Can #Ebola thrive in Nigeria? We trace the history, and progress

by Adedayo Ademuwagun

John got a call last week from his cousin Steven who lives in another part of Lagos. His voice was very urgent that morning.

“I’m having symptoms of Ebola. I think I have Ebola.”

The next day he was well and recuperating in a private hospital. It turned out to be malaria.

The ongoing Ebola epidemic began thousands of miles away in Guinea last December, but few Nigerians panicked about it until the Patrick Sawyer case was discovered in Lagos last month. Since then,  many people in this city and the rest of the country have bothered that the disease would overrun Lagos and pervade Nigeria.

But can this epidemic thrive in Nigeria?

To consider this issue, it is important to look at previous major Ebola outbreaks in history and the contexts in which they occurred, then look at them in comparison to the Nigerian context.

The first outbreak happened in 1976 in Sudan, and in Zaire, now DR Congo.

In August 1976, a man went to a hospital in Yambuku, Zaire because of a fever, and he was given a chloroquine injection.

The next week, he was dead. By the end of the next month, more than half of the hospital staff and about 260 other people were also dead, and the hospital was shut down.

It turned out that the man had Ebola and the syringes and needles used for his injection were not sterilised. So the reuse of these objects on other patients spread the infection, and since no one in the medical field had ever seen this disease before, it took the hospital staff some time to realise that it was contagious by close personal contact. By then, many had caught the virus. But after the hospital was closed, the epidemic did not spread further because of the remoteness of this area in which it occurred.

The next major case occurred in Kikwit, Zaire, and was traced to a man who worked in a forest adjoining the city.

A picture dated May 14, 1995 shows a patient affected by the deadly Ebola virus carried on a stretcher at the Kikwit hospital, 530km southeast of the Congolese capital Kinshasa. The Ebola virus has been identified as the source of an outbreak of hemorrhagic fever in southern Guinea, the west African nation said on March 22, 2014 as the death toll rose to 34. Experts in Guinea had been unable to identify the highly contagious disease, whose symptoms -- diarrhoea, vomiting and bleeding -- were first observed six weeks ago, but scientists in the French city of Lyon confirmed it was Ebola, the Guinean health ministry said. AFP PHOTO/ CHRISTOPHE SIMON
A picture dated May 14, 1995 shows a patient affected by the deadly Ebola virus carried on a stretcher at the Kikwit hospital, 530km southeast of the Congolese capital Kinshasa. The Ebola virus has been identified as the source of an outbreak of hemorrhagic fever in southern Guinea, the west African nation said on March 22, 2014 as the death toll rose to 34. Experts in Guinea had been unable to identify the highly contagious disease, whose symptoms — diarrhoea, vomiting and bleeding — were first observed six weeks ago, but scientists in the French city of Lyon confirmed it was Ebola, the Guinean health ministry said. AFP PHOTO/ CHRISTOPHE SIMON

The man had apparently been exposed to animals who may have been carriers of the virus. He directly infected relatives and the contagion spread in the area and environs, leaving some 250 people dead.

In this case, burial rituals in which relatives of a dead person washed the body facilitated the contagion. Also, the inadvertent transfer of patients from one hospital to three other hospitals further blew the epidemic. Personal contact and the lack of standard protective procedures and equipment were also factors.

More so, there was a lingering  war in the country at the time, so the healthcare infrastructure was broken and unable to cope with the problem.

The next one occurred in Uganda in October 2000 and is the second deadliest Ebola outbreak till date. It lasted three months.

It started sporadically and spread from one town to two others, killing 265 people including health workers. As in Kikwit, corpse-washing and the inadequate use of protective measures by health workers transmitted the virus widely. Efforts to stop the spread of the disease were also inhibited by the reluctance of the communities to turn in their affected relatives for isolation.

However, it could have been worse if not for the international emergency response coordinated by the WHO. Response measures included surveillance, community mobilization, case and logistics management.

The current outbreak  began in the Guinean village of Guéckédou near the borders of Liberia and Sierra Leone. Researchers believe that the first human case leading to this outbreak was a 2-year-old boy who died in December a few days after falling ill. He infected his family, who in turn infected a health worker, and then the virus jumped from there.

It wasn’t until March this year that the contagious disease spreading in Guinea was confirmed to be Ebola. By the end of the month when the Centre for Disease Control and Prevention team arrived in the country to help mount a defensive, it was three months into the epidemic and cases had been reported even in the capital, Conakry. The first few cases were soon reported in neighbouring Liberia, too.

Between April and June, the virus advanced deeply into Sierra Leone and Liberia through the leaky borders, and the statistics continued to climb steadily in the three countries. By July, the number of cases and deaths were in hundreds. Even Sierra Leone and Liberia had overtaken Guinea in terms of casualties. According to the medical charity Doctors Without Borders, the situation was totally out of control.

Then last month, the Patrick Sawyer case was reported in Lagos, sparking global concern about a worsening situation. After Sawyer’s case, there have been two other fatal cases, and a number of people have been placed under surveillance or in isolation.

The two other cases are Justin Ejelonu, a nurse who cared for Sawyer, and Jatto Abdulqudir, an ECOWAS worker who accompanied Sawyer to a meeting.

People who have been on the ground say that public ignorance, sluggish government response and a weak healthcare system have paved the way for the ebola disease to sprawl across the affected countries.

Doctors Without Borders Director-General Christian Captier said, “Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.”

Nigeria is in a more favourable position than the three other countries battling this outbreak, given its relative wealth and relatively better healthcare system. However, some people are sceptical about the situation. Definitely, an outbreak of Ebola in Nigeria is a catastrophe.

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