* Virus hunters battle coronavirus stigma
* Lagos state has 200 contact tracers for 25 million people
* Easing of lockdown is making job harder
By Libby George, Paul Carsten and Alexis Akwagyiram
LAGOS/ABUJA, July 14 (Reuters) - Early one evening, Folasade
Fadare and her team of four disease hunters piled into a van and
headed for Okegun, a rural community down a narrow potholed road
in eastern Lagos state.
A coronavirus patient had visited the area, and it was their
task to find anyone exposed, isolate them and trace their
contacts. The team quickly realised the job was too big: more
than 100 people needed to be interviewed and tested.
Ultimately, only the two sickest people, feverish and
gasping for air, were sent to hospital to be isolated and
tested. The rest were told what symptoms to watch for and urged
to stay home for two weeks.
"We are not enough," said Fadare, an epidemiologist who has
battled Ebola and Lassa fever for more than 20 years.
Contact tracers like Fadare are among the few safeguards
standing between Africa's fragile public health systems and a
pandemic that could quickly overwhelm them. Infections are
rising, but many governments have been easing lockdowns to save
their economies.
In Nigeria, medics who do tracing say they are near breaking
point.
Confirmed cases of COVID-19 have increased tenfold to over
32,000 since the government began easing restrictions in May,
the Nigeria Centre for Disease Control (NCDC) says. At least 740
have died.
Lagos, Nigeria's largest state and epicentre of its
outbreak, has 200 tracers for a population of 25 million. That
is fewer than one per 100,000 people, compared to around 14 per
100,000 in Turkey. The state's health commissioner, Akin Abayomi, dismissed
concerns about the scale of its tracing efforts.
"We recruit contact tracers as necessary. We have a large
pool of primary health care staff and volunteers to select
from," he said in a text message, adding there were 1,000 people
in the pool.
POLIO NETWORK
Nigeria's experience with infectious diseases meant it could
quickly mobilize veteran epidemiologists like Fadare along with
hundreds of medics and community volunteers already embedded in
remote communities to fight polio.
But nothing prepared them for this epidemic, Fadare said.
More than 12,400 cases have been confirmed in Lagos state alone
- any one potentially infecting scores of others, she said.
Members of her team say they are overwhelmed, receiving updates
about infected people as late as midnight.
Unlike South Korea and Singapore, which used contact tracing
apps, Nigeria has had to resort to more labour-intensive
methods. Only a quarter of the population uses smartphones.
A team of medics is tasked to visit each contact to verify
symptoms, identify contacts and ask them to stay at home for 14
days. The team then checks in with the person each day by phone,
to monitor compliance. If the person reports symptoms, they will
be referred to another team for testing.
However, the stigma associated with COVID-19 means many are
keen to avoid tracers, Fadare said. People commonly turn off
their phones, deny their identity and lie about when they last
saw coronavirus patients.
Such fears can be justified. In Abuja, one man's neighbours
moved out after he was tested. Others suspected of being
infected have been told to leave, said Ramatu Abdu-Aguye, head
of tracing in the capital.
So the teams keep a low profile, using unmarked vans to
visit homes.
Nigeria's low testing rates are making the tracers' job
harder, they say. Just over 183,000 tests have been conducted in
a country of 200 million, according to the NCDC. A government
target announced in April was for 2 million tests by the end of
July.
Olujimi Oyetomi, a Nigerian health ministry spokesman, said
more testing machines and materials were being deployed.
Adding to the challenges, 10 tracers working for Fadare
contracted COVID-19 and had to take up to three weeks off.
As lockdowns ease, many Nigerians are moving around and
ignoring safety measures.
Traffic jams have returned to Lagos, increasing the time it
takes tracers to reach contacts, many of whom are already hard
to find because their homes have no formal address.
Outside the Lagos clinic where Fadare's teams meet, life
goes on as normal. Men sit around on plastic chairs, women sell
instant noodles, and yellow minibuses weave through the streets.
Nobody keeps their distance, and those who wear masks pull them
down to speak.
Fadare fears they don't realise the danger: "The truth is
that we are all at risk now."
(Writing by Alexis Akwagyiram; Editing by Alexandra Zavis and
Giles Elgood)