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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.”
(Score: 4, Insightful) by frojack on Friday October 17 2014, @01:11AM
Not everybody agrees [slate.com] that they did a good job:
But arguably, Nigeria didn’t actually do a very impressive job. A single Liberian man, who traveled to Nigeria in July, infected 11 hospital staff in the time between his admission to a hospital and when his test results were received. There might have been more infections if not for a doctors’ strike that reduced the number of people who came in contact with him. One doctor told the New York Times, “At the time, nobody was prepared for it.”
In short, they got lucky. A guy presents in the airport, among crowds, and ONLY 20 got sick, which was pretty much because people were already aware and on alert for ebola cases. Yet, 11 people in the hospital got infected, and they should have known better.
Most of the infectited were among medical professionals, who probably knew enough to cooperate with the contact tracing and self quarantine.
1-to-20 infection rate (R0) is very bad. [forbes.com]
At the start of an outbreak, the rate is called ‘R0′ (the basic reproductive number). R0 indicates whether or not a contagious disease has the potential to become an epidemic. Populations can evolve natural immunity or gain artificial protection through health interventions like vaccination, reducing the proportion of susceptible people, so the reproductive number for later periods of time is ‘Rt’.
R0 was 1.7 to 2 during the initial period of exponential growth in West Africa, while the current Rt is 1.4-1.8 [1]. (Calculations by the WHO Ebola Response Team are roughly in line with estimates by other researchers.) R = 2 doesn’t sound high until you hear that the deadliest pandemic in recorded history, the 1918 Spanish flu, killed up to 100 million people even though the influenza virus had an R of 2.
They got lucky.
No, you are mistaken. I've always had this sig.
(Score: 1, Informative) by Anonymous Coward on Friday October 17 2014, @01:44AM
The Spanish flu was an airborne virus. Easily transmitted.
Ebola in a fluid-borne infection. It requires close contact with a victim.
The reason so many people have gotten Ebola is that families gather for ritual washing of the corpse before internment|cremation.
-- gewg_
(Score: 2, Informative) by khallow on Friday October 17 2014, @03:16AM
The reason so many people have gotten Ebola is that families gather for ritual washing of the corpse before internment|cremation.
The reason so many people got Ebola is because, with the limits of its current means of transmission, it is very infectious. Ritual washing is far from the only means of spreading the disease by close contact.