Last week, Ebola Virus Disease (EVD) claimed its first victim in Nigeria, though he was a foreigner. Patrick Sawyer, 40, a Liberian, died five days after his arrival from Monrovia. His death has sparked fear of the deadly virus emergence in the country. Can the government curb its spread? WALE ADEPOJU asks.
It was a testy week for Nigerians. Barely hours after the reported arrival of an Ebola victim in the country, he was confirmed dead.
The death of the 40-year-old Liberian, Patrick Sawyer, sparked fear that the disease is now in the country.
The late Sawyer flew into the country from Monrovia, Liberia, aboard Asky Airline through Lome, Togo.
On arrival at the Murtala Muhammed International Airport, Ikeja, Lagos, the late Sawyer was reportedly found ill. He had fever, diarrhoea and was vomiting.
He was handed over by the airline to the Airport Health Services of the Federal Ministry of Health, which quarantined and transported him straight to a private hospital to avoid contact with the public.
Experts from the Federal Ministry of Health (FMoH) and Lagos State Ministry of Health swung into action and collected some samples from him to determine the cause of his illness.
The result was shocking. The Lagos State government called reporters to brief them.
His blood sample was sent to Dakar, Senegal and Atlanta, Georgia, United States, to ascertain the real cause of his ailment.
Despite the urgent specialised care provided for him, he died last Friday morning.
Report from Monrovia, indicated that Sawyer was the second member of his family to die of Ebola virus in three weeks.
Health authorities in that country are now investigating the degree of contact between them.
Liberia’s Finance Minister Amara Konneh said the deceased was until his death a consultant at the country’s finance ministry.
The patient’s remains, according to report, were cremated to prevent further spread of the disease.
Minister of Health Prof Onyebuchi Chukwu said Sawyer was subjected to a thorough medical evaluation.
Speaking in Abuja, Chukwu confirmed that the deceased’s blood samples were sent to an advanced laboratory at the Lagos University Teaching Hospital (LUTH), the World Health Organisation (WHO) Reference Laboratory in Dakar, Senegal and Centre for Disease Control (CDC) Laboratory in Atlanta, Georgia, which confirmed the diagnosis of Ebola Virus Disease (EVD).
To contain the spread of the virus, Chukwu said certain measures had been taken by his ministry.
They are: tracing and investigating the passengers on board with the patient; placing all ports of entry under red alert in line with WHO regulations; equipping all government tertiary health institutions in Nigeria to handle any emergency that may arise from the disease and providing supportive drugs and medical consumables at all entry points and stepping up collaboration with all the states of the federation.
He said: “I want to assure the public that the Federal Ministry of Health (FMoH) is presently working with other ministries, agencies and international organisations and the Lagos State Government to prevent the possible spread of the virus.
‘‘Emergency operation centres have been established and coordinated by the Nigeria Centre for Disease Control (NCDC) of my ministry in collaboration with an Inter-ministerial Committee set up by Mr President”.
The committee, according to him, is headed by the Minister of Information, Mr. Labaran Maku. It was set up to stimulate sensitisation of the public on the danger and preventive measures of EVD.
Hot lines have also been opened to enquiries and complaints on EVD cases.
The minister said the following numbers had been opened to reach the centre: 08023210923, 08097979595 and 07067352220 with an email: ebolainfo@health.gov.ng.
He urged Nigerians to be vigilant and ensure improved personal and environmental hygiene, adding that they should report any suspected case to the nearest medical facility.
Besides, needed measure to control the possible spread of the virus has been taken care of by the ministry.
Chukwu said Nigerians should be calm as there is no cause for alarm.
Maku said jingles and other awareness programmes have been provided by his committee to help raise awareness in the media (conventional and social).
He appealed to the media to support government’s effort in curbing the spread of the virus by airing the jingles and other programmes free.
“This is a national emergency and so, I expect no demand for payment from any media to air the jingles and programmes prepared by the centre and Presidential committee on Ebola virus,” Maku said.
What is Ebola virus?
Is EVD, which has killed no fewer than 650 persons in West Africa, in Nigeria?
EVD is a “very” deadly disease. It is also known as Ebola haemorrhagic fever (EHF). It has a 90 per cent fatality rate.
It is one of the world’s most virulent diseases. Its virus is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people.
In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
The first case was recorded in Guinea. Liberia and Sierra Leone have since recorded casualties.
Nigeria is vulnerable to an outbreak, yet it is shocking that the government is neither proactive nor aggressive in preventing an occurrence. I should there be an outbreak, Nigeria does not have a laboratory that can diagnose Ebola. Samples have to be sent to countries, such as Senegal and the United States.
President, Academy of Science, Prof Oyewale Tomori, said the Nigeria Academy of Science has observed that precautionary measures, such as effective laboratory diagnosis, strict barrier attention, public health education and awareness, as well as domestic airport monitoring of travellers, and other important actions to contain Ebola virus, are yet to be put in place.
