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Nigeria is Ebola free! It’s the best news millions of
Nigerians have heard in a long, long while. “Today, exactly
42 days (twice the maximum incubation period for Ebola
virus disease) after the country’s last infectious contact
with a confirmed or probable case occurred, the chains of
transmission have been broken. The virus is gone – for
now. The outbreak in Nigeria has been defeated.”
Such was the manner of the official declaration of Nigeria as
an Ebola-free nation, last Monday by the World Health
Organisation, WHO. It was the climax of an odyssey that
began exactly 93 days earlier and a comeback from the
proverbial journey of no return.
Further, the WHO noted: “This is a spectacular success
story that shows that Ebola can be contained. The story of
how Nigeria ended what many believed to be potentially the
most explosive Ebola outbreak imaginable is worth telling in
detail.”
This is a good public health story with an unusual twist at
the end. As part of preparedness for an imported case,
several advanced countries with good health systems are
now studying technologies “made in Nigeria”, with WHO
support, to improve their own contact tracing capacities.
Nigeria’s Ebola success story has another very clear
message, as noted by Dr Margaret Chan, the WHO Director-
General. “If a country like Nigeria, hampered by serious
security problems, can do this – that is, make significant
progress towards interrupting polio transmission, eradicate
guinea-worm disease and contain Ebola, all at the same
time – any country in the world experiencing an imported
case can hold onward transmission to just a handful of
cases.”
It is indeed a story worthy of telling. Like a bad dream,
Nigerians woke up one bright July day to the terrifying
news that the nation’s health authorities were investigating
a suspected and probable case of the dreaded Ebola Virus
Disease, EVD, in Lagos.
Reports explained that the condition of the suspected case
– a 40-year-old American-Liberian male, who was working
for a West African organisation in Monrovia, Liberia, was
“stable and in recovery” while the confirmatory test results
for Ebola infection were still pending.
It was a bombshell! Granted, the people had been wary,
watching by day and expectant at night, to hear that the
dreaded Ebola had actually made an incursion into Lagos,
the world’s 5th most populous metropolitan settlement, was
almost beyond contemplation. Ebola came like a thief in the
night and caught everyone completely unawares.
The nation was in shock. Regardless of preparations of
sorts on ground, nothing prepared Nigerians and the entire
global public health community for the anxiety and paranoia
that trailed the entry of one of the world’s deadliest
infectious disorders into Africa’s most populous nation.
Happenings within the West African sub-region since the
beginning of the year did little to help matters. On the
contrary, they made matters worse.
Over the next couple of days following the nerve wracking
announcement, residents of the sprawling megacity hurried
to work in the dreary early morning hours, and returned
home at twilight, habouring expectations of an apocalyptic
outbreak, with nightmarish pictures of zombie-like
apparitions in their minds. Even in the safety of their homes,
panic, mixed with raw, naked fear remained etched on their
faces.
Is Ebola indeed in Nigeria – it was more a statement than a
question. It didn’t take long for the nation’s worst fears to
be confirmed.
On the morning of Friday July 25, 2014, a worried former
Minister of Health, Professor Onyebuchi Chukwu, broke the
news at a world press conference in Abuja. The message
was brief but total. “The suspected case, an American-
Liberian, who was subjected to thorough medical tests that
confirmed he had the Ebola virus, had died.
Hours later, in Lagos, a sad-looking state Commissioner for
Health, accompanied by a bleary-eyed Special Adviser to
the Lagos State Governor on Health, Dr Yewande Adeshina
further confirmed the news at another media briefing. “The
Liberian national, Mr. Patrick Sawyer, believed to have
imported the highly contagious Ebola Virus Disease to
Nigeria died on Thursday night in a Lagos private hospital,”
Idris announced.
It was an unforgettable day in the nation’s history.
Sawyer’s death from Ebola spontaneously set off a chain
reaction, in addition to further raising fears that the dreaded
virus could spread beyond the epicentre of what was
already the deadliest ever Ebola outbreak and into Africa’s
most populous nation, Nigeria.
Chasing the virus
The Ebola outbreak in West Africa, which drew first blood in
southern Guinea in February, spread like a forest fire in the
harmattan, hitting Sierra Leone and Liberia with full force.
In March, on the heels of the outbreak, the Federal Ministry
of Health issued alert urging persons with high fever,
headache, severe abdominal pain, diarrhoea and bleeding
and especially with a history of travel to Guinea, Sierra
Leone or Liberia, to report to the health authorities at once.
