The lockdown of cities and countries due to the coronavirus pandemic impacted every aspect of society, and the healthcare system was not exempted.

The lockdown and quarantine that followed this global disease took a toll on the mental health of the populace. The psychologic and psychiatric disturbances include anxiety, post-traumatic stress disorder, stigmatization, depression, panic attacks, and behavioural changes.

From our analysis, only 32% of respondents observed the lockdown fully 24% said they did not while 44%% said they observed the lockdown partially.

The effects the coronavirus pandemic has had on Africa’s largest economy are starting to show in data. The Nigerian Bureau of Statistics showed that Nigeria’s economy contracted by 6.1% year on year in the second quarter of this year. The dip follows thirteen quarters of positive but low growth rates. The −6.1% decline is also Nigeria’s steepest in the last 10 years.⁷

The COVID-19 pandemic has had far-reaching consequences beyond the spread of the disease itself and efforts to quarantine it, including political, cultural, and social implications, including world peace, education, religion and social issues such as domestic violence and inequality.

The virus has also had an unprecedented impact on the environment. Some studies estimated a positive indirect impact on the environment. Climate experts anticipated that greenhouse gas (GHG) emissions could drop so low to proportions never before seen since World War II.¹⁰ This result is mostly due to the social distancing policies directed by the governments due to the onset of the pandemic.

An analysis of 22 hospitals in France showed a decrease in all emergency department visits by 26 percent, including a decrease in strokes, transitory ischemic attacks, unstable angina, appendicitis, and seizures.¹¹ These events are unlikely to have reduced within the population, which leaves the authors with the conclusion that these events are occurring with no emergency medical intervention.

Other health challenges besides COVID-19 require treatment even in the wake of the pandemic. One such disease that requires ongoing treatment, follow-up and procedures is cancer. In a study published in Target Oncology, it was concluded that contracting the COVID-19 infection along with the breakdown of healthcare, and the economic crisis, will have an unprecedented impact on cancer patients worldwide.¹²

From our study, 41% of people got sick during this lockdown, 29% had relatives and loved ones who died due to Covid-19 and 64% of the people they know died during this period due to both Covid-19 and other causes. 31% of people self-medicated, and 42% of people called their doctors. This showed there were reduced hospital visits (walk-in) from non-communicable diseases during the lockdown.

A recent report from the group that has worked on COVID-19 models at Imperial College London has shown that if all malaria-control activities are highly disrupted, the malaria burden for 2020 could more than double that of 2019, resulting in large malaria epidemics across Africa.¹³ The prevalence of non-communicable diseases during the pandemic was 39.9% as against 29%.¹³

The closure or slowdown in normal clinical services further aggravated the underlying conditions of patients, leading to more severe cases of non-communicable diseases. The highly contagious measles cases continued to increase in Nigeria (Cases in December 2020 were 9,316 compared to 2,064 confirmed cases in November 2019.⁵

A paper published in the Lancet has modelled three scenarios in which coverage of basic life-saving interventions for maternal and child health is reduced for different durations as a result of a combination of factors including reduction in demand for health services, availability of supplies and equipment, as well as health workers.

These early estimates show a worrying 9.8 percent to 44.7 percent increase in under-five child deaths per month and an 8.3 percent to 38.6 percent increase in maternal deaths per month.¹⁴ Presently, due to the restrictions on movement and lockdown, commuting to the healthcare facilities when children are sick might be delayed.

One of the routine health services that is being disrupted by COVID-19 is childhood immunization. According to the World Health Organization, an estimated 80 million children in 68 countries are at risk of developing vaccine-preventable diseases such as measles, diphtheria, and polio, because of the disruption of routine immunization services.¹⁵

There was also a decrease in the utilization of services. Immunization was adversely affected by the coming of COVID-19 with a decline in several fully immunized children. Comparing the pentavalent performance in 2019 with that of 2020, it shows a decline in performance especially in the COVID-19 months. ¹⁵

Another study reported widespread fear, of getting turned away from hospitals, delays in infant immunization, missed immunization opportunities and increasing recourse to traditional treatments as the pandemic spread in Nigeria. There has also been a perceived low quality of care among patients during this period.⁷

