Nigeria is now firmly in the second wave of the COVID19 pandemic and the numbers indicate this wave is more intense and deadlier than the first wave. It is important that we talk about COVID19 Etiquette and how to stay safe.
A few months ago it was common to hear Nigerians say “Coro dey look face” and “We have natural immunity” as well as “Nigerians cannot get COVID because of our weather, our BCG immunization practices etc”.
These and other similar statements aiming to explain our supposedly low numbers. However, we must admit that many people who feel unwell in Nigeria assume they have malaria and usually treat themselves for malaria even before visiting a clinic.
From late December 2020, and into January 2021 however, the Presidential Task Force on COVID19 has repeatedly raised the alarm of the rapidly rising numbers of positive cases. “Majority of the cases are between the ages of 21 and 50 and pose a risk for the elderly- Elsie Ilori- (Nigerian) Presidential Task Force member- January 7th 2020.
According to a recent report released January 2021, by the Centers for Disease Control and Prevention of the US, it shows that 35% of new cases are from people who infect others before they show symptoms and 59% of all transmission come from people without symptoms at all.
Preventing the Transmission of COVID19
It is important to prevent transmission of COVID because this disease although it is asymptomatic in most people, can still be transmitted by them. It is important to note that it can be deadly in people who are vulnerable; including the elderly and people with underlying medical conditions. These include diabetes, uncontrolled hypertension, obesity, cardiovascular disease. As well as people with immune compromise, and cancer, whether on treatment or not.
In Nigeria, although we have a mostly youthful population, we have a high burden of undiagnosed and poorly managed underlying medical conditions including diabetes, obesity and hypertension.
The most important things to do to prevent transmission of COVID by people presumed to be either negative or asymptomatic positives include:
Wear a mask- that covers your face, including your nose, mouth and chin. You should not take it off to use the phone, to cough or sneeze. You should keep your mask on at all times when you are around other people.
Regular handwashing with soap and water for at least 20 seconds or use of hand sanitizer containing at least 60% alcohol- use soap and water when hands are visibly soiled. Rinse thoroughly and dry your hands preferably using dry single use paper towels.
Maintain social distancing – at least 6 feet or 2 meters between you and the person closest to you
Avoid crowds- do not remain indoors in a crowded place (where you cannot maintain social distance) for longer than 20 minutes; ventilation is important- keep windows and doors open as much as possible wherever you are
Note that face shields used alone without a mask have not been proven to be protective, so it is at best a fashion statement when you wear a shield without a mask.
Also unless you are a healthcare worker and you are following proper infection prevention protocols while wearing gloves, there is no need for you to wear gloves in and around the house or at work unless you would normally be using gloves for house work or in the workplace.
Symptoms of COVID19
Symptoms of COVID19 include any combination of these: fever, chills (a feeling of being cold), headaches, fatigue, nausea, vomiting, and diarrhoea, muscle aches, sore throat, stuffy nose or mild runny nose.
In many people, their initial symptoms may make them think they could have malaria, and commonly, people have initially treated themselves for malaria in spite of a negative malaria test because “I was sure I had malaria”
If you are unwell, you feel like you have malaria, or you suspect that you have COVID19:
Do go and get a test as soon as possible- when you are going, wear a mask and use hand sanitiser copiously to prevent transmission to other people
Once you get tested and while you await your results, there is a set of covid etiquette and protocol to observe.
Before you get your test result:
Stay at home and Isolate in one room. Do not go around spreading this highly infectious disease.
Ensure your family members know how you are feeling and that you can plan how to keep you isolated but not alone.
Someone should be available to serve you food, medicines and do your shopping so that you don’t have to go out or cook by yourself unless you are able to
Keep your phones charged so you can reach family
Keep a record of your symptoms especially your temperature if you can.
Wear a mask throughout the time you are in the room to contain the spread of the infection – you might feel like you don’t need to when you are alone., but you should. If you were in the hospital, you would be wearing a mask. If you are sneezing and coughing, then you want to be able to contain that.
Wash your hands regularly
If you live with family, separate yourself from the rest of the family. If possible isolate in a room by yourself; and if you can avoid sharing a bathroom. Ensure that it is thoroughly cleaned with bleach each time you use it.
