Ebola in Nigeria is not ‘epidemic’
With over 300 Ebola-related deaths recorded in Guinea since March, the disease is already endemic in that nation, whose southern border nearly wraps around Sierra Leone and crawls through most of Liberia’s northern border. Combined fatalities from both neighbouring countries compare to Guinea and the disease is, in effect, endemic in Liberia and Sierra Leone also. The blood-borne virus spreads from living or deceased patients, contaminated bodily fluids, and infected human or animal tissues. You do not contract it from the fresh air you breathe, the water you drink, properly cooked foods, or casual person-to-person contact. It does not enter the body through the palm of your hands: handshake is only risky when unwashed hands that are already contaminated touch body cavities or injured body parts. Ebola cannot be spread by anybody that is not already infected or anything that is not contaminated with the virus.
Nigeria is over 1,600 kilometres (1,000 miles) east of Monrovia, with four other safe countries of Cote d’Ivoire, Ghana, Togo, and Benin Republic, between them. It was well removed from threat and had been Ebola-free until Sunday, July 2o14. Air travel and the ECOWAS Treaty make nonsense of land borders and enabled a compromised, 40-year-old American from Coon Rapids (25 kilometres or 16 miles North of Minneapolis) Minnesota, to board a sub-continental flight from Monrovia, only to arrive in Lagos indisposed. He was not Nigerian and never lived in Nigeria until this visit. Liberian news agencies that monitored closed-circuit security video from James Sprigg Payne’s Airport described him “lying flat on his stomach” in pain at the departure lounge before boarding ASKY Airline to Lagos. Acute illness prevented him from proceeding to an ECOWAS event in Calabar, Cross River State that would have potentially exposed most southern states, had he gone there by road.
Hospitalisation at a private hospital in Lagos was not for Ebola because the symptoms he presented mimicked malaria or typhoid. Therefore, the hospital was oblivious to his clinical history and its staff became exposed to nosocomial Ebola, even after taking disease-control precautions. Within five days, the American, Mr. Patrick Sawyer, was dead and was correctly labelled Nigeria’s “Ebola index person” by Nigeria’s Health Minister, Prof. Onyebuchi Chukwu. His doctor and two nurses tested positive for the virus, while the matron at his hospital succumbed to Ebola, as Nigeria’s only indigenous victim. His diplomatic status may also have put others who served him at risk, causing much anxiety all over the country. The current nationwide state of mass hysteria about Ebola in Nigeria may make every one more careful, but is ultimately unhelpful and counterproductive, especially beyond Lagos. Lost in the paranoia is the fact the Ebola virus does not spread easily and every single positive case can be traced to direct or remote contact with one American “index person”, within a defined area of Lagos, which illustrates classic patterns of epidemiology:
- an infected, symptomatic, patient (Sawyer) travels undiagnosed from an endemic region (Monrovia, Liberia) and transmits the etiology of disease to an otherwise healthy population (Lagos, Nigeria). This has triggered a medical emergency; but an epidemic? …Probably not.
Decontee Sawyer, Patrick’s widow, disclosed that he contracted the bug while caring for his sister, who died of Ebola, Tuesday, on July 8. That fact was sufficient grounds to place Sawyer under voluntary quarantine and travel restrictions. Liberia now regrets that Sawyer “ignored medical advice and escaped out of Liberia”, avoiding contact with airport personnel, and declining handshake from a Liberian immigration staff in the process. It is also rumoured that he became uncooperative when his hospital communicated his positive Ebola status (with unconfirmed reports of pulling off his intravenous infusion, which spilled his Ebola-tainted blood over the premises).
As alarming as all this sounds, it is fortuitous because it is not ordinarily possible to determine how Ebola arrives within national borders. Nigeria, because of how events unfolded, identified the exact source, localised the course, traced the chain of transmission, and limited the epidemiology of Ebola. Full credit for presumptive diagnosis of Sawyer’s Ebola must be given to Nigeria, specifically, the Lagos University Teaching Hospital and Redeemer’s University: both had accurate results within 36 hours. Absent this index Ebola patient, speculation would have been rife about which species of bush-meat was the Nigerian culprit! (Speaking of ‘bush-meat’, while not illegal or unethical, this is no time to patronise them. For those who still must, avoid direct contact with unprocessed bush-meat, handle with gloves, wrap in plastic bags without holes, and wash hands. Since intense heat is a verified anti-viral agent, boil for at least 10 minutes or until all red parts are fully cooked and brown.)