Increase in endemic diseases because of the focus on the pandemic, many clinical activities have either been halted or reduced to curb COVID-19 transmission. The number of antenatal care services performed also dropped and by January 2021, it was 2.9% compared to 56.8% as of 2018 (NDHS); the number of Postnatal care services performed-was 7.7% by January 2021, compared to 67.0% in 2018.⁴

Wang and colleagues investigated the psychological impact of the pandemic, including anxiety, depression, and stress during the initial stage of the outbreak in China.¹⁶ COVID-19 has already been recognized as a cause of direct and indirect psychological and social consequences that might impact mental health not only during the pandemic per se but also in the future.¹⁷ Indeed, the quarantine effects have already been explored during past outbreaks, such as during the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 and Ebola in 2014, indicating that the mental health impact can be broad, massive and long-lasting. Quarantine can be very stressful; period, especially if one is away from loved ones. Among the consequences of quarantine, are acute stress disorders, anxiety, irritability, poor concentration and indecisiveness, deteriorating work performance, post-traumatic stress disorders, high psychological distress, depressive symptoms and insomnia.

The lockdown was particularly oppressive and caused financial insecurity and subsequently depression because merchants were hoarding their wares as a result of fear of not finding goods to buy and sell. And many people lost their jobs, and as expected depression would arise from this severe financial uncertainty. From our study, 35% of respondents had a financial loss The effect on drug addicts was also enormous as they were compelled to stay indoors; so they had withdrawal syndrome since they could not access their illicit drug. It is not surprising that the pandemic and concomitant lockdown are presenting a remarkable increase in psychiatric disorders in health workers and the general public.¹⁷

The researchers suggest that restrictions on movement and fears about COVID-19 transmission might have prevented caregivers from accessing services. In addition to this, the negative impact of the lockdown on the economy has affected the cash reserves of families, rendering them unable to afford healthcare, as the major means of healthcare financing in Nigeria is out-of-pocket payment.

Community participation is essential in the collective response to coronavirus disease 2019 (COVID-19), from compliance with lockdown to the steps that need to be taken as countries ease restrictions, to community support through volunteering. Unfortunately, this has largely not been the case with Nigeria. A large number of people have not cooperated with the guidelines due to a lack of sustenance and livelihood.¹²

Healthcare workers were impacted physically and psychologically; the lockdown does not apply to them as they are essential workers and are indispensable in the battle against coronavirus disease, but quarantine or self-isolation may be necessary. Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment and make difficult decisions involving ethical implications.¹⁵ This breeds frustration. An Italian nurse committed suicide after being traumatized trying to save the lives of those with COVID-19.20 This emphasizes the need for better working conditions for healthcare workers and closer attention to their mental health.

The lockdown has also negatively affected the training of healthcare personnel. Undergraduate medical training particularly in Nigeria has been put on hold as universities closed down. For post-graduate medical training, there have been delays such as postponed examinations and workshops. The West African and National Postgraduate Medical Examinations all failed to be held in April/May 2020. Local and international conferences, trainings, workshops and seminars have been delayed or cancelled altogether, thereby putting a strain on medical training. Hospitals suffered from the decline in other patients. The private healthcare sector witnessed an 80% fall in patient visits, leading to salaries of clinical staff being reduced or frozen, and some staff being furloughed or even laid off.¹⁸

Black people are among the worst affected by the COVID-19 epidemic unlike in the Western countries where the spending is less out-of-pocket. Healthcare in Nigeria is largely financed by out-of-pocket spending.

A persistent and major weakness of the country’s health system is the poor functioning of the health financing building block, which is characterized by low public spending, very high levels of out-pocket spending (one of the highest in the world), high incidence of catastrophic health spending and impoverishment due to spending on healthcare. With the worsening of the economy during the lockdown, the state of health financing in Nigeria is catastrophic indeed. Increased hospital bills due to additional PPE charges and low accessibility of cash during the period of the lockdown further worsened the condition.

The lockdown in Nigeria and its management was a policy decision of the federal government in conjunction with the state governments. The enforcement was however poorly coordinated and sometimes subject to the whims and caprices of the security agencies. Some healthcare workers were at various times and in various places harassed by security agencies on their way to or from work, while some patients were turned away or unduly delayed on their way to access healthcare. From our study, 63% of respondents expected government intervention by giving palliatives, providing security, providing social amenities and if possible, ending the lockdown.

