Is Nigeria prepared for the Ebola virus disease (EVD), which is ravaging Guinea, Liberia and Sierra Leone? No, says the Nigeria Academy of Science (NAS), but things are expected to change following the return of Minister of Health Prof Onyebuchi Chukwu from the World Health Organisation (WHO) retreat in Accra, Ghana, where EVD issues topped the agenda. OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU report.
Experts are worried that Nigeria seems not to be prepared to tackle the Ebola Virus Disease (EVD), which has hit some of its neighbours. EVD is a severe, often fatal illness. It was formerly known as Ebola haemorrhagic fever with a fatality rate of up to 90 per cent. It is one of the world’s most virulent diseases. The infection is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people. Presently, the disease is ravaging the West African coast.
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 susceptible to an outbreak, yet it is shocking that the government is neither proactive nor aggressive in preventing an occurrence. And should there be an outbreak, Nigeria does not have a laboratory that can diagnose Ebola.
According to the President, Academy of Science, Oyewale Tomori, 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 the World Health Organisation’s (WHO) warning to all West African countries about strengthening their response mechanism to the disease, 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 lingers.
Tomori said: “The simple truth is that Nigeria is yet to prepare to handle an Ebola outbreak. Perhaps when the Minister returns from Ghana, we will start preparing. Although the ministry sent out an alert letter on March 24 and followed it with another on June 30 to hospitals and others, not much has been done and the current strike by doctors; will set our preparedness back by decades.
“One area we have neglected is our border. The Port Health team should have been up and doing, monitoring travelers from other West African countries, especially from Liberia, Sierra Leone and Guinea, checking them for fever on arrival, their travel history etc. 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 EDV. 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 said further: “Healthcare workers must be able to recognise cases of the disease when they appear, as well as use barrier isolation techniques to avoid direct contact with infected people. One more thing, Nigeria does not have a laboratory that can diagnose Ebola. This is the greatest shame of all. 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 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”.
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.
Ebola virus disease outbreaks 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 the World Health Organisation (WHO), Ebola disease is an often fatal illness in humans characterised by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
Containment of this outbreak requires a strong response in the affected countries and especially along their shared border areas.
As one of the response elements, WHO organised a high-level meeting for the Ministers of Health in the sub-region scheduled between Wednesday and Thursday, last week in Accra, Ghana.
The meeting brought together Ministers of Health and the Directors of disease prevention and control from 11 African countries (Côte d’Ivoire, the Democratic Republic of the Congo, 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 to 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 bodily 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 EBV 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, Lagos University Teaching Hospital (LUTH), Idi Araba, Dr Sofela Oridola, identified three key factors that can predispose people to diseases: the agent, host and environment.
Dr Oridota 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.
“Health workers should be educated and protected with the right and adequate kits against contacting this disease because. The data of the outbreak in Guinea showed that about 14 health workers had Ebola and eight of them died. When the disease first broke out in 1995 in Congo, a quartre of the carriers were health workers. Health workers should use gloves, goggles and clothing that are normally used as a universal precaution. It is not when it gets to the country that people should start running helter-skelter.”
He said the Centre for Disease Control (CDC) and the World Health Organisation (WHO), has eqully 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.
“People who have been to the sites where there were outbreaks happened 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. Nigerians should embrace personal hygiene such as hand washing with soap and water after contact with filth. Environmental sanitation and positive lifestyle changes are also important,” he stated.
Speaking further on how to handle those infected, Dr Oridota said: “People who are sick should not be admitted with those having the virus because of its highly contagious nature. This is a wake-up call for the Western coastal region to maintain personal hygiene like in the 60s when there was regular environmental sanitation and cleanliness.
“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.”
And should there be suspected cases, 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.”
According to him, health workers and family members of the patients who have Ebola disease should not have direct contact with the suspected body, body fluid and other secretions.
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 having 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.
