Lagos in Nigeria is known to be the epicentre of the spread of the virus with the highest number of cases (with 16,503 cases recorded of the total 49,068 confirmed cases in Nigeria as at Monday, 17 August 2020), keeping the pace of raising in a slow but steady way. The spread of the disease has long reached community transmission level where the government has actively been involved in contact tracing in other to contain the spread of the virus. Both government and private organisations are implementing the use of Telemedicine in other to enhance their response, contact tracing and overall case management. 

 

Nevertheless, fear and stigmatisation of COVID-19 patients still exist, as a large number of people who tested positive for the virus do not show up to COVID-19 care centres for isolation and treatment. "About 1,192 active cases in communities are yet to turn up for admission in COVID-19 Lagos care centres", says Professor Akin Abayomi, the commissioner for health in Lagos State, Nigeria, during the situation report/update press briefing on COVID-19 in Lagos as at 16 August 2020. Dr Ahjoku Amadi-Obi, a Research Fellow (Telemedicine) at Royal College of Surgeons of Ireland, and the founder of Hudibia (Nigeria's first medical super app) attributed this to lots of fake news which make people paranoid and lost their trust in government. In another way, "Many are healthy and don't see why they should be isolated", he said.

 

Telemedicine definitely has a lot to offer in supporting doctor's activity by streamlining and facilitating their work which would help to mitigate the fear, stigmatisation, and perhaps to restore the trust of people in government about the COVID-19 treatment. "Personally, I don't buy the idea that all COVID-19 patients should be admitted at isolation centres; some can be placed on treatment and follow-up through Telemedicine. This will also protect and limit the fear of physicians, nurses, and other allied health personnel on contracting the virus, and overall mitigate the overwhelming of the healthcare system", says Dr Abayomi Sule, a front line COVID-19 health worker.

 

However, in view of the current situation which posed the need for governments and other stakeholders to reimagine healthcare delivery, the government has been implementing Telemedicine in COVID-19 case management response. For instance, PharmAccess and developer Luscii work with the Federal Medical Centre (FMC), Ebute-Metta in Lagos, to develop digital COVID-19 home monitoring and support. The service screens for COVID-19 symptoms and connects users to medical professionals for advice on how to manage their care. Those that fall within the high-risk category are connected to trained medical responders at the FMC Ebute-Metta. The digital service can detect suspected cases in an early stage and those with mild symptoms can, with remote support stay at home. In that way, hospitals save healthcare capacity for high-risk patients and patients with other, more acute illnesses. "This will really help in the management of the disease and mitigate the overwhelming of the healthcare capacity", Dr Abayomi added.

 

Furthermore, many private hospitals and Telemedicine providers have adapted and supported the COVID-19 case management in Nigeria, along with their primary commitments. For instance, Oncopadi - Africa's 1st Digital Cancer Clinic - have adapted their services to respond and provide services to COVID-19 patients, thereby enhancing the work of government and contributing to the case management in Nigeria.

 

"Telemedicine is ideal for treating asymptomatic patients even only with phone calls. But the problem we had in Nigeria is that Telemedicine has very poor penetration. It thus presents an opportunity for the future", Dr Ahjoku further explained. Also, large population, overcrowding in Nigerian household where families live in slums as well as lack of technical skills needed minimises the potential of Telemedicine in COVID-19 case management in the country. "Telemedicine has a role, but in a situation like crowded accommodations, it's role may be limited. However, even in this situation, Telemedicine can help groups that isolate in place", he added.

However, the adoption of Telemedicine is seen in a limited number of states. More participation of states by providing enabling environment to providers is key for a coordinated response to COVID-19 case management. "The key for states to partner with providers is to create an enabling environment by enhancing infrastructure support such as ambulance systems, telecommunications systems and proper regulatory and governance systems. Financial incentives such as grants and Paycheck Protection Program (PPP) programs may help", Dr Ahjoku said.

 

"Telemedicine represents the future of healthcare even in Nigeria, so everything should be done to encourage it. Low-interest loans grants and creating tech hubs are ways government can help", he added. In this sense, the COVID-19 pandemic represents a positive input for the acceleration and enhancement of these tools in Nigeria.

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