The supply of essential medicines and supplies was threatened by the lockdown. This includes antibiotics, vaccines, consumables like gloves, masks, and resuscitation fluids. This is felt most acutely in developing countries. The COVID-19 pandemic triggered several challenges that have led to shortages and price hikes, and could potentially fuel an epidemic of fake and substandard medicines.¹⁹

The surge in demand and pressure on supply chains has also resulted in severe constraints on the supply of raw materials, especially for N95 masks, surgical masks, and medical gowns, which are the products in highest demand (given their importance for frontline healthcare workers). This has led to a shortage and therefore increase in the costs of PPE.

Ventilators are essential to support lung function, especially for patients with the most severe cases of COVID-19 infection. As the COVID-19 pandemic spread, the demand for ventilators increased worldwide. With limited stock, governments and health systems around the world enlisted the help of various companies to produce medical ventilators. 100 more ventilators were purchased (in addition to the existing 350), although these too, were not enough, considering the growing caseloads.⁴

Maintenance of equipment already owned by healthcare centres was also put on hold or difficult to access. Medical Equipment maintenance in Nigeria took a hit during the pandemic due to restricted local and international travel. The spares and technical know-how for the maintenance of most medical devices, normally scarce in Nigeria were exacerbated by the restrictions of the lockdown.

It is estimated that during the lockdown periods Nigeria’s GDP suffered a 34.1 percent loss due to COVID-19, amounting to USD 16 billion, with two-thirds of the losses coming from the services sector.²⁰ The agriculture sector, which serves as the primary means of livelihood for most Nigerians, suffered a 13.1 percent loss in output (USD 1.2 billion). As with most other economies around the world, the sharp drop in Nigeria’s GDP growth is largely down to the slowdown in economic activity after the country resorted to a lockdown back in April to curb the spread of the virus. In the wake of the pandemic, the World Bank forecast a decline of −3.2% for 2020—a five percentage point drop from its previous projections.²⁰

Furlough and layoff of staff employment. Salaries were slashed. Businesses were closed. The aviation sector suffered losses. Banks closed branches. The service sector was the hardest hit.

However, some sectors saw a boom in sales (Pharmaceuticals, Medical consumables specifically Hand sanitisers, soap and detergents, plastic industries, chemical markets, home delivery services like Amazon). Rice boom (huge sales due to bulk buying).

Emergency Palliatives Committee (EPC) was set up as a COVID relief strategy for the masses, a bailout for businesses and food support for the people.

Nigeria’s economy has also been crippled by external factors such as the near-total shutdown of economic activity around the world during the lockdown. The accompanying steep drop in oil prices amid a drop in global demand left Nigeria drastically short of earnings given its dependence on the commodity as its biggest revenue source. For context, the United States slashed its Nigerian crude oil imports oil by 11.67 million barrels in the first five months of 2020, compared to what it bought in the same period of 2019. In fact, in the second quarter of 2020, local oil production dropped to its lowest since 2016—when Nigeria endured a full year of negative growth.²¹

The latest economic data shows Nigeria’s government continues to fall far short of projections in its Economic Recovery and Growth Plan, created in the aftermath of the 2016 recession. World Bank predicts Africa’s most populous country is set for its worst recession in four decades.

From this study, 22.2% of respondents said there was not enough food available during the lockdown. However, 37% of people gained weight due to inactivity and eating too much, out of boredom, even though 6% of people claimed they lost weight due to lack of food during the lockdown.

22% of respondents said they were spending more during the lockdown .88% of participants believed internet usage increased during this lockdown. 54% of people observed all the infection prevention protocols like the use of hand sanitisers, and face masks, washing hands frequently and maintaining social distancing.

We estimate that households lost on average 33 percent of their incomes during the period, with the heaviest losses occurring for rural non-farming and urban households. This study shows that 23% of respondents said their income/source of income was reduced during this lockdown period and 35% of respondents had a financial loss.

