PLAGUED by concurrent outbreaks of contagious diseases like coronavirus, cholera and Lassa fever, fears have been raised that Nigeria’s vulnerable health delivery system might soon succumb to another deadly occurrence of the Ebola Virus Disease. Therefore, the alert by the Nigeria Centre for Disease Control on the possibility of a fresh Ebola outbreak requires drastic proactive action by all tiers of government.
The current disquiet is traceable to the Sudan EVD strain outbreak in Uganda, East Africa. Already, it has killed 29 persons there, including four healthcare workers since its onset on September 20. The federal and state governments and international partners should revive the local preventive measures.
“The overall risk of importation of the Ebola virus disease and the impact on the health of Nigerians has been assessed as high based on available data,” the NCDC Director-General, Ifedayo Adetifa, said. This is foreboding for a country battling several diseases, including cholera, and meningitis that have been eradicated in many other countries.
Ebola, like any other virus, does not respect physical borders. “The likelihood of importation is high due to the increased air travel between Nigeria and Uganda, especially through Kenya’s Nairobi airport, a regional transport hub, and other neighbouring countries that share a direct border with Uganda,” Adetifa warned.
The World Health Organisation describes Ebola as “a rare but severe, often fatal illness in humans.” Transmitted from wild animals, especially bats, monkeys, forest antelopes and porcupines to humans, the virus can be contracted through body fluids, semen, blood, vomit, and faeces of infected persons. Humans contract it from objects contaminated with it, and corpses of victims. It has an incubation period of two to 21 days. The fatality rate is around 50 per cent.
The first two outbreaks occurred in 1976 in Sudan and DR Congo. Since then, the largest outbreak had occurred in West Africa (2014 to 2016). It ensnared 28,600 persons; 11,000 of them died and cost an estimated $53 billion economic burden. Gabon, Ivory Coast, Senegal, South Africa, Mali, the United States, United Kingdom, Spain and Italy have also suffered outbreaks. Ominously, the WHO says the Sudan strain is more deadly because there is currently no vaccine to treat it.
Instructively, Nigeria experienced the outbreak of Ebola and COVID-19 through incoming air travellers from Liberia and Italy respectively. To avoid such a reoccurrence, the health authorities must be on high alert.
In July 2014, Ebola hit Nigeria hard. Patrick Sawyer, a Liberian-American seriously sick with the virus, travelled to Nigeria. Curiously, he failed to disclose his status and was admitted to First Consultants Hospital in Lagos to treat fever. By the time it was discovered that he was down with Ebola, he had done much damage. In all, eight Nigerians died in the outbreak, including Stella Adadevoh, the consultant who treated him.
As the index case, Sawyer caused a major medical crisis in Nigeria. It took the sterling efforts by the Lagos State Government, which responded quickly by establishing isolation and treatment centres, and the Federal Government to contain the EVD. Apart from the isolation centres, government set up a tracing system, and temperature checks became mandatory at entry points to detect possible cases.
There was also a major awareness campaign on non-pharmaceutical protocols in which hygiene, washing of hands with soap and running water were promoted. Nigerians were advised to suspend hugging and shaking of hands because Ebola can spread from human-to-human contact.
Indeed, these efforts significantly paid off relatively in quick time in comparison to other countries in the sub-region. By October 20, the WHO declared Nigeria Ebola-free, joining Senegal as the only countries in the sub-region to be so classified. That outbreak ended in 2016 in West Africa, though another one lasted from 2018 to 2020 in which Nigeria was spared.
Similarly, Nigeria suffered the COVID-19 outbreak in February 2020 when an Italian travelled to Nigeria undetected. As of last weekend, Nigeria had 3,155 deaths from coronavirus out of 265,741 infected persons; Nigeria currently has 3,593 active cases.
As it presents itself with common symptoms of fever, fatigue, muscle pain, headache and sore throat, an undeveloped healthcare system might not be able to cope with Ebola effectively. This calls for utmost vigilance.
Entry routes into Nigeria are the seaports, airports and land borders. With temperature checks and documentation, the spread can be detected at airports. It is not so with the seaports. Worse are the land borders. They are poorly manned and constitute gaping loopholes. The Chief of Defence Staff, Lucky Irabor, recently declared that 137 of the 261 border points in the North-West and North-East are unmanned. The government should secure these crossings immediately.
Besides, the hygiene protocols should be revived across the country—in offices, schools, churches, mosques and at social gatherings. Nigerians should be warned to desist from eating wild animals, especially bats and monkeys. The WHO recommends burying people who die of Ebola safely.
The Nigerian authorities should quickly procure the Evrebo vaccine, which was approved by the US Drug Administration in 2020, in adequate quantity. In Guinea, 350,000 people over 18 years of age have been vaccinated against Ebola. This is another cogent reason for Nigeria to rebuild its domestic vaccine production industry.
Covering up cases is dangerous, health experts say. Therefore, state governments and the centre should encourage Nigerians to swiftly report possible Ebola cases. This will aid contact tracing, a key factor in containing its spread. UNICEF also recommends strong international support.
Nigeria, Africa’s largest economy and most populous, cannot afford another outbreak; it has a doctor-patient ratio of 1:4,000-5,000, according to the Nigerian Medical Association, as against the 1:600 recommended by the WHO. Medical personnel are fleeing the country in droves for better conditions overseas.
Nigeria is still reeling from several endemic health challenges like malaria, maternal/infant mortality. With the weak healthcare system, allowing Ebola would be calamitous. Prevention is infinitely better than cure; therefore, Ebola should be prevented at all costs.
