Here's What We Should Learn From Nigeria's Incredible Effort To Shut Down Ebola
Nigeria, the most populous country in Africa, can provide a "hopeful roadmap to overall containment," NBC News noted in a recent report.
It is much closer to the West Africa outbreak than the US is, yet even after Ebola entered the country in the most terrifying way possible - via a visibly very sick passenger on a commercial flight - officials successfully shut down the disease and prevented widespread transmission.
In Sierra Leone, Liberia, and Guinea, which have been ravaged by the deadly virus, this isn't the case. Unlike more developed and wealthier nations, those countries simply aren't equipped to take the necessary precautions to prevent the spread of Ebola. That's why international help is so desperately needed.
But when Nigerian officials found out that a man who traveled to the country from Liberia was sick with Ebola, they quickly figured out who he'd been in contact with and acted on that information to successfully contain the disease. Nigeria ended up seeing 19 confirmed cases of Ebola, but no new cases have been reported in over a month.
On Monday, October 20, if there are still no new cases, the World Health Organization will officially declare the country "Ebola-free." Here's how Nigeria did it.
Nigeria's Patient Zero
The first person to bring Ebola to Nigeria was Patrick Sawyer, who left a hospital in Liberia against the wishes of the medical staff and flew to Nigeria, according to the Centers for Disease Control and Prevention. Once he arrived, it became obvious that he was ill when he passed out in the Lagos airport, and he was taken to a hospital in the densely packed city of 20 million.
Sawyer reportedly told hospital staff that he hadn't been exposed to Ebola, so he was treated for malaria. When he didn't respond to treatment, doctors suspected Ebola, and Sawyer tested positive.
Hospital staff recognized the potential for spread of the virus, and they refused to let him leave, according to The Independent. He died five days after he arrived, and several people who cared for Sawyer while he was sick contracted Ebola themselves.
Containment
Once the country's first Ebola case was confirmed, Port Health Services in Nigeria started a process called contact tracing to limit the spread of the disease and created an Emergency Operations Center to coordinate and oversee the national response.
They worked with the airport and airlines, triaged any potential cases, and decontaminated the airport as well as areas inhabited by people who might have come into contact with the virus, according to the CDC. Entry and exit screening was also established at ports in Nigeria.
Health officials used a variety of resources, including phone records and flight manifests, to track down nearly 900 people who might have been exposed to the virus via Sawyer or the people he infected. That group was monitored for symptoms for 21 days. Those under observation were required to check in with officials twice a day to provide health updates, according to The Independent.
If someone was showing symptoms or failed to provide an update, they were checked on.
As soon as people developed symptoms suggestive of Ebola, they were isolated in Ebola treatment facilities. Without waiting to see whether a "suspected" case tested positive, Nigeria's contact tracing team tracked down everyone who had had contact with that patient since the onset of symptoms.
During this contact tracing process, officials made a staggering 18,500 face-to-face visits.
Aside from the contact tracing, Nigeria ensured a highly organized, methodical, and informed response to the outbreak, which was crucial. Officials who were part of the Emergency Operations Center had access to the proper resources, and some had experience containing other viral diseases like polio.
All 19 confirmed cases were traced back to Sawyer and no cases have come up since, marking a successful containment of the virus. The outbreak in Nigeria will be declared officially over on Monday if no new cases come up before then.
The US has many of these same procedures in place for containing Ebola, making the risk of an outbreak here very low. Contact tracing is exactly what is happening in Dallas right now; if any one of Thomas Eric Duncan's contacts shows symptoms, that person will be immediately isolated and tested.
Why The Virus Is Still Spreading
West Africa, meanwhile, does not have the means to implement containment procedures to the same extent - the few health workers in the nation are struggling just to care for the existing Ebola patients, and hundreds of new cases are appearing each week.
Nurses at many hospitals in West Africa are "lightly trained and minimally protected," and Ebola patients are dying "surrounded by pools of infectious waste," according to a recent New York Times report. Some hospitals don't have access to running water, soap, or clean needles, which are all crucial to controlling the outbreak and preventing further spread of disease.
The US has seen only two Ebola cases so far - one from a man who was infected in Liberia and then traveled to the US before showing symptoms, and another from a nurse who was caring for him.
More than 4,000 people have died in this year's Ebola outbreak. It is mostly concentrated in West Africa, where nearly more than 8,000 people have contracted the disease.
World Health Organization officials have said that if the global response to the outbreak isn't stepped up in 60 days, "a lot more people will die."
The death rate in the current outbreak is about 70%, but chances of survival improve the earlier the disease is caught and treatment is started.