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Sometime in mid-May, Joseph Osuigwe, 35, started noticing a sudden loss of the senses of taste and smell. He could not perceive the aroma of his wife’s food; he thought her food that used to be irresistible tasted bland. The symptoms became worse.

“I started noticing I could no longer smell my bathing soap or perfume. I concluded that something was wrong when I bought a balm and rubbed it all over my nose but felt nothing,” said Mr Osuigwe, a human rights activist.

The medical term of what Mr Osuigwe was experiencing is anosmia – the loss of sense of smell, and ageusia – an accompanying diminished sense of taste.

In April, the World Health Organisation (WHO) listed the loss of smell and taste as some of the less common symptoms of coronavirus also known as COVID-19.

In recent weeks several Nigerians have taken to social media to complain of symptoms similar to that experienced by Mr Osuigwe, during or after treating a fever.

The increasing complaints have triggered a coronavirus scare among Nigerians. Surprisingly there has been no official response from health authorities about the symptoms.

Spike?

A post by Tunde Ajayi, a Twitter user asking Lagosians to click ‘like’ on his thread if they have experienced the sudden loss of smell and taste garnered more than 3,300 likes within a day.

Mr Osuigwe said on realising that he could have been exposed to the coronavirus, he tried to get tested but was initially turned away. He was later tested after he insisted.

“I went to the NCDC (Nigeria Centre for Disease Control) COVID-19 testing centre in Abuja to test myself but they refused to attend to me. Some staff told me what I have presented is not really a symptom of COVID-19 because I have not travelled out and there is no record I have contact with a known COVID19 patient that tested positive.

“They said it’s a minor thing that will clear at anything but when I persisted for two days, they reluctantly tested me”, he said.

Mr Osuigwe tested positive for COVID-19.

Conundrum

The rising loss of the sense of smell and taste has drawn several debates not just in Nigeria but globally as the coronavirus virus remains unrelentingly.

According to the American Academy of Otolaryngology-Head and Neck Surgery, reports of people who tested positive for the disease but had no noticeable symptoms, apart from the mysterious loss or reduction of their sense of smell, are mounting.

In South Korea, where testing has been widespread, 30 per cent of 2,000 patients who tested positive experienced anosmia as their major presenting symptom, according to a recent report by The Times.

But some health experts said the loss of smell and taste does not necessarily mean a person has coronavirus. They say the best way of knowing if a person has the disease is by testing for the disease.

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Even if there is a link, they say, simply losing your sense of smell isn’t enough to say for sure that you have the coronavirus.

Godwin Ntadom, the head of Nigeria’s National Malaria Elimination Programme says the only way of knowing if someone has coronavirus is for them to test for coronavirus.

“It all boils down to testing because you need a diagnosis to confirm if someone has malaria as you need testing to ascertain for sure if a person is COVID-19 positive,” he said.

Many Nigerians who have recently complained of a loss of the senses of taste and smell have associated it with malaria.

Valentine Osondu, an Abuja resident who shared a similar experience, said his test result showed he had “high-grade malaria”.

He said he did not test for coronavirus but used a treatment regimen recommended by a friend who also had the loss of the senses of smell and taste.

“I was treating malaria for almost a week but it was not working. The loss of sense of smell and taste got worse. A friend recommended that I should buy ginger, garlic and lime then boil them together. That is what I have been drinking every morning and I am getting myself,” he explained.

However, Mr Ntadom said it was wrong to link the frequency of sensory deprivation to malaria without proper diagnosis.

“We are not in the malaria season so it’s a question difficult to answer without a diagnosis. The dividing line between both sicknesses is very thin. They are synonymous with fever, body weakness and difficulty breathing.”

Ifunanya Ezeigwe, a public health nurse, said even if anosmia has been included as one of the symptoms of COVID-19, “there is also differential diagnosis where someone can lose senses of smell and taste and still be negative to the Coronavirus”.

Nigeria’s slow testing capacity

Since Mr Osuigwe tried to get tested and was initially turned away, the NCDC has updated its case definition of common symptoms of COVID-19 to include sudden loss of sense of smell and or taste.

“A sudden loss of taste and smell with fever, headache or runny nose may be #COVID19. Please do not ignore these symptoms. Call your state hotline immediately to arrange for a test,” the NCDC twitted on its official handle Monday, few weeks after the agency denied but eventually tested Mr Osuigwe reluctantly.

But with Nigeria’s limited testing capacity , here is little chance that people whose primary symptoms is the loss of taste and smell will be given prompt attention.

These reported losses of the senses of smell and taste should ordinarily warrant massive screening for the coronavirus and “deserve serious consideration for self-isolation and testing of individuals showing such symptoms,” said the president of the National Association of Residents Doctors (NARD), Aliyu Sokomba.