All 36 States were put on alert to mobilise against the
disease, while the apex health Ministry worked closely with
the West African Health Organisation, WAHO, and the World
Health Organisation, WHO, to deploy experts to affected
countries to strengthen its response capacity.
Everyone knew the danger and risk of an EVD outbreak, but
no one, in their wildest dreams, prayed to have an
encounter o the first kind.
As at the time the index case landed in Nigeria, no less than
1,093 confirmed, probable and suspected Ebola cases, had
been reported in Guinea, Sierra Leone and Liberia since
February. Of this number, 667 died, The World Health
Organisation confirmed Ebola in 786 of those cases, of
whom 442 died.
The Federal government and Lagos state government
embarked on frantic efforts to calm frayed nerves of
Nigerians. Even before the two press conferences, the
government had swung into action, obtaining the manifest
of passengers the victim travelled with from Togolese Asky
Airlines and mounting a siege at the nation’s borders and
entry ports.
Nigeria quickly put all entries into the country on red alert
after confirming that Sawyer was carrying the Ebola virus.
There is no cause for alarm; Nigerians and the world were
told. Necessary steps are in place to prevent further spread
of the virus.
It was announced that the President had set up a special
information committee for Ebola, chaired by the former
Minister of Information, Labaran Maku. Nigerians were
called upon to be vigilant and observe basic hygiene
principles such as proper hand washing with soap and
water and use of hand sanitisers.
The deceased’s body was disposed properly (cremated),
while the Lagos State Government dealt with the hospital.
Those who had got in contact with Sawyer were also being
handled.
The Nigeria Centre for Disease Control, NCDC, stepped in to
volunteer. The United Nations Children Fund, UNICEF also
stepped in. A contact screening centre was set up. All stake
holders were involved to stop further propagation of the
disease. Pleas were made to desist from spreading scary
messages so as not to spread panic.
Assurances that structures had been put in place to ensure
that it does not spread beyond what it is presently, were
routinely announced. “If you know anybody who has
travelled to Liberia where the viral is established, report to
us on time. We have set up treatment centre for probable
symptoms.
”We are at risk, but at alert,” Director, National Centre for
Disease Control, FMOH, Abuja, Professor Abdulsalam
Nasidi, had admitted few days before the Sawyer incident.
But Nigerians were highly suspicious and doubtful about the
nation’s true readiness and preparedness. They had reason
to be concerned.
The NCDC had no website, and had not been previously
communicating with the public about its coordination of the
EVD outbreak. Even the health professionals were not taken
serious.
The Health Ministry did not do much by way of Their
answers to questions about preparedness and in terms of
health infrastructure and medical as well as scientific
awareness and readiness, were taken with a pinch of salt.
People had wanted to know what was truly on ground.
Should Nigerians be concerned? Who was in charge of the
response and who was leading the preparedness? Who was
communicating with health professionals and with the
public?
What structures were in place? What had been prepared in
terms of diagnosis, isolation rooms in health facilities,
medication, and other important steps? Where was proper
and effective communication?
Many questions, few answers. All these elicited worry. The
common notion was one of pessimism, doubt, anxiety and
palpable fear. There were concerns about the likelihood of
catastrophe likely to occur should the nation fail to get the
EVD response exactly right. Indeed, the odds enormous and
the signals were bad. To the generality, the nation could be
preparing for a battle it might not win.
Consensus was that there was need for Nigeria to be
concerned, and the concern ought to be directed into
holding government and its health officials accountable.
The reason was obvious. Nigeria is a nation with so many
problems, and few were questioning the salient questions
concerning the challenges confronting the health system.
The bottom line was that the incursion of the Ebola crisis
was the right time to put the health sector issue on the
political agenda.
While it lasted
Months before the Sawyer saga, the entire West African
sub-region had been on alert following the outbreak of what
has come to be known as the largest Ebola epidemic in
history. People in affected countries had adopted a number
of fail-safe and often bizarre proactive measures to tackle
the rampaging pestilence.
For instance, Senegal and a few other neighbouring West
African countries went into lock-down, shutting their
borders against the incursion. In several countries, people
stopped sharing personal items such as towels,
toothbrushes, cups, cutlery and hankies. Then the tendency
to indulge in shaking of hands, hugging, kissing or even
having sex reduced significantly.