Upon reflection, this episode teaches vital lessons. Infections and diseases are not crimes but realities of life; failure to report them or seek proper diagnosis may be dangerous. Basic laws of infectious diseases can help control their prevalence. It is un-African to speak ill of the departed; so, this is not about Sawyer but the epidemiological consequences of choices we make in a free society – a lesson learnt relatively late in 1981, when five patients in San Francisco presented symptoms that became pandemic AIDS. Cremation of Sawyer’s remains and wholesale incineration of contaminated supplies at his hospital are standard international protocols against infectious agents. Personal hygiene and normal hand washing can do wonders, but concentrated salt solution will inflict irreversible bodily harm with unproven effects on the virus; antiseptic soap is much safer and more effective. Even if bitter kola inhibits the virus in vitro, it is utterly useless in vivo. The decision to go into dialogue with the Christian community via Pastor Enoch Adeboye and Prophet T. B. Joshua ensures that carriers do not cross international borders to be physically present for prayers of faith (Matt. 8: 8 – 10).
The imminent end of an estimated incubation period of two to 21 days (August 17, at most) should provide short-term relief to anxious passengers, airline crew, diplomats, and hospital staff that were exposed to Sawyer. If they knew that they were in close contact with an Ebola patient, they might have approached him with proper protective clothing and not be at potential risk; the single fatality was also avoidable. They can only complicate their predicament by being ashamed to come forward: they have done nothing wrong and, in the abundance of caution, should get tested. Sadly, a couple of positive results are likely, but most of the estimated 177 being monitored should be negative; but this assumption cannot be made without scientific testing. Our leaders can help remove the stigma by volunteering as negative controls for tests.
In a country of 170 million, there are two (the third was announced as this paper was being put to bed on Thursday) confirmed indigenous fatalities from direct contact with the late American ‘index person’, Sawyer. This does not rise to the threshold of an “epidemic”; however, it is still three preventable deaths too many. Lagos State and Nigerian health ministries have provided leadership in epidemiological control. The Nigerian print and electronic media have displayed professionalism in informing the public about the incident without sensationalism.
Finally, it would be irrational, at best, and inhumane, at worst, to regard Nigeria or any Nigerian in transit as a potential risk because the cause, single source, and course of Ebola were relatively well-defined and contained. Left to Donald Trump, the American Ebola patients evacuated from Liberia should be barred from entering their own country. Paranoia must not replace rational caution. If that fateful flight to Nigeria had been off his schedule, and he was symptom-free, Sawyer would have returned to the US for his daughters’ birthdays this August, according to his widow. The US, not Nigeria, would have had an Ebola dilemma in her hands! The Director of the US Centre for Disease Control concurs, but is “…confident that there will not be a large Ebola outbreak in the US”: Amen for Nigeria as well. Given known facts, this is a localised ‘Sporadic’ occurrence and there is no scientific reason for Nigeria to carry ‘Ebola epidemic’ stigma in international media or for her citizens to live in paralysing fear of catching it from air or casual contact.
With over 300 Ebola-related deaths recorded in Guinea since March, the disease is already endemic in that nation, whose southern border nearly wraps around Sierra Leone and crawls through most of Liberia’s northern border. Combined fatalities from both neighbouring countries compare to Guinea and the disease is, in effect, endemic in Liberia and Sierra Leone also. The blood-borne virus spreads from living or deceased patients, contaminated bodily fluids, and infected human or animal tissues. You do not contract it from the fresh air you breathe, the water you drink, properly cooked foods, or casual person-to-person contact. It does not enter the body through the palm of your hands: handshake is only risky when unwashed hands that are already contaminated touch body cavities or injured body parts. Ebola cannot be spread by anybody that is not already infected or anything that is not contaminated with the virus.
Nigeria is over 1,600 kilometres (1,000 miles) east of Monrovia, with four other safe countries of Cote d’Ivoire, Ghana, Togo, and Benin Republic, between them. It was well removed from threat and had been Ebola-free until Sunday, July 2o14. Air travel and the ECOWAS Treaty make nonsense of land borders and enabled a compromised, 40-year-old American from Coon Rapids (25 kilometres or 16 miles North of Minneapolis) Minnesota, to board a sub-continental flight from Monrovia, only to arrive in Lagos indisposed. He was not Nigerian and never lived in Nigeria until this visit. Liberian news agencies that monitored closed-circuit security video from James Sprigg Payne’s Airport described him “lying flat on his stomach” in pain at the departure lounge before boarding ASKY Airline to Lagos. Acute illness prevented him from proceeding to an ECOWAS event in Calabar, Cross River State that would have potentially exposed most southern states, had he gone there by road.
Hospitalisation at a private hospital in Lagos was not for Ebola because the symptoms he presented mimicked malaria or typhoid. Therefore, the hospital was oblivious to his clinical history and its staff became exposed to nosocomial Ebola, even after taking disease-control precautions. Within five days, the American, Mr. Patrick Sawyer, was dead and was correctly labelled Nigeria’s “Ebola index person” by Nigeria’s Health Minister, Prof. Onyebuchi Chukwu. His doctor and two nurses tested positive for the virus, while the matron at his hospital succumbed to Ebola, as Nigeria’s only indigenous victim. His diplomatic status may also have put others who served him at risk, causing much anxiety all over the country. The current nationwide state of mass hysteria about Ebola in Nigeria may make every one more careful, but is ultimately unhelpful and counterproductive, especially beyond Lagos. Lost in the paranoia is the fact the Ebola virus does not spread easily and every single positive case can be traced to direct or remote contact with one American “index person”, within a defined area of Lagos, which illustrates classic patterns of epidemiology:
- an infected, symptomatic, patient (Sawyer) travels undiagnosed from an endemic region (Monrovia, Liberia) and transmits the etiology of disease to an otherwise healthy population (Lagos, Nigeria). This has triggered a medical emergency; but an epidemic? …Probably not.
