COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolved into a pandemic. On the 27th of February 2020, Nigeria recorded its COVID-19 index case . Following the detection of the index case, the Nigeria Centre for Disease Control (NCDC) and World Health Organization (WHO), responsible for the control of disease outbreaks activated a multi-sectorial National Emergency Operations Centre (EOC) to oversee the country’s response to the pandemic. Subsequently, the Presidential Task Force on the control of COVID-19, initially given a 6-months mandate, was inaugurated on the 17th of March 2020 as the government’s focal point of effort in tackling COVID-19 pandemic  and this was followed by activation of EOCs by all states in the country. Hotspot strategy came into play in August 2020, after the 2-day Mid-Term Retreat organized by the presidential taskforce and the strategy form an important aspect of the detailed roadmap of key initiatives and activities for improving COVID-19 response in Nigeria.
In Oyo state, the index case of COVID-19 was recorded on the 12th of March 2020, with 3761 confirmed cases and 46 deaths at the end of epidemiological week 50 being December 13, 2020. This is about 9 months after recording the index case. As at this period, the State ranked 5th among the contributing State to the nation’s burden of the disease and was responsible for 5.1 and 3.8% respectively of all COVID-19 recorded cases and death in Nigeria . The test positivity rate (TPR) of Oyo State as at that week 502,020 was 13.1% and this was comparatively far higher than the National average of 8.5% for the same period. The case fatality rate (CFR) of the State however was 1.2%, a little below the National average of 1.6% for the same period. The State has been using the platform of the EOC to drive response activities which have since commenced to combat the spread of the disease in Oyo State.
Despite these efforts, the COVID-19 surveillance systems in most LGAs in the State was highly suboptimal which could be indicative of undetected ongoing transmission, while other LGAs have become hotspots for transmission of the virus. A major challenge faced in implementing this strategy was the state inadequate healthcare workforce during the outbreak . Some Countries like New Zealand, Australia, Taiwan, Thailand, investigated by Furuse at al., (2021)  that have conducted testing with great intensity, have been able to maintain low number of COVID-19 cases. It is therefore imperative to strengthen the existing surveillance system by the implementation of the “Hotspot Strategy” put together by WHO in the State to help address existing gaps identified in the system.
The Hotspot strategy is a surveillance initiative conceptualized to identify areas with weak COVID-19 surveillance system, with the purpose of increasing the surveillance sensitivity. The Hotspot strategies involve a beam focus on LGAs where there is high number of cases and community transmission is well entrenched and accelerating in an effort to slow the spread of the virus and protect vulnerable people most at risk through upswing active case search, contact tracing and testing.
This strategy requires the work and effort of all levels of government, working in partnership with NGOs, community networks, volunteers and health workers. It also requires every individual to take responsibility to ensure that they are protecting themselves, and their loved ones and help to slow the spread.
For Oyo State, each hotspot LGA is overseen by a WHO officer, reporting back to the State EOC on plans and progress regularly. Each report focuses on issues including active surveillance, identification of persons of interest, identification of points of entry and screening of travelers, case detection and notification, case investigation, sample collection and testing, case management, identification and institution of isolation and treatment centers, contact tracing and follow-up, risk communication and community engagement, Operationalization of the State Rapid Response Team (RRT), Decentralization of RRTs to LGAs. The strategy included interventions to strengthen surveillance system sensitivity through upswing active case search, contact tracing and testing to slow the spread of the virus and protect vulnerable people most at risk. Here we describe an innovative surveillance strategy implemented in the context of the hot spot strategy and its impact on the community transmission in Oyo State.
The aim of this paper is to evaluate the impact of the hotspot strategy a special innovation in Oyo State at increasing COVID-19 case detection, reporting and investigation in the vulnerable communities.