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Medicine

How Nigeria Stopped Ebola 381

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."
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How Nigeria Stopped Ebola

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  • by Anonymous Coward on Thursday October 16, 2014 @04:45AM (#48157421)

    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.

    • by Anonymous Coward on Thursday October 16, 2014 @07:01AM (#48157755)

      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.

      • by Anne Thwacks ( 531696 ) on Thursday October 16, 2014 @07:25AM (#48157835)
        You are forgetting Texas is a third world country.

        Oh, wait ...

      • by Spazmania ( 174582 ) on Thursday October 16, 2014 @08:27AM (#48158231) Homepage

        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.

        • I'm pretty sure they're not actually on the team.

        • by mspohr ( 589790 ) on Thursday October 16, 2014 @12:12PM (#48160629)

          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.
           

          • Sent the guy home with antibiotics when he presented with a fever after travel to Ebola infected area.

            THAT mistake I can understand. They've seen SO many cases of Ebola after all. But permitting scores of people to be in the room with the guy *after* they decided to test for Ebola was a preventable error. And failing to tell the folks involved in his treatment to stay away from public transportation for a safety period following their contact with a confirmed Ebola patient was total amateur hour. Seriously, WTF do we have a no-fly list for anyway?

      • 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.

        Maybe we should spend a little less time and money militarizing our police forces, and more time and money getting ho

        • by Znork ( 31774 ) on Thursday October 16, 2014 @11:41AM (#48160305)

          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_.

        • by Rich0 ( 548339 ) on Thursday October 16, 2014 @12:43PM (#48160943) Homepage

          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).

      • by h4ck7h3p14n37 ( 926070 ) on Thursday October 16, 2014 @09:38AM (#48158759) Homepage

        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.

    • 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 you watched "The Stand" last night I take it? In real life it doesn't work that way. They are still using this method even in the hot spots where the potential contacts include just about the entire population. It lets them narrow down who to test and who to quarantine.

  • by Psilax ( 1297141 ) on Thursday October 16, 2014 @04:49AM (#48157427)

    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?

    • Re: (Score:3, Interesting)

      by MrDoh! ( 71235 )
      Yup, only takes one person holed up in their bunker, seeing the gubmint trying to take their guns away for it to turn... well, as these things usually go. Though I suspect the police storming the compound might take a bit more care than usual.
      • by link-error ( 143838 ) on Thursday October 16, 2014 @05:16AM (#48157503)
        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.
        • Even worse: she's a nurse. She felt there was a chance she might have Ebola, so much that she called the CDC. She didn't err on caution. Forget the CDC's (non)answer. She knew what she was doing was risky. Even if no one gets infected, she had better talk to a lawyer about all the "mental anguish" lawsuits she'll soon be subjected to.
          • Re: (Score:2, Interesting)

            by Anonymous Coward

            A non-issue. She called the CDC, which is the apex organization in dealing with this sort of thing, and they cleared her. It's called due diligence, and she exercised it, and the CDC is the one at fault.

            If I were her, anybody filing against me would get an instantaneous counter suit for mental anguish as well for putting me through the legal process and not going after the CDC directly.

      • Wouldn't a person holed up in a bunker be in an very effective self quarantine? If they had the disease whether or not they recovered it would be contained which is a lot different than an Ebola contact nurse who jumps on a commercial airliner despite symptoms. Both are crazy but one is at risk of infecting no one, one just put thousands of people at two airports and on a tightly confined aircraft at risk. So which is more dangerous?

      • Burn down the compound.

        Both problems solved.

    • by Anonymous Coward on Thursday October 16, 2014 @05:00AM (#48157463)

      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.

      • by CrimsonAvenger ( 580665 ) on Thursday October 16, 2014 @07:51AM (#48157975)

        swine flue

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

        Please clarify.

      • by _merlin ( 160982 ) on Thursday October 16, 2014 @07:51AM (#48157977) Homepage Journal

        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.

      • by weave ( 48069 ) on Thursday October 16, 2014 @07:53AM (#48157991) Journal
        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. :(
    • by geekmux ( 1040042 ) on Thursday October 16, 2014 @05:16AM (#48157499)

      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.

