When the first case of Ebola was
discovered in Nigeria this summer, Jeffrey
Hawkins, the U.S. Consul General in Lagos,
said that an outbreak there could become
an "apocalyptic urban outbreak. The last
thing anyone in the world wants to hear is
the two words, 'Ebola' and 'Lagos,' in the
same sentence," Hawkins said in July.
Americans yawned, assured that if Ebola
did somehow make it to their shores, the
world's richest country would swiftly and
easily eradicate it from its borders. "The
United States had overconfidence in their
ability to stop it," said David Dausey, a
Yale-trained epidemiologist who works on
controlling pandemics and who is dean of
the School of Health Professions and Public
Health at Mercyhurst University.
However, Hawkins and others had plenty
of reason to worry about Africa's most-
populous country, Nigeria, which had 20
Ebola cases and eight deaths. Lagos, with
some 21 million residents, is the
continent's biggest city.
In addition, 49 percent of Lagos state's
population lives in poverty in slums with
little sanitation. Making matters worse is
that doctors discovered an Ebola case in
Port Harcourt, another extremely poor
area where the majority of people live in
shanties with almost nonexistent
sanitation (keep in mind, the disease is
spread by bodily fluids).
And it was not just lives at risk. As FP
reported in August, an outbreak in Nigeria
had the potential to devastate West Africa's
economy.
Nigeria seemed like the ideal petri dish for
the virus to grow. That's what makes the
World Health Organization's
announcement that "Nigeria is now free of
Ebola virus transmission" a massive relief
in the fight to stop the pandemic that
began in December 2013.
That WHO announcement reveals an
organization that seems to be in disbelief.
In a situation assessment, the WHO called
it a "spectacular success story" that
prevented "potentially the most explosive
Ebola outbreak imaginable."
So how did Nigeria, a country with poor
public-health infrastructure and a GDP of
$510 billion, manage to contain the disease
when the United States, a country with
sophisticated public-health infrastructure
and a GDP of $17.3 trillion, could not?
First, a bit of luck: Nigeria's "patient zero,"
a man from Liberia, collapsed in a Lagos
airport, making it easier to identify those
exposed to the disease.
"What helped Nigeria is that they quickly
traced the source of the virus," said
Richard Downie, an expert on Nigeria at
the Center for Strategic and International
Studies. "The fact that he collapsed in the
airport was good luck in a good way."
However, Downie credits Nigeria, a
country not known for coordinated or
effective action at the national level (see
the fight against Boko Haram), for what
came next.
"What impressed me the most about the
response, and somewhat surprised me
given Nigeria's track record in dealing with
other crises, is that they were so thorough
about it," Downie said. "They quickly
amassed a list of anyone who may have
come into contact with the index case.
They hit the streets. They had a fast
response, came up with a plan, and did the
legwork on the ground."
According to the WHO, the public-health
community knew an outbreak in Nigeria
was a potential disaster. As soon the first
case was discovered, the WHO, the CDC,
and other government officials "reached
100 percent of known contacts in Lagos
and 99.8 percent at the second outbreak
site, in Port Harcourt, Nigeria's oil hub."
Isolation wards were then created,
followed by treatment facilities. People
who tried to escape were digitally tracked
and returned to isolation. Doctors Without
Borders and the WHO quickly trained local
doctors to treat the disease. And while
Nigeria's public-health system is poor, it's
not nonexistent; aid groups have been
working to eradicate polio there for years.
In an interview with Time magazine, Faisal
Shuaib, a doctor at Nigeria's Ebola
Emergency Operation Center, also said that
stopping public panic was instrumental.
"People began to realize that contracting
Ebola was not necessarily a death
sentence," Shuaib said. "Emphasizing that
reporting early to the hospital boosts
survival gave comfort that [a person] has
some level of control over the disease
prognosis." Shuaib added that keeping
Nigerian borders open -- the opposite of a
strategy being thrown around in
Washington right now -- helped to contain
panic.
On the other hand, the United States has
done almost the complete opposite of
Nigeria. It took 11 days to diagnose Thomas
Eric Duncan with Ebola after he was
turned away from a