ABSTRACT
COVID-19 has humbled countries with a sophisticated healthcare system and exposed the rot in the health system of developing countries like Nigeria. The medical laboratory component is vital in the epidemiology and management of public health diseases such as coronavirus. The medical laboratory approaches used in testing COVID-19 are neutralization (viral culture), molecular techniques (RT-PCR and GeneXpert systems), immunological diagnostics (including antigen/antibody diagnostics for rapid test kits), and genomic sequencing. The medical laboratory methods involved in the medical laboratory approaches can detect COVID-19 in any of the following samples: nasopharyngeal swabs, oropharyngeal swabs, throat swabs, sputum, saliva, bronchoalveolar lavage fluid, conjunctival swabs, whole blood, serum/plasma, stool, urine, and rectal swabs. Nigeria may be challenged by emergency training of laboratory staff, limited access to COVID-19 testing consumables, delayed COVID-19 testing and reporting, unavailable local testing kits, absence of validated rapid testing kits, less research capacity and resources, poor medical laboratory infrastructure, and lack of political will before and during the pandemic. However, Nigeria adopted a molecular techniques protocol for the testing of COVID-19 since the index case when only 6 molecular laboratories existed in the country and can boast of 71 molecular (52 RT-PCR and 19 GeneXpert) laboratories as at September 11, 2020. Nigerian protocol also adopted nasopharyngeal swabs as the choice of specimen for molecular testing. Most of the laboratories were established in haste or under emergency conditions without adequate laboratory organization and plans in some places. The post-COVID-19 medical laboratory services, especially at the established COVID-19 testing sites under the Nigerian Center for Disease Control (NCDC) laboratory network, if not followed with government political will, may be in a sorry state, to the extent of having to close down. Though the GeneXpert laboratories may continue to function optimally for COVID-19 and tuberculosis testing because they were well incorporated under the hospital system, some molecular laboratories outside the hospital environment may not function optimally except during an outbreak or with support from the federal government and international donors, considering the capital-intensive nature of molecular machine maintenance and services. Though NCDC had a plan to establish at least one molecular laboratory in its network in every state, some states have more than one, which may increase the budgetary provisions of NCDC and, in a bid to cut down the cost, some laboratories may be closed down, waiting for another outbreak before reconsideration. Nigerian medical laboratory testing of COVID-19 has indeed moved from grass to grace, with a hope of maintaining and improving upon the levels attained concerning testing capacity and infrastructure in the containment of the pandemic.
