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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."

24 of 381 comments (clear)

  1. That works fine if you manage to nip it in the bud by Anonymous Coward · · Score: 4, Insightful

    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.

  2. It only takes one ... by Psilax · · Score: 5, Interesting

    It only takes one stupid uncooperative idiot ( maybe from a certain news station) to spread the disease.

    And I wouldn't compare USA (or for that matter EU ) citizens to Nigerian citizens, Nigeria is known for it scare tactics, I don't see our governments try the same tactics without getting trouble back.
    Let alone that no lower class person will stay home from their job for 3 weeks without pay, they will lose their job and get evicted.
    Or is the government finally going to pay for those kind of expenses?

    1. Re:It only takes one ... by Anonymous Coward · · Score: 5, Interesting

      When my wife came back from Asia with a heavy fever in the swine flue days, she warned the officials and had to spend 24h in isolation for tests. She had to pay 1500€ for this as she was not a national. This don't motivate to declare anything, she had just graduated and was without money. Apply this to a bunch of people and many will skip warning about signs.

    2. Re:It only takes one ... by geekmux · · Score: 4, Insightful

      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.

    3. Re: It only takes one ... by link-error · · Score: 5, Interesting

      The second nurse had a slight fever and called the CDC. They gave her the OK to FLY! She has since tested positive. They were not prepared at all.

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    4. Re:It only takes one ... by squiggleslash · · Score: 4, Funny

      EBOLAGHAZI!!!!

      --
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    5. Re:It only takes one ... by CrimsonAvenger · · Score: 4, Funny

      swine flue

      Can't tell here if your chimney was built by pigs, or had a pig stuck in it.

      Please clarify.

      --

      "I do not agree with what you say, but I will defend to the death your right to say it"
    6. Re:It only takes one ... by _merlin · · Score: 4, Interesting

      When H1N1 was spreading around Melbourne, people wouldn't go to the doctor if they thought they had caught it, because if you did and they diagnosed you with it you were legally required to take time off work and isolate yourself. People just didn't want the inconvenience, and taking your chances with swine flu didn't usually kill you. Ebola's a bit more risky to play with.

    7. Re:It only takes one ... by weave · · Score: 4, Interesting

      That's my fear too. I live in a small town in Appalachia with dirt-poor but stubborn^H^H^H^H^H^Hproud conservative folk. When they get sick, they just don't go into the hospital. They ride it out at home. They have no health insurance and won't even sign up for it if they can because -- Obamacare. They *may* go to the free clinic in town that's open Tuesdays from 1-3pm. They live in remote areas down dead-end gravel roads that lead to the side of a mountain that other locals know you don't drive down if you have no business going down. If Ebola comes to visit it'll wipe out my mountain town. :(

    8. Re: It only takes one ... by Artifakt · · Score: 5, Insightful

      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.

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  3. Re:US,Nigeria by Anonymous Coward · · Score: 4, Insightful

    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.

  4. Not the same thing at all. by Anonymous Coward · · Score: 5, Insightful

    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.

  5. How to tell if you live in a 3rd World country by koan · · Score: 5, Insightful

    Nigeria does it better.

    --
    "If any question why we died, Tell them because our fathers lied."
  6. Cultural attitudes by Anonymous Coward · · Score: 5, Insightful

    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.

  7. Re:That works fine if you manage to nip it in the by Anonymous Coward · · Score: 5, Insightful

    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.

  8. Re:US,Nigeria by myid · · Score: 5, Insightful

    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.

  9. Re:Ebola vs HIV by Stripe7 · · Score: 5, Insightful

    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.

  10. Re:That works fine if you manage to nip it in the by Anne+Thwacks · · Score: 4, Funny
    You are forgetting Texas is a third world country.

    Oh, wait ...

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  11. Re:US,Nigeria by CrimsonAvenger · · Score: 4, Insightful

    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"
  12. Re:US,Nigeria by Ol+Olsoc · · Score: 4, Funny

    No, the US is hoping that it will be able to handle the situation as well as Nigeria did.

    So far it isn't.

    If we would only learn to allow the free market to decide.

    --
    The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
  13. Re:US,Nigeria by freezin+fat+guy · · Score: 4, Funny

    Exactly. Typical Obama nanny state government thinks it's their business to protect us from ebola.

  14. Re:That works fine if you manage to nip it in the by h4ck7h3p14n37 · · Score: 4, Interesting

    The hospital also waited until they got a positive Ebola test result back before taking any safety precautions. Staff were exposed for something like two days and administration resisted isolating the patient. The sample was sent through the normal channels for testing which potentially contaminated their tube system. High-risk individuals who treated Duncan were not placed in quarantine and they allowed something like 70 different people to come into contact with him. Then there's the issue of them initially prescribing antibiotics for a viral infection.

  15. Re:That works fine if you manage to nip it in the by Znork · · Score: 4, Insightful

    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_.

  16. Re:That works fine if you manage to nip it in the by mspohr · · Score: 5, Informative

    The Texas case just exposes (again) the fallacy that the US has the best healthcare in the world.
    This hospital made too many amateur mistakes to count:
    - Sent the guy home with antibiotics when he presented with a fever after travel to Ebola infected area.
    - Did not institute full isolation protocol until three days after he was admitted (thus exposing nurses and other patients to the disease).
    - Did not follow CDC protocol even after confirmed Ebola.
     

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