Brazzaville, 28 February 2020 - Dr Temidayo Fawole may have been at the WHO Regional Office for Africa in Brazzaville this week to attend training on the management and treatment of COVID-19 patients, but home – Nigeria – was never far from her thoughts.

Especially not after the country reported, on 27 February, its first confirmed case of novel coronavirus COVID-19, which was also the first case in Sub-Saharan Africa. Before the day’s training commenced on the 28th, she was briefing her deputy and team at the Nigeria Center for Disease Control (NCDC) by phone, where she is the national case management lead.

Back in Nigeria, one NCDC team was preparing to make the nearly 700km trip to Lagos to help manage the patient, an Italian who works in Nigeria who had recently returned from Milan. Another was making their way to Ogun State, where the patient had first been screened and isolated, to trace his movements and identify anyone he may have been in contact with.

Nigeria had spent the better part of the past month preparing for just this eventuality, Dr Fawole explains. The country had in place a multi-sectoral, NCDC-led Coronavirus Preparedness Group, which met regularly. A pre-incident action plan had been developed and rolled out, as had been protocols and guidelines for surveillance, infection prevention and control, and the treatment of patients. Three labs had been readied to test for COVID-19. Isolation and treatment centres in four priority states where there are international airports have been assessed, with upgrades planned where necessary.

Dedicated staff had been recruited and trained to work in those centres. “The emphasis of this training was really on clinical management, and it wasn’t just theoretical but we also worked through scenarios,” explains Fawole. “It included an overview of the entire management of patients, from the transfer of patient from the point of entry, to treatment and even discharge.

To ensure that the support provided by WHO addressed areas of potential weakness for member states, an extensive survey was conducted at the end of January 2020.  Patient treatment – also known as case management - emerged as an area of particular concern.  

“Case management is an area in which the region is still struggling,” said Dr Zabulon Yoti, Acting Director of the Health Emergencies Programme in the WHO Regional Office for Africa.  He spoke at the official opening of the WHO Critical Care Training on the Clinical Management of Patients with Severe Acute Respiratory Infections (SARIs) Associated with COVID-19, which took place in Brazzaville from 26-28 February.

Twenty-two participants – including Fawole –  from 11 countries took part in the training which is designed to support countries in the African Region improve their skills and capacity to treat confirmed cases of COVID-19.

Dr Janet Diaz, unit head of clinical care in the WHO Health Emergencies Programme at the global headquarters, and one of the facilitators on the programme said, “For countries that are preparing now, I think you have to focus on the basics of any response to an infectious respiratory pathogen”. She said that this would include “early detection of the suspect patient; early isolation – so separation of patients so that you reduce spread of infection, either among the community or in a hospital setting; and then early treatment.” 

These are measures that countries like Algeria have been applying for some time now, explained Professor Ghania Brahimi of the Beni Messous University Hospital. Algeria has been using similar treatment principles to that for H1N1 seasonal flu, said Brahimi, who was also attending the case management training in Brazzaville. “The protocols are already in place. There are several training sessions, awareness training sessions that have been held throughout the hospital centres, in the east, west and centre of the country. So I think that people are aware that we can deal with the epidemic and that we are prepared.”

Many participants found the training was helpful, and that all-too-often neglected aspects of emergency response were being addressed. Ms Judith Komuhendo, a psychiatric nursing assistant at the Mulago National Referral Hospital in Kampala, Uganda, said, “One of the most important things that I have learnt here is that each patient has a different case management, depending on whether they have mild, severe or critical symptoms.” Dr Aschalew Worku, an internal medicine and pulmonary critical care specialist at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia, added that “almost everything we learnt here was important, starting from the initial point of care to the ICU, but I found the critical care part useful because it is my field and because it is usually neglected in epidemic management.”