Experts fear Madagascar’s organics could accelerate malaria resistance

THE GUARDIAN Newspaper- Igho Akeregha, Azimazi Momoh Jimoh, Terhemba Daka (Abuja) Chukwuma Muanya

• As Buhari Takes Delivery Of ‘Drug,’ Promises To Listen To Scientists
• Why Nigeria Must Look Inward For Cure Of Pandemic – PTF
• How 97% Of First 32 COVID-19 Cases In Lagos Were Treated With Iopinanir-ritonavir – Study
• PDP Gives FG 48-hour Ultimatum To Declare Whereabouts Of Chinese Medical Team
• They Are With CCECC, Says Chinese Embassy

President Muhammadu Buhari, yesterday, at the State House, Abuja, received the Madagascan native formulation against the Coronavirus Disease (COVID-19), and reiterated that he will listen to scientists before allowing traditional or any new medicines to be administered on Nigerians.

While receiving a sample of COVID-Organics from the President of Guinea Bissau, Umaro Sissoco Embalo, Buhari said his position on all such herbal or traditional medicinal postulates had remained the same, stressing that he would not allow the solution, or any other drug to be administered on Nigerians without scientific instructions.

It would be recalled that President of Madagascar, Andry Ranoelina, recently dispatched consignments of the drug to African countries, some of which were sent to Guinea Bissau for onward delivery to West African countries.

According to Buhari: “We have our institutions, systems and processes in the country. Any such formulations should be sent to them for verification. I will not put it to use without the endorsement of our institutions.”

Embalo said one of the reasons he was in the country having stabilized his country after the crises that attended the general elections won by him, was to come and seek counsel from his “father,” President Buhari, on his plan for a “government of national unity,” and a proposed war against corruption in his country.

He also said that his new government met a country beset with a number of issues and problems, the resolution of which would require tremendous assistance from “big brother,” Nigeria.

“Problems of Guinea Bissau are problems of Nigeria. I have come to you as your son. I need your help and assistance to make the people happy. I will not let you down, neither will I put you in any difficult situation,” the visiting leader told President Buhari.

In response to these demands, the Nigerian leader commended “General“ Embalo on his confirmation as President and for stabilising the country.

“I commend your political dexterity in getting the opposition to join the proposed unity government,” he said, adding that Nigeria was determined to keep West Africa politically stable and promised to support the new government in Guinea Bissau. “I will cooperate and help in every way possible,” assured the Nigerian President.

But as Buhari promised not to allow the Madagascan solution, or any other drug to be administered on Nigerians without scientific instructions, some experts have warned that the misuse of Artemisia, one of the main plant extracts in the tonic (from Artemisia annua), could accelerate malaria resistance to artemisinin-based drugs, used as treatment for malaria.

Already, Artemisia annua, which is a source of artemisinin, a significant component of modern anti-malarials, has been the subject of some international research looking at possible Coronavirus treatments.

Scientists at Germany’s Max Planck Institute, in Potsdam are among a group of researchers from Germany and Denmark collaborating with a United States company, ArtemiLife to explore whether Artemisia plant can be used against the raging contagion.

Recently, the Minister of Health, Dr. Osagie Ehanire, during Presidential Task Force (PTF) briefing on COVID-19, in Abuja, also said that samples of plant from Madagascar would be compared with the ones that grow here in the country.

He said, “The cure from Madagascar has been making the news and we have promised to get samples of the herb or the botanical products that is there for analysis and (also) use (that) as an opportunity to speak with the health authorities, particularly the scientific community, on how they use it.

“We will give that to the research community with us here to examine and see what they can do with it. We understand that it is something called Artemisia annua, which also grows here but if we get it, we will like to compare it with the strain here whether they are identical or whether they are similar, and see what properties they have. Things like that are subjected to analysis.

“All countries in the world are interested in finding a cure and we are no different, and we will look at all options, possibilities, and promises that were made. But before we give them to our people, we will ensure they are safe and make sure they work.”

The WHO recently also warned against using untested herbal therapies to treat COVID-19 patients without first “establishing their efficacy and safety through rigorous clinical trials” in step with global standards.

The United Nations agency in a release this month acknowledged that medicinal plants such as Artemisia annua, were “being considered as possible treatment of COVID-19,” but stressed that they “should be tested for efficacy and adverse side effects.”

The organisation added that efforts were underway to find treatment for COVID-19, but cautioned against misinformation, especially on social media, about the effectiveness of certain remedies.

“Many plants and substances are being proposed without the minimum requirements and evidence of quality, safety and efficacy. The use of products to treat COVID-19, which have not been robustly investigated can put people in danger, giving a false sense of security and distracting them from hand washing and physical distancing, which are cardinal in COVID-19 prevention, and may also increase self-medication and the risk to patient safety,” the agency wrote.

