Nigeria's health system could come under immense stress as it faces a two-pronged fight.

BENIN CITY, Nigeria — Hours after Amodu's 21-year-old son was admitted to hospital after contracting the deadly Lassa fever, the livestock farmer received a phone call from a relative that his younger half-brother had tested positive for the novel coronavirus that is ravaging the entire world and has led to more than 175,000 deaths globally.

Amodu was devastated and feared that he could lose both his only son and brother in the blink of an eye to two deadly viruses that are highly contagious and wrecking lives in several parts of Nigeria.

"There'll be nothing to live for if I lose both of them," Amodu, who lives near Benin City in Nigeria's southern Edo state, told TRT World. "Every day, I wake up thinking it could be the last day my son and brother spend alive on earth."

But that's not the only concern. Amodu's son and brother had come into contact with several family members — some of whom had returned to their remote village — before their illnesses were diagnosed, raising concerns that more family members could be Lassa fever or Covid-19 positive.

"We've not been able to reach everyone who came in contact with my son, as some came from the village and have returned home," said 60-year-old Amodu, whose infected half-brother resides in neighbouring Lagos state. "I'm told that some of the people who came in contact with my brother have also not been traced."

The situation underscores the problems thousands of families could face in Nigeria, especially in Edo state where 320 cases of Lassa fever — the highest in the country — and 15 cases of coronavirus have so far been recorded. 

The fact is that not everyone who needs to be tested for either of the viruses can get access to testing suggests that the number of Lassa fever and Covid-19 infections could be far higher than what has been reported. The situation has left many families extremely frustrated.

"When my husband returned from Italy in March, he wanted to do a Covid-19 test, but the NCDC (Nigeria Centre for Disease Control) said he couldn't because he isn't showing symptoms despite the fact that he was coming from an area with very high infections," said Mary Akpom, who lives in Benin City with her husband and three children. 

"My paternal grandmother also requested a Lassa fever test after coming in contact with someone who got infected, but she was denied because her symptoms were not severe."

There's also the issue of the amount of time spent before tests are made, and results become available, meaning that infected persons can quickly spread either of the viruses to others before even finding out about their status or may even deteriorate in health before the right treatment is administered.

"It took days before my son's test result became available," said Amodu, who added that he tested negative to both Covid-19 and Lassa fever. "They had to travel with his sample to Irrua (116 km north of Benin City) for testing, and by the time the result came his situation had gotten worse."

A man reacts as a medical worker takes a nose sample for coronavirus during a community testing, as authorities race to contain the spread of coronavirus disease (Covid-19) in Abuja, Nigeria April 15, 2020.
A man reacts as a medical worker takes a nose sample for coronavirus during a community testing, as authorities race to contain the spread of coronavirus disease (Covid-19) in Abuja, Nigeria April 15, 2020. (Reuters)

Untested

In all of Nigeria, there are only five modular laboratories able to test for Lassa fever and only six currently available to test for Covid-19. Most of the laboratories are located either in the southern or central parts of the country, meaning people in the northwest or northeast regions have to wait extra days before finding out about their Lassa fever or coronavirus status.

"Anything could happen within those extra days spent waiting for the test result," said Dr Collins Anyachi, a senior physician at the Department of Family Medicine in the University of Calabar Teaching Hospital in southeast Nigeria. "The patient could become extremely anxious, and that can be dangerous, especially for people with severe heart conditions."

Just like the rest of the world, Nigeria is battling to contain the highly contagious coronavirus but, unlike other nations fighting the pandemic, the country is also dealing with what is turning out to be the world's largest epidemic of Lassa fever, a viral disease even deadlier than Covid-19.

Lassa fever, which was first reported in 1969 in the northeastern Nigeria town of Lassa, is a severe viral hemorrhagic fever (VHF) that occurs throughout the year in Nigeria (although more cases are recorded during the dry season — from November through May) and was declared an "active outbreak" by the NCDC in February. 

