Ebola: The enemy at your door!

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West Africa is gripped by the worst outbreak of Ebola Virus Disease (EVD)  in history. The deadly virus, which has over 90 percent fatality, could cross borders to more African nations and even Europe. Last week, Nigeria recorded the first ever suspected case of Ebola. What implications does this development portend for Africa’s most populous nation. What lessons do we learn from the outbreak in the sub-region?

By Sola Ogundipe

IS Ebola in Nigeria? Are Nigerians at risk of transmission the incurable disorder? No one could provide a definite answer to this question on Friday after the confirmation of the suspected case by the Nigeria Centre for Disease Control, NCDC, Abuja, and the Lagos State Ministry of Health the previous day.

- A file photo taken on June 25, 2014 shows the isolation ward at the Donka Hospital in Conakry where people infected with the Ebola virus are being treated. A regional centre is being set up in Guinea to coordinate the response to the worst-ever outbreak of Ebola that has killed hundreds of people in West Africa, the World Health Organisation said on July 11, 2014. The haemorrhagic fever sweeping through Guinea, Liberia and Sierra Leone has left an estimated 539 people dead, according to the latest WHO figures.    AFP PHOTO

– A file photo taken on June 25, 2014 shows the isolation ward at the Donka Hospital in Conakry where people infected with the Ebola virus are being treated. AFP PHOTO

Prior to this development, millions of Nigerians did not imagine the seriousness of the threat of the EVD epidemic ravaging the West African sub-region. Currently, the probable risk of transmission of the disease is the newest security threat confronting Nigeria. With the persistent epidemic incursions into the West African sub- region, the threat of possible outbreak in neighboring countries including Nigeria was never in doubt.

Worst outbreak ever
But experts are worried that rather than come under control, the situation seems to have worsened.   “This is the first time we have ever seen an urban as well as rural Ebola outbreak,” noted Laurie Garrett, a Senior Fellow for Global Health at the Council on Foreign Relations. “It is the first time we have seen Ebola in the capital cities. It is the first time we have seen Ebola crossing borders, now in three countries. And it is the first time we are having an Ebola experience in an area rife with the tensions and the hostilities born out of two really brutal civil wars in Sierra Leone and in Liberia, with spillover into neighboring Guinea.

Garrett, who lamented that Ebola has worsened survival, safety and security in Guinea, Liberia and Sierra Leone, where, in the best of times, they are hard-pressed to meet the public health needs of their people, said they are now dealing with   what is officially designated an out-of-control epidemic on their hands.
Caution

In the view of Dr Chikwe Ihekweazu, an Infectious Disease Epidemiologist & Managing Partner, EpiAfric, there is a real need for Nigerians  to be concerned about the Ebola Virus disease threat. “That  but that concern should be directed into holding our government,  and health officials accountable.  For now, let’s hope that it does not spread to Nigeria,  because if it does, it will really test our health systems, especially now that doctors are on strike.

“If it does spread to Nigeria, then we will all be at  the mercy of the response mechanism and we can only hope that they are prepared. If we are not, it will expose our incompetence in a way that has not been done before. There is no easy way to say it. We just hope there is no out break, if there is it will be really bad. An Ebola outbreak at this period would be dangerous  for the country,” he cautioned.

First indication
EVD not only brings about a general fearfulness from the population, but also elicits widespread crazy rumours that are making the problem more difficult to contend with. In Nigeria, the first indication of Ebola trouble came through a red alert issued by the NCDC to all Port Health Services staff nationwide after the suspected case, in a 40-year old Liberian, was picked arrived the country through Murtala Mohammed International Airport, Lagos on Sunday, July 20, 2014.

Vigilance all around
Port staff were urged to be extra vigilant, and report on suspected cases while taking into consideration necessary aseptic techniques in handling such cases and to institute the necessary actions to the border communities. But all that appears to be cold comfort.

Earlier in March 2014, on the heels of the outbreak of  in Guinea, the Federal Ministry of Health issued alert urging persons with high fever, headache, severe abdominal pain, diarrhoea and bleeding and especially with a history of travel to Guinea, Sierra Leone or Liberia, to report to the health authorities at once. All 36 State Commissioners of Health were put on alert to mobilise against the disease, while the Federal Ministry of Health collaborated closely with the West African Health Organisation, WAHO, and the World Health Organisation, WHO, to deploy experts to affected countries to strengthen   response capacity.

Findings by Sunday Vanguard show as far as the average Nigerian is concerned, a confirmation of suspected Ebola Virus Disease in Lagos is alarming, while   a positive confirmation would be catastrophic. Such fears are well founded. The   latest Ebola outbreak in West Africa is now the largest and deadliest outbreak ever.