On the argument that the Ebola virus could be spread
through bodily fluids including semen and vaginal
secretions, Liberian President, Ellen Johnson, advised
Liberians to desist from sexual intercourse, whether
penetrative or non-penetrative.
Nigeria also had its own share of the bizarre. People
stopped shaking hands as a means of greeting; public
gatherings involving large crowds such as Church
conventions, revivals, etc., were discouraged. The NCDC
and Lagos state government visited the Synagogue Church
of All Nations and a few other worship centres with large
followership to be wary of persons seeking divine healing
from the Ebola-affected countries. They were also urged to
suspend public activities that would attract large
gatherings for the time being.
Healthcare providers became reluctant or altogether
stopped attending to patients with symptoms of fever and
other suspected Ebola-like signs and symptoms. Some
persons were going about permanently wearing hand gloves
and face masks and became paranoid about touching
anything that could possibly serve as a mode of
transmission for the deadly virus. Hand washing with soap
and water and the use of hand sanitiser became the rule and
everyone went about carrying one. The killing and
consumption of suya, bush meat and other suspect
delicacies reduced drastically and virtually stopped in some
instances. Transportation of corpses across international
borders required clearance by the FMOH, while carrying of
corpses across state borders was restricted. Burial of
corpses anywhere in the country required a mandatory
death certificate. Nigeria’s request for the experimental
Ebola drug ZMapp was turned down. Another proposed drug
Nano Silver, that was sent to the country from the US, was
dropped after it was said to be a pesticide. There were
several Ebola cure claims ranging from consumption of
bitter kola to ewedu and salt water. The format for taking
the Holy Communion changed. A nurse at First Consultants
Hospital and one of the first contacts of Patrick Sawyer,
escaped from isolation and went to Enugu. A Nigerian
ECOWAS diplomat, Koye Olu-Ibukun, also jumped
observation and escaped to Port Harcourt where a medical
practitioner, Dr. Iyke Enemuo, who attended to him later
died of Ebola infection . The diplomat survived.
In Lagos, some unscrupulous persons took the opportunity
to cash-in by selling fake hand sanitisers, as well as “Ebola
Cassettes and Test Kits” to the unsuspecting public.
The date of resumption of schools from the long holidays
was shifted twice, while a Nigerian football team was
barred from participating in an international competition
that took place in China.
Such was the magnitude of the threat of the disorder which
in the worst of times kills nine out of 10 victims.
People knew better than to “wish” or “hope” it would all just
go away. Beyond hoping Ebola would go away, Nigeria
made it go away. According to the WHO, the nation’s
response was just right. “Nigeria did all the right things at
the right time and for the right purpose.
Series of rumours punctuated the Ebola crisis in Nigeria.
There were reports of suspected cases of Ebola in the
Federal Capital Territory, FCT, Calabar, Kaduna, Kwara,
Delta, Edo and other states, all of which turned out to be
false. A story that the body of the late Port Harcourt doctor
was transported to Edo or Delta State turned out to be
untrue.
What Nigeria did right
A strong leadership and effective coordination of the
response was key. The Nigerian response to the Ebola
outbreak was greatly aided by the rapid utilisation of the
NCDC and the prompt establishment of an Emergency
Operations Centre, supported by the Disease Prevention and
Control Cluster within the WHO country office. Another key
asset was the country’s first-rate virology laboratory
affiliated with the Lagos University Teaching Hospital. That
laboratory was staffed and equipped to quickly and reliably
diagnose a case of Ebola virus disease, which ensured that
containment measures could begin with the shortest
possible delay. In addition, high-quality contact tracing by
experienced epidemiologists expedited the early detection of
cases and their rapid movement to an isolation ward,
thereby greatly diminishing opportunities for further
transmission.
With assistance from WHO, the US Centers for Disease
Control and Prevention, CDC, and others, government
health officials reached 100 percent of known contacts in
Lagos and 99.8 percent at the second outbreak site, in Port
Harcourt, Nigeria’s oil hub. Federal and State governments
provided ample financial and material resources, as well as
well-trained and experienced national staff. Isolation wards
were immediately constructed, as were designated Ebola
treatment facilities, though more slowly.
Vehicles and mobile phones, with specially adapted
programmes, were made available to aid real-time
reporting as the investigations moved forward. Unlike the
situation in Guinea, Liberia and Sierra Leone, all identified
contacts were physically monitored on a daily basis for 21
days.
