Taming the Ebola Monster

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Quarantined Ebola patient under treatment

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The arrival of Ebola Virus Disease in Nigeria has sparked off renewed global efforts to combat the resurgence of the deadly disease which has wreaked havoc in some African countries since 1976

By Olu Ojewale  |  Aug. 25, 2014 @ 01:00 GMT

TO a lay person, the microscopic image of a virus looks like an ordinary worm. But Ebola Virus Disease, EVD, is not ordinary in every sense of the word. It is deadly and perhaps the deadliest virus around in the modern world. Since its appearance in Guinea in February, the EVD has literarily plunged the West African sub-region into chaos with government and medical teams scampering for a quick fix. By the last count, the Ebola virus has killed 1014 in the West African countries of Liberia, Guinea, Sierra Leone and Nigeria.

Until July 25, the EVD was alien to Nigeria, but the death of Patrick Sawyer, a Liberian government official, in a Lagos hospital on July 25, has changed all that. Sawyer, an Ebola victim, was visiting the country to attend a meeting of the Economic Community of West African States, ECOWAS, in Calabar. His death has led to the death of three other persons including the matron and a nurse of the hospital where he received treatment before he died. The other person was Jatto Abdulqadir, 36, a protocol staff of ECOWAS, who was to assist the Liberian delegate at the regional meeting in Calabar, Cross River Sate. A statement from the ECOWAS said Abdulqadir had been under quarantine following the death of Sawyer. By the end of the week, about 178 persons who had had primary and secondary contacts with Sawyer were quarantined and put under strict observation.

Jonathan
Jonathan

As if that was not bad enough, one of the nurses that had contact with Sawyer and quarantined in Lagos, still managed to travel to Enugu and when this was discovered, the government moved in quickly to arrest the situation by getting her into a designated hospital in the state with 21 persons she has had contacts with since she arrived in Enugu without government approval.

Government’s concern is not limited to those who have had contact with Sawyer and care givers who treated him before his death. The federal government, led by President Goodluck Jonathan, has risen to the challenge by holding meetings with various stakeholders in the health sector in a bid to curtail the spread of the virus.

On Wednesday, August 13, the president held a meeting with all the state governors, their health commissioners and representatives of the World Health Organisation, WHO, in the country, to map out various strategies to deal with the scourge. Some of the measures being taken by the government include establishment of at least one Ebola centre in each state of the federation including Abuja federal capital territory.

After the meeting, Governor Babatunde Fashola of Lagos State, advocated for the stoppage of traditional shaking of hands as part of measures to stop the spread of the Ebola virus in the country. He said: “We have to drop our traditional behaviours like shaking of hands and nobody should be offended,” he stated while briefing newsmen on the outcome of the meeting. He also urged people to stop defecating and urinating in public, particularly at this time of the country’s health crisis. He added: “This is not the time to make fast naira. Next week will be defining for us to know what cases have multiplied. This is not something you keep in a religious house to pray. Infected persons are not patients you can move by taxis, if they need prayers now it can be done electronically. We are now 99 percent following the cases. We need to have a 100 percent because if we have one infected person, it is a global risk not just Nigeria.”

The governor asked that health workers should be provided with advanced equipment to protect them in their first line of duties. Governor Sullivan Chime of Enugu State said from the reports at the meeting, it was clear that Nigeria had the capacity to fight Ebola but there was need for standardised practice to combat it.

Chukwu
Chukwu

At another press briefing, on Wednesday, Onyebuchi Chukwu, minister of Health, announced that the federal government would receive Nano Silver trial drug for the treatment of EVD on Thursday, August 14. The drug is from a Nigerian scientist. He said the drug had been used for many things experimentally. This was apparently in line with the decision of the National Health Research Ethics Committee, Nigeria, which on the same Wednesday, approved the use of an experimental Ebola drug ZMapp for the treatment of patients infected with the virus.

The committee, which is made up of research scientists, is a national body under the Federal Ministry of Health. The approval was contained in a statement issued by Clement Adebamowo, chairman of the committee, in Abuja on Wednesday, August 13.  In the statement, the ethics committee said: “It is ethical to use these treatments in the current situation without first submitting an application to national, state or institutional health research ethics committee for prior review and approval. In addition, the committee waives the current requirement that international shipment of any biological samples out of Nigeria should be preceded by the establishment of a Materials Transfer Agreement. This waiver is to promote rapid international response to this global emergency.”  It therefore, enjoined all agencies, development partners and research scientists to follow the guidelines for the rapid resolution of the current emergency situation.  “The guidelines will contribute to preparedness in case of future occurrences and contribution to scientific knowledge. It must be noted that all Phase 0 and Phase 1 Clinical Trials that may subsequently be designed for treatment of this infection can be approved only by the National Health Research Ethics Committee,” it stated further.

