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the deadly virus has overwhelmed already weak public health systems
and left thousands of people dead, and anxiety grips the United States
over the first case of Ebola diagnosed in the country, one nation
serves as an example of hope: Nigeria, which appears to have
successfully contained Ebola.
Concerns spread over U.S. hospital readiness, there are some lessons
to be learned from Nigeria, where officials managed to get ahead of
the fast-moving virus after it was brought into Africa's most populous
country by an Ebola-infected man who'd flown into Lagos. This week,
the U.S. Centers for Disease Control and Prevention reported that the
outbreak could be coming to an end in Nigeria, with no new Ebola cases
since Aug. 31.
As in the U.S. case, Ebola arrived in Nigeria by passenger plane. But
unlike Thomas Eric Duncan — who arrived in Dallas before he became
symptomatic and was therefore not contagious during his flights from
Liberia to Texas through Brussels and Dulles International Airport —
Patrick Sawyer was already symptomatic when he landed in Lagos on July
20. At that point, Sawyer, Nigeria's Patient Zero, was contagious and
dying.
It was a nightmare scenario with the potential to spiral out of
control, given the bustling city of Lagos, Africa's largest, is a
major transportation hub. As Sawyer was placed in isolation, public
health officials had to track down every single person who'd come into
contact with him, from the flights he'd boarded to the Lagos airport
and the private hospital where he went after landing. And they had to
do so quickly, making the process known as contact tracing a priority.
"In the whole system approach in beating the war on Ebola, contact
tracing is the key public health activity that needs to be done," said
Gavin MacGregor-Skinner, who helped with the Ebola response in Nigeria
with the Elizabeth R. Griffin Research Foundation. "The key is to find
all the people that patient had direct close contact with."
From that single patient came a list of 281 people, MacGregor-Skinner
said. Every one of those individuals had to provide health authorities
twice-a-day updates about their well-being, often through methods like
text-messaging. Anyone who didn't feel well or failed to respond was
checked on, either through a neighborhood network or health workers.
Nigeria took a "whole community approach," with everyone from military
officials to church elders in the same room, discussing how to handle
the response to the virus, MacGregor-Skinner said.
Such an approach, and contact tracing in general, requires people be
open and forthright about their movements and their health, he said.
Stigmatization of patients, their families and contacts could only
discourage that, so Nigerian officials sent a message to "really make
them look like heroes," MacGregor-Skinner said.
"This is the best thing people can do for Nigeria: They are going to
protect and save Nigeria by being honest, by doing what they need to
do, by reporting to the health commission," he said. This made people
feel like they were a part of something extremely important, he said,
and also took into account real community needs. "You got real
engagement and compliance from the contacts. They're not running and
hiding."
Sawyer had come into contact with someone who ended up in Port
Harcourt. That person, a regional official, went to a doctor who ended
up dying from Ebola in August. Within a week, 70 people were being
monitored. It ballooned to an additional 400 people in that one city.
Success stories of people coming through strict Ebola surveillance
alive and healthy helped encourage more people to come forward, as
they recognized that ending up in a contact tracer's sights didn't
mean a death sentence.
In the end, contact tracers — trained professionals and volunteers —
conducted 18,500 face-to-face visits to assess potential symptoms,
according to the CDC, and the list of contacts throughout the country
grew to 894. Two months later, Nigeria ended up with a total of 20
confirmed or probable cases and eight deaths.
The CDC also pointed to the robust public health response by Nigerian
officials, who have had experience with massive public health crises
in the past — namely polio in 2012 and large-scale lead poisoning in
2010.
When someone is on a contact list, that doesn't mean that person has
to stay at home for the entire incubation period of 21 days from the
last contact with someone who had Ebola. People on contact lists are
not under quarantine or in isolation. They can still go to work and go
on with their their lives. But they should take their temperature
twice a day for 21 days and check in with health workers.
Officials in Texas began with a list of about 100 names; they have
whittled the list down to 50 people who had some contact with Duncan.
Of those, 10 are considered high-risk.
The CDC recommends that people without symptoms but who have had
direct contact with the bodily fluids of a person sick with Ebola be
put under either conditional release, meaning that they self-monitor
their health and temperature and check in daily, or controlled
movement. People under controlled movement have to notify officials
about any intended travel and shouldn't use commercial planes or
trains. Local public transportation use is approved on a case-by-case
basis.
When symptoms do develop, that's when the response kicks into high
gear. People with Ebola are contagious only once they begin exhibiting
symptoms, which include fever, severe headaches and vomiting.
While four people in Dallas are under government-ordered quarantine,
that is not the norm. Those individuals "were non-compliant with the
request to stay home. I don't want to go too far beyond that," Dallas
County Judge Clay Lewis Jenkins said Thursday.
On Friday, the four people were moved to a private residence from the
apartment where Duncan had been staying when he became symptomatic.
A law enforcement officer will remain with them to enforce the order,
and none of the people are allowed to leave until Oct. 19.
Duncan is the only person with an Ebola diagnosis in Dallas, and no
one else is showing symptoms at the moment. But, as Nigeria knows, the
work in Dallas has just begun.
(http://www.washingtonpost.com/news/to-your-health/wp/2014/10/04/what-texas-can-learn-from-nigeria-when-it-comes-to-containing-ebola/)
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