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How Nigeria Stopped Ebola
HughPickens.com writes Pamela Engel writes that Americans need only look to Nigeria to calm their fears about an Ebola outbreak in the US. Nigeria 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 sick passenger on a commercial flight — officials successfully shut down the disease and prevented widespread transmission. If there are still no new cases on October 20, the World Health Organization will officially declare the country "Ebola-free." Here's how Nigeria did it.
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. Once Sawyer 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. 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. 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. 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 making a staggering 18,500 face-to-face visits.
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. "That experience shows us that even in the case in Nigeria, when we found out later in the timeline that this patient had Ebola, that Nigeria was able to identify contacts, institute strict infection control procedures and basically bring their outbreak to a close," says Dr. Tom Inglesby. "They did a good job in and of themselves. They worked closely with the U.S. CDC. If we can succeed in Nigeria I do believe we will stop it here."
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. Once Sawyer 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. 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. 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. 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 making a staggering 18,500 face-to-face visits.
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. "That experience shows us that even in the case in Nigeria, when we found out later in the timeline that this patient had Ebola, that Nigeria was able to identify contacts, institute strict infection control procedures and basically bring their outbreak to a close," says Dr. Tom Inglesby. "They did a good job in and of themselves. They worked closely with the U.S. CDC. If we can succeed in Nigeria I do believe we will stop it here."
Once you have a couple dozen actual cases on your hands, this method is quickly overwhelmed. All it takes is for a few infected people to slip through and infect several people before they can be found and isolated. Nigeria did the right thing and was lucky.
So, USA is following safety standards equivalent to those in Nigeria?
American exceptionalism at its finest. We know everything, the rest of world doesn't know jack shit.
Keep having that attitude and Ebola from an insignificant problem in the US will become a great problem.
Ebola is not a smart virus, killing its host so soon. It can be handled quite easily -- just isolate the people and you have your results within a month. ... I don't get the comparison the CDC drew. HIV can spread easier and stays in the body for such a long time, giving the virus many years to contaminate more hosts before becoming problematic. It's a bigger problem by magnitudes.
HIV on the other hand
Yes, but Nigeria went "Isolate THEN test", the US is doing "Test (and by the time they test possible other people may be infected) then isolate" i.e. Nigeria took this seriously, the US isn't.
Nigeria does it better.
"If any question why we died, Tell them because our fathers lied."
It only takes one stupid uncooperative idiot ( maybe from a certain news station) to spread the disease.
Oh, you mean when the CDC themselves clears a caregiver known to be in direct contact with Eric Duncan to fly on a commercial airline with a low-grade fever?
Yeah, you're right, it only takes one. Too bad that "one" is the CDC fucking up in the worst way possible.
It's one thing to have the official protocols in place. However the biggest problem is with cultural attitudes. If you have a huge portion of the population who are highly superstitious, and suspicious of the government, scientists, and modern medicine, as well as a lack of basic social safety nets, then you have a recipe for disaster. So what may have worked well in Nigeria is not guaranteed to be so effective in USA.
The Texas Health Presbyterian Hospital seems to have been overwhelmed with one case. That one case did not "slip through". he was turned away and sent home. Training was non-existent, proper supplies were not available. It's a fiasco.
Nigeria was more than lucky; they were prepared. Texas Health Presbyterian was not.
Countries do some things well, and other things badly. Apparently Nigeria has done a good job at stopping Ebola. We should respect that, and learn lessons from them on how to stop it here in the US.
Obama's response to Ebola is driven by politics and media not science or health. Doing this here would of course be condemned as being racist, homophobic, Islamophobic, immigrantophobic, and anyway, we're way passed the point where it's even practical to conduct face to face visits. So much time has gone by that we're in the millions of visits needed. No I'm afraid the best approach is Obama's approach which is to do nothing and blame it on someone else until it burns itself out.
You god damned parrot. It's not about shutting them down, it's about recognizing their errors and finding some damn way to hold them accountable. The current administration is completely against accountability. See IRS, Fast and Furious, Benghazi...
Grey's Law: Any sufficiently advanced incompetence is indistinguishable from malice. That's why you have to fight - not people ranting "shut down the govmint!", but rather the people in the government that allow such incompetence that it becomes dangerous to the nation.
The math says there are at least fifty infected traveling around the country right this minute, two and a half weeks after his arrival.
And the real world evidence says none of them have come down with the disease yet, which is a strong indication that they aren't actually infected. Math isn't much use when your assumptions are wrong.
Hmm, interesting theory, that.
Both Nigeria and the USA began their ebola problems with one (1) Liberian man entering their country with ebola.
Nigeria ended up with ~20 ebola cases, of which 9 died.
So far, the USA has had ~3 cases, of which one has died.
Now, the USA isn't done yet. Probably. Maybe. We'll see.
But so far, our situation is essentially identical with Nigeria's, and our outcome is the same as or better than their outcome. Note the "so far" - it's important.
"I do not agree with what you say, but I will defend to the death your right to say it"
The basic problem with Ebola in the US is that everybody in the US who knows what to do about Ebola is over in Africa right now trying to stop it at the source. The folks still stateside are the B team.
Moderating "-1, Disagree" is simple censorship. Have the guts to post your opinion.
The experts only screwed up if it turns out that a low grade fever of less than 100.4 F actually indicates the Ebola patient has entered the contagious stage. (Her fever reached 99.5 F, less than a degree above normal.). What reasonable people here are debating is whether the current standard rules are enough or if we should adjust them further to 'err on the side of caution'. Personally, I would go with more caution by the CDC, AND more caution by the airline, but carry that far enough, and we take a flamethrower to a perfectly good airplane. Constant calls for more caution have associated costs, and need to come from people who generally think about consequences.
Unfortunately, some people in the discussion are neither reasonable nor unbiased. Bill O'Riley for example, is calling for mass firings and resignations at the CDC, going all the way to the top, but has been unwilling to even criticise the fact that his own party has blocked selecting a new surgeon general for seven months. If America does end up with Tens of Thousands dead, it will be because of people who are so political that they want immediate reprisals against people of the other party they think may have made mistakes that may contribute to deaths in the future, but no action taken when we already have at least one actual death and clear indications of actual negligence, unless there's political capital to be made and it doesn't step on anyone in their own party's toes.
Who is John Cabal?
NIH's budget was reduced by $446m from 2010 to 2014, and subjected to inappropriate politically motivated interference in its decision-making. The CDC's discretionary funding was cut by $585m during this same period. Shockingly, annual funding for the CDC's public health preparedness and response efforts were $1b lower for 2013 fiscal year than for 2002. These funding decreases have resulted in more than 45,700 job losses at state and local health departments since 2008.
- Judy Stone, infectious disease specialist
That doesn't seem like a very good October Surprise...
The performance so far does not inspire confidence. Mistake after mistake and being reactive instead of proactive.
So far neither the CDC (nor WHO) has explained exactly how more cases of Ebola in more locations leads to eventual control. Texas is an informative example of what to expect when Ebola shows up in a new location that has no experience with such an unusual and deadly disease.
[And the flu trolls have to stop. Flu is already endemic. Meanwhile Ebola must be prevented from becoming endemic. There is a very rational reason to be agitated by the apparent lack of competent response. Ebola has never before been contained after an outbreak this large. This outbreak is already twenty times larger than the largest successfully contained outbreak.]
I live in a small town in Appalachia with dirt-poor but stubborn^H^H^H^H^H^Hproud conservative folk.
If Ebola comes to visit it'll wipe out my mountain town.
:(
Not sure I understand. What's the downside?
This is the strange thing. It isn't like no one knew of the ebola threat, unless you didn't watch television, listen to the news, or use the internet.
It isn't that strange. Because if you did listen to the news or watch television, then no, you didn't know about the 'threat', because what has been repeated time after time is 'there is no threat, relax, we can deal with this, we're prepared'. Nigeria probably had a quite different message running through both media and government knowing that they have one single chance to stop this and that's at the source. Screw up a single thing and the preview of what happens was available next door.
Some like to think our health care standards make a difference, that the West is more civilized and it can't happen here. But the thing is, after a few ICU places and a few quarantine beds, modern medicine is left with aspirin and electrolytes as far as 'treatment' goes which doesn't give us much edge on African medicine. This needs to be taken as seriously in the developed world as it does in Nigeria, and we need to get useful treatments available _now_.
To be fair, there is an incubation period of about a week (the time between infection and transmissibility). You can still have geometric progression and not really know it for a couple of months before it becomes a crisis.
That said, Ebola has been around for years in Africa, where people don't have some basic sanitary practices. Even with a long incubation period, we'd have already seen a global outbreak if this virus were really as bad as the fear-mongerers are making it out to be.
Keep in mind that there's a difference between an exposure from one viral particle (as you might get from being handed a beverage cup) and a mass of them (handling the bodily fluids of the exposed as a nurse would). With one particle, your immune system has time to detect and react. It is those exposed to the mass particulates who will likely die.
I'll do what I can to avoid being exposed. I'll wash my hands, cook my food, and stay away from obviously sick people. Since I'd have done that anyway, my life hasn't changed much...
Nigeria was more than lucky; they were prepared. Texas Health Presbyterian was not.
This is the strange thing. It isn't like no one knew of the ebola threat, unless you didn't watch television, listen to the news, or use the internet. In addition, terrorist issues include biological warfare, a situation where similar isolation and contamination issues exist. Why didn't a hospital in Dallas Texas have materials on hand to provide a proper response - if it didn't have them.
Materials and preparation cost money. Hospitals that don't have them make more money than hospitals that don't, unless they actually have an Ebola outbreak. Hospitals figure they never will, so they don't prepare.
That is what happens when you don't mandate preparation by regulation and audit compliance, and combine that with a competitive market-based healthcare system. Nobody has incentive to prepare for anything unlikely to occur. If anything does go wrong they just throw their hands in the air and say that nobody could have seen this coming and beg for help from the (CDC/Federal Reserve/FEMA/whatever).