The decision by the committee came on the heels of the WHO’s approval on Tuesday, for the use of ZMapp for treatment of Ebola patients. But there was no mention of the Treatment Research Group for Ebola Disease, which followed a renewed interest in a 1999 work by Maurice Iwu, a professor of ethnophamacology and former national chairman of the Independent National Electoral Commission, INEC, which claimed that certain chemicals called flavinoids contained in bitter kola, had anti-viral properties. Iwu’s  work was focused on tests in in-vitro (in test tubes in laboratories), but never made it to in-vivo (human testing) and remained inconclusive.

The research findings generated interest among Nigeria’s scientific community in the wake of Ebola, a virus similar to the flu-causing viruses that bitter kola extracts were found to work against. “In-vitro tests showed some activities against the virus,” Chukwu said. But the minister said there had been “no scientific evidence that the use of bitter kola will also prevent or cure Ebola.” Nevertheless, the rumour mill was awash with speculations that eating bitter kola might be a possibility cure  for EVD, hence Nigerians went out in their numbers to buy up the available stock in the market thereby forcing the price to rise by about 500 percent.

Maku
Maku

In any case, a committee of Nigerian medical experts and researchers has been set up to work in conjunction with their colleagues in the US to produce a vaccine for Ebola virus. Speaking on the development to state House correspondents after a meeting of the federal executive council  in Abuja, on Wednesday, August 13, Labaran Maku, minister of information, said: “In terms of possible treatment, the Ministry of Health has set up a special committee specifically to take claims from Nigerians who believe they could help and so far, we have had a lot of reports from Nigerians at home and abroad who have come forward to say look, they have a chance of developing therapies that could help in fighting the virus. There is no cure so far anywhere in the world. Even the trial drug in the US is still a trial drug, it’s not been established.

“One of the doctors and research experts that came forward was Dr. Simon Agwale, who has been one of the frontline global researchers on developing vaccines for HIV and other viral diseases. He came forward and said he could help, both in terms of working out to develop a vaccine which, he said, he has started work on it between himself and his fellow experts in the US. He said this is ongoing. The Minister of Health has given him support and directed him to the committee. He also discussed the possibility of using a certain therapy that they are now using which could be applied. And that is being discussed and once it is approved, it could be used.”

Maku also revealed that the 198 persons who made secondary contact with the 10 primary contacts that were infected with Ebola by the index case, had been traced and were currently under surveillance. Of the total being quarantined, 21 are in Enugu.”

According to the minister, the number of people that had so far been traced is 198, out of which 177 are in Lagos and were under surveillance, while 21 persons in Enugu were also being monitored by health specialists. “This is because one of the nurses that was involved with the treatment of the index case (Sawyer) unfortunately, disobeyed medical instructions and somehow travelled to Enugu. All those who she was in contact with, including her husband, are under quarantine. The medical team has been able to trace all those who made contact with her,” he said.

Kieny
Kieny

The minister further disclosed that health workers had been deployed to all the nation’s border units. “At all the entry points into this country and exit points, we have port health workers that are working in our airports and seaports. We are calling on citizens specifically to cooperate. If health workers say you have had contact with A, B, C, don’t travel; respect that judgment. It is very important. In one or two cases where we have had disobedience, we lost one of them and this one now moved with it to another place (Enugu). So we are urging Nigerians, to please help us in making sure that all these messages and appeals we are making are implemented.”

Earlier, before the Wednesday meeting, President Jonathan had declared a national emergency on the control and containment of the disease in the country. To give effect to the government’s action, Jonathan on Friday, August 8, directed the federal Ministry of Health to work in collaboration with state ministries of health, the National Centre for Disease Control, NCDC, the National Emergency Management Agency, NEMA, and other relevant agencies to ensure that all possible steps were taken to effectively contain the threat of Ebola virus in line with international protocols and best practices.