Unlike outbreaks of the past, it is affecting both rural and urban areas. In the affected West African sub-region, already a heavy-duty malaria area, millions of people are walking around with high fevers and other kinds of symptoms that could confuse diagnosis of Ebola. Worse still, the West African sub-region is known for Lassa fever, another terrible, viral disorder carried by rats.

Anxiety
Now health workers are having difficulty in making a proper diagnosis even in the affected countries. Reports from Sierra Leone, Liberia, and Guinea, reflect the plight of people being turned away from hospitals for routine care simply because they have a fever or simply because they seem dizzy and a little out of it, as, of course, would be a symptom of malaria. Already widespread fear and rage is building in the populations against the health care systems, because the system is afraid to take the contaminated patients into the facilities.

All health workers are under attack. Even the Red Cross has abandoned parts of Guinea because their workers are being physically attacked ,Medecins Sans Frontieres, the Doctors Without Borders, In the sub-region, Médecins Sans Frontières which has intervened in almost all reported Ebola outbreaks in recent years, are also under violent attack. They confessed it is facing an unprecedented epidemic of a magnitude never before seen in terms of the distribution of cases.

Nigeria up to task – Nasidi
Nevertheless, Project Director of the NCDC, Professor Abdulsalam Nasidi, affirms that the country’s response mechanism is up to the task. Nasidi, who had long admitted that Nigeria is at risk noted: “We are at alert. We are prepared in terms of diagnosis, isolation rooms in health facilities,” he assured even in the face of growing speculations that the nation may not be truly ready in terms of the most important steps.

“Nigeria has capacity to diagnose the disease if it appears here. We are studying the outbreak trends and have mobilised rapid response teams in addition to developing a detailed response plan that includes a comprehensive health education/health promotion to sensitise Nigerians, enhanced surveillance to detect and treat the disease.”

Gaps in preparedness
But doubts about the level of preparedness persist. For instance, a visit to the website of the FMOH does not provide cogent information on the Ebola Virus disease. Prior to the confirmation of the suspected case, most Nigerians had been at a loss as to who is leading the preparedness against the threat in the country. Who is communicating with health professionals and the general public? Who is to be held accountable, many kept asking? In other countries like Mali, Ghana and Cameroun, health officials have routinely investigated possible infection cases.

Alert in West Africa
Since March 2014 at the onset of the outbreak of in Guinea, Sierra Leone and Liberia, Nigeria and neighbouring West African countries have been on the alert. Also in the affected countries, anxiety is at fever pitch. People have generally stopped sharing personal items such as towels, toothbrushes, cups, cutlery and hankies. The tendency to indulge in shaking of hands, hugging, kissing or even having sex has also reduced significantly.

Public gatherings involving large crowds have more or less disappeared. Healthcare providers have become reluctant to attend to patients with symptoms of fever and other suspected signs of illness. Everybody goes about wearing hand gloves, wary about touching anything that might serve as a model of transmission of the deadly virus. The practice of killing and consuming fruit bats and other suspect delicacies has declined drastically.

Around the same period, Executive Director of Liberia’s Environmental Protection Agency, EPA, had warned Liberians to desist from consumption of bush meat. In a terse statement, the health official highlighted the connection between the Mano River countries and danger of the bush meat trade to lives of animals and humans in the region. Such has been the magnitude of the threat of the disorder which kills nine out of 10 victims.

Why Ebola is spreading
Theoretically, anyone that is ill with a travel history of traveling to or from Liberia, Sierra Leone or Guinea, is suspect. Sunday Vanguard investigations reveal there are two theories from the medical community about how and why Ebola has spread to so many different countries and to the urban areas. The first concerns the habitat.

The unique nature of the problem is linked to the West African rain forest swathe that cuts across all three affected countries. The swathe is inhabited by the Fruit bats that normally carry the Ebola virus. The argument is that the bats are believed to be coming in proximity with monkeys or other animals that humans secondarily come in contact with in order to become infected.

The second theory is tied to the porosity of the borders between the three countries. A visit to these borders reveals the disdain for etiquette and lack of respect for immigration laws at the boundaries. A similar situation is replicated at the Seme and Idi-Iroko borders where people of all kinds of ethnic groups cross unimpeded from one country to the other.

There are no visible certified screening or containment procedures for possible bearers of the communicable diseases such as Ebola Virus who might have travelled down from the neighbouring affected countries. The chaotic nature of the posts adds to the feeling of vulnerability of Nigeria.

At the Murtala Mohammed International Airport, Lagos, the scenario is a noticeably better. Security officials screen every traveler arriving at all times of the day. Passports are carefully checked and travelers who may have visited Guinea, Liberia and Sierra Leone in the recent past are invited for questioning and further screening.

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