Making history by eradicating Ebola

Kenneth Okpomo
(Spring 2016)

 

A medical worker burns any possible Ebola-carrying material
DFID – UK Department for International Development

“Funerals have become one of the most common social events in Africa in the late 1990s. Elderly parents are burying their sons and daughters…Workers are burying their bosses or their colleagues…” noted Elizabeth Pisani, an HIV and AIDs consultant, nearly fifteen years ago.1

But with the new highly contagious virulent Ebola virus ravaging West Africa, the mortality rates have been unequalled and unprecedented in human history.

While HIV-AIDs victims stood better chances of survival, the chances of surviving Ebola have remained slim owing to a lack of skilled health workers, vital infrastructure, and resources. The Ebola plague has continued to claim the lives of thousands, including health workers, care-givers and other vital support persons. Even burying the corpses of victims in West Africa proved to be difficult, as traditional burial practices were identified as a major source of mass infection. Even the relatives of Ebola orphans in Guinea, Liberia, and Sierra Leone became too scared to take them into their homes for fear of being infected.

Given these realities, the manner in which Nigeria curtailed the spread of the virus cannot be overemphasized. In less than twelve weeks the country completely eradicated the virus from its shores, a spectacular success story laden with key lessons for future containment efforts.

The deadly incursion of the Ebola virus into Nigeria began with the acutely ill forty-year-old Liberian-American Patrick Sawyer importing the virus into the country. He had flown in from Monrovia (with a flight stopover in Lome, Togo) to Accra, Ghana, from where he boarded another flight to Lagos, Nigeria. On July 20, 2014, he collapsed on arriving at the Murtala Muhammed International Airport in Lagos.

Sawyer had petitioned the Liberian Finance Ministry and was allowed to attend the upcoming Economic Community Of West African States conference in Calabar as ambassador. Later the Liberian government would apologize for the lack of communication between offices and for not listing Sawyer’s name at the airport, as he had informed the management of ArcelorMittal about his exposure to Ebola, for which he was granted twenty-eight days leave of absence.2

Transported to the First Consultants Medical Centre, he was attended by a team of health workers led by consultant physician Dr. Stella Ameyo Adadevoh. He had fever, vomiting, diarrhea, and died five days later, on July 25. His disease was not diagnosed for three days, during which time he infected eleven staff members of First Consultants, including Dr. Adadevoh, having already exposed to the virus tens of people at the airport. The 58-year old Dr. Adadevoh tested positive for Ebola on August 4 and died on August 19.

Dr. Adadevoh had vehemently turned down a request by Sawyer’s employers to have him discharged so he could catch a flight to Calabar, a coastal city where he had been due to attend a conference.3 Had Dr. Adadevoh buckled under pressure to discharge Sawyer, the virus would have spread in Lagos to its dense population of more than seventeen million as well to Calabar.

Sawyer had shown bad faith by concealing his exposure to Ebola when questioned by Dr. Adadevoh. He denied being exposed to Ebola in his native Liberia even though he was caring for his Ebola-stricken sister, said to have died two weeks or so before his arrival in Nigeria.

However Dr. Adadevoh quarantined him and alerted the public health authorities. A specimen of Sawyer’s blood tested positive for acute Ebola. Dr. Adadevoh made sure that Ebola protective and educational materials were made available to the hospital staff. It is obvious that the medical center (and the entire Nigerian health system) had been caught unawares and in a state of unpreparedness in the wake of the deadliest Ebola outbreak ever.

Nonetheless the national and state public health authorities swiftly intervened. A rapid multi-sectoral response utilized all available public health assets. The Federal Ministry of Health, with guidance from the Center for Disease Control in Nigeria, immediately declared an Ebola public health emergency. In this battle against Ebola, Nigeria heavily depended on its public health system – incorporating a national public health institute, an Emergency Operations Center (EOC) and Incident Management System (IMS) – created in 2012 after a national health emergency on polio.

Port Health Services carried out early contact tracing at the airport, working with the airlines to ensure that the outbreak was pronounced in accordance with the International Health Regulations (IHR) 2005. The inaugurated EOC case management team then began to manage each lab-confirmed or suspected case. Potential Ebola patients were triaged and areas inhabited or in contact with them were disinfected and decontaminated. The Ebola patients and suspected patients were isolated at the case ward in the Ebola Treatment Facilities set up in Lagos and later in Port Harcourt.

A contact tracing team comprised of skilled epidemiologists was constituted and tasked with probing all primary contacts. They were to alert the case management teams of symptomatic contacts for assessment and possible classification. The role of the Lagos State University Teaching Hospital (LUTH) in undertaking in-country Ebola diagnosis needs to be acknowledged. Their effort facilitated the quick identification of confirmed cases and discharge of negative testing patients. The contact tracing team also applied to the letter the standard twenty-one-day follow up of every released patient.

Nigeria strongly applied rapid preventive measures, including isolating the First Consultants Medical Center, distributing protective gears to health workers, and screening passengers arriving from countries with widespread Ebola transmission at the various port of entry. Useful information about the Ebola virus and its mode of transmission was disseminated through radio, television, and GSM phone platforms..

Locals were advised not to touch monkeys, gorillas, and bats, known vectors of the disease, and to not to eat bush meat for the time being. Frequent use of hand sanitizers and cleansing gels was promoted. Banks and other public places had to station trained personnel with hand-held screening devices at the entry points to screen customers and visitors.

In summing up the entire Ebola episode in Nigeria, the Center for Disease Control and Prevention noted that the index patient died on July 25. As of September 24 there were nineteen laboratory-confirmed Ebola cases and one probable case in two states, with 894 contacts identified and followed during the response. Eleven laboratory confirmed Ebola patients were discharged, an additional patient at convalescent stage, and eight patients died and no new cases occurred after August 31.4 Director Tom Frieden of the Center of Disease Control in the United States, noted that Nigeria’s extensive response to a single case of Ebola shows that control is possible with rapid focused intervention.5 On October 20, 2014 the World Health Organization declared Nigeria free of Ebola.

 

References

  1. Elizabeth Pisani, “Health Warning”, BBC FOCUS ON AFRICA, Africa 2000 edition, p. 58
  2. Wikipedia, “Patrick Sawyer, http://en.wikipedia.org/wiki/Patrick_Sawyer
  3. Tolu Ogunlesi, “Dr Stella Ameyo Adadevoh: Ebola victim and everyday hero”, 20 October 2014, http://www.theguardian.com/lifeandstyle/womens-blog/2014/oct/20/dr-stella-ameyo-adadevoh-ebola-doctor-nigeria-hero
  4. Center for Disease Control and Prevention, “Ebola Disease Outbreak – July – September, 2014, October 3, 2014, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm
  5. Hugo Odiogor, “US Sends Medical Experts to Nigeria to Learn How to Contain Ebola”, Vanguard, October 2, 2014, http://www.vanguardngr.com/2014/10/us-sends-medical-experts-study-nigeria-tamed-ebola/

 


 

KENNETH OKPOMO

 

Highlighted in Frontispiece Spring 2016 – Volume 8, Issue 2

Hektorama  | Infectious Disease