Ebolas Threat Forced Nigerias Lagos to Scramble Creative Hustle, Lucky Breaks Helped Tamp Down Deadly Virus By DREW HINSHAW in Lagos, Nigeria, and BETSY MCKAY in Atlanta Aug. 1, 2014 8:47 p.m. ET LAGOS, Nigeria—Doctors were on strike the day a man infected with Ebola landed at a packed airport in Africas biggest city. In a few days a Muslim holiday would send health workers on a break and millions of ordinary people crowding into buses and planes. The citys health commission was out of thermometers, said its commissioner Jide Idris. It could have been a nightmare, except that a chaotic overpopulated city showed how a dash of organization and creative hustle can tame one of the worlds deadliest viruses. While nearby nations Liberia, Guinea and Sierra Leone have been struggling to tamp down an Ebola outbreak that has killed 729 people this year, Nigerian officials crash-trained lab technicians and civil servants on how to enter a house and check for the virus. In four days, they turned an abandoned government building into an isolation unit. In a week they managed to find and cold-call scores of people from blue-collar workers to diplomats who may have touched Patrick Sawyer, the Liberian-American passenger whose landing in Lagos could have sparked an outbreak in a city of as many as 21 million people. Lagos also got lucky: Mr. Sawyer, a consultant at the Liberian Finance Ministry, collapsed on arrival in the city and was put in isolation at a hospital. Had he spent even a few hours outside the airport, he might have spread his illness to exponentially more people, many of them impossible to trace in the endless sprawl of tin-roof shacks and walk-up apartments that is Lagos. More than 1,323 people have been sickened, about 60% of them fatally, in West Africa since Ebola erupted from the forested interior of Guinea, according to the World Health Organization. The hundreds dead include a top Sierra Leonean doctor and another from Liberia, while two U.S. health-care workers are ill. On Friday, Guinea, Sierra Leone and Liberia agreed to quarantine the area where their countries share a border, said Liberian Information Minister Lewis Brown. Also on Friday, WHO Director-General Margaret Chan said the outbreak is spreading faster than health workers can control it. Yet it can be stopped with a well-managed response, she said. She put her finger on the problem that has allowed West Africa to lose control over Ebola, disease experts have been treating for some 40 years elsewhere: This is not just a medical or public-health problem, she said. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment. Health workers have been up against doubts about Western medicine compounded by belief systems that encourage family members to care personally for their infected loved ones. Mobs of angry and suspicious citizens have attacked teams of health workers. Families have hidden suspected cases, preferring to keep them at home rather than allow them to be taken to a treatment center and isolated. A few weeks ago, staff members at one Ebola treatment center thought they had gotten through the worst when they were down to one convalescing patient, said Pierre Rollin, a veteran Ebola expert at the U.S. Centers for Disease Control and Prevention, who is currently in Guinea. Then one family that hadnt brought its sick for treatment sparked a resurgence, he said. The treatment center now has as many as 17 patients. At the same time, Ebola is so rare a disease that no more than 300 professionals globally have worked on outbreaks before, Dr. Rollin said: We need more people. Lagos, meanwhile, might not be out of the storm yet. There are still a small number of people who were on the flight with Mr. Sawyer that health workers havent found, said Oluwakayode Oguntimehin, a permanent secretary on the Lagos State Primary Healthcare Board, who helped to lead the response. If they caught the virus, the next three days are a critical period when it is likely to flare and become contagious. What is clear, though is that hundreds more lives could have been saved if more West African governments acted as Lagos did. Mr. Sawyer told flight attendants, the handlers who carried him off the plane, and then nurses that he had Malaria, said Dr. Idris, the health commissioner. Only after two days of raging fever did they decide they were staring down a potential case of Ebola. The Primary Health Board, an obscure city agency, set about finding anyone who might have it next. When the agency received the passenger list for Mr. Sawyers flight, it was missing contact information for 18 of the flights 48 passengers. All officials had to go by were names and their nationality—in a part of the world where phone books dont exist, houses lack an address, tickets are bought with cash, and government records on citizens are both scarce and kept in stacks of paper. The airline tracked down some passengers by calling the ticket agents that booked the flight, and Nigerias government found others by contacting local embassies. Again, they were lucky: The plane was full of government workers on their way to a conference, passengers who were easy for diplomats to track. A crew of health workers set about cold-calling people with the terrifying news they might have Ebola. Are you feeling feverish, was their opening question, said Dr. Oguntimehin. Youre trying to reassure them. They sent nurses, lab technicians and civil servants into homes to deliver forms that potential carriers now fill out twice daily, asking about muscle aches, fever or nausea. By Friday, only two had developed a fever—the handlers at the airport who helped Mr. Sawyer into a wheelchair. Their blood tested negative, and they are still under close watch.
Posted on: Sat, 02 Aug 2014 12:00:58 +0000
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