The few contacts who attempted to escape the monitoring
system were all diligently tracked, using special
intervention teams, and returned to medical observation to
complete the requisite monitoring period of 21 days.
One important lesson for countries facing their first
imported Ebola case or preparing for one, is the need to
carefully document a large number of “best practices” for
containing an Ebola outbreak quickly. The most critical
factor is leadership and engagement from the head of state
and the Minister of Health. Generous allocation of
government funds and their quick disbursement helped as
well. Partnership with the private sector was yet another
asset that brought in substantial resources to help scale up
control measures that would eventually stop the Ebola virus
dead in its tracks.The full range of media opportunities was
exploited – from social media to televised facts about the
disease delivered by well-known “Nollywood” movie stars.
The importance of communication with the general public
was not overlooked. House-to-house information
campaigns and messages on local radio stations, in local
dialects, were used to explain the level of risk, effective
personal preventive measures and the actions being taken
for control..
When the first Ebola case was confirmed in July, health
officials immediately repurposed polio technologies and
infrastructures to conduct Ebola case-finding and contact-
tracing.
The use of cutting-edge technologies, developed with
guidance from the WHO polio programme, put GPS systems
to work as support for real-time contact tracing and daily
mapping of links between identified chains of transmission.
World-class epidemiological detective work would
eventually link every single one of the country’s 19
confirmed cases back to direct or indirect contact with that
20 July air traveller from Liberia.
Traditional, religious and community leaders were engaged
early on and played a critical role in sensitizing the public.
Like many others, the strategy drew on successful
experiences in the polio programme.
The awareness campaigns that worked so well to create
public acceptance of polio immunization were likewise
repurposed to encourage early reporting of symptoms,
backed by the message that early detection and supportive
care greatly increase an Ebola patient’s prospects of
survival.
In the end, Nigeria confirmed a total of 19 cases, of whom
seven died and 12 survived, giving the country an enviable
case fatality rate of 40 percent – much lower than the 70
percent and higher seen elsewhere.
Finally, to help maintain the confidence of citizens and
foreign companies and investors alike, the government
undertook the screening of all arriving and departing
travellers by air and by sea in Lagos and Rivers State. The
average number of travellers screened each day rose to
more than 16 000. So, vigilance remains high.
What Nigeria needs to do
Nigeria is Ebola free, but alert is still required. According to
the WHO, Nigeria will remain vulnerable to another imported
case as long as intense transmission continues in other
parts of West Africa. The surveillance system remains on
guard, at a level of high alert. Moreover, the country’s
success, including its low fatality rate, has created another
problem that calls for a high level of alert.
Many desperate people in heavily affected countries believe
that Nigeria must have some especially good – maybe even
“magical” – treatments to offer.
The WHO and others see a real risk that patients and their
families from elsewhere will come to Nigeria in their quest
for first-rate, live-saving care. Based on the experience
gained from the response in Lagos and rivers states, the
national preparedness and response plan has also been
revised and refined. This strengthened response plan
further boosts confidence that Nigeria’s well-oiled
machinery has a good chance of working miracles again
should another traveller – by land, air or sea – carry the
Ebola virus across its borders again.
Standard precautions recommended in the care and
treatment of all patients regardless of their perceived or
confirmed infectious status must remain in place. They
include the basic level of infection control—hand hygiene,
use of personal protective equipment to avoid direct contact
with blood and body fluids, prevention of needle stick and
injuries from other sharp instruments, and a set of
environmental controls.
Prevention efforts must continue to focus on avoiding
contact. Wash your hands frequently.
As with other infectious diseases, one of the most important
preventive measures for Ebola virus is frequent hand-
washing. Use soap and water, or use alcohol-based hand
rubs containing at least 60 percent alcohol when soap and
water aren’t available. Avoid bush meat. Avoid contact with
anyone who may have been exposed to the Ebola virus.
In particular, caregivers should avoid contact with the
person’s body fluids and tissues, including blood, semen,
vaginal secretions and saliva.
Follow infection-control procedures. If you are a health care
worker, wear protective clothing — such as gloves, masks,
gowns and eye shields. Keep infected people isolated from
others. Carefully disinfect and dispose of needles and other
instruments.
Injection needles and syringes should not be reused. Don’t
handle remains people that died of unknown disease. The
bodies of people who have died of Ebola disease are still
contagious.