Decontee Sawyer, Patrick’s widow, disclosed that he contracted the bug while caring for his sister, who died of Ebola, Tuesday, on July 8. That fact was sufficient grounds to place Sawyer under voluntary quarantine and travel restrictions. Liberia now regrets that Sawyer “ignored medical advice and escaped out of Liberia”, avoiding contact with airport personnel, and declining handshake from a Liberian immigration staff in the process. It is also rumoured that he became uncooperative when his hospital communicated his positive Ebola status (with unconfirmed reports of pulling off his intravenous infusion, which spilled his Ebola-tainted blood over the premises).
As alarming as all this sounds, it is fortuitous because it is not ordinarily possible to determine how Ebola arrives within national borders. Nigeria, because of how events unfolded, identified the exact source, localised the course, traced the chain of transmission, and limited the epidemiology of Ebola. Full credit for presumptive diagnosis of Sawyer’s Ebola must be given to Nigeria, specifically, the Lagos University Teaching Hospital and Redeemer’s University: both had accurate results within 36 hours. Absent this index Ebola patient, speculation would have been rife about which species of bush-meat was the Nigerian culprit! (Speaking of ‘bush-meat’, while not illegal or unethical, this is no time to patronise them. For those who still must, avoid direct contact with unprocessed bush-meat, handle with gloves, wrap in plastic bags without holes, and wash hands. Since intense heat is a verified anti-viral agent, boil for at least 10 minutes or until all red parts are fully cooked and brown.)
Upon reflection, this episode teaches vital lessons. Infections and diseases are not crimes but realities of life; failure to report them or seek proper diagnosis may be dangerous. Basic laws of infectious diseases can help control their prevalence. It is un-African to speak ill of the departed; so, this is not about Sawyer but the epidemiological consequences of choices we make in a free society – a lesson learnt relatively late in 1981, when five patients in San Francisco presented symptoms that became pandemic AIDS. Cremation of Sawyer’s remains and wholesale incineration of contaminated supplies at his hospital are standard international protocols against infectious agents. Personal hygiene and normal hand washing can do wonders, but concentrated salt solution will inflict irreversible bodily harm with unproven effects on the virus; antiseptic soap is much safer and more effective. Even if bitter kola inhibits the virus in vitro, it is utterly useless in vivo. The decision to go into dialogue with the Christian community via Pastor Enoch Adeboye and Prophet T. B. Joshua ensures that carriers do not cross international borders to be physically present for prayers of faith (Matt. 8: 8 – 10).
The imminent end of an estimated incubation period of two to 21 days (August 17, at most) should provide short-term relief to anxious passengers, airline crew, diplomats, and hospital staff that were exposed to Sawyer. If they knew that they were in close contact with an Ebola patient, they might have approached him with proper protective clothing and not be at potential risk; the single fatality was also avoidable. They can only complicate their predicament by being ashamed to come forward: they have done nothing wrong and, in the abundance of caution, should get tested. Sadly, a couple of positive results are likely, but most of the estimated 177 being monitored should be negative; but this assumption cannot be made without scientific testing. Our leaders can help remove the stigma by volunteering as negative controls for tests.
In a country of 170 million, there are two (the third was announced as this paper was being put to bed on Thursday) confirmed indigenous fatalities from direct contact with the late American ‘index person’, Sawyer. This does not rise to the threshold of an “epidemic”; however, it is still three preventable deaths too many. Lagos State and Nigerian health ministries have provided leadership in epidemiological control. The Nigerian print and electronic media have displayed professionalism in informing the public about the incident without sensationalism.
Finally, it would be irrational, at best, and inhumane, at worst, to regard Nigeria or any Nigerian in transit as a potential risk because the cause, single source, and course of Ebola were relatively well-defined and contained. Left to Donald Trump, the American Ebola patients evacuated from Liberia should be barred from entering their own country. Paranoia must not replace rational caution. If that fateful flight to Nigeria had been off his schedule, and he was symptom-free, Sawyer would have returned to the US for his daughters’ birthdays this August, according to his widow. The US, not Nigeria, would have had an Ebola dilemma in her hands! The Director of the US Centre for Disease Control concurs, but is “…confident that there will not be a large Ebola outbreak in the US”: Amen for Nigeria as well. Given known facts, this is a localised ‘Sporadic’ occurrence and there is no scientific reason for Nigeria to carry ‘Ebola epidemic’ stigma in international media or for her citizens to live in paralysing fear of catching it from air or casual contact.
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