At the frontlines of Nigeria’s COVID-19 response: The Laboratory

Ultra-low freezers hum and beep continuously in the biorespository room, supporting the non-stop diagnostic activities at the National Public Health Reference Laboratory in Gaduwa, Abuja, on a relatively quiet Friday afternoon. This is one of the reference laboratories of the Nigeria Centre for Disease Control (NCDC). The laboratory is open 24 hours a day as Nigeria is currently responding to the global pandemic of Coronavirus disease (COVID-19). At the same time, the NCDC is also responding to the largest Lassa fever outbreak in Nigeria.

Important for the government’s outbreak response by providing testing for samples of suspected cases, the National Public Health Reference Laboratory is one of seven laboratories in the NCDC’s laboratory network with the capacity to test and diagnose the disease. The other six labs are dotted around the country, with two in Lagos, and one each in Osun, Edo, Oyo, and Ebonyi State.

Setting up the laboratories and building up the capacity of scientists to diagnose the disease is part of the preparedness effort of the NCDC  as outlined in the National Action Plan on Health Security (NAPHS). These preparations were critical because, as the Roman Writer Publius Flavius Renatus put it, “In time of peace prepare for war”.

The National Public Health Reference Laboratory in Gaduwa. Beyond the building are the people who work round the clock to test samples of suspected COVID-19 cases. They put great passion and energy into the work they do.

Mrs Nwando Mba, Director Public Health Laboratory Services Department said  that once they understood that COVID is a respiratory infection, they quickly brought out Nigeria’s influenza pandemic preparedness plan. “This became our blueprint because influenza surveillance is the bedrock of our COVID response,” She works in sync with other people and gives the young people in her team opportunity to take lead.

Celestina Obiekea (centre) is the Network Coordinator of COVID-19 Laboratories in Nigeria. She says she was in Dakar when the index case was reported in Nigeria, and life has not been the same since. She is still able to smile and maintain a positive energy for her team, despite the gruelling long days at the laboratory.

Quality laboratory investigation and dissemination of results can only be guaranteed with correct sample collection. A young scientist is ready to set out with his team for sample collection to test for COVID-19. He has his material and personal protective equipment in the red bag.

The first point of contact with the lab once samples are collected is the sample collection unit. It is located beside the main laboratory building, away from areas with frequent human access.

Erasogie Evbuomwan and another team member dressed in Personal Protective Equipment (PPE) receive, document and prepare the samples for transfer to the next phase in the testing process.

Once samples are received and documented, the sample transportation containers are disinfected and handed back to the collection team. The lab currently receives samples for both COVID-19 and Lassa Fever. On the day our team visited, they had already received 31 samples… with more on the way.

From the collection area, samples are taken to the processing area for inactivation. This is an important step because any potentially harmful virus in the sample is rendered harmless to protect the people working with it.

The process is performed in an enclosed class 3 biosafety cabinet commonly called a glove box to ensure no dangerous pathogens escape. Shamsu Munzali uses one of the two boxes and is quick to describe the complex scientific principles behind the inactivation procedure once engaged.

Christopher Chukwu and other team members got trained on COVID-19 diagnosis from the African Centres for Disease Control and Prevention in Dakar before the first case of COVID-19 in Nigeria. He had been trained on molecular diagnostics previously from numerous trainings courses, including training delivered by Public Health England in 2019.

Nneamaka Uba says even though the outbreak has changed a lot for her, she still enjoys doing her work and giving it her best. “My work is my life,” she said. While it is not  easy working with samples that are potentially infectious, Uba said she is confident that the PPE will protect her if it is used correctly.

Samples are ready for movement to the next laboratory for extraction and Polymerase Chain Reaction (PCR) amplification which is the only validated procedure used to diagnose COVID-19.

The PCR inactivation room has restricted access to only relevant laboratory staff and movement is in one direction. Mrs Mba said the training the team had received in molecular diagnostics made it easier to evolve to diagnosing COVID-19 before the first case of COVID-19 in Nigeria.

The laboratory manager, Mr Akinpelu Afolabi said their work has been intense since the outbreak. “Unlike before, we now work 24 hours. I came here around 11pm yesterday and left by 6am today. By 12pm, I returned and as of now (5pm), I’m not sure  when I’ll leave,” he said.

Once done testing, materials such as PPE and other disposables are taken outside for incineration and the process ends for those batch of samples. But you can be rest assured, another is on its way to the laboratory.

Obiekea says it can be challenging when everyone wants to be tested, as it takes a  toll on both human and material resources. She advises that people stick to the advisory from the NCDC and Federal Ministry of Health to stay at home, practice social distancing, self-isolate if they feel they have been exposed to someone who has COVID-19, and to call the NCDC toll free numbers if they are having symptoms.