Coronavirus (Covid-19); Review from A Nigerian Perspective

Federal Ministry of Health [1] announced her first case (index case) of COVID-19 on 27th February 2020 to have come from an Italian doing a business with Ogun State. The coronavirus is believed to have come from Hunan Seafood Market in Wuhan China. This was based on Chinese Health Authority report of a type of pneumonia that could not be understood as at 31st December 2019 [2,3]. The situation and unabated increase in the number of infected Nigerians has made all activities in Nigeria to a standstill by the stay at home orders from the federal to state governments which is also binding on the Federal School of Medical Laboratory Technology, Jos. The Federal School as a training and research institution forms a committee to review the coronavirus (COVID-19) and that prompts this paper aimed at proffering a solution towards prevention, management and treatment of the pandemic for the institution, state, Nigeria and the world at large.


Introduction
Federal Ministry of Health [1]  and that prompts this paper aimed at proffering a solution towards prevention, management and treatment of the pandemic for the institution, state, Nigeria and the world at large.

History and taxonomy of coronavirus
Coronavirus is as old as virus in its entirety. Coronavirus just like other viruses are surrounded by lipid envelope that is used to bind to plasma membrane of target cells by attaching to specific proteins on the cell surfaces [4]. History of coronavirus is traced to Copy@ Obeta M Uchejeso    Coronavirus is in the family of RNA viruses that infect birds and many mammals including humans. The viruses cause illnesses that range from common cold to more severe respiratory diseases and rarely gastroenteritis. COVID-19 is caused by an emerging strain of SARS-COV-2 that is novel in humans, though, belongs to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), for which can be referred as zoonotic in transmission and person-to-person transmission [8,9].

Current trend of coronavirus as COVID-19
Coronavirus ( Transmission of the novel virus COVID-19 is human to human though said to have started from animals and can be direct in transmission from respiratory droplets produced by an infected person while coughing or sneezing or indirect transmission by touching a surface or object that has the virus on it and then touching their own mouth, nose, and eyes [13]. SARS-COV-2 (COVID- 19) has a unique pathogenicity and transmissibility, which has been confirmed to be highly infectious than SARS-COV and MERS-COV [14]. An encounter with COVID-19 patient can easily lead to cross infection from one person to another in absence of personal protective equipment [15] for example: Masks, gown, goggles, boots, gloves etc. Wrapp et al. [16] explained that SARS-COV-2 has a powerful infectivity as it binds to angiotensin-converting enzyme 2 (ACE-2) receptors in the afflicted patient thereby, showing a higher affinity than SARS-COV-S. Zou et al. [17] explained that viral nucleic acid in patients infected with SARS-COV-2 is similar to that of influenza patients.
SARS-COV-2 has shown quick and easier transmission among the clusters, for example: family clusters, board room clusters, restaurant clusters etc. which has accounted for 50-80% of all confirmed cases of COVID-19 [18]. Transmission between clusters of family members occurred in 13-21% of MERS patients and 22-39% of SARS cases [19] which shows the infectivity nature of SARS-COV and MERS-COV through nosocomial transmission in the assessment of human-to-human transmissions.

The evidence of contact transmission SARS-COV and MERS-
COV via droplets, contacts and environment has been established [20,21]. To add, novel viruses have been found in the faeces of COVID-19 patients [22,23], but faecal-oral transmission of the coronavirus has not been shown in SARS-COV having noted that the virus could survive at room temperature for at least 1-2 days in faeces [24]. There is a possibility for SARS-COV to spread via faecaloral route [25] but not frequent. In patients with MERS-COV, faeces and urine samples also yielded viral RNA [26]. Given the evidence of faecal contamination of SARS-COV and MERS-COV as well as their ability to survive in faeces, then, SARSCOV-2 can also be transmitted through the faecal-oral route [27] though subject to more research studies. It is also possible that gas from COVID-19 patient after fat can infect close subjects just as spills of COVID-19 patient urine can be very infectious.
Asymptomatic patients of SARS-COV-2 may transmit virus to others just as patients with negative SARS-COV-2 swabs may also be diagnosed with COVID-19 but there is no current evidence that SARS-COV-2 can be transmitted in the uterus [28] while COVID-19 transmission via air (air-borne) is still under contention [29] which has thrown up arguments among researchers.