In addition, he approved a special intervention plan and the immediate release of N1.9 billion for its implementation. The plan includes the establishment of additional isolation centres, case management, contact tracing, deployment of additional personnel, screening at borders, and the procurement of required items and facilities. A statement signed by Reuben Abati, special adviser to the president on media and publicity, said in part: “As the effective implementation of the Federal Government’s Special Intervention Plan will require other stakeholders to take certain precautionary steps that are supportive of the government’s initiative, the president calls on members of the public to follow all directives by health authorities and report any suspected Ebola case to the nearest health facility for immediate medical attention…

“President Jonathan urges that the movement of corpses from one community to the other, and from overseas into the country should be stopped forthwith. Every death should be reported to the relevant authorities, and special precautions should be taken in handling corpses. Religious and political groups, spiritual healing centres, families, associations and other bodies should, in the meantime, discourage gatherings and activities that may unwittingly promote close contact with infected persons or place others at risk.”

Sawyer
Sawyer

In line with President Jonathan’s directive, the National Council on Health on Tuesday, August 12, formally banned the transportation of corpses and critically ill persons on both local and international routes with immediate effect. It said only dead bodies with waivers granted by the federal ministry of Health would be transported within and into Nigeria. Such corpses must be conveyed only in ambulances. In addition, the council advised state governments to enact legislation for its effective compliance. The NCH, the highest policy making body in the health sector, which has in its fold, the minister of health; the minister of state for health; state health commissioners; secretary of health and human services in the Federal Capital Territory, and the permanent secretary, federal Ministry of Health, reached the decision after a meeting in Abuja on Tuesday, August 12.

Chukwu, who briefed the press after the meeting, explained that the council deliberated extensively on strategies to contain the spread of EVD beyond those who had primary contact with the late Sawyer, who brought the virus to Nigeria. He said since it had been established that the disease could only be spread through contact with either the corpse of someone who died of the virus or anyone who became sick as result of the viral infection, necessary steps had to be taken.

The minister added: “The corpses of all persons confirmed to have died of EVD must be buried according to WHO standard protocol. Council further directed that the transport of corpses into Nigeria as well as inter-state transport be banned until further notice except with approved waivers that may be issued by the Federal Ministry of Health”

To ensure immediate compliance with the ban, Chukwu briefed the leadership of the National Union of Road Transport Workers and   the National Road Transport Owners on the council’s decisions. He told those whose vehicles ply international routes to demand medical reports from sick passengers before accepting to carry them to Nigeria.

Chukwu also emphasised that corpses from other nations must have waivers from the FMW and must be carried in only ambulances. “From today, don’t allow any sick person to enter your vehicle again except he or she produces a medical report which should contain the nature of the ailment and the fact that other passengers will not be infected. Only the dead and the sick can transmit the (Ebola) disease.

“Secondly, don’t carry any corpse unless you have the waiver which is obtainable only from the Federal Ministry of Health, duly signed by the Minister. So, you must demand to see a waiver from anybody who may ask you to carry a dead person. Find out from the ministry, the authenticity of the waiver in case you are in doubt. Without a waiver, we will not allow you to enter Nigeria and your vehicle will be impounded because Ebola disease is transmitted mainly by someone who died of the virus and infected persons.” The minister also advised drivers and owners of commercial vehicles to insist that passengers must henceforth fill correctly, their names, next of kins, phone numbers and their seat numbers in manifests.

Martins
Martins

Representatives of the two transport bodies, Ayoola Sadiku of NARTO and Alhaji Dansaki Sulaiman of the NURTW, pledged to convey the minister’s message to their members. They assured the minister of   immediate compliance with the directives.

In addition, the federal government has also directed that all the primary and secondary schools in the country should remain shut until further notice. Jude Imagwe, senior special adviser to the president on youth and students matters, who announced this, said the decision  became necessary to ensure that there was no further outbreak of the EVD.The amount of time that the students would spend at home was not specified but it was stated that they would be on holiday until the country could find a way to stop the current outbreak.

To help alleviate the burden of the EVD in the neighbouring countries where cases are more pronounced, it has been disclosed that President Jonathan had donated $3.5 million to the governments of Guinea, Liberia and Sierra Leone. The money is expected to be spent on medicaments, equipments and all necessary facilities to normalise the situation in the countries.

In the same vein, the WHO said in Geneva, Switzerland, on Tuesday that the approval for the use of the trial drugs was the most ethical thing to do considering the fact that Ebola had killed more than 1,000 persons in West Africa within seven months. The global health body added in a statement released after scientists met to discuss the threat of the disease to humanity at its headquarters on Monday, that there were very limited supplies of potential treatments for infected persons. The scientists also discussed how some protocols that pharmaceutical companies needed to go through before giving the drugs to patients could be waived.

