Described as a “spectacular success story,” the World Health Organization declared Nigeria to be Ebola free on Monday October 20, three months after the disease arrived in Lagos, a vast city of 21 million. It was the first time Ebola had been contained in an urban context. Four days later, New York City confirmed its first case of Ebola.
Ebola came to Nigeria following the arrival of a Liberian man who flew from Monrovia in late July. The index patient, who vomited on the plane and upon arrival at Lagos airport, was taken directly to a private hospital. The doctor who treated him there, Dr. Ameyo Adadevoh, seeing his blood-shot eyes and blood in his urine, suspected he had Ebola. She tested him for the virus and held him at the hospital against his will, awaiting confirmation of the disease. Pressure from the Liberian Ambassador urging Dr. Adadevoh to release the patient did not sway her. Once Ebola was confirmed, the Ministry of Health set up an isolation unit and all those who might have been exposed to Ebola were tracked down and monitored for 21 days. Those who became symptomatic were put in isolation, curtailing the spread of the disease.
Dr. Adadevoh’s care, courage and determination with that first patient in all likelihood saved Nigeria, Africa’s most populous country of 170 million, from a disaster. Sadly, her heroism cost Dr. Adadevoh her life. Six others also died, including the original patient, but remarkably, Nigeria’s Ebola outbreak was confined to 19 confirmed cases. Factors which the WHO credit Nigeria with for containing Ebola include: leadership at the national and state levels, a top-notch virology lab in Lagos able to test for Ebola, and targeted community-based education which involved using Nigeria’s film industry stars from Nollywood to deliver Ebola prevention messages.
New York City shares a number of things in common with the Lagos situation. The first patient diagnosed with Ebola, a physician who cared for those with Ebola in Guinea, was quickly identified and is now being treated in isolation. Three others who were with this patient in the days leading up to his diagnosis have also been isolated. Public health officials have traced the physician’s steps ruling out others who may have been at risk. The Governor, the Mayor, and the City and State Health Commissioners all stepped forward to provide a coordinated leadership response. These are encouraging actions.
The key to containing the spread of Ebola is to stay ahead of the virus by isolating and tracking down anyone who has symptoms or has come into close contact with the diseased. In the case of Nigeria, using a sophisticated satellite GPS system of contact tracing put in place for polio outbreaks, the health authorities were able to respond quickly and thoroughly. This process required following almost 900 people and thousands of visits to check them all for symptoms. Even when one person under observation in Lagos managed to travel to the southern city of Port Harcourt seeking treatment, 98% of people known to have had contact with that person were subsequently traced. A rapid response and having a reliable infrastructure pays off. These factors, evident in New York City, can also help to curb the secondary outbreak of fear that accompanies Ebola.
We must remain vigilant. There are no guarantees Nigeria will remain Ebola free. The government continues to screen all those entering by air and sea in Lagos and Port Harcourt, which are both on the coast. As for New York City, its unlikely the first Ebola patient diagnosed here will be the last. Screening travelers arriving at Kennedy or Newark airports from Guinea, Sierra Leone, and Liberia and mandating temperature-taking twice a day for 21 days following one’s arrival must continue. But quarantining health care workers or those exposed to Ebola is not the answer, nor is this decision based on scientific evidence. However, the Department of Health and the specific hospitals set up to care for Ebola patients must be ready to respond in the event that another Ebola case arrives here. It will just be a matter of time.