      • by Greyfox ( 87712 )
        Yeah. Between vials of smallpox showing up and their handling of ebola, I've gotten the impression that the CDC are a bunch of inept fools. Probably a bunch of cronies appointed in various administrations. You know when a bad time is to discover the people running your organization that's supposed to deal with infectious diseases in your country are a bunch of inept fools? When a disease that's so far killed 70% of the people who've contracted it enters your country. So far we've been very arrogant in our h
    • Perhaps like a nurse who traveled right after caring for an ebola patient?

      • Have you missed the part where she asked the CDC for permission first?

        The CDC is screwing this up big time.

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

      And when that stupid idiot is thrown into jail for manslaughter the other stupid idiots will think about it.

  • Ebola vs HIV (Score:2, Insightful)

    by Anonymous Coward

    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.
    HIV on the other hand ... 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.

    • Re:Ebola vs HIV (Score:4, Informative)

      by aaaaaaargh! ( 1150173 ) on Thursday October 16, 2014 @05:46AM (#48157575)

      The difference is that you can live with an HIV infection nowadays provided you are treated early and continuously, whereas there is a 50-90% chance of dying from Ebola.

      • by Bengie ( 1121981 )
        That's the point, Ebola kills itself as long as people die faster than they can come in contact with others. All you need to do is stop people from contacting others for a relatively short time and it fixes itself.
      • Tell that to the millions of people that die from it every year.
        Ebola is like an airline crash. It's horrible to hear about and shocking... but likely to happen to you? No...
        You are far more likely to get killed by HIV, The Flu, Heart Disease than Ebola. Even if we have a major outbreak here.

    • Prevent HIV -- put condom on penis.

      Prevent ebola -- put condom on city.

  • You cannot predict what happens in face of a real treat from the - lucky - turnout of just one single case. That is statistically meaningless. The next time the same process may as well fail at one point...
    • Re: (Score:2, Informative)

      by Anonymous Coward

      But it's not just one case, it's 19, all of whom appear to have been prevented from spreading the disease to the wider population.

  • by Anonymous Coward on Thursday October 16, 2014 @05:01AM (#48157467)

    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.

    • by Luckyo ( 1726890 )

      To be fair, I think this is the problem with general population more than anything. With success of vaccines people forgot that there are actually crippling and lethal infectious diseases. They may intellectually understand it, but there's very little understanding on everyday life level. The current panic underscores it as well - first people underreact and now they are overreacting.

      CDC is supposed to be professionals trained for this kind of a situation, but they're not immune to being well off for last h

      • The current panic underscores it as well - first people underreact and now they are overreacting.

        The shwinesflu scare a couple of years ago may also be an explanation for the initial under-reaction...

  • by koan ( 80826 ) on Thursday October 16, 2014 @05:08AM (#48157483)

    Nigeria does it better.

  • Comment removed based on user account deletion
    • You cannot prevent an American citizen from returning home. However, a mandatory, no exceptions 60 day quarantine would have worked (60 days from departure of affected country).

      • You cannot prevent an American citizen from returning home. However, a mandatory, no exceptions 60 day quarantine would have worked (60 days from departure of affected country).

        Who is going to pay for that, the traveler? And do you realize that the absolute longest it would take to diagnose someone with Ebola is only 20 days from exposure? So why keep them quarantined for an additional 40 days? Perhaps you should do some research on the illnesses in question before you start suggesting solutions to prevent its spread?

      • by geekoid ( 135745 )

        So people will go to another country, and then enter from there.

    • by u38cg ( 607297 )
      But on the other hand, people that actually know what they're talking about say travel bans are counter-productive and hence bullshit. Who to believe?
    • by Charliemopps ( 1157495 ) on Thursday October 16, 2014 @08:16AM (#48158149)

      Yeah, good luck with that. The last thing I saw on TV was people from her plane made hops to at least four states.

      The President should have just ordered people with passports and travel stamps from these countries to not be allowed to enter the US.

      A travel ban would kill more people than Ebola ever would.

      Due to western workers refusing to travel to certain countries in Africa because of Ebola, the Cocoa crop has already been threatened:
      http://www.reuters.com/article... [reuters.com]

      There are also travel bans between those countries. Because of that, the migrant workers that harvest them will have no work for the year. No income. Many will starve to death. MORE than would have been killed by Ebola. As bad as dieing from Ebola is, Starvation is worse.