Nigerians have heard in a long, long while. “Today, exactly
42 days (twice the maximum incubation period for Ebola
virus disease) after the country’s last infectious contact
with a confirmed or probable case occurred, the chains of
transmission have been broken. The virus is gone – for
now. The outbreak in Nigeria has been defeated.”
Such was the manner of the official declaration of Nigeria as
an Ebola-free nation, last Monday by the World Health
Organisation, WHO. It was the climax of an odyssey that
began exactly 93 days earlier and a comeback from the
proverbial journey of no return.
Further, the WHO noted: “This is a spectacular success
story that shows that Ebola can be contained. The story of
how Nigeria ended what many believed to be potentially the
most explosive Ebola outbreak imaginable is worth telling in
detail.”
This is a good public health story with an unusual twist at
the end. As part of preparedness for an imported case,
several advanced countries with good health systems are
now studying technologies “made in Nigeria”, with WHO
support, to improve their own contact tracing capacities.
Nigeria’s Ebola success story has another very clear
message, as noted by Dr Margaret Chan, the WHO Director-
General. “If a country like Nigeria, hampered by serious
security problems, can do this – that is, make significant
progress towards interrupting polio transmission, eradicate
guinea-worm disease and contain Ebola, all at the same
time – any country in the world experiencing an imported
case can hold onward transmission to just a handful of
cases.”
It is indeed a story worthy of telling. Like a bad dream,
Nigerians woke up one bright July day to the terrifying
news that the nation’s health authorities were investigating
a suspected and probable case of the dreaded Ebola Virus
Disease, EVD, in Lagos.
Reports explained that the condition of the suspected case
– a 40-year-old American-Liberian male, who was working
for a West African organisation in Monrovia, Liberia, was
“stable and in recovery” while the confirmatory test results
for Ebola infection were still pending.
It was a bombshell! Granted, the people had been wary,
watching by day and expectant at night, to hear that the
dreaded Ebola had actually made an incursion into Lagos,
the world’s 5th most populous metropolitan settlement, was
almost beyond contemplation. Ebola came like a thief in the
night and caught everyone completely unawares.
The nation was in shock. Regardless of preparations of
sorts on ground, nothing prepared Nigerians and the entire
global public health community for the anxiety and paranoia
that trailed the entry of one of the world’s deadliest
infectious disorders into Africa’s most populous nation.
Happenings within the West African sub-region since the
beginning of the year did little to help matters. On the
contrary, they made matters worse.
Over the next couple of days following the nerve wracking
announcement, residents of the sprawling megacity hurried
to work in the dreary early morning hours, and returned
home at twilight, habouring expectations of an apocalyptic
outbreak, with nightmarish pictures of zombie-like
apparitions in their minds. Even in the safety of their homes,
panic, mixed with raw, naked fear remained etched on their
faces.
Is Ebola indeed in Nigeria – it was more a statement than a
question. It didn’t take long for the nation’s worst fears to
be confirmed.
On the morning of Friday July 25, 2014, a worried former
Minister of Health, Professor Onyebuchi Chukwu, broke the
news at a world press conference in Abuja. The message
was brief but total. “The suspected case, an American-
Liberian, who was subjected to thorough medical tests that
confirmed he had the Ebola virus, had died.
Hours later, in Lagos, a sad-looking state Commissioner for
Health, accompanied by a bleary-eyed Special Adviser to
the Lagos State Governor on Health, Dr Yewande Adeshina
further confirmed the news at another media briefing. “The
Liberian national, Mr. Patrick Sawyer, believed to have
imported the highly contagious Ebola Virus Disease to
Nigeria died on Thursday night in a Lagos private hospital,”
Idris announced.
It was an unforgettable day in the nation’s history.
Sawyer’s death from Ebola spontaneously set off a chain
reaction, in addition to further raising fears that the dreaded
virus could spread beyond the epicentre of what was
already the deadliest ever Ebola outbreak and into Africa’s
most populous nation, Nigeria.
Chasing the virus
The Ebola outbreak in West Africa, which drew first blood in
southern Guinea in February, spread like a forest fire in the
harmattan, hitting Sierra Leone and Liberia with full force.
In March, on the heels of the outbreak, the Federal Ministry
of Health issued alert urging persons with high fever,
headache, severe abdominal pain, diarrhoea and bleeding
and especially with a history of travel to Guinea, Sierra
Leone or Liberia, to report to the health authorities at once.
