The current epidemic of Ebola, which started in March 2014, has reached Lagos, the most populous city in the most populous country in Africa. This is a huge concern. And while Margaret Chan, director-general of the WHO has called for international help for “fragile” West African health systems unable to cope with what it has declared an international public health emergency, it’s clear that the Nigerian authorities could have done much more to prepare for it.

Ebola is spread through contact with fluids of an infected person who is showing symptoms. But the virus has an incubation period of up to 21 days so knowing who is infected is difficult. Patrick Sawyer, the first ever recorded case of Ebola in Nigeria, died after flying in from Liberia and there are now seven other deaths related to his case.

The WHO has stopped short of recommending a general travel ban, but British Airways has cancelled connections to Sierra Leone and Liberia. Does this go far enough?

Ample time

On a recent live radio programme in Zaria, northern Nigeria, last month a caller asked me whether they should be worried about the fact that one Ebola case had been diagnosed in Lagos. I reassured the caller against panic and advised on general precautions that should be taken. But deep inside I knew that, with the way public health emergencies are handled in Nigeria, it would be all too easy for the disease to find its way to other parts of the country and become a national problem. It’s likely to be just a matter of time.

Nigeria had ample time to prepare for Ebola but it did little about this right up until the moment Patrick Sawyer, the first ever recorded case in the country, came to Nigeria and collapsed in a Lagos hospital. This was a man whose sister, with whom he had close contact, had died of Ebola and who had reportedly been under surveillance by Liberian authorities. We’ve been carrying out investigations into the outbreak and it’s likely he knew he had the disease.

It is worrying that the free movement of people within the West African sub-region remains unrestricted. Nigeria has installed infra-red detectors and set up quarantine procedures for suspected passengers at our international airports; but our borders are notoriously porous and a lot of people travel between Nigeria and other West African countries by road. A corpse was hazardously transported from Liberia to Nigeria. News reports demonstrate that people continue to move freely in and out Sierra Leone, Liberia and Guinea. And people simply deny contact with Ebola cases to avoid quarantine. People have even dumped corpses by the roadside in Liberia to avoid association with an Ebola victim.

In order to forestall a disaster, the Saudi government has banned pilgrims from Guinea, Liberia and Sierra Leone from this year’s hajj. I think Nigeria should be included in this list even though the WHO in Nigeria encourages the screening of all out-bound travellers to prevent exporting the virus.

Right now I do not know of any health facility with a ward or room that has adequate isolation facilities for epidemic-prone infectious and severe diseases such as Ebola. This is despite the fact that every year we have outbreaks of the equally deadly viral haemorrhagic fever, Lassa fever. These outbreaks are often attended by the spread to and death of health workers and other patients. We also have limited capacity to carry out laboratory tests when timely diagnosis is of the essence. Only two labs in the most populous country in Africa are capable of diagnosing Ebola and are both located in the south-west.

By August 6, seven primary contacts with Sawyer – including doctors and nurses – had tested positive and one nurse has died. The driver who picked up Sawyer at the airport fled to Port Harcourt, another city in the deep south of the country. We managed to get him to Lagos this week to interview as part of our outbreak investigations and his status is yet to be determined. Not all of his close contacts have been traced so far.

The government has been very slow in responding to the presence of the disease in Nigeria. Even the Emergency Operations Centre, which should be co-ordinating control activities is yet to take off. The health minister, Onyebuchi Chukwu, said on August 6 that each of the 36 states in the country would set up isolation facilities. I know that’s going to take another couple of weeks. And the situation is not helped by striking doctors.

Chukwu has also declared an emergency and specifically asked the United States to help with the Zmapp treatment which seems to be helping the American doctors, although the US has said that even if it proves safe and effective in trials, it wouldn’t be available for at least several months.

The WHO has convened a special meeting to discuss the implications of using experimental drugs and some Ebola experts have called for the treatment be made available to Africans. It’s time we looked at stricter measures to contain the virus too.

If you’re interested in more commentary on the Ebola outbreak, read these:

We need to fast-track clinical trials of new drugs to treat Ebola in Africa

We’ll never find an Ebola vaccine without taking some risks

Tackling Ebola: isolate, hydrate and educate

Author

1. 

   Muhammad Shakir

   Field Co-ordinator, Nigeria Field Epidemiology and Laboratory Training Programme at Ahmadu Bello University