The age range of those interviewed was 27 to 45 years of age, out of which seven were females and five males.
Table 1: Characteristic of respondents
|
s/no
|
age
|
sex
|
occupation
|
|
1
|
42
|
Female
|
Epidemiologist
|
|
2
|
42
|
Male
|
Epidemiologist
|
|
3
|
43
|
Male
|
Epidemiologist
|
|
4
|
45
|
Male
|
Epidemiologist
|
|
9
|
33
|
Female
|
Epidemiologist
|
|
5
|
29
|
Female
|
Medical Doctor
|
|
5
|
34
|
Male
|
Medical Doctor
|
|
7
|
27
|
Female
|
Nurse
|
|
8
|
35
|
Female
|
Nurse
|
|
10
|
33
|
Female
|
Pharmacy technician
|
|
11
|
45
|
Male
|
Hygienist
|
|
12
|
40
|
Female
|
Hygienist
|
Theme: Knowledge on COVID-19 by respondents
All the respondents (n=12) had knowledge of the virus while two (n=2) of the 12 respondents stated that transmission could be air-borne due the high rate of infectivity of the virus. Their knowledge of COVID-19 was indicated under the subthemes; knowledge of the virus, mode of transmission and prevention/control.
Theme: likely means of exposure
Eleven respondents reported that they had primary contact with confirmed case or cases (n=11) while one was a secondary contact of a confirmed case. All the participants (n=12) likely place of exposure was at workplaces (hospitals/clinics) or at their various duties on the field during the outbreak investigation and mitigation. This was because a number of their colleagues tested positive and they had contacts with them before they went for testing. A respondent was not sure if the infection was acquired at the place of work.
Theme: Reactions
- Reactions form positive patients (n=12)
Reaction of positive frontline health workers on receiving the news includes initial denial due to being asymptomatic (n=2), feeling bad (n=3), anxiety, crying; some due to the fear of stigmatization, weakness, distress, pain, feeling disoriented, none specific reaction because the patients mind was prepared by a superior officer, looking forward for evacuation due to stigmatization by family members.
Other positive reactions despite tested positive were faith in God, bracing up to face the worst outcome after taking the test, overcoming the shock phase before the result was out, consoled by the recovery rate despite the test outcome, positivity that they will be negative in a few days, some felt that the situation could be avoided if only they wore mask while attending meetings and the issue of death did not cross their mind at any point.
Majority of the respondents’ colleagues (n=7) were empathic, supportive, always called and encouraged the patients to stay positive, prayed fervently for the patients, assured patients that they will come out victorious and came visiting with provisions. Emails were sent by the Head of the organization to encourage those that got infected in the line of duty and to reassure them of continued support and also wished them quick recovery. Some immediate supervisors called to encourage and counsel patients. A patient had a consultant psychiatrist as a supervisor who helped the patient psychologically and also engaged his psychiatrists’ colleague in the counselling process. A respondent’s team lead immediately started crying when informed of the patient’s positive status. Both the team and pillar leads were highly supportive as stated by some respondents.
On the contrary, the experience of others, (n=3) of the respondents had negative reactions from their colleagues, they were stigmatized by their colleagues. Reactions includes colleagues distancing themselves, accused of bringing the infection to the health facility, was told by colleagues they promised never to eat food procured by her at the health facility.
two respondents (n=2) had no reaction from colleagues because they were at home when their results came out.
- Reaction of the family and friends
Six (n=6) of the respondents disclosed to their family and friends about their disease status while the rest did not disclose their status. Two of the respondents that disclosed their status had negative response from family members while the rest (n=4) revealed that they got maximum support from their family and friends which turned out to be helpful emotionally and psychologically. They were prayed for, encouraged, and visited by family members and friends.
The rest of the respondents (n=6) kept their status away from their family members for fear of inflicting distress, worries and possible psychological breakdown.
The community was oblivious of the fact that these patients were positive (n=12), partly because some of them were evacuated from the hospitals where they worked and those staying in the hotels informed the authorities of their status for their rooms and the environment to be decontaminated after departure to the isolation Centre.
Theme: Challenges and coping methods
Challenges mentioned were late processing of samples, delay in getting results up to two weeks after the test was done and late evacuation to the isolation centre. All the respondents (n=12) related the challenges they went through during the period of isolation. While at the isolation centre, patients struggled with loneliness, insomnia, anxiety, movement restriction, worries about the welfare of their families at home, long duration of stay at the isolation centre about two weeks and yet to be discharged, lack of empathy by some of the staff at the isolation centre, the psychosocial group counselling made some patients more anxious instead of receiving comfort. Adverse side effects of drugs administered (n=3); some adapted to it after some days while others could not. Keeping their status secret from family members because they didn’t want them to be worried was challenging to some. Other challenges include stigmatization by the health workers at the centre; the workers seemed to be distancing themselves from the patients while wearing complete PPE. Not receiving the medical care that they expected, being shouted at for mistakenly shutting the door, faulty doors and windows in a patients bath room and the timing of the meals was not also acceptable to some (provision of meals at late hours).