Responding to WHO’s warning to strengthen response mechanism, Prof Tomori, said: “If these things are not already in place by now, we are in trouble, should the disease enter the country today, especially if the Nigeria Medical Association (NMA) strike continues.
Tomori said the country is not yet prepared to handle an Ebola outbreak.
He said: “One area we have neglected is our border. The Port Health team should have been up and doing, monitoring travellers from other West African countries, especially from Liberia, Sierra Leone and Guinea, checking them for fever on arrival, their travel history, among others.
“The team must have the contact phones and addresses of such travelers. They should be monitored over a period of two weeks or more to check if they fall sick or display any sign of the EVD. Yet containing Ebola is simple, good surveillance before an outbreak to rapidly identify cases is the first step; while strict adherence to infection control within the hospital environment and avoiding direct contact with body fluids of an infected person, and with the body of an Ebola victim who has died are important.”
Prof Tomori added: “Healthcare workers must be able to recognise cases of the disease when they appear.
“They should use barrier isolation techniques to avoid direct contact with infected people”.
He said Nigeria does not have a laboratory that can diagnose Ebola, describing it as ‘the greatest shame of all’.
“Besides, if we have any case in Nigeria now, the samples will have to be taken to the Centre for Disease Control (CDC), in the United States or other advanced countries; that is why a lot of health workers are getting infected.
“There are no vaccines and there are no drugs to treat it. The drugs available are just to treat the symptoms unlike Lassa fever that one can administer drugs,” he said, adding that severely ill patients require intensive supportive care”.
During an outbreak, those at higher risk of infection are health workers, family members and others in close contact with sick people and deceased patients.
EVD outbreak can devastate families and communities, but the infection can be controlled through the use of recommended protective measures in clinics and hospitals, at community gatherings, or at home.
According to WHO, Ebola is an often fatal illness in humans characterised by the sudden outset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
To contain an outbreak requires a strong response in the affected countries and especially along their shared border areas.
Recently, the WHO organised a high-level meeting for the Ministers of Health in the sub-region in Accra, Ghana.
It brought together Ministers of Health and the Directors of disease prevention and control from 11 African countries (Côte d’Ivoire, Democratic Republic of the Congo, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Senegal, Sierra Leone, and Uganda), as well as partners, Ebola survivors, representatives of airlines and mining companies, and the donor communities. The objective of the meeting was to analyse the situation, identify gaps, develop operational response plans, and ensure increased political commitment and enhanced cross-border collaboration for EVD response activities among the countries in the sub-region.
Ebola spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other body fluids of infected people, and indirect contact with environments contaminated with such fluids. If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.
It is not always possible to identify patients with EVD early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, and the use of personal protective equipment. WHO is not recommending any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone based on the current information available for this event.
Consultant Public Physician, LUTH, Dr Sofela Oridota, said three factors that can predispose people to diseases are the agent, host and environment.
He said: “Nigerians need to be educated that when they travel to those places where Ebola virus outbreaks were reported they should not touch any dead person, should they be involved in burial at all. And they should not touch dead bats or dead wild animals. If they are not exposed to some of the infected sources mentioned they would not contract the disease”.
Dr Oridota said the Centre for Disease Control (CDC) and WHO have equally developed a manual for viral haemorrhagic fevers known as universal precaution manual, to protect health workers from contacting the virus, which any country can adapt.
His words: “People who have been to the sites where there were outbreaks have a high risk and as such should be identified and properly screened. This is known as contact tracing because they have a history of contact in the place they visited.”
The community health expert said: “About 70 per cent of deaths are caused by ignorance and poverty. The government should increase surveillance to track the disease. There are other epidemics growing in the society from lifestyle diseases. These outbreaks depend on people’s hygiene level and lifestyle.”
Dr Oridota said the spread of an outbreak can be contained by ensuring that those who have the Ebola virus are “barrier north” or secluded to avoid direct contact with them.”
The public health expert said: “People can incubate Ebola from three to 21 days and still look okay. The government should create awareness for people not to touch dead bodies, dead animals or eat leftovers of fruits eaten by bats.
The region, Oridota said, should ensure that there is “contact tracing” to stop the spread of the disease, saying those who have had contact with the cases of Ebola virus and who have not used universal precaution should be screened. Health workers should have a high index of suspicion when patients come to their facility and not assume that it is malaria a patient is suffering from. The government should also plan ahead. We should have a response system to track the virus in place. Experts cannot go and investigate Ebola without having a system in place, especially universal precaution materials. Hygiene and environmental sanitation are crucial to ward off an outbreak of Ebola in West Africa. Moreover, Nigeria and other countries in West Africa have what it takes to contain Ebola disease.
