Travel restrictions and curfew
Travel restrictions into Nigeria were announced on March 18, 2020; 3 weeks after the first index case. This allowed enough time for the importation of the virus into the country, as returnees from abroad comprised the majority of those who tested positive for the virus (The Punch 2020a). Inter-state lockdown was first placed on three states with high incidence on March 29, and then on April 23, 2020, all the 36 states in the country and the FCT were placed on inter-state travel restriction, that is, 57 days after the index case was confirmed (The Punch 2020b). This response by the Nigeria’s government in imposing lockdown after 8 weeks was rather slow compared to countries like South Korea and Germany (Balmford et al. 2020), and this may have undermined conventional global COVID-19 prevention strategies and also indirectly aided community spread of the virus in the ensuing months in the country (Flaxman et al. 2020). Moreover, there is evidence that countries such as Germany and South Korea that imposed lockdown measures early on following the index cases or even before the index cases, were able to flatten the curve while countries such as the United States of America and the United Kingdom that did not introduce the lockdown measures early on witnessed virus exponential growth (Balmford et al. 2020). Although dusk-to-dawn curfew was enforced, the daily socio-economic activities of the citizens may have largely invalidated the impact the curfew was supposed to have on curtailing the spread of the virus by breaking the transmission chain (Ibrahim et al. 2020).
Nevertheless, the gradual ease of travel restriction/lockdown, first on May 4, 2020, than on June 6, 2020, was in disregard to World Health Organization guideline on ease of lockdown. As at the time when the lockdown measures began to be eased; the number of new infections was higher than number of recoveries, there was never 14-day fall in new infections and there was no evidence that showed that COVID-19 transmission is controlled, nor was the reproduction number less than 1 at any time in the country and in all the states (WHO 2020). Therefore, the ease of lockdown may have been majorly influenced by economic considerations and not out of regard for evidence-based epidemiological data. NCDC, the Nigeria’s public health authority argued that the ease of the lockdown measures at a time when COVID-19 cases was on the increase was a tradeoff aimed at balancing the public health concerns with the devastating economic consequences of the lockdown on Nigerians especially the most vulnerable including women, internally displaced persons, poor individuals, small and medium business enterprises among others (Dan-Nwafor et al. 2020).
Social distancing measures
Social distancing is a strategy aimed at reducing physical contact between people, so as to reduce the risk and spread of COVID-19 in a community. This measure meant that, at least, two meters in physical distance must be maintained between two individuals. Moreso, physical greetings-hugs and handshakes were to be avoided (NCDC 2020c). In order to enforce this, the federal government of Nigeria prohibited large gatherings, issued compulsory stay-at-home directives to non-essential public servants, and also shut down schools, markets, and churches (NCDC 2020c). Not surprisingly, compliance with these directives was resisted by majority of the populace. In a country where the survival of over 85% of its population rely on their daily economic activities, even the meager palliatives given by the government could only reach about 2% of the population (Actionaid 2020), the bulk of the remaining 98% would inevitably starve to death if they were to abide by the social distancing measures. Faced with the grim choice of exposure to COVID-19 virus or hunger, most Nigerians choose to ignore social distancing measures in pursuit of their livelihood. This measure which failed in its enforcement may have sustained the transmission chain of the virus in states with high-density population such as Lagos, Oyo, Plateau, and FCT that recorded increased incidence of the virus.
Source control measures
Measures taken in anticipatory bid to reduce likelihood of disease spread or prevent infected individuals from spreading disease are referred to as source control. These include but are not restricted to wearing face masks, hand hygiene, and respiratory hygiene (NCDC 2020d; MDH 2020). The NCDC advocated for the use of proper handwashing with soap and water, use of alcohol-based sanitizer, and respiratory hygiene when coughing or sneezing (NCDC 2020d). However, the use of face mask only received late attention after recommendation by Presidential Task Force (PTF) on April 27, 2020, a move that was then followed by the NCDC in May 4, 2020 (Abubakar et al. 2021), despite that there was scientific evidence from China, South-East Asia, and Europe as early as February/March 2020 that demonstrated the potency of face masks in reducing the spread of the virus (PAHO 2020). The NCDC decision on the use of face masks about 9 weeks after the first index case was rather improvident and may have further fueled the virus spread in the country.
Self-isolation and quarantine measures
Self-isolation, defined by the NCDC to mean staying at home or in an identified accommodation, away from situations where one can mix with family members or the general public, for a period of 14 days, was also adopted as part of the measures to combat the virus. All returning travelers to Nigeria, anyone who had contact with a confirmed case, and COVID-19 patients who had just been discharged from the hospital were expected to self-isolate (NCDC 2020e). As is the case with South Africa, it is unclear how the quarantine process is being implemented as people self-isolate in homes (Moodley et al. 2020). Thus, the compliance level is difficult to estimate. This also means that the impact of this measure on Nigeria’s first wave COVID-19 response is inconclusive, but is however still subject to further investigation. However, it is important to note that prior to the ban on international travel, international passengers arriving at Nigerian international airports were allowed to self-quarantine for 14 days without testing and supervision by the Nigerian public health authority. Consequently, multiple undetected cases of COVID-19 may have been imported into Nigeria between January 2020 to March 18, 2020 (Dan-Nwafor et al. 2020). Expectedly NCDC with the introduction of travel ban migrated to obligatory supervised quarantine for all arriving passengers at Nigerian international airports and borders (Dan-Nwafor et al. 2020).
As of October 17, 2020, 34,901 were persons of interest in contact tracing, out of which 97.4% (33,994) have been traced. This is not so remarkable a feat because about 73% (44,483) of 56,557 confirmed cases were due to unknown source of exposure (NCDC 2020a). A likely explanation for this is that sustained community transmission of the virus has been ongoing prior to individuals testing positive for the virus. Moreover, the absence of a robust national health database in Nigeria means that contact tracing had to be done manually, which is rather slow and rely on the patient’s ability to recall. Furthermore, no attempt has been made in scaling up to a faster and more efficient digital tracing which seemed very effective when used in Taiwan (Wang et al. 2020b).
Public health education campaign
The perception of the general populace is that they are at low risk for the disease, a misguided notion which was in part fueled by the poor handling of the early stage of the epidemic by the government agencies and health officials, as well as infodemics including the myths that Nigerians are immune to the virus and that COVID-19 is a fiction (Aiyewumi and Okeke 2020). Consequently, so as to sensitize the public on the virus transmission and infection dynamics, the NCDC released jingles, videos, and leaflets for public awareness on televisions, radio channels, and social media (NCDC 2020f). Although there is no independent evaluation of the effectiveness of these educational campaigns, it is likely that this move may have informed public acceptance of the other non-pharmaceutical intervention measures.