macroafricaintel | Rules of contagion

By Rafiq Raji, PhD
Twitter: @DrRafiqRaji

When I woke up to the news in late February of a confirmed case of COVID-19 in Nigeria, quite frankly, I was not surprised. It was inevitable; after cases started emerging in Europe, at least. With the benefit of hindsight, it is probably a good thing that our land borders had been closed a long while before the outbreak reached our shores. The border closure did not make sense economically at the time. But bizarrely and even paradoxically, it has turned out to be a blessing in disguise.

I am not really interested in what it is, COVID-19 or coronavirus; such fancy names, they give these viruses. As an individual, the best you can do is what you should ordinarily do in normal times: maintain good hygiene, eat healthy, exercise regularly, and so on. There are additional measures, of course. In figuring these out, I have been doing some reading. Yes, one follows the regular updates by the federal and state governments, World Health Organisation and others. But it is also important to understand what underpins the measures they announce and the advice they give.

In Nigeria, based on my own observations, our best shot at dealing with the crisis is finding and isolating whoever is infected before he or she mixes with the general population. This is because even as the majority of Nigerians desire to live clean and healthy lives, the poor circumstances of the majority of us suggest this remains a desire than reality for most. Thus, an outbreak of Chinese or Iranian proportions would almost certainly be devastating. We must not allow that to happen. And it is in our power to do so. How so?

The Chinese and Iranians made a couple of mistakes. There is a natural tendency to hide the undesirable for sometimes justifiable reasons like avoiding a panic, bad press and so on. But there are exceptions. It is widely known that a disease outbreak with the potential to become an epidemic or pandemic, must be quickly contained and communicated. The natural tendency is to hope that a full containment would make the latter needless. Time and time again, this has proven not to be the case.

Health epidemics are eventually revealed, no matter how hard a government tries to hide the facts initially. And the very measures, which if taken much earlier, would have prevented a worsening of the situation, tend to be implemented eventually. To find answers and put my observations in context, I read London School of Hygiene & Tropical Medicine associate professor Adam Kucharski’s 2020 book “The Rules of Contagion: Why things spread – and why they stop”. It was one of a couple of books recommended by the Financial Times for readers who might be interested in understanding epidemics – or pandemics if global – as we all grapple with the current one. I found some of Kucharski’s insights to be very instructive and shall share them forthwith.

A disease outbreak typically has four main stages: spark, growth, peak and decline. And in some cases, it is a cycle, repeating the four stages continously until the end. In my view, the individual can take the most effective precautions at the spark and early growth stages. If you do nothing then, there is little else you would be able to do as an individual that would likely really matter. Coercive measures, like quarantines, curfews, school closures, restrictions on public gatherings, and so on tend to be implemented by the authorities at the high growth stage. That is, when it is abundantly clear that an outbreak has reached epidemic proportions. But the individual who has not done the needful, like stocking up (not hoarding) on essentials, etc. would be greatly inconvenienced at this stage. Because at this time, it would take longer to procure these things and you would probably not get everything you seek. Thankfully, our situation in Nigeria has not reached that level yet.

By my reckoning, we are still at the spark stage. And thankfully, a very small spark at that; considering there is only one confirmed case of COVID-19 in Nigeria (at the time of this writing). By about a month from when that case was confirmed, in early April, say, our situation would probably be clearer. That is, we would then know for sure if there is going to be a growth stage, with more cases confirmed, or if as was previously the case for Ebola, we have successfully nipped the outbreak in the bud.

Hide
But what is the individual to do? In Kucharski’s narration, Andy Haldane, chief economist of the Bank of England identifies two typical responses by the public in past epidemics: flight or hide. The former is irresponsible, of course; and increasingly not feasible even for the well-heeled. Hiding behaviour is more ideal. This entails “dodging situations” that could lead to infection, washing hands, avoiding public gatherings and so on. Put more systematically, “outbreaks need three things to take off: a sufficiently infectious pathogen, plenty of interactions between different people, and enough of the population who are susceptible.” Which one of these three can the individual manage? Social interactions.

But are you going to just isolate yourself wherever you are? Certainly not. You could, if you could. But you would still need to go out from time to time. Still, it is generally accepted wisdom that large public gatherings should be avoided. And yes, Friday Muslim prayers and Sunday Christian services qualify as large public gatherings. You do not have to attend that party. A foreign trip can be postponed. An upcoming sports festival in one of the states should probably be postponed. As research finds that children have by far the most social contacts, especially in “intensely social environments” like schools, it may be wise for schools to be closed for a period of two weeks or more. (Kucharski highlights how schools are “potential mixing pot[s] of infection.”)

High-capacity mosques and churches are intensely social environments as well, and should probably be closed to the public for the same period. Our famed religiosity could be an inhibitor. Telling Nigerian Imams and Pastors to suspend their prayer events for a period, when many are likely to become even more religious, is not likely to sit well with many. This is not surprising. As I recall, at some point during the 2014-16 West African Ebola epidemic, it became increasingly astonishing that Liberia was recording greater success with managing the crisis than neighbouring Sierra Leone. The reason why became obvious soon enough. The large Muslim population in Sierra Leone continued to wash the bodies of their infected dead in the Islamic way, increasing transmission.

As a Muslim, I understand quite well the difficulty in subscribing to the more effective solution of burning the infected bodies instead. While in the end, that is an individual choice, the reason for the different outcomes are glaringly obvious. And for the current oubreak, Iran eventually closed its religious shrines and has stopped Friday prayers for the time being and Saudi Arabia has banned all pilgrimages to Mecca this year. These are sensible moves.

Precautionary measures are most effective when things are relatively okay. But naturally, there is a tendency to wait until the risks are writ large. And probably rightly so. Later certainty makes hindsight biting, however. Could the already more than 100,000 COVID-19 cases around the world have been lower had precautionary measures been taken earlier; that is, even as the current global response has been relatively swift? Maybe. Maybe not. And yes, it has probably not come to the point where we need to take such extraordinary measures in Nigeria. And hopefully, there would not be a need to. Still, why take the risk?

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