The coronavirus pandemic appears to have worsened conflict dynamics. It has also led to a United Nations Security Council resolution demanding a global ceasefire. On March 23, 2020, United Nations Secretary-General Antonio Guterres issued an appeal for a global ceasefire as part of the United Nations’ response to the COVID-19 coronavirus pandemic and calling for greater international cooperation to address the pandemic.²²

According to data released by UNESCO on 25 March, school and university closures due to COVID-19 were implemented nationwide in 165 countries. Including localized closures, this affects over 1.5 billion students worldwide, accounting for 87% of enrolled learners.30. From this study, 30% of respondents occupied their time with watching television. 52% of respondents thought their kids were missing out on school, even with internet schooling and 39% of respondents felt that their children missing school would hurt them like depression and increase in crime rate.

Churches were forced to close because of the coronavirus. The pandemic impacted religion in various ways, including the cancellation of the worship services of various faiths, as well as the cancellation of pilgrimages surrounding observances and festivals. Many churches, synagogues, mosques, and temples have offered worship through livestream amidst the pandemic. Relief wings of religious organisations have dispatched medical supplies and other aid to affected areas. In the United States, Trump designated 15 March 2020 as a National Day of Prayer for "God’s healing hand to be placed on the people of our Nation".²³

The impact on personal gatherings was strong as medical experts advised, and local authorities often mandated stay-at-home orders to prevent gatherings of any size, not just the larger events that were initially restricted. Such gatherings may be replaced by teleconferencing, or in some cases with unconventional attempts to maintain social distancing with activities such as a balcony sing-along for a concert, or a "birthday parade" for a birthday party.

Many countries have reported an increase in domestic violence and intimate partner violence attributed to lockdowns amid the COVID-19 pandemic. Financial insecurity, stress, and uncertainty have led to increased aggression at home, with abusers able to control large amounts of their victims’ daily lives. United Nations Secretary-General António Guterres has called for a domestic violence "ceasefire". From this study, 45% of respondents said there would be a change in their relationships with their spouses by the time the lockdown is over.

Older people are particularly affected by COVID-19. They need special attention during the COVID-19 crisis. While the number of older persons is relatively and smaller in developing countries, particularly in Africa, this coincides with other serious structural risks. Countries with the fewest older persons have the fewest health resources, limited experience caring for older patients (including few geriatric specialists), less institutional care for older persons, and far fewer public or NGO support structures for outreach, screening and community-based care of older persons.

Older persons living in long-term care facilities, such as nursing homes and rehabilitation centres, are particularly vulnerable to infection and adverse outcomes from COVID-19. Older persons who live alone may face barriers to obtaining accurate information, food, medication, and other essential supplies during quarantine conditions and community outreach is required. Older persons, especially those in isolation, those with cognitive decline, and those who are highly care-dependent, need a continuum of practical and emotional support through informal networks (families), health workers, caregivers, and volunteers.

There are Decreased concentrations of NO2 and PM 2.5. 91% of the world’s population live in places where poor air quality exceeds the permissible limits.²⁴ The consequences of air quality degradation are demonstrated in a significant percentage of global mortality each year. China implemented strict traffic restrictions and self-quarantine measures to control the spread of SARS-CoV2. These actions generated a change in air pollution. Due to quarantine, NO2 was decreased by 22.8 μg/m3 and 12.9 μg/m3 in Wuhan and China, respectively. PM 2.5 fell by 1.4 μg/m3 in Wuhan but decreased by 18.9 μg/m3 in 367 cities.²⁵

Additionally, the Copernicus Atmosphere Monitoring Service (CAMS) of the European Union observed a drop of PM 2.5 last February about the previous three years. In China alone, all of these air quality improvements generated human health benefits that have outnumbered confirmed SARS-CoV2 deaths thus far.²⁶

Additionally, 58% of respondents believed that crime increased during this lockdown period but 52% believed that Road traffic accidents reduced due to the lockdown (even though domestic violence increased). However, 70% of respondents observed that traffic, with its effects reduced during this period of lockdown.

Beaches are one of the most important natural capital assets found in coastal areas. They provide services (land, sand, recreation, and tourism) that are critical to the survival of coastal communities and possess intrinsic values that must be protected from over-exploitation.²⁷ The lack of tourists, as a result of the social distancing measures, has caused a notable change in the appearance of many beaches in the world. For example, beaches like those of Acapulco (Mexico), Barcelona (Spain), or Salinas (Ecuador) now look cleaner and with crystal clear waters.²⁸

Environmental noise is one of the main sources of discomfort for the population and the environment, causing health problems and altering the natural conditions of the ecosystems.