Worries Over Artemisia Annua
One of the earliest concerns about accelerate malaria resistance to artemisinin-based drugs was raised by a Professor of Pharmacological Science and Experimental Medicine at Stony Brook University, New York, Dr. Arthur Grollman, who speaking to CNN said: “Widespread use of Artemisia annua in the pandemic will accelerate resistance to it, endangering people in countries, including Madagascar, where artemisinin-based drugs are being used to treat malaria.

“The product won’t work and will result in more people dying from Coronavirus due to the false sense of security created by the advertisement and also more people dying from malaria due to artemisia resistance,” Grollman said.

Reacting to this, a clinical pharmacist and public health expert Kingsley Chiedu Amibor, said: “In treatment of malaria, if artemisinin is used as monotherapy (that is alone without combining with an additional antimalarial medicine, then resistance could develop to it. That is why the World Health Organisation (WHO) insists on artemisinine being combined with other anti-malarial medicines. When the product is used alone at sub-optimal doses, resistance could develop. When used at higher than recommended doses, toxicity or adverse drug reactions can set in.”

The plant artemisia is found to be effective in treatment of malaria, but according to Chiedu, if used in sub-therapeutic dose, could lead to years of treatment failure.

Malaria is endemic in many African countries, and as many as 400, 000 people died of it globally in 2018, according to WHO.

In terms of side effect, Chiedu said, “Artemisia herb is known to be quite safe. Safer than some orthodox medicine, but the problem is standadisation of dose. People tend to use such drugs as they like. In terms of efficacy tests, it is trial and error.”

Regarding injecting higher than recommended therapeutic doses, Chiedu said this could lead to toxicity and adverse reaction. “But for now, it is too early to speculate that it can lead to drug resistant. What we need to do now is to encourage our own local herbal products up to the point of testing,” he said.

Another pharmacist, Olumide Akintayo, said when people begin to misuse herbs, they are exposed to consequences like ulcer, and gastrointestinal diseases. “Before you get to the stage of drug resistance, you must have abused the drug over and over again. If you begin to abuse lime for instance, within a week, I can assure you that you will come up with a gastrointestinal issue.

“There is no prophylaxis for the virus. The best people can do is to use supplements like Vitamin C- a high dose for a short period then substitute with fruits and vegetables. Avoid crowded areas, avoid air-conditioned areas were you have lots of people, this is why you have lots of people contracting it through flying in aircraft. People should focus on these preventive measures instead of focusing on herbal preparation,” he said.

Akintayo stressed the need to evaluate the safety profile of the drug saying: “It’s important that pharmacists embark on national dialogue with NAFDAC, to agree on the necessary pharmacological tests of some of these herbal preparations.

Artemisinin is not the first malaria treatment to gain attention in the search for a treatment for COVID-19. The malaria drug hydroxychloroquine has also been hyped in recent months despite little data supporting its effectiveness against coronavirus infection.

The Co-Chair, Presidential Taskforce on COVID-19 in Kano, Prof. Abdulsalam Nasidi, yesterday, said there was urgent need for Nigeria to search inward for a veritable treatment and cure for the pandemic.

The professor of infectious diseases and public health, who spoke in Kano, noted that it was high time Nigeria and Africa focused more on local scientific research and development in a bid to finding homegrown treatment for the virus.

Although, Nasidi disclosed that several clinical tests on vaccines for the cure of COVID-19 pandemic were presently at advanced stages, he reminded that such vaccines when finally certified may be difficult to access in Africa, even as he alleged that world powers may make it extremely expensive and reserved for their citizens first, before thinking of Third World countries.

Nasidi, who expressed the belief that Nigeria and Africa have the scientific and alternative medicine competence to finding a cure for the virus, urged government to increase funding for research centres in the country.

How First 32 COVID-19 Cases Were Treated
Meanwhile, Nigerian researchers have published the first-ever study on how the first 32 COVID-19 patients were treated with lopinavir-rotonavir, with no recorded death.

The study titled, “Clinical Presentation, Case Management and Outcomes for the First 32 COVID-19 Patients in Nigeria,” was published in The Pan African Medical Journal.

The researchers led by a consultant public health physician and former Chief Medical Director of Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun, include, Abimbola Bowale, Akin Abayomi, Jide Idris, Sunday Omilabu, Ismail Abdus-Salam, Busayo Adebayo, Folarin Opawoye, Ore Finnih-Awokoya, Emmanuella Zamba, and Hussein Abdur-Razzaq among others.