“But the fact remains that the government doesn’t have the capacity to test the people that are supposed to be tested. Our case definition is still limited. Critically impaired people are not even tested due to lack of test kits let alone people suffering from the loss of smell and test,” he explained.

On April 28, the Nigerian government announced its target of testing at least two million people within the next three months.

Almost halfway into the ambitious 90 days’ target, the country is yet to cover 10 per cent of the two million.

Nigeria still conducts only about 900 to 1,400 tests per day across 26 molecular laboratories in the country, a source confirmed to PREMIUM TIMES.

As of June 22, Nigeria has conducted a little over 115,760 tests of its estimated 200 million population and found more than 20, 000 infected persons. Out of these, over 7,000 have been treated and discharged and over 500 fatalities recorded.

Repeated calls and texts to Chikwe Ihekweazu, NCDC Executive Director, on seeking to find how the agency would expand testing to include those with symptoms of loss of smell and taste were not responded to as of press time.

Health minister, Osagie Ehanire, also did not give a definitive response when questioned over the current trend during the Presidential Task Force meeting last Thursday.

The minister, however, alluded to the possibility of a new strain of COVID-19 in the country.

Self-medication

But amid the controversy trailing the strange symptoms, many Nigerians have resorted to self-medication.

Unlike Mr Osuigwe, several Nigerians sharing their experience on social media appeared not to have done any COVID-19 tests.

Anayo Acho, a Lagos based ICT manager who resorted to self-diagnosis, shared his experience with PREMIUM TIMES.

“It started with fever which I treated with basic malaria drugs which went away but then I started having a loss of sense of smell. I could not eat food properly.

“I researched online and also visited a pharmacist who told me to use chloroquine, vitamin C and some other drugs and everything returned to normal within days.

“I didn’t try to go for COVID-19 tests because I know the drugs I got will ‘purge’ the virus if it was actually in my system”, he narrated.

Mr Acho is one of five others interviewed by this newspaper who used various self-remedies.

A concoction of ginger, garlic and lime was the predominant homemade treatment used, as explained by Mr Osondu.

Others resorted to the malaria drug, chloroquine, and a related drug, hydroxychloroquine, which was banned in Nigeria in 2005 due to high treatment failures resulting from drug resistance.

“If someone like me could have these symptoms and test positive of COVID-19, what about people that have same symptoms and didn’t go for tests,” queried Mr Osuigwe who was recently discharged from the isolation centre inside Asokoro general hospital.

He has since tested negative after being treated for two weeks.

“We have more people carrying this virus than we know because people who have a strong immune system can stay for 10 days and still be going around and sharing it.”

The NCDC has repeatedly warned Nigerians against self-medication, especially when experiencing symptoms similar to that of COVID-19.

Solution

Some health experts have advised the government on how to handle the situation.

Tolu Fakeye, a public health physician,

said the NCDC needs scientific evidence in order to expand testing to cover symptoms such as loss of smell.

“NCDC has a record of over 17,000 (now more than that) cases in Nigeria. I am sure they have records of individual symptoms patients exhibit.

“With this, they can look at if these symptoms have occurred in a significant proportion of cases in early stages. It then boils down to the preponderance of the availability of the test kits.

“If they have a lot of test kits then as they are planning to test two million in the next two months, the strange symptoms will become one of the criteria for testing COVID19 but if there is no abundance of test kits, they will be prudent in testing.

“It’s a matter of balance between science and availability of resources.”

Roland Aigbovo, the president of the National Association of Resident Doctors (NARD) Abuja chapter, said the only option is for the NCDC to improve the testing capacity of teaching and specialist hospitals.

“This is to make the testing process less cumbersome and more accessible. With the active community transmission, more people have to be tested with less encumbrance,” he said.

For Emeka Onwuali, a public health physician, the job is not for the NCDC alone.

“What is the National Orientation Agency doing? They should also be very vocal this period in persuading people to go for testing for any sickness symptom not just COVID-19,” he said.

“The habit of home treatment and self-medication has eaten deep into the country’s fabric. This is not something that can be corrected without massive sensitisation campaigns.”

Stigma, misinformation

Mr Fakeye, the physician, said there is still stigma and misinformation associated with the pandemic making people resist visiting the isolation centre.

About three in ten Nigerians believe they have some form of immunity to the coronavirus, according to a poll conducted in April.

The survey, which was conducted by NOIPolls Limited, a country-specific polling service, shows that poor knowledge and perception of the virus is still rife, even as fact-checkers and health officials work to provide accurate information and save lives.

“The government should through the National Orientation Agency (NOA) take enlightenment sensitisation to the grassroots. Many Nigerians no longer take coronavirus seriously and that is dangerous.

“Religious and traditional leaders advocating for places of worship to open should be more focused on sensitising people on why they should be committed to getting tested,” Mr Fakeye said.

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