      Panic will always kill more people than the disease. Think critically before you demand action. The cable news networks are reveling in the profit they are making off of your panic.

  • Cultural attitudes (Score:5, Insightful)

    by Anonymous Coward on Thursday October 16, 2014 @06:15AM (#48157647)

    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.

  • by gelfling ( 6534 ) on Thursday October 16, 2014 @07:23AM (#48157823) Homepage Journal

    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.

  • by russotto ( 537200 ) on Thursday October 16, 2014 @07:42AM (#48157927) Journal

    This disease can spread from surface contact with contaminated fluids (which Ebola victims tend to leak profusely). Indoors, even dried fluids can remain infectious for hours. All it takes is to touch the fluids and then touch your eyes or mouth (which you do all the time) Something like the NYC subway provides very good conditions for spread, once the first sick people take a few trips

    • Re: (Score:2, Informative)

      This disease can spread from surface contact with contaminated fluids (which Ebola victims tend to leak profusely). Indoors, even dried fluids can remain infectious for hours. All it takes is to touch the fluids and then touch your eyes or mouth (which you do all the time) Something like the NYC subway provides very good conditions for spread, once the first sick people take a few trips

      Stop spreading FUD.
      You cannot get it that way.
      Saliva does not count. You need to ingest Blood/Vomit to catch it.
      By the time they are sick enough to be leaking that stuff, they would be in the hospital in this country.

      In Africa they are much more used to going about their day while deathly ill. That's the problem.
      The only people truly at risk in this country are Healthcare workers.

      • You're a fucking liar.

        http://en.wikipedia.org/wiki/E... [wikipedia.org]

        "Human-to-human transmission occurs only via direct contact with blood or body fluid from an infected person (including embalming of an infected dead body), or by contact with objects contaminated by the virus, particularly needles and syringes.[24][25] Other body fluids that may transmit ebolaviruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen. Entry points include the nose, mouth, eyes, or open wounds, cuts and abr

      • by geekoid ( 135745 ) <{moc.oohay} {ta} {dnaltropnidad}> on Thursday October 16, 2014 @09:48AM (#48158851) Homepage Journal

        Yes, you absolutely can get it that way.
        From the CDC: [cdc.gov]
        "blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
        objects (like needles and syringes) that have been contaminated with the virus
        infected animals
        Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus"

        The problem in Africa is any fold. People lying and saying the people their to help are causing it. People spreading rumors that the people their to help are harvesting organs, The tradition of kissing the dead, the habit of not going to the doctor. Africans being target by peddlers of SCAMSs(Supplement, Complementary, Alternative Medicines). All of that is possible with exceedingly high levels of illiteracy, and a high belief in woo.

  • by starless ( 60879 ) on Thursday October 16, 2014 @08:03AM (#48158061)

    From the NYT today:
    http://www.nytimes.com/2014/10... [nytimes.com]

    Federal health officials effectively acknowledged the problems with their procedures for protecting health care workers by abruptly changing them. At 8 p.m. Tuesday, the Centers for Disease Control and Prevention issued stricter guidelines for American hospitals with Ebola patients.

    They are now closer to the procedures of Doctors Without Borders, which has decades of experience in fighting Ebola in Africa. In issuing the new guidelines, the C.D.C. acknowledged that its experts had learned by working alongside that medical charity.

    But...
    The Doctors Without Borders guidelines are even stricter than the new C.D.C. directives

    • by geekoid ( 135745 )

      Just so you know.
      The CDC guidelines for America are different then their guidelines for Africa.
      The DWB guidelines are for moving around high level of infection rates.

      tl;dr really? it's three line.

    • by geekoid ( 135745 )

      New York Post? I wouldn't even trust them to print the data without it being alarmist FUD.
      Use better sources.

  • by Anonymous Coward

    on a side note Nigeria also banned flights to/from these hotspots - Arik Air (Nigeria), Gambia Bird and Kenya Airways have suspended services to Liberia and Sierra Leone. source: https://www.internationalsos.com/ebola/index.cfm?content_id=435&language_id=ENG

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