All 36 States were put on alert to mobilise against the
disease, while the apex health Ministry worked closely with
the West African Health Organisation, WAHO, and the World
Health Organisation, WHO, to deploy experts to affected
countries to strengthen its response capacity.
Everyone knew the danger and risk of an EVD outbreak, but
no one, in their wildest dreams, prayed to have an
encounter o the first kind.
As at the time the index case landed in Nigeria, no less than
1,093 confirmed, probable and suspected Ebola cases, had
been reported in Guinea, Sierra Leone and Liberia since
February. Of this number, 667 died, The World Health
Organisation confirmed Ebola in 786 of those cases, of
whom 442 died.
The Federal government and Lagos state government
embarked on frantic efforts to calm frayed nerves of
Nigerians. Even before the two press conferences, the
government had swung into action, obtaining the manifest
of passengers the victim travelled with from Togolese Asky
Airlines and mounting a siege at the nation’s borders and
entry ports.
Nigeria quickly put all entries into the country on red alert
after confirming that Sawyer was carrying the Ebola virus.
There is no cause for alarm; Nigerians and the world were
told. Necessary steps are in place to prevent further spread
of the virus.
It was announced that the President had set up a special
information committee for Ebola, chaired by the former
Minister of Information, Labaran Maku. Nigerians were
called upon to be vigilant and observe basic hygiene
principles such as proper hand washing with soap and
water and use of hand sanitisers.
The deceased’s body was disposed properly (cremated),
while the Lagos State Government dealt with the hospital.
Those who had got in contact with Sawyer were also being
handled.
The Nigeria Centre for Disease Control, NCDC, stepped in to
volunteer. The United Nations Children Fund, UNICEF also
stepped in. A contact screening centre was set up. All stake
holders were involved to stop further propagation of the
disease. Pleas were made to desist from spreading scary
messages so as not to spread panic.
Assurances that structures had been put in place to ensure
that it does not spread beyond what it is presently, were
routinely announced. “If you know anybody who has
travelled to Liberia where the viral is established, report to
us on time. We have set up treatment centre for probable
symptoms.
”We are at risk, but at alert,” Director, National Centre for
Disease Control, FMOH, Abuja, Professor Abdulsalam
Nasidi, had admitted few days before the Sawyer incident.
But Nigerians were highly suspicious and doubtful about the
nation’s true readiness and preparedness. They had reason
to be concerned.
The NCDC had no website, and had not been previously
communicating with the public about its coordination of the
EVD outbreak. Even the health professionals were not taken
serious.
The Health Ministry did not do much by way of Their
answers to questions about preparedness and in terms of
health infrastructure and medical as well as scientific
awareness and readiness, were taken with a pinch of salt.
People had wanted to know what was truly on ground.
Should Nigerians be concerned? Who was in charge of the
response and who was leading the preparedness? Who was
communicating with health professionals and with the
public?
What structures were in place? What had been prepared in
terms of diagnosis, isolation rooms in health facilities,
medication, and other important steps? Where was proper
and effective communication?
Many questions, few answers. All these elicited worry. The
common notion was one of pessimism, doubt, anxiety and
palpable fear. There were concerns about the likelihood of
catastrophe likely to occur should the nation fail to get the
EVD response exactly right. Indeed, the odds enormous and
the signals were bad. To the generality, the nation could be
preparing for a battle it might not win.
Consensus was that there was need for Nigeria to be
concerned, and the concern ought to be directed into
holding government and its health officials accountable.
The reason was obvious. Nigeria is a nation with so many
problems, and few were questioning the salient questions
concerning the challenges confronting the health system.
The bottom line was that the incursion of the Ebola crisis
was the right time to put the health sector issue on the
political agenda.
While it lasted
Months before the Sawyer saga, the entire West African
sub-region had been on alert following the outbreak of what
has come to be known as the largest Ebola epidemic in
history. People in affected countries had adopted a number
of fail-safe and often bizarre proactive measures to tackle
the rampaging pestilence.
For instance, Senegal and a few other neighbouring West
African countries went into lock-down, shutting their
borders against the incursion. In several countries, people
stopped sharing personal items such as towels,
toothbrushes, cups, cutlery and hankies. Then the tendency
to indulge in shaking of hands, hugging, kissing or even
having sex reduced significantly.