They are drawn from Mainland Hospital, Yaba, Lagos; Lagos State Ministry of Health; College of Medicine, University of Lagos; Lagos State University Teaching Hospital (LUTH); Office of the Senior Special Assistant to the Governor; Lagos State Primary Health Care Board; World Health Organisation, Nigerian Office, Lagos; Nigerian Centre for Disease Control, Lagos, and African Field Epidemiology Network, Lagos.

According to the researchers, success in curtailing pandemic depends largely on a sound understanding of the epidemiological and clinical profile of cases in a population, as well as the case management approach.

“This study documents the presenting characteristics, treatment modalities and outcomes of the first 32 COVID-19 patients in Nigeria,” they noted.

The retrospective study used medical records of the first 32 patients admitted and discharged from the Mainland Hospital, Lagos State, between February 27 and April 6, 2020. The outcomes of interest were death, promptness of admission process and duration of hospitalisation.

According to the results, “the mean age of the patients was 38.1 years (SD: 15.5) and 66% were male. Three-quarters (75%) of the patients presented in moderately severe condition while 16% were asymptomatic. The most common presenting symptoms were fever (59%) and dry cough (44%). The mean time between a positive test result and admission was 1.63 days (SD: 1.31). Almost all (97%) the patients were treated with lopinavir-ritonavir with no recorded death. The median duration of hospital stay was 12 days.”

They concluded: “In this preliminary analysis of the first COVID-19 cases in Nigeria, clinical presentation was mild to moderate with no mortality. Processes to improve promptness of admission and reduce hospital stay are required to enhance the response to COVID-19 in Nigeria.”

On what this study adds to existing literature on the scourge? Osibogun told The Guardian: “Literature on COVID-19 is currently unfolding worldwide and the study would contribute to the growing body of knowledge. In particular, this study helps in identify the defining clinical characteristics of COVID-19 and shares experience with case management in an African context.”

PDP Demands Whereabouts Of Chinese Medical Team
In a related development, the Peoples Democratic Party (PDP), yesterday, gave the All Progressives Congress (APC)-led Federal Government a 48-hour ultimatum to declare the whereabouts of the Chinese medical team it brought in purportedly to assist in the fight against the spread of the COVID-19.

The party said its position is predicated on the declaration by the Minister of Health, Dr. Osagie Ehanire, that the Federal government could not account for the whereabouts of the Chinese team.

In a statement by its national publicity secretary, Kola Ologbondiyan, the PDP noted that the Chinese medical team was brought into the country from the epicenter of the pandemic (China), despite repeated warnings and disapprovals by medical experts and professional bodies.

It equally noted that “Ehanire’s statement had heightened apprehensions in the public space that the Chinese team, whose identity and activities have been shrouded in secrecy, might have been brought in by a certain cabal for another purpose outside the general public good.”

The party described as “suspicious, creepy and weird that the minister of health, who had repeatedly assured that the Chinese were brought to render medical services and trainings, and even went personally to receive them at the Nnamdi Azikwe International Airport, Abuja, on April 8, 2020, in an elaborately publicised event, can no longer account for the team.”

The PDP recalled how officials of the APC-led administration had vehemently defended the invitation of the Chinese team, and offered them full state protocol upon arrival, only to now turn around to disclaim the supposed experts, deny involvement with them, and even forbid Nigerians from enquiring about their whereabouts.

“Our party is worried that the APC-led Federal Government is being economical with the truth, with its officials playing politics with the lives of our citizens and health safety of our nation.”

Chinese Medical Delegation Is With CCECC- Embassy
However, upon The Guardian inquiry, Sun Saixiong, a spokesman of the China Embassy in Nigeria said that the Chinese delegation is currently with the China Civil Engineering and Construction Company, CCECC, where they have held some lectures with the staff of the company on how to effectively follow the NCDC guidelines on self-protection during the pandemic.

According to him, the lectures include how to wear a mask the right way, social distancing and other safety tips. “You know CCECC has thousands of employees in Nigeria, they deserve a supportive team that can give epidemic control guidance and basic health advice during this trying time and because they have many employees, the company must do its best to guarantee that its employees are safe and sound.”

However, another source that declined to be named said there was so much misinformation before the team arrived the country. “The truth of the matter is that the medical team came at the invitation of the CCECC as part of its Corporate Social Responsibility, CSR, to help the country combat COVID-19.”

The source further disclosed that the team came with medical supplies worth over $2m as donation to the Presidential Task Force on COVID-19, through the Federal Government, adding that “the health ministry and the government are aware of the donation and were also aware of the development.”

The source added that at some point, everything that had to do with the visit was hijacked by the Ehanire. But this backed-fired because he sounded in his announcement and gave the impression that the team was coming to help the country tackle COVID-19.

In this article:
Andry RanoelinaCCECCCoronavirusCOVID-19Dr. Osagie EhanireIopinanir-ritonavirMuhammadu Buhari‎
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