Don’t use public transport – buses or taxis, ubers
Don’t go to any public places- malls, pharmacies, parks, parties, weddings, owambe, naming ceremony, garden party, joint, bar, the beach - do not go anywhere where other people are.
You should not be receiving visitors and you should not be visiting anyone
Prepare to be in isolation for at least 14 days from the date your symptoms started
Sneeze or cough into a tissue, and dispose of your tissues properly into a trash bag in a covered bin which is disinfected regularly, and then wash your hands.
The only reason to leave your house is if you are going to the hospital or to the testing centre.
Practices for staying healthy
As primary care providers, we emphasize strengthening your immune system and maintaining healthy lifestyle practices.
It is important to prioritize sleep and to aim for at least 8 hours of sleep a day. A healthy diet is also important as well as remaining well hydrated by drinking water, and staying active.
At least one day or a week, ensure that you get foods with all the colours of the rainbow. This usually means you will end up eating a well-rounded diet that includes fruits, vegetables, carbohydrates, proteins, fats and micro-nutrients.
A healthy lifestyle cannot be overemphasized. There is a lot to be gained from regular exercise outside; early in the morning or evening. The two benefits are safe sunlight exposure for vitamin D and aerobic exercise for the heart.
We advise at least 150 minutes a week of moderately intense activity such as brisk walking for five days for thirty minutes each day. Additionally, we recommend at least 2 days a week of activities that strengthen muscles and that work all major muscle group; such as the legs, hips, back, abdomen, chest, shoulders, and arms.
Being outside is important because studies have shown that people with normal vitamin D levels who get COVID19 infection do better than those with reduced vitamin D levels. Sunlight is the best source of vitamin D.
For those who this is not immediately available, we recommend regular vitamin D tablets at 1000 International Units (25 micrograms daily). In addition, Vitamin C can be taken at 1000 mg daily and Zinc is taken at a dose of 200 mg daily.
We advise people with underlying medical disorders to take medications at the right time and the right dose. It Is important to have blood pressure and blood sugar monitoring devices at home and to be able to use them unassisted.
Considerations for expectant mothers and mothers with newborns and young babies
It is important as part of covid19 etiquette to continue to maintain social distancing practices.
When you have a newborn, only one person should visit you at the hospital (your spouse or your partner). Send photos and do video calls to introduce the baby. Avoid exposure of any kind.
Also, continue to maintain prevention practices. These include wearing of masks, handwashing with soap and water, use of hand sanitiser and lastly the recommended social distancing.
Keep your hair away from your face and avoid makeup and jewellery to reduce the need to touch your face. It is also advisable that you avoid peak periods when using public transport, or avoid it altogether if you can.
Switch to cashless transactions as much as possible and wash your hands after handling money, objects or surfaces.
If you feel sick or your baby is sick, call your healthcare provider. You might want to first arrange a virtual visit if possible; as this will reduce the risk of exposing yourself and your baby to a crowd.
Considerations for families with young children and nannies who have gone home for the holidays
For families who have nannies who might have gone away over the holidays, there is some covid19 etiquette to observe. Anyone who has not been in your household and who returns after any period away; should quarantine for one to two weeks in a separate room from the rest of the household. This would largely prevent transmission. Lastly, it would help you to identify anyone with symptoms. As a result, you would know who needs to get tested and keep the rest of the family safe.
Considerations for families with adolescents and young children
The covid19 pandemic and associated lockdowns had deleterious effects on the mental wellbeing of children and adolescents. This is due to its significant interference with their ability to socialize; which is an essential part of development.
It remains vital to support children and adolescents through this period. And critical to help them continue to develop normally while they remain safe. All of this must be down while maintaining social distance practices. This will maximize their opportunities for safe socialization. Furthermore, it is essential to ensure that they remain in touch with friends. And as they continue to learn, they need to have access to supportive teachers, tutors, coaches and instructors and counsellors.
It is a well-known fact that children may sometimes be infected and asymptomatic. Therefore, being able to safely remain connected with grandparents and the wider family and friend networks is essential.
Many extra-curricular activity providers have innovated around virtual sessions including coaching instructions via Zoom and WhatsApp. When it comes to using Zoom, once the meeting is limited to under 40 minutes it is free to use.
It is important to stay safe, follow the guidelines and protect yourself and your family at this time.