Some of the coping mechanism employed were phone calls, surfing the web, listening to music, reading spiritual books, watching movies, working on some initial projects, attending webinars and working from the isolation centre.
Theme: Recommendations
- Recommendation for positive patients
Recommendations made by (n=12) of the respondents during the period of isolation include: they should put their trust and faith in God; positives should be optimistic staying in isolation centre is not forever; and they should not think of stigmatization but to survive first. Others were: they should engage in activities that make them happy and shouldn’t feel guilty for being positive and “COVID-19 is not a death sentence”.
- Recommendations to improve the outbreak response and case management
To improve the outbreak response and case management, recommendations were made by all the respondents (n=12). Implementation of standard guidelines for procedures for people receiving treatment at the isolation centres. The guidelines should be well communicated to the persons being brought for admission. There should be a single treatment policy in all the isolation centres. Increase testing capacity and prompt processing of samples collected so that results can come out in good time. Results of samples collected should be communicated not more than 48 hours after collection. A respondent suggested that the number of patients per tent should be reduced due to overcrowding.
Creation of more public awareness about the disease. The staff in these centers should be more empathetic to patients. Stigmatization by isolation centre staff should be reduced as much as possible. Training and retraining of isolation centres staff (case management team and hygienists) on how to interact with people recovering from COVID-19.
Timely evacuation of positive persons and the use of ambulance should be discouraged for both evacuation and home return after treatment to avoid community stigmatization. Equipping of Health facilities to tackle the disease. There is a need for a counsellor to be made available at the isolation centre to screen and identify those who need psychological support and provide such. Regularization of meal timetable at the isolation centres.
Table 2: Quotations of respondents under the various themes and subthemes
|
Theme
|
Subthemes
|
Quotations
|
|
Knowledge on COVID-19 by respondents
|
Knowledge of the virus
|
- “I don’t know much about it, but I know that it is caused by a virus and it is spread by speaking with infected patient and prevented by keeping social distancing and using face mask”
- “Airborne due to the high rate of infectivity”
- “It is a viral infection, affects the respiratory system and other systems of the body, that may result in multiple organ failure.”
- “Symptoms include difficulty in breathing, runny nose, diarrhea, chest pain, headache, fever, muscle pain, weakness, arthritis and in some cases, the individual may be asymptomatic. The disease is more severe in people that are advanced in years, about 20% case fatality in people above the age of 75 years.”
- “COVID-19 is a viral disease, affects the respiratory system and is caused by corona virus specifically SARS-COV-2. Transmitted via droplets usually presents with fever, cough and respiratory distress.”
|
|
Mode of transmission
|
- “Spread through the crowd without social distance”
- “A viral infection transmitted via aerosol, droplets or contaminated surfaces. By touching the face with contaminated hand (nose). I am not too sure if food can transmit it.”
- “It is spread through droplets and aerosol when an infected person, speaks, cough or sneezes. Can be transmitted through contaminate hands or environment.”
- “COVID-19 is a viral disease that is transmitted through droplets from the mouth, and nose. Transmission can occur through direct contact of droplets with the eyes, nose and mouth or indirectly by touching surfaces contaminated with droplets. The hand serves as a means by which the droplets are carried to from contaminated surfaces to the mouth, nose and eyes.”
- “caused by virus droplet, I feel it is airborne due to the high rate of infectivity. I feel many people have it though they may be asymptomatic like me”
- “Viral infection, transmitted through droplets from coughing, sneezing and touching surfaces”
- “Is a viral disease caused by SARS-CoV-2 that is highly infectious, spread from person-to-person through droplets from respiratory tracts of infected persons to their close contacts when they cough, sneeze or shout and can also be transmitted when someone comes in contact with contaminated surfaces and/or fomites and touches his nose, eyes or mouth. It can also be transmitted via aerosols but airborne transmission has not been reported.”
|
|
Prevention/control
|
- “Preventive measures include Social distancing (2 meters), use of hand sanitizers (70% alcohol) to disinfect the hand, proper washing of the hand under running water for about 30 seconds, cleaning of high touched surfaces with disinfectant, the use of face mask and staying away from high risk areas.”
- “The spread can be prevented or reduced by ensuring strict environmental hygiene, regular washing of hands with soap and running water for at least 20 seconds or the use of hand sanitizers with at least 60% alcohol, cough into flexed elbow or a tissue and immediately disposed hygienically, keep at least 2 meters’ physical distance and avoid crowded environment and the use of face mask.”