Marie-Paule Kieny, a WHO official, said the medical experts voted overwhelmingly in support of giving the trial drugs to affected persons. The organisation said in a statement : “In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention.”

Fashola
Fashola

Perhaps, in reaction to the decision, Canada said it would donate between 800 and 1,000 doses of the experimental Ebola vaccine developed in its government laboratory to the WHO for use in Africa. Rona Ambrose, Canadian health minister, who announced the gesture on Tuesday, said the country had offered the vaccine to Margaret Chan, director general of the WHO. She said the government would also keep a small supply in case it was needed domestically.

To further make the drugs available, the US has given a biopharmaceutical company in Ames, Iowa, the go-ahead and funding to work toward human testing of an Ebola vaccine. NewLink Genetics and BioProtection Systems, its subsidiary, were recently given a government contract from the US Defence Threat Reduction Agency, totalling  $1 million, to research and speed up the process to begin human clinical testing of their existing Ebola vaccine. As of now, the vaccine has only been tested on animals, like rodents and monkeys, and scientists have seen positive results. However, before a vaccine can be tested on humans, there are many time-consuming precautionary steps that have to be taken. With the deadly Ebola outbreak in West Africa, these processes are being speeded up.

“Times change and so do perceptions of risk. So, at this point, although there’s still a lot of attention paid to ethical issues, everyone is acting as it hits their desk,” Jay Ramsey, clinical and regulatory compliance officer for NewLink Genetics, said in an interview.

A clinical trial of an experimental vaccine against the deadly Ebola virus is also set to start shortly, according to GlaxoSmithKline, a British drug-maker, which is co-developing the product with US scientists.

Besides, since the reported cases of EVD, a number of states in Nigeria have taken measures to prevent the outbreak of the disease. For instance, many hospitals in Lagos have stopped taking in patients with high fever or dysentery for fear of being infected with EVD. Some of the hospitals have also provided water, soap and sometimes, sanitisers and ask all visiting persons to wash their hands before entering the hospital. This is probably in line with the president’s directive to the NEMA and similar agencies at the state level to strengthen their public enlightenment campaigns and to use their networks to distribute hand sanitisers and other protective items nationwide. This has, in effect, helped to increase the retail price of sanitiser from N150 to N600 within a week.

Apart from that, doctors in public hospitals have also called on the Lagos State government to equip all its hospitals with adequate personal protective equipment to prevent the spread of the virus. The doctors under the aegis of the Medical Guild, said infection control equipment should not be limited to the Infectious Disease Hospital in Yaba, Lagos, as any patient could present the disease in any other hospital in the state.

Iwu
Iwu

Biyi Kufo, chairman of the Guild, said at a news conference on Tuesday that adequate facilities would help to protect workers from contracting the virus. “We are not sure there is adequate Personal Protective Equipment on ground from what we are gathering from our colleagues at the IDH. It is the foot soldiers who feel the   battle. We work in these facilities and we are aware of the situation on the ground. If adequate protective measures are put in place, doctors can treat patients without fear.”

It similarly appealed to striking government doctors to end their seven-week-old strike and return to work in order to help save lives. But that seems to have fallen on deaf ears as none of the doctors appears to be willing to return to work especially with the threat that they might also contact the disease.

Even in churches, the usual practice of shaking hands with fellow worshippers has been discouraged. Prominent among the churches that have suspended the practice are the Catholic and the Anglican. The churches have instructed their priests to henceforth suspend all forms of physical contacts during service, including the traditional sign of peace, which involves shaking of hands with other worshippers during service. The Catholic directive was contained in a statement by Adewale Martins, Catholic Archbishop of the Metropolitan See of Lagos, which said in part: “Taking into consideration the fact that this rite is optional, we shall henceforth omit it, that is, not invite people to offer the sign of peace. When you get to this rite, skip it. “The use of Holy Water Fonts at the entrance of the church should be discontinued forthwith until the virus alert is lifted. This does not preclude private use of Holy waters in homes and offices. Priests are also advised to be cautious when visiting sick members, especially when they are to administer the sacrament of anointing for the sick. They are equally advised to avoid physical contacts when giving out the Holy Communion to members.

A pastor in a Pentecostal church even announced that government officials had held meetings with heads of religious organisations to tell them not have more than 500 people at a time in a congregation.

The Ebola virus
The Ebola virus

Beyond all these, there is also a conspiracy theory that the sudden emergence of EVD could be the handiwork of some pharmaceutical companies in the United States. Realnews learnt that before the new outbreak of the disease, the manufacturing companies that are producing the Zmapp drugs were in financial trouble, but since the approval of the drugs by the US government without formal testing them on human beings, shares of those drug companies have gone up.

