Lagos (AFP)

Five months after the appearance of the first case of Covid-19 in Nigeria, all actors in the health world are exhausted and see that the virus is spreading in a very worrying way in this country of 200 million inhabitants, although " the case fatality rate remains low ".

- How many real cases? -

The virus is spreading "exponentially," said Health Minister Osagie Ehanire, especially in the large megalopolises of Lagos, Ibadan or Abuja, all populated by more than 10 million inhabitants.

The country officially counted at the end of July some 41,000 cases, including 860 deaths, but the figures are not representative of the real level of contamination.

"For each case identified, others escape us," admitted Sani Aliyu, who heads the taskforce in charge of fighting the virus.

The most populous country in Africa is one of those which, proportionally, performs the fewest tests: 3,000 on average per day, or one tenth of the number of daily tests in South Africa, a country four times less populated.

Nigeria has the capacity to do more, especially since private laboratories have been given the green light to participate in screening. But the country is sorely lacking in roads, medical centers and the transport of samples is very complicated.

On the other hand, trust in the public health sector has eroded after decades of neglect. Worse, a large part of the population doubts the very existence of the disease in Africa.

"You have to go from village to village, from community to community (...) and inform the populations, tell them that the Covid is real", explains to AFP Innocent Ujah, president of the main association of doctors (Nigerian Medical Association, NMA).

- Unknown foci of mortality? -

"We are always receiving more positive cases, Lagos is infested by the Covid", assures the director of a private laboratory, but it is clear that since the appearance of the first case at the end of February "the case fatality rate remains low".

Foci of "mysterious deaths" nevertheless emerged, notably in Kano (north), where dozens of people were buried every day between April and May. An official investigation has attributed around 800 deaths to Covid-19, without scientific certainty.

"Since the rainy season has arrived, we have buried a lot less. It's back to normal," Muhammad Abubakar, an undertaker from Kano, told AFP.

"With the high heat, come chronic epidemics of measles, meningitis or typhoid," explains Dr Safiyanu Ahmad. "You add the Covid and it makes a deadly cocktail. The patients no longer had access to care."

These "collateral deaths" are what worries Nigerian healthcare workers the most. "The fight against Covid is at the expense of other diseases," said Abayomi Sule, medical consultant in Lagos. "We already have a lot of health problems to manage. Immunization and vaccination campaigns are disrupted and fewer people go to the hospital," he worries.

Respiratory diseases, but also malaria, HIV, already cause hundreds of thousands of deaths in Nigeria each year, but they often remain invisible: the vast majority of deaths are never declared and no official data or estimate is available.

- What consequences for medical personnel? -

The World Health Organization (WHO) estimates that the proportion of doctors is 0.3 per 1,000 inhabitants in Nigeria (35,000 per 200 million inhabitants approximately), while the country would need at least 237,000 doctors.

Nigeria, like many countries in Africa, confined its population at the very beginning of the epidemic, but for economic reasons this was not sustainable.

"Here we will not have a first, second wave, the cases will just continue to increase, increase ... Until when?", The virologist Dr Adeola Fowotade is in despair. "There is already a dire shortage of doctors in this country, and there, many are threatening to return their gowns to go to work in Great Britain or elsewhere."

Nigeria has seen several strikes by doctors since the start of the epidemic, to denounce the lack of protective equipment. Many patients have also been turned away at the entrance of certain hospitals, because medical staff feared they had the coronavirus.

Dr Folakemi Ezenwanne has just completed her four-month assignment in an isolation center in Lagos. "We could not go home, it was the hardest psychologically," says the mother of two young children.

But after a "very short break", she wants to return to hospitals as soon as possible. "I am passionate about public health, I cannot stop working".

© 2020 AFP