- “Keeping social distance at two meters or six feet and the use of face mask “
|
|
Likely means of exposure
|
Likely means of exposure
|
- “Exposed at the Primary Health Centre where I work”
- “Exposure from an outpatient in the hospital where I worked”
- “I can’t really tell but I came in contact with a staff of the hospital that later on became positive, I had no symptoms, I went and tested because my contact became positive”
- “Colleagues at the hospital, some of them tested positive”
- “Place of work, I was engaged in case investigation and had a lot of contact with positive and suspected cases”
- “Not really sure but feels I feel it’s from my place of work”
- “We managed a positive patient at work. I wasn’t the primary person that managed but one of my colleagues.”
- “I must have been exposed through infected friends at my place of work. Some of my colleagues were infected and as contacts I went for my test and it was positive.”
- “I think I was exposed at my place of work. Some of my close colleagues tested positive to the disease warranting me to also check my status and it turned out positive.”
- “I had contact with few confirmed cases and a lot of suspected cases in the line of duty even though I was observing the safety measures.”
- “I really don’t know, I am a frontline health worker and in the case investigation team and my work involves filling of case investigation forms for suspect cases, so I wouldn’t know if some are positive cases”
- “The infection was contracted through colleagues at the treatment centre and my screening test came out positive”
|
|
Reactions
|
Immediate reactions form positive patients
|
- “I was already looking forward for evacuation because it was delayed”
- “Initial denial because I don’t have any symptom”
- “Weakness, comforted myself on finding out that I was not the only positive case in the facility and putting my faith in God”
- “Denied, because I had no symptoms, I was anxious and I cried”
- “Accepted it when I was told by my resident advisor, self-denial because I was asymptomatic, I wanted to be tested again to be sure but that was not accepted”
- “I am a strong believer in the supreme being, so I left everything to faith”
- “Distress, pain because I have been on admission for over a week at Saint Nicolas hospital before I tested positive.
- “I felt bad but I was consoled that the recovery rate is high. I also had it before my grand mum. I felt I infected her and I felt very bad about that. I cried the first few days. Death did not cross my mind at any point.”
- “I did not feel bad I knew that I would be negative within a few days to week. Though, I felt I could have avoided being positive. This would have been accomplished by using face mask while attending meetings. I was not symptomatic, and I saw that as a good prognosis.”
- “I had encouraged myself and brace up for whatever outcome. So when I was called that it was positive, I had already gone through that phase of shock, I took it in good fate and looked forward to be evacuated”
- “Though felt bad initially because I thought I had been careful enough not to get infected but knew it’s just a matter of time that I will be let out of the treatment centre”
- “Because of the delay in results and the symptoms I already had, I was already expecting to be positive.”
- “ I was distraught, I didn’t feel happy about it”
|
|
Reactions of their families and friends
|
- “Telling my family helped me to settle down by talking to my wife regularly and being encouraged by my wife”
- “I stay with my uncle and his family, their immediate reaction was dramatic, I did expect the reaction but I was not ready for it. I was happy coming to the isolation centre because of the reaction of my family members”
- “My family helped by showing me care, they kept calling, encouraging me and telling me about remedies that might be of help. In some instance I say no that the measures are extreme.”
- “Disclosed it to my sister in-law and my friend. They were really empathic and supported me throughout my period of stay”
- “My husband has been very supportive though I did not inform my children so that they will not be worried.”
- “I live with my parents, my mom felt awfully bad, my dad felt bad, but he denied that I can’t be positive”
- “I could not inform my immediate family members; my wife will be devastated. I want to prevent the trauma. She will become anxious to see me and it will be difficult for her to travel to Lagos”
- “I didn’t inform members of my family for fear of their psychological breakdown”
- “I could not inform my wife till now for fear of her not taking the news well. Informed my brother who is a medic too and he has been supportive”
- “Family? No, friends? Yes “
- “No, I didn’t inform them because I felt it was unnecessary especially for the fact that I was not symptomatic and I know that I will get over it”
|
|
Reaction from colleagues
|
- “Stigmatized by colleagues, a colleague of mine said that I was the one that brought the disease to them, that I use to bring some Hausa people into the health facility.”
- “Distancing themselves from me”
- “No negative reaction from colleagues because I was already at home when my results came out”
- “None”
- “My colleagues were empathic and always called to encourage me”
- Some of my colleagues reacted in not too good manner and one of them promised never to eat food procured by me again.”
- “Supportive”
- “Most of my colleagues were supportive, they came visiting and came with gifts. Only a few behaved as if it could not have been them. My immediate supervisor called to encourage and counselled me. He is a consultant Psychiatrist; he did a good job on me. He also shared my contact with another Psychiatrist who called and encouraged me as well.”
