Nigeria’s Ebola crackdown is an example to the world
The public health crackdown on Ebola in Nigeria, which has been declared free of the virus, serves as a model for the rest of the world.
The outbreak began in Nigeria when a Liberian man, Patrick Sawyer,
who had been to the funeral of his sister who died from Ebola, flew to
Lagos on 20 July, against medical advice. At the departure airport, he
was visibly very ill, according to the World Health Organisation (WHO),
lying on the floor of the departure lounge. “He vomited during the
flight, on arrival and, yet again, in the private car that drove him to a
private hospital. The protocol officer who escorted him later died of
Ebola,” said WHO, but he was treated for malaria because he insisted he
had not had contact with any Ebola patients.
It took three days, during which time nine medical staff nursing him
became infected, of whom four died, before Ebola was diagnosed and he
was placed in isolation. Sawyer died two days later.
But as soon as the virus was confirmed, a massive public health
effort began. Containment has been key to ending every Ebola outbreak in
Africa in the past. Every person who may have been exposed to the virus
has to be found, monitored and isolated if they develop symptoms. Even
though that involved hunting through crowded buildings in streets
without door numbers, Nigerian teams managed to trace everybody who had
been in contact with Sawyer and everybody who had contact with those who
later developed the disease.
In total, 19 people became ill in Nigeria, seven of whom died. It
could have been so much worse in Nigeria’s densely populated cities:
there are 21 million people in Lagos. The US consul general in Nigeria,
Jeffrey Hawkins, said at the time: “The last thing anyone in the world
wants to hear is the two words ‘Ebola’ and ‘Lagos’ in the same
sentence.” That juxtaposition, he added, conjured up images of an
“apocalyptic urban outbreak”.
But Nigeria set up a centralised emergency operations centre, staffed
with many public health experts who work on the polio eradication
effort. It also had a first-class virology laboratory affiliated to the
Lagos University teaching hospital which turned around testing and
diagnoses in 24 hours. Generous government funds were allocated and
quickly disbursed, says WHO. TV broadcasts by movie stars and social
media were used to reassure and inform people. More than 150 people were
sent out to look for contacts of people who had become ill and GPS
systems in place to counter polio were used for tracking Ebola contacts.
It was, said WHO, “world-class epidemiological detective work”.
According to a paper written by some of those involved, in the journal Eurosurveillance, the
list of contacts reached 898 and they were not all in Lagos. A nurse
who became infected travelled more than 310 miles (500km) to Enugu,
finding at least 21 contacts. But the biggest crisis was caused by one
of Sawyer’s contacts, who had been infected, fleeing to the oil capital,
Port Harcourt, where he infected a doctor. That doctor, who died, was
linked to 526 contacts, including many members of his church who carried
out a healing ceremony for him involving the laying on of hands.
In total, the contact tracers made 18,500 face-to-face visits to
check on people for raised temperature, which can indicate the onset of
symptoms, – not easy given the stigma around the disease. Their
persistence – anybody who fled the monitoring teams was tracked down and
returned to medical supervision – and disinfection of premises paid
off.
The authors of the paper say: “No country is immune to the risk of
Ebola virus disease in a globally connected world, but … rapid case
identification and forceful interventions can stop transmission.”
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