THE recent wave of mysterious deaths in Kano metropolis may have resulted from COVID-19 infection, the report of a smart investigation undertaken by a group of medical doctors known as Young Doctors has revealed.
The report sighted by National Record and authored by three medical doctors, namely; Dr Maryam Nasir; Dr Zainab Mahmoud and Dr Khadija Rufai, is said to be based on what is medically known as verbal autopsy, a method of gathering information about symptoms and circumstances prior to the death of an individual acquired from conversations or interviews with a person or persons familiar with the deceased to be analysed in order to determine the cause of death.
According to the report, there were reports of 183 deaths that occurred in Kano metropolis between April 18-25, 2020. Out of this figure, the Young Doctors, the report said, obtained direct information on 51 deaths.
“Our findings indicate a trend of febrile [feverish] and respiratory illness that progresses to death within one to two weeks. These deaths occurred in various localities in Kano and are predominantly amongst elderly people with underlying medical conditions. This presentation mirrors severe COVID-19 cases reported around the world.
“Some family members volunteered further information around cases. One of the contacts, who had lost a father, stated that he [his father] became ill about 1 week after a wedding ceremony. He had fever, shortness of breath and diarrhea. Attempts to contact the Nigerian Centre for Disease Control (NCDC) were unsuccessful and he passed away 1 week later.
“Another contact stated that the deceased had fever and shortness of breath for a week. He was initially treated for pneumonia at a private hospital and subsequently required a ventilator. There were several reports of multiple people in a household or in a neighborhood dying from a similar illness. Of note, 40 out of 51 deaths had no recent travel history,” the report noted in detail.
In their conclusion, the reported asserts: “Our findings indicate an uptake in deaths from a febrile illness in Kano. Given the COVID-19 pandemic, it is highly likely and plausible that these deaths reflect similar pattern occurring around the world. However regardless of etiology [cause or set of causes], it is imperative that local authorities, concerned groups and international organizations collaborate to create an emergent response…to the dire situation in Kano.”
Rationale for Investigation
According to the Young Doctors, the objective of its project was to investigate the clinical presentation of COVID-19 in Kano state and not really to investigate the deaths. The initiative, they argued, was based on the earlier assumption in the course of the spread of the COVID-19 pandemic that tends to suggest that “the clinical course of COVID-19 in Nigeria and perhaps Africa was mild.
“We initiated a research project to investigate the clinical presentation of COVID-19 in Kano state. Our aim was to determine the severity of cases and outcomes. If indeed the cases were mild, then we could avoid stringent measures that have significant economic impact.
“However, prior to collecting our data, several media outlets as well as reports on social media purported an increased death rate in Kano metropolis. Undertakers interviewed at various cemeteries also reported increased frequency of burials. The events and facts around the cases remained unclear. Incidentally, at the same time, in the United States, autopsy reports revealed deaths that occurred in February under unclear circumstances were due COVID-19. Given the current state of the global pandemic, we sought to investigate the circumstances around the Kano deaths and determine if these cases may be due to COVID-19.”
According to report, the verbal autopsy methodology they used was not new as it had been used by the World Health Organization (WHO) during the Ebola outbreak.
“We disseminated a message via social media with our contact details encouraging people who have heard of deaths to report to us for investigation. We made phone calls to families of the deceased to obtain information regarding the death. We obtained verbal informed consent and notified families that information provided will be confidential. We gathered two sets of data. The first data set was obtained through direct family members (first degree relatives) of the deceased and the second data set was from indirect sources (friends, neighbors or relatives of the deceased).
“We gathered data for 48 hours. We obtained demographics, symptoms, exposure history and medical history of the deceased. Some family members volunteered further information around the deaths. We compiled and analyzed the data,” stated the reported.
While noting that because they are not able to conclusively determine the cause of death “as none of these deaths were tested for COVID-19” and against the backdrop of the fact that “our data was collected over the phone” under circumstances likely to be unreliable due to lack of trust or due to anguish of family members with many “understandably hesitant to give out personal information to strangers over the phone,” the Young Doctors made a number of recommendations.
The called for “further and timely investigations into these deaths” suggesting that family members of the deceased be traced through cemeteries or hospitals. In addition, it was further recommended that the enhancement of testing capacity through community-based testing and setting up of mobile testing centres within Kano in order to forestall the devastating effect of community transmission in Kano metropolis as that might have led to the high fatality rate in such a short period.