The Nigerian Situation of COVID-19
Nigeria

Medical Laboratory Testing of COVID-19
The best testing methodology of COVID-19 is real time reverse transcription -polymerase chain reaction (RT-PCR) as recommended by WHO [12,13] and implemented by NCDC [8]. This method could be well positioned at the geopolitical centers while lesser and cheaper methodologies could go on at the state and local government public health laboratories thereby bringing the test closer to the people. This could be achieved with Rapid Detection and Point-of-Care Diagnostics for COVID-19 [3,13]. The testing protocol is however dependent on the NCDC and WHO guidelines in Nigeria.
In relation to China, NHC [12] and Nigeria [13] shows criteria that must be satisfied to be considered a potential COVID-19 for Nonetheless, the quality of PCR results for COVID-19 is directly proportional to the quality of the kits and that of the medical laboratory scientist or the laboratorian doing the testing as well as to the novel coronavirus's characteristics, sampling location, sampling volume, transportation and storage, with laboratory test conditions. The principle is based on the fact that COVID-19 interacts with the ACE-2 receptor, a cell-surface protein mainly found on lung alveolar epithelial cells [31]. The procedural methodology with principles of RT-PCR is shown in Figure 4. It is also, very important to consider the use of rapid test kits as preliminary screening before confirmation with RT-PCR.

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The NCDC planned for a Public Health Laboratory Network that shall cut across the states of Federal Republic of Nigeria and Viral antigens present in the clinical specimens can also detected by using direct immune fluorescent assay (IFA) [35,36] and Antigen / Antibody reaction testing [37].
With the current scarcity of testing centers and PCR testing kits across the globe and particularly in Nigeria, there is need to consider rapid testing using new detection medical laboratory technology and point of care testing kits [28,38] or creating mobile biosafety laboratory as exemplified in Wuhan china [39] where the coronavirus started of recent. The NCDC have developed a very good safety and diagnosis procedures [13], however, the clarity in terms of job description and roles of the laboratory staff in the public health laboratories was not clearly stated. This calls for concern on the quality of test results expected in line with international best practices. There is a need to specify the role of Pathologists,

Management and Treatment of Corona Virus
There is a management guideline by WHO globally as adopted by NCDC for use in Nigeria [13].

Ethical Implications of COVID-19
Several ethical issues arise in any pandemic as observed during influenza pandemic just like COVID-19 currently ravaging the whole world and Nigeria in particular. Such ethical concerns are noticed during planning, organizing and responses to issues surrounding any pandemic and no wonder it is very important as future pandemics are important to consider, so as to ensure that response efforts are not hindered in the event of any pandemic.
The priority for access to healthcare by patients during COVID-19 pandemic in Nigeria is of great concern especially as Kano State citizens cry out due to neglect of treatment of the masses who need adequate healthcare and are been ignored because of the attention given to treating potential COVID-19 patients. Though such treatment might have been necessitated by shortage of resources with increased demand of care and scarcity of human resources for health and personal protective equipment.
The obligations of healthcare workers in amidst risks to their own health is a big challenge; and the balance between reducing disease spread through isolation, and travel measures whilst protecting the right of individuals to freedom treatment and movement creates an ethical issue [48].

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Nuffield council [49] on Bioethics highlights that the public health measures need to be evidence-based and proportionate to the public. It is therefore imperative to add that coercion and

2.
Recruit more Medical and Health Professionals with good insurance / payment packages to ensure optimal performance.

3.
Decentralize testing of COVID-19 and possibly use regional centers as confirmation where the states cannot confirm.

4.
Encourage local production of COVID-19 materials and consumables eg face masks, goggles, shoes, clinical and laboratory wears.

Facilitate local production of COVID-19 test kits and
COVID-19 transport medium (Virus transport medium-VTM).  if supported by the Federal Government of Nigeria. Figures 5(a-c) is evidence that COVID-19 has stimulated Federal School of Medical Laboratory Science, Jos towards producing hand hygiene products (hand sanitizer spray) and equally providing them to government and the public.

Conclusion
The Federal School of Medical Laboratory Science Jos is strategically capable of providing the needed solution through research and training.