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Thursday, October 23, 2014

How Nigeria Defeated the Ebola Scourge (2)

Photo-courtesy: Doctors Without Borders
Here is the concluding part of the story on how Nigeria overcame Ebola virus disease as I promised…
The WHO puts the fatality rate at 70 per cent but in Nigeria it was less than 40 per cent. The public health expert explained: “Actually, the case fatality rate in the Nigeria outbreak was 40 per cent. This means that 40 per cent of those who developed the disease died in Nigeria. This proportion includes the index case that arrived  in  Nigeria with already advanced Ebola disease.
   “Clearly, the patients in Nigeria were given the best level of care possible. We had Ebola case management experts from  WHO working with our equally qualified Nigerian medical doctors, nurses and other health care workers. They provided the highest level of clinical care to EVD patients round the clock. As you are aware, treatment of EVD is mainly supportive. However, the quality of this supportive care does determine the trajectory of the disease.
   “Furthermore, the chances of survival from the disease improve when a patient is able to report early to a treatment centre. So once an individual knows they have been exposed to the disease and develop symptoms, they should seek urgent medical care by calling the Ebola help hotline (0800-EBOLA-HELP).” Continue...
   One of the survivors, a medical doctor, said the major thing that was used was the oral rehydration therapy (ORS) solutions.  But  according  to the EOC Incident Manager, the  treatment of EVD is mainly supportive. He further explained: “Among other symptoms, EVD presents with vomiting and diarrhea. Patients lose a lot of fluids and electrolytes from their body, which can be life-threatening. Giving oral rehydration solution (ORS) helps restore this balance once the patients are able to eat and drink on their own. Otherwise, fluid and electrolyte replacement is done using intravenous fluids (IVF).”
   The survivor also painted the picture that it was the Lagos State government that did the job not the Federal Ministry of Health. Shuaib, however, said the outbreak response in Nigeria was a collaborative effort involving the Federal Ministry of Health, the NCDC, and the Lagos and Rivers State Governments working together  with  international development partners. None would have been successful without the other.
     He explained: “This was an effort that saw seamless and consistent teamwork through the mechanism of the EOCs. We should celebrate our collective success as a country. Within the partnership, different team members had their strong suits, but being able to harness these resources towards such a goal is unprecedented. Team Nigeria stepped up to the challenge and did an outstanding work of containing the EVD outbreak. That is the message I think we should align on.”
   Some people are saying that Nigeria was lucky and that it was an act of God that saved her from possible Ebola epidemic. In this regard, Shuaib said : “There is always an element of luck in man’s endeavors; it could have been worse. However, the overarching theme is that the epidemic was contained due to exemplary leadership, teamwork and rapid action.”
   Some stakeholders say the success vindicates the WHO statement in March this year that Nigeria has one of the best disease surveillance systems in Africa. The public health expert said: “You are absolutely right. Nigeria has a very vibrant integrated disease surveillance and response network. The detection of the disease followed the linkages in our alert system, between the health facilities and our response teams. The surveillance system in Nigeria continues to enhance surveillance for EVD in our health facilities, ports of entry and communities. This is to ensure that any case of EVD is swiftly reported and investigated.”
   On the drugs that were used by Nigeria and how  it happened, Shuaib explained: “There are no specific drugs for treating EVD. The treatment given to individual patients depends on the presentation. Generally speaking, as afore-mentioned, supportive treatment was provided to the patients: fluids and electrolytes are replaced; drugs to prevent and control hemorrhagic events, pains, fever, etc. are administered. We did not use experimental drugs in the treatment of EVD during this outbreak but were able to achieve a relatively high survival rate using accepted, high quality standards of care.”
   On whether Nigeria has successfully eradicated or stopped Ebola,  Shuaib said: “We have managed to control this outbreak. However, from an epidemiological point of view, we have to wait until 42 days or two incubation periods after the last infectious case has been discharged before declaring an outbreak as over. There is a need to sound a note of caution though. Although the outbreak may be declared over within our Nigerian borders, we must remain steadfast in our vigilance. As long as the epidemic continues in Liberia, Sierra Leone and Guinea, there is always a threat to our public health system. We could find another individual who may enter our shores without disease but develop symptoms later. So we must maintain a high index of suspicion. We must continue our active surveillance, screening at all points of entry and increase public awareness around EVD.
    “Although we may declare Nigeria EVD free, our joy must be subdued because we continue to sympathise with the families, friends and colleagues of those who paid the ultimate price during this outbreak. While we acknowledge our success, we cannot celebrate because our neighbours, our brothers and sisters in Sierra Leone, Liberia and Guinea continue to witness an extraordinary level of death and human suffering. Now is the time for us to mobilise resources to support and comfort them.”
   On when Nigeria  could be certified Ebola free and whether people  were under surveillance,  he said the last EVD case became EVD negative and was discharged on September 7, 2014. “Forty-two days after this date means we declare Nigeria Ebola free by October 20, 2014”, he said.
   Shuaib explained: “I want to reiterate that the war against EVD is far from over. We must not let our guard down; we cannot afford to become complacent. The price to pay for losing sight of this would be heavy, because no country is free from the threat of Ebola until all countries in West Africa become Ebola free. The recent report of imported EVD from Liberia into Texas, USA, underscores this reality.
   “No, there are currently no contacts under surveillance in Nigeria.”
    On the lessons learnt from the Ebola scare and    the challenges,  Shuaib  said : “The lessons learned are that we can defeat EVD and indeed manage any disease outbreak with adequate preparedness, effective coordination, rapid action and cohesive teamwork.
   “The challenges related to the initial misconceptions and panic caused by misinformation. Once we got over this hurdle and the press provided correct information about the nature of the virus and the evolution of the outbreak, the situation became more manageable.”
   Asked what was next  after Ebola,  he said: “I am back to trenches fighting in the last frontiers of polio eradication. We are closer than ever to eradicating polio from Nigeria. I am going back to help ensure we finish the job of stopping transmission this year.”
      There is the fear that the attention being given to Ebola may shut down efforts to control other important diseases such as Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), tuberculosis (TB), malaria and polio. But Shuaib said this fear may have been justifiable early in the outbreak but this was no longer the case because the outbreak had been contained.
     He explained: “In places like Liberia, Sierra Leone and Guinea, where the outbreak has increased exponentially, their health systems are completely overwhelmed. Theirs is a story of working far behind the curve, too little resources, coming too late to help stave off the outbreak, let alone control these other diseases effectively. 
    “Clearly, this is a time for us to use the experience of our successful outbreak response to strengthen the Nigeria Centre for Disease Control (NCDC) so that epidemic preparedness and response will consistently be comprehensive and institutionalised. 
   “Credit must be given to the Minister of Health, Professor Onyebuchi Chukwu for his foresight in pushing for the establishment of the Nigeria Centre for Disease Control and to President Goodluck Jonathan for approving it as a full-fledged parastatal of the Federal Ministry of Health as recommended by the report of the Orosanye committee on the rationalisation of federal parastatals and agencies. In a way, this singular move prepared Nigeria for the successful containment of Ebola outbreak in the country.”

 Source: The Guardian

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