On the argument that the Ebola virus could be spread
through bodily fluids including semen and vaginal
secretions, Liberian President, Ellen Johnson, advised
Liberians to desist from sexual intercourse, whether
penetrative or non-penetrative.
Nigeria also had its own share of the bizarre. People
stopped shaking hands as a means of greeting; public
gatherings involving large crowds such as Church
conventions, revivals, etc., were discouraged. The NCDC
and Lagos state government visited the Synagogue Church
of All Nations and a few other worship centres with large
followership to be wary of persons seeking divine healing
from the Ebola-affected countries. They were also urged to
suspend public activities that would attract large
gatherings for the time being.
Healthcare providers became reluctant or altogether
stopped attending to patients with symptoms of fever and
other suspected Ebola-like signs and symptoms. Some
persons were going about permanently wearing hand gloves
and face masks and became paranoid about touching
anything that could possibly serve as a mode of
transmission for the deadly virus. Hand washing with soap
and water and the use of hand sanitiser became the rule and
everyone went about carrying one. The killing and
consumption of suya, bush meat and other suspect
delicacies reduced drastically and virtually stopped in some
instances. Transportation of corpses across international
borders required clearance by the FMOH, while carrying of
corpses across state borders was restricted. Burial of
corpses anywhere in the country required a mandatory
death certificate. Nigeria’s request for the experimental
Ebola drug ZMapp was turned down. Another proposed drug
Nano Silver, that was sent to the country from the US, was
dropped after it was said to be a pesticide. There were
several Ebola cure claims ranging from consumption of
bitter kola to ewedu and salt water. The format for taking
the Holy Communion changed. A nurse at First Consultants
Hospital and one of the first contacts of Patrick Sawyer,
escaped from isolation and went to Enugu. A Nigerian
ECOWAS diplomat, Koye Olu-Ibukun, also jumped
observation and escaped to Port Harcourt where a medical
practitioner, Dr. Iyke Enemuo, who attended to him later
died of Ebola infection . The diplomat survived.
In Lagos, some unscrupulous persons took the opportunity
to cash-in by selling fake hand sanitisers, as well as “Ebola
Cassettes and Test Kits” to the unsuspecting public.
The date of resumption of schools from the long holidays
was shifted twice, while a Nigerian football team was
barred from participating in an international competition
that took place in China.
Such was the magnitude of the threat of the disorder which
in the worst of times kills nine out of 10 victims.
People knew better than to “wish” or “hope” it would all just
go away. Beyond hoping Ebola would go away, Nigeria
made it go away. According to the WHO, the nation’s
response was just right. “Nigeria did all the right things at
the right time and for the right purpose.
Series of rumours punctuated the Ebola crisis in Nigeria.
There were reports of suspected cases of Ebola in the
Federal Capital Territory, FCT, Calabar, Kaduna, Kwara,
Delta, Edo and other states, all of which turned out to be
false. A story that the body of the late Port Harcourt doctor
was transported to Edo or Delta State turned out to be
untrue.
What Nigeria did right
A strong leadership and effective coordination of the
response was key. The Nigerian response to the Ebola
outbreak was greatly aided by the rapid utilisation of the
NCDC and the prompt establishment of an Emergency
Operations Centre, supported by the Disease Prevention and
Control Cluster within the WHO country office. Another key
asset was the country’s first-rate virology laboratory
affiliated with the Lagos University Teaching Hospital. That
laboratory was staffed and equipped to quickly and reliably
diagnose a case of Ebola virus disease, which ensured that
containment measures could begin with the shortest
possible delay. In addition, high-quality contact tracing by
experienced epidemiologists expedited the early detection of
cases and their rapid movement to an isolation ward,
thereby greatly diminishing opportunities for further
transmission.
With assistance from WHO, the US Centers for Disease
Control and Prevention, CDC, and others, government
health officials reached 100 percent of known contacts in
Lagos and 99.8 percent at the second outbreak site, in Port
Harcourt, Nigeria’s oil hub. Federal and State governments
provided ample financial and material resources, as well as
well-trained and experienced national staff. Isolation wards
were immediately constructed, as were designated Ebola
treatment facilities, though more slowly.
Vehicles and mobile phones, with specially adapted
programmes, were made available to aid real-time
reporting as the investigations moved forward. Unlike the
situation in Guinea, Liberia and Sierra Leone, all identified
contacts were physically monitored on a daily basis for 21
days.