The virus is transmitted to humans through direct contact with urine, faeces, saliva or blood of infected rodents or by ingesting food and drinks contaminated with urine, faeces, saliva or blood of infected rats. It's also known to spread from person-to-person through contact with blood, urine, faeces, vomitus and other bodily fluids of an infected person.

In most cases, the fever is asymptomatic, but for some, the symptoms include fever, headache, sore throat, general body weakness, cough, nausea, vomiting, diarrhoea, muscle pains, chest pain, and in severe cases unexplainable bleeding from ears, eyes, nose, mouth, vagina, anus and other body orifices. 

Because initial symptoms are similar to common illnesses like typhoid and malaria, which affects an estimated 100 million people in the country every year and is often treated through self-medication, many sufferers of Lassa fever do not quickly seek medical attention until the situation gets out of hand.

"We did not immediately go to the hospital because we thought he had malaria," Amodu, the livestock trader, said of his son. "We only acted when his condition became worse."

Based on data from the NCDC, the viral hemorrhagic fever has affected more people in Nigeria than Covid-19. While only 782 coronavirus infections and 25 deaths have been recorded, there are nearly 1,000 confirmed cases of Lassa fever and almost 200 deaths so far this year. However, virtually all these numbers are conservative since testing has been limited.

An elderly woman is seen with a food parcel she received from volunteers at a relief distribution, during a lockdown by the authories in efforts to limit the spread of the coronavirus disease (Covid-19), in Lagos, Nigeria April 9, 2020.
An elderly woman is seen with a food parcel she received from volunteers at a relief distribution, during a lockdown by the authories in efforts to limit the spread of the coronavirus disease (Covid-19), in Lagos, Nigeria April 9, 2020. (Reuters)

Under pressure

But testing is not the only problem Nigeria is facing in its fight to defeat both Lassa fever and Covid-19. The country’s hospitals already face a massive challenge as the high numbers of infectious diseases and common illnesses like malaria and cholera are coupled with poor medical facilities and inadequate numbers of health workers. 

According to the Nigeria Medical Association (NMA), there are only 40,000 doctors in a country of about 180 million inhabitants. The World Health Organization (WHO) says the country’s doctor-to-patient ratio is four physicians per 10,000 patients. 

Across the country, there are only five hospital beds for every 10,000 people according to the organisation. Even the head of the NCDC was forced to admit last month that Nigeria’s “health system is not as strong as we’d like it to be” and that in the middle of other pandemics like Lassa fever the government is “worried about our capacity to deal with a large outbreak [of coronavirus] that we are focused so intensively on prevention and early detection.”

Like Covid-19, Lassa fever has no vaccine but can be treated, although a lack of valid diagnoses of patients and delays in admitting sick persons to the hospital means many victims die or infect others before their status is confirmed. The rapid spread of the disease this year is raising concerns of an outbreak that could overwhelm Nigeria’s health systems.

There were only 308 confirmed cases of Lassa fever in the whole of 2017, 663 reported infections in all of 2018, and 810 cases in the entire 2019. But those numbers have risen dramatically in the first four months of 2020 with 963 infections and 188 deaths so far this year. The reason for the surge remains elusive.

“It could be that some parts of Nigeria are experiencing a drastic increase in the amount of rodents and that’s why there’s a surge in the number of infections,” said Dr Anyachi, who has treated several Lassa fever victims in northern Nigeria. 

“It could also be that many communities are not aware of the symptoms, and that is why it is easy for them to contract the virus having come in contact with an infected person.”

As Covid-19 continues to spread rapidly across the country, families fear that their relatives battling to deal with Lassa fever could face grave danger should they by any means contract the coronavirus.

“We are seriously worried,” said 30-year-old Anita Bassey, whose 55-year-old uncle was diagnosed with Lassa fever in Edo state early this year. “Coronavirus is spreading here and if he gets that as well, that could be his death.”