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Continued lockdown: Public Health experts call attention to other considerations to flatten the COVID-19 curve

The  Coronavirus disease is novel and the best approaches to flatten the curve must be tailored to the peculiarities within the country. 


Direct country comparisons and total adoption of strategies from other countries may not be in our own interest.

The Covid-19 curve shows a gradual increase in confirmed cases rather than an exponential rise and this may be explained by a largely asymptomatic pattern of the disease here in Nigeria coupled with the effect of suboptimal testing.
We acknowledge the challenges with testing as this is not only a local problem but a global issue.
While testing more people is important, community engagement and education is still the best tool to prevent spread because viruses are spread by the behaviour of the people.
As we embark on a further 14-day lockdown, we must bear in mind the consequences that are likely to ensue within our State if we do not support the lockdown with appropriate palliatives.
Already the economic implications are biting hard on individuals and families, and recently, there has been an increase in unrest and insecurity needing urgent attention.
The Association commends the efforts of His Excellency the Governor of Lagos State, Babajide Sanwo-Olu, in setting up the Incident Command system even before the occurrence of the first case. 
As an association, we propose a gradual reversal of the lockdown and urgent review of the distribution of palliative measures.
Given our observations of the pattern and spread of COVID-19 in Lagos State:
1. It is unlikely that we can attain to the level of testing required to make the continued lockdown achieve optimal epidemiological benefit;
2. The severity of disease in our clime is yet to transit to that seen in countries with older populations;
3. There is rising insecurity due to the large numbers of people living on the fringes of society and reliant on now non-existent informal occupations for daily subsistence;
4. Active case search can continue in a localized manner through the LGA/LCDA mechanisms;
5. Active and passive surveillance systems can be strengthened through training of ad hoc volunteers and sustained through retention of those trained;
6. The use of scientific data should be employed to determine the epicentres of the disease within the State and to tailor specific interventions;
7. There is need for continuation and strengthening of the preventive measures – hand hygiene, cough etiquette, physical distancing, and use of home-made masks to reduce droplet contamination of hands and surfaces.
The maxim “Never waste a good crisis” can be leveraged on by Lagos State to buttress the uniqueness of its informal social networks that were so crucial in mitigating the portended disaster during the Ebola crisis. 
Communities, and communities within communities, are strategically placed to mitigate the spread
of COVID-19 through the Community Development Associations, Ward Health Committees, and other committees established by HE the Executive Governor.
As a follow-up to this press release, the Association is working on a proposal for a phased reversal of the lockdown within the State, which will be released shortly.
The Association of Public Health Physicians of Nigeria (APHPN) is a professional body made up of disciplinary Public Health/Community Health Physicians in Nigeria.


Signed: Dr Tolu Olufunlayo
Chairman, Association of Public Health Physicians of Nigeria (Lagos Chapter).




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