The few contacts who attempted to escape the monitoring
system were all diligently tracked, using special
intervention teams, and returned to medical observation to
complete the requisite monitoring period of 21 days.
One important lesson for countries facing their first
imported Ebola case or preparing for one, is the need to
carefully document a large number of “best practices” for
containing an Ebola outbreak quickly. The most critical
factor is leadership and engagement from the head of state
and the Minister of Health. Generous allocation of
government funds and their quick disbursement helped as
well. Partnership with the private sector was yet another
asset that brought in substantial resources to help scale up
control measures that would eventually stop the Ebola virus
dead in its tracks.The full range of media opportunities was
exploited – from social media to televised facts about the
disease delivered by well-known “Nollywood” movie stars.
The importance of communication with the general public
was not overlooked. House-to-house information
campaigns and messages on local radio stations, in local
dialects, were used to explain the level of risk, effective
personal preventive measures and the actions being taken
for control..
When the first Ebola case was confirmed in July, health
officials immediately repurposed polio technologies and
infrastructures to conduct Ebola case-finding and contact-
tracing.
The use of cutting-edge technologies, developed with
guidance from the WHO polio programme, put GPS systems
to work as support for real-time contact tracing and daily
mapping of links between identified chains of transmission.
World-class epidemiological detective work would
eventually link every single one of the country’s 19
confirmed cases back to direct or indirect contact with that
20 July air traveller from Liberia.
Traditional, religious and community leaders were engaged
early on and played a critical role in sensitizing the public.
Like many others, the strategy drew on successful
experiences in the polio programme.
The awareness campaigns that worked so well to create
public acceptance of polio immunization were likewise
repurposed to encourage early reporting of symptoms,
backed by the message that early detection and supportive
care greatly increase an Ebola patient’s prospects of
survival.
In the end, Nigeria confirmed a total of 19 cases, of whom
seven died and 12 survived, giving the country an enviable
case fatality rate of 40 percent – much lower than the 70
percent and higher seen elsewhere.
Finally, to help maintain the confidence of citizens and
foreign companies and investors alike, the government
undertook the screening of all arriving and departing
travellers by air and by sea in Lagos and Rivers State. The
average number of travellers screened each day rose to
more than 16 000. So, vigilance remains high.
What Nigeria needs to do
Nigeria is Ebola free, but alert is still required. According to
the WHO, Nigeria will remain vulnerable to another imported
case as long as intense transmission continues in other
parts of West Africa. The surveillance system remains on
guard, at a level of high alert. Moreover, the country’s
success, including its low fatality rate, has created another
problem that calls for a high level of alert.
Many desperate people in heavily affected countries believe
that Nigeria must have some especially good – maybe even
“magical” – treatments to offer.
The WHO and others see a real risk that patients and their
families from elsewhere will come to Nigeria in their quest
for first-rate, live-saving care. Based on the experience
gained from the response in Lagos and rivers states, the
national preparedness and response plan has also been
revised and refined. This strengthened response plan
further boosts confidence that Nigeria’s well-oiled
machinery has a good chance of working miracles again
should another traveller – by land, air or sea – carry the
Ebola virus across its borders again.
Standard precautions recommended in the care and
treatment of all patients regardless of their perceived or
confirmed infectious status must remain in place. They
include the basic level of infection control—hand hygiene,
use of personal protective equipment to avoid direct contact
with blood and body fluids, prevention of needle stick and
injuries from other sharp instruments, and a set of
environmental controls.
Prevention efforts must continue to focus on avoiding
contact. Wash your hands frequently.
As with other infectious diseases, one of the most important
preventive measures for Ebola virus is frequent hand-
washing. Use soap and water, or use alcohol-based hand
rubs containing at least 60 percent alcohol when soap and
water aren’t available. Avoid bush meat. Avoid contact with
anyone who may have been exposed to the Ebola virus.
In particular, caregivers should avoid contact with the
person’s body fluids and tissues, including blood, semen,
vaginal secretions and saliva.
Follow infection-control procedures. If you are a health care
worker, wear protective clothing — such as gloves, masks,
gowns and eye shields. Keep infected people isolated from
others. Carefully disinfect and dispose of needles and other
instruments.
Injection needles and syringes should not be reused. Don’t
handle remains people that died of unknown disease. The
bodies of people who have died of Ebola disease are still
contagious.
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