- “They were quite supportive. They called frequently, prayed fervently for me, ensured me that I will come out victorious and some came visiting with goods. My team lead immediately started crying when, I informed her of my positive status. Both my team and Pillar leads were highly supportive.”
- “They were supportive and tried to calm me down. I also received calls from my colleagues outside Lagos.”
- “Had very good support from colleagues but clinical and non-clinical which was encouraging enough. Calls and visits regularly was strengthening. Non-specific untoward reaction was noticed. Senior colleagues who had the same experience called to encourage me and also close friends who were not at my present location”
- “they were sympathetic and they shared in my fears and tried to allay my fears and told me that I am fine especially the fact that I am not symptomatic”
|
|
Community Reaction
|
- “Oblivious of the fact that she is positive”
- “Community not aware”
- “The community are not aware that I tested positive”
- “None”
- “When I informed the manager of the hotel where I stay, she prayed that I get well soon, I taught the manager how to decontaminate my room and she was thankful.”
- “Not really”
|
|
Challenges and copping methods
|
Challenges and copping methods
|
- “Living very far from home, couldn’t tell my wife, I didn’t want to create unnecessary worries.”
- “stigmatization by the health workers here”
- “I cried because I might be stigmatized. Only temperature is checked here. Twice daily. The window of my room and the door of the bath room were not good.”
- “Loneliness, worried about my children at home, staying because it is compulsory, late processing of my samples, my result came out about two weeks after taking the test and I have stayed for about 2 weeks already at the isolation centre”
- “Some of the staff here are not empathetic, the psychosocial group counselling made me more anxious instead of calm me down”
- “The workers at the hotel seem to be distancing themselves from us even while wearing complete PPE while mopping my room, I was told to stay inside the bathroom which I did until the person finished the mopping; being shouted at because I mistakenly shut my door; away from home and alone”
- “Not been able to move freely, not been able to see my immediate family for some time.”
- “Not been able to move freely as I desire, I could not do my usual work. However, I spent the time attending webinars and working from my isolation room.”
- “Restriction of my movement, the effects of the drugs, meals were not coming at the right time, poor treatment and avoidance mechanism established by the case management team at the isolation centre”
- “The solation centre was not conducive, not enough space in the tent, didn’t have enough sleep, noise from television from other patients. I copped through; watching movies, having long calls with family members, working on my laptop on some of the works that I started.”
- “Not been able to move freely as I desire. A bit of worry when I noticed a symptom that was not present before (loss of smell).”
- “I am not finding the isolation easy, especially the fact that my result is still pending, there is no feedback from the laboratory and I have spent 16 days already in isolation waiting for my second result. have been watching movies in and out of sleep and I have been talking with family and friends”
- “No challenges personally, I coped through using my phone, listening to music and reading spiritual books,”
|
|
Recommendations
|
Recommendation for positive cases
|
- “They should put their trust in God”
- “They should surround themselves with things that make them happy, they shouldn’t feel guilty for being positive”
- “Put their faith in God and stay positive”
- “Positives should be optimistic staying in isolation centre is not forever, they should not think of stigmatization but to survive first.”
- “COVID-19 is not a death sentence”
|
|
|
Recommendations to improve the outbreak response and case management
|
- “House to house testing, increase testing capacity and samples should be processed immediately so that results can come out in good time.”
- “Create more public awareness about the disease”
- “The staff in this centre should be more empathetic to patients, there should be standard guidelines for procedures, timely processing of samples collected, and timely dissemination of results, timely evacuation of positive persons.”
- “The process of evacuation of patients should be considered because of community stigmatization.”
- “Showing of more care by the health workers”
- “People should be alerted about their status on time and not being worried for several days or weeks before result notification. Stigmatization by isolation centre staff should be reduced as much as possible. Health facilities should be equipped more to tackle the disease. The government should make house to house screening of population mandatory.”
- “There should be plan for discharge after admission here, the use of ambulance should be discouraged for both evacuation and return home after treatment. People should be alerted about their status on time and not been worried for several days of weeks before result notification. Decontamination of the items owned by the persons discharged should be done in their rooms and not outside.”
- “There is a need for a counsellor at the isolation centre. The person will screen and identify those who need psychological support and provide such. Training and retraining of isolation centre staff on how to handle cases is important.”
- “Regularize mealtime. Case management team should show more care to patients. Results of samples collected should be communicated not more than 48 hours after collection. There should be a single treatment policy in all the isolation centers
- “Special treatment for all the frontline health workers. Reduce the number of patients per tent.”
- “Support the government and Nigeria Centre for Disease Control by adhering strictly to all the preventive measures to avoid transmission.”
- “Coordination; the whole response is not well coordinated and there is need for timely laboratory feedback. Whether you are a frontline health worker or not, the delay was a general case”
|