With the enforcement of quarantine measures, the use of private and public transportation has decreased significantly. Also, commercial activities have stopped almost entirely.²⁹ These changes have caused noise levels to drop considerably in most cities in the world. 58% of people believed that crime increased during this lockdown period but 52% believed that Road traffic accidents reduced due to the lockdown (even though domestic violence increased). However, 70% of people observed that traffic, with its effects reduced during this period of lockdown.^30,31

There were also negative impacts on the environment like increased waste. The generation of organic and inorganic waste is indirectly followed by a wide range of environmental issues, such as soil erosion, deforestation, and air, and water pollution.³²

The quarantine policies, established in most countries, have led consumers to increase their demand for online shopping for home delivery.³³ Consequently, organic waste generated by households has increased. Also, food purchased online is shipped packed, so inorganic waste has also increased.³⁴

Medical waste is also on the rise. Hospitals in Wuhan produced an average of 240 metric tons of medical waste per day during the outbreak, compared to their previous average of fewer than 50 tons. In other countries such as the USA, there has been an increase in garbage from personal protective equipment such as masks and gloves.³³

Also, there is a reduction in waste recycling. Recycling is a common and effective way to prevent pollution, save energy, and conserve natural resources. As a result of the pandemic, countries such as the USA have stopped recycling programs in some of their cities, as authorities have been concerned about the risk of COVID-19 spreading in recycling centres. In particularly affected European countries, waste management has been restricted. For example, Italy has prohibited infected residents from sorting their waste.³⁴ Also, the industry has seized the opportunity to repeal disposable bag bans, even though single-use plastic can still harbour viruses and bacteria.³⁵

In Nigeria, the lockdown led to the generation of enormous domestic wastewater and solid waste within the residential areas and along major streets. Wastewater in the form of sewage is seen in gutters, drainage channels, along streets and in open spaces.³⁶ Similarly, hospitals, clinics and medical stores during this pandemic have increased amounts of medical waste and infectious waste.³⁷ Healthcare workers are encouraged to wear. Personal protective equipment (PPE). Medical waste may be carelessly managed in this critical period of the COVID-19 pandemic.¹⁸ COVID-19 and Challenges of Management of Infectious Medical Waste in Nigeria). Some of the waste is disposed of at dumpsites or burnt without compliance with the rules stipulated by the National Environmental Standard and Regulation Enforcement Agency (NESREA).³⁸

In the same vein, during the lockdown, many less privileged families who cannot afford gas or kerosene as cooking fuel have been cutting down trees in the communities for fuel purposes.³⁹ NESREA provided guidelines for handling infectious waste within the context of the pandemic as well as other waste. ⁴⁰

COVID-19 Lockdown has aided the reduction of Air Pollution. A study sought the opinions of 180 residents in the metropolis through the administered questionnaires and found out that 86% agreed that the lockdown has greatly reduced air pollution and greenhouse gas production.⁴¹

Similarly, an assessment of pollution by the National Aeronautics and Space Administration and the European Space Agency showed that the reduced transport activities have led to limited consumption of energy and less oil demand. These changes have had an important impact on the environmental air quality.^42,43

It is essential to mention that although the emissions of some Green House Gases (GHG) have decreased as a result of the pandemic, this reduction could have little impact on the total concentration of GHGs that have accumulated in the atmosphere for decades.⁴⁴ For a significant decline, there should be a long-term structural change in the countries’ economies.⁴⁵ This result can be achieved through the ratification of the environmental commitments made. Furthermore, the decrease in GHG emissions currently observed in some countries is only temporary. Once the pandemic ends, countries will most likely revive their economies, and GHG emissions will skyrocket again.^46,47

Finally, from this study, 71% of people perceived the effect of this lockdown to be negative, with 62% saying they were bored, and 42% being sad. Many of the respondents (35%) had a financial loss and 32% had a negative change in their relationship with their spouse 64% of people were anticipating the end of the lockdown, 27% Of respondents said they would have a mental breakdown if this lockdown happens again. Nevetheless, 73% of people did not support a second/repeat lockdown.