Ebola in Nigeria: should we be worried?
Prologue
We are putting up this post as a result of increasing demand for
information on this disease. As of today, the 7th of August 2014 there
have been
9 cases (2 probable, 7 suspect)
on Ebola Virus Disease in Nigeria and 2 deaths. All nine cases have
been known primary contacts of the index case in Nigeria; Mr Sawyer. At
this point therefore, as far as we know, while there has been
transmission in Nigeria, it is limited to contacts of the primary case.
There is no confirmed community transmission i.e. further transmission
from any of the currently infected cases.
This is significant because the rest of this post has to be
interpreted in this context. If community transmission occurs –it
changes the scenario significantly. However, given that the contacts of
each case will need to be under close observation, and using a
conservative estimate of 3 contacts for each case, there will be over
100 people under close observation at the moment. If any of them
develops symptoms, this will change the picture dramatically.
My name is Chikwe Ihekweazu – I am an infectious disease
epidemiologist and have worked on several WHO outbreak responses across
the continent including an
Ebola outbreak in South Sudan in 2004. I have included this information in order to contextualize the information below.
Having said this, we are in the middle of the largest Ebola outbreak
ever; showing that the virus is adapting fast to the environment and
causing more harm. At the same time medical science is making rapid
advances so, as much as I may have some understanding of the issues at
hand, knowledge is expanding rapidly and this post may rapidly become
out of date.
We will frame the post in line with the questions we have been asked recently.
1. Should we be worried?
We should be worried enough to inform ourselves appropriately but we
must not panic. The people most at risk at the moment are healthcare
workers and family members caring for ill patients that may have been
exposed to the index case, or caring for other returned patients from
Sierra Leone, Liberia or Guinea. Specific efforts are going at the
moment targeting these two groups. They must follow the infection
control guidelines that I presume have been issued to them
“religiously”. If you do not fall into any of these categories, please
keep yourself informed of the general picture, take normal precautions
and go about daily life. If you are caring for anyone with fever, body
aches etc, please continue to care for the patient with compassion. The
most important question to ask is if there has been contact with any of
the nine known cases or a recent travel history to the 3 most affected
countries; Guinea, Liberia or Sierra Leone. If this is the case, please
call the helpline 0800ebolahelp. Remember to continue taking precautions
against other communicable diseases; use a bed net against malaria,
condoms to prevent STIs and HIV, boil your water – a cholera outbreak is
going on in Plateau State, and if you are coughing for more than 2
weeks, see your doctor; TB killed approximately 27,000 people in Nigeria
last year.
2. Where can you get information on the disease?
An excellent website has been put up –
http://www.ebolaalert.org/.
This was initiated by the Lagos state government with its partners. The
information contained there is accurate and informative. The website
could have benefitted with some audiovisuals – find
here and
here links
to two good podcasts in pidgin English by Ruona Meyer. Another aspect
missing on the website is information for health care workers, here the
CDC manual will be useful to some extent.
3. How is the virus spread?
The virus is spread by contact with body fluids (blood, sweat, semen,
saliva) of an infected and sick person. There is no evidence that it can
be spread by air, water, or vectors such as mosquitoes or flies. People
who are well cannot transmit Ebola. So, it is actually not an easily
transmissible virus and proper adherence to infection control principles
will protect most people from getting the virus. Next time you visit
your doctor or nurse and he/she tries to give you an injection without
gloves on – insist on their wearing gloves and report him/her to the
appropriate medical/nursing council, and change your care provider. No
ifs, no buts. The most important thing now is to break the chain of
transmission – the first patient in Nigeria infected 8 others, if we
continue at that rate of transmission – we are in big trouble. We must
ensure that these nine do not infect any more, and the main way to do
this is through effective and consistent implementation of infection
control measures.
4. Should we stop eating meat?
The “jump” of the virus from an animal host (we still do not know the
host animal(s) for sure) to humans is an extremely rare event. Once this
happens, the most likely subsequent source of infection is
human-to-human transmission. Heating kills the virus so all cooked meat
is safe; yes, including suya. The most important risk at the moment is
from humans infected with the virus and not animals!
5. Can prayer cure the virus?
No – God has given us brains – He expects us to use them.
6. Is Government doing enough to contain the disease?
They are doing the best they can, given the circumstances. A lot of
support is now being received from the World Health Organisation, the US
Centres for Disease Control and other partners. There are many
Nigerians and International colleagues working for these organisations
that are rapidly scaling up the response. Could we have been better
prepared? Maybe – but this is not the appropriate time to discuss this.
We must all rally around the incredibly brave colleagues that are on the
frontline of the response now.
7. Is the strike by doctors having an impact on the level preparedness of the clinical response?
Yes – obviously. It is a tragedy for the country that doctors and the
government have not found a resolution to their differences during this
trying period for the county. Our patients need us the most now.
Whatever the issues are, I appeal to my colleagues to suspend the strike
and rise to the challenge of today. Our patients need us not only to
provide clinical care but to restore confidence in the ethos of our
profession. In no other country would the index patient have been taken
to a private hospital for care as was the case in Nigeria with Mr.
Sawyer. Nigerians need us, now more than ever.
8. Who is actually leading the Nigerian response?
The response is being led by the Nigerian Centre for Disease Control, a
directorate under the Department of Public Health of the Federal
Ministry of Health. As Nigeria is a Federal Republic, the states also
have a leading role to play. The responsibilities for the provision of
care are poorly delineated by the Nigerian constitution. A National
Health Bill that will solve this has been pending between the National
Assembly and the president for over eight years.
9. Why are African patients not being given the experimental medicines being used on the two American survivors?
First, every country has the option of developing its own scientific
capacity in drug development, therefore they can use these drugs as they
deem fit. We could ask what new compounds have been developed by the
Nigerian Institute for Medical Research (NIMR) and the Nigerian
Institute for Pharmaceutical Research (NIPRD) since their inception, but
again, that is a question for another day.
Secondly there are very difficult ethical issues around using
experimental treatments. Many Nigerians will remember the consequences
of the use of an unlicensed medicine during a meningitis outbreak in
Kano by Pfizer in 1996. Discussions are going on at the moment, led by
WHO on how access to these experimental medicines can be scaled up, but
it will not happen overnight as we still do not know for sure that they
made a difference for the two Americans. Remember 10 – 40% of all those
infected will survive.
10. What is your most important advice?
Do not panic. Dealing with the outbreak itself is hard enough; dealing
with panicking public will be disastrous. The outbreak can be contained
by doing “simple” things diligently and consequently.
If you think that someone you know may be infected call 0800Ebolahelp.
We hope this helps, feel free to share.
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