case is suspected.”

She said in Edo State, some COVID-19 carriers are still entering public buses to go and seek testing and treatment.

“They send people to go to Irua to test if they think they might have contracted the virus, now they would enter public transport and before they get to Irua additional people have been exposed,” she said.

Experts at the NCDC meeting estimated Nigeria’s 350 ICU beds meant that one in 285,000 people would have access to critical treatment, using medical practice of calculating half of the population.

Last week, The Punch gathered from across the country that less than 500 ventilators are available, with many hospitals having only a few functional ones.

Latest findings by PREMIUM TIMES showed that only 20 ICU beds are available at National Hospital Abuja, while the University of Benin Teaching Hospital has between six and eight beds.

‘Grossly inadequate’

As of March 27, Mr Buhari has only released about N15 billion ($40 million) for Nigeria’s fight against COVID-19. But in a system that has been moribund for decades, the money is seen by experts as grossly inadequate.

“Without sugarcoating the situation, the response from the president has been grossly inadequate,” Folashade Adeyemi, an economist, told PREMIUM TIMES. “We are looking at a situation far more critical than we have ever been in.”

Ms Adeyemi said even though the prices of crude had dwindled recently, making revenues difficult for government, COVID-19 should take priority over other government expenditure for now.

“Across the world, you have seen governments announcing huge stimulus for their citizens, and that is because they realise what damage the virus could cause in the long run,” she added.

Mr Buhari’s N15 billion would go to Lagos and the NCDC, but it failed to address critical but expensive medical supplies that may be required.

A few churches and businesses have been making donations towards the country’s health. Earlier this week, Herbert Wigwe and a few other top bankers and business executives donated N1 billion each, to help Nigeria combat the crisis.

Innoson Motors, Nigeria’s indigenous car manufacturer, recently told PREMIUM TIMES it was ready to convert its production lines to making ventilators as part of Nigeria’s response to the crisis. As of Saturday afternoon, no concrete plans had been put in place, even though the company told PREMIUM TIMES representatives of federal and state governments had reached out days ago.

“Nigeria does not have a defence production law to implement in the manner we saw with President Trump,” Ms Adeyemi said. “But there are many steps that could be taken to get the company to start producing as soon as possible.”