Slashdot Mirror
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."
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'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.
The US health care system is a for profit medical system. This has resulted in a darwinian devolution of health care. The hospitals that care too much about treating patients and not their bottom line go out of business and fold. This leaves those that balance on the brink of bankruptcy and those who make a profit at the expense of patients who are uninsured or otherwise cannot pay for their medical services. Some keep their hospitals running by over billing those who are insured and those who can afford to pay, others do it by cutting back on training and equipment that is rarely used, like training for an infectious disease like Ebola or buying the equipment needed to prevent their own workers from being infected. The CDC sends out their protocols to all the hospitals, they cannot force the hospitals to buy the equipment, and train their staffs. Once the hospitals acknowledge they have received the protocols, not that they have implemented them, it seems the CDC marks them as being prepared for Ebola. Thus stands the current US preparedness for Ebola, a hodge podge of hospitals totally prepared and some totally without a clue, with protocols sitting in some filing cabinet somewhere.
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?