That theory is further given an impetus with the report that Sawyer, while receiving treatment at the First Consultant Hospital, Lagos, and having realised that he was not going to be allowed to travel to Calabar as planned, peed on nurses taking care of him, knowing full well that he was contaminating them with the virus. The heroic act by the hospital appears to be backfiring on it as the place has remained under lock and key.

Perhaps, what makes the virus more devastating than any other diseases in recent past is that it kills immediately because it takes a minimum of two days and a maximum of 21 days of infection for the virus to incubate. This has succeeded in putting the global scientists to work to immediately find a cure to eliminate the deadly scourge. Be that as it may, it is very obvious that Nigeria and the world at large, have a monster on their hands and all efforts must not be spared to either tame or destroy it.

Facts on Ebola

Ebola virus disease, previously known as Ebola hemorrhagic fever, derives its name from Ebola River in the Democratic Republic of the Congo, DRC, where it was first discovered in 1976 and most of those who develop the full blown disease die.

HEALTH ALERT: AVOIDING EBOLA (Message from UNILAG Medical Centre)

1.      Ebola virus disease, previously known as Ebola hemorrhagic fever, derives its name from Ebola River in the Democratic Republic of the Congo, DRC, where it was first discovered in 1976.

2.      It is quite deadly as most people that develop the full blown disease die.

3.      It is caused by a virus called Ebola, having at least five species.

4.      No drug cure or vaccine has been developed against the disease though work is ongoing in that respect. Early supportive medical treatment reduces risk of death from the disease.

5.      The virus is primarily transmitted to man by wild animals (dead or alive) like the fruit bats, chimpanzees, gorillas, monkeys, forest antelopes and porcupines.  However, the spread among people is by direct human to human contact through body secretions and fluids like blood, sweat, semen, vaginal secretions and saliva(also in stool and vomits). This can be facilitated through broken skin and items contaminated with these fluids.

6.      Outbreak of the disease has been reported in Central and West Africa. Current outbreaks are in Guinea, Liberia and Sierra Leone.

7.      A person who has recovered from the disease may still transmit the virus weeks after recovery.

8.     The time interval between when a person is infected with the virus and when he manifests the disease (incubation period) is 2 to 21 days.

SIGNS AND SYMPTOMS

It is a sudden illness characterized by fever, weakness, muscle pain, loss of appetite, sore throat, vomiting and diarrhoea. Internal organs like liver and kidneys are not spared resulting in internal and external bleeding. The patient may also develop a rash.

Common diseases that can have similar signs and symptoms as above are Malaria, Typhoid, Cholera and Shigella infection.

AVOIDING EBOLA

Since there are no approved vaccines yet for the disease, avoiding exposure to potential sources of the disease is key to prevention; and you can do this by –

•        Avoiding contact with wild animals such as the ones mentioned above. If you must, put on personal protective devices like face mask, head cover, hand gloves and protective clothing

•        Avoiding consumption of raw animal products like blood, meat and milk. Cook well before eating.

•        Evacuating bodies of animals or men suspected to have died of the disease and burying promptly

•        Wear adequately protective clothing that covers most parts of your body while in public.

•        Observing good general and personal hygiene  to reduce the risk of infection, including:

*Avoid close personal contact with people and overcrowded environment. Adequate spacing between people.

*Treat body wounds promptly and report to health facilities.

*Avoid touching your eyes, ears, nose, mouth and genital area especially when you are in public. Use clean disposable serviette or tissue paper or wash your hands with soap and water before you do. If unable to wash, use sterile wipes or hand sanitizers. Do not reuse the same wipe for another surface area.

*Wash hands regularly as opportunity allows.

*Avoid personal close contact with ill patients especially those with sudden illness

*Cover your mouth and nose with handkerchief while sneezing and encourage others to do the same.

*Avoid casual and indiscriminate sexual intercourse as Ebola can be sexually transmitted

*Don’t share sharp instruments that may have penetrated the skin of other people like blades, needles, scissors and hair clippers.

*Avoid direct personal contact with dead bodies.

•        Reporting illnesses promptly to the hospital.

At community level the following are strongly recommended:

•        Ensure regular (30mins to hourly) disinfection of public restroom area.

•        Ensure adequate and safe water supply

•        Ensure prompt and proper waste disposal including sewage.

•        Priority support for the health system.

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