Nigeria expected to be declared Ebola-free

Lagos – Nigeria is expected to be declared
Ebola-free on Monday, just three months after
fears that the virus could spread like wildfire
through Africa’s most populous nation.
The World Health Organisation (WHO) is
preparing to announce that Nigeria has not had
a confirmed case of Ebola for 42 days – or two
incubation periods of 21 days – just as it did for
Senegal on Friday.
The achievement is being welcomed, with no end
in sight to the disease that has claimed more
than 4 500 lives this year, most of them in west
Africa, and mounting fears about cases around
the world.
Close attention is being paid to how Nigeria, with
an under-funded and ill-equipped health system,
managed to contain the virus, as specialists look
for a more effective response to control its
spread.
But there were warnings against any premature
celebration, with complacency still a risk and
luck considered to have played a part in
containing the outbreak.
Monitoring, awareness
Eight people died out of 20 confirmed Ebola
cases in Nigeria, with all infections traced back
to a single source – Liberian finance ministry
official Patrick Sawyer, who arrived in Lagos on
20 July.
Many feared the worst when Sawyer died on 25
July in a private hospital in Nigeria’s biggest
city, which is home to more than 20 million
people, with poor sanitation and inadequate
health facilities.
Doctors were on strike at the time over pay and
conditions in the public health sector, where
many state hospitals lack running water, let
alone soap and other basic equipment.
Yet the doomsday scenario of rapid spread
among a 170-million-strong population,
devastating Africa’s leading economy and oil
producer, did not materialise.
“Nigeria acted quickly and early and on a large
scale,” John Vertefeuille, from the US Centers for
Disease Control and Prevention (CDC), told AFP.
“They acted aggressively, especially in terms of
contact-tracing.”
Key to the response was an existing plan for a
mass outbreak of polio, which was adapted to
Ebola, as well as a rapid appeal for foreign help.
The Ebola Emergency Operations Centre (EEOC)
prioritised contact-tracing and twice-daily
monitoring of those at risk, with experts aware
that every Ebola case is in contact with about 50
people.
In all, nearly 900 people were monitored in Lagos
and the oil city of Port Harcourt, where one
contact of Sawyer travelled after slipping
surveillance, going on to infect another doctor.
About 1 800 people were trained to trace and
monitor those at risk, as well as decontaminate
infected places and care for the sick, said the
head of the EEOC, Faisal Shuaib.
Luck, concerns
Luck cannot be discounted in Nigeria’s first
brush with Ebola. Sawyer was taken straight to
hospital after arriving from Monrovia visibly ill,
keeping him off Lagos’ teeming streets.
Doctors also prevented him from discharging
himself into an area of the city frequented by
tens of thousands of people with a bus station
that serves the entire country.
The EEOC in the early days of the outbreak
highlighted concerns such as a lack of personal
protective equipment for medics, which could
have had serious implications in any rapid
spread.
Public health campaigns, including a giant
electronic billboard warning about Ebola just
outside the hospital where Sawyer died, have
helped raise awareness.
Airports and seaports have introduced
compulsory screening on arrival and departure;
temperature checks and hand sanitiser use for
the public are now the norm.
Greater knowledge about Ebola is likely to help in
reporting any new cases, said epidemiologist
Chukwe Ihekweazu, who runs the Nigeria Health
Watch website.
But he warned Nigeria against celebrating its
Ebola-free status.
“It’s premature when you see the situation in
west Africa right now. There’s still a lot to do.
It’s not the right time to celebrate,” he said.
Vertefeuille admitted that there was “no equal
level of preparedness everywhere in the country”
but still said Nigeria was better equipped to deal
with any future Ebola cases.
Isolation centres have now been identified in
most Nigerian states, while six laboratories have
been accredited by the WHO to conduct Ebola
tests, said Shuaib.
But concerns remained, not least about funding.
Vertefeuille said the federal authorities had been
slow to match state government funding for the
outbreak, which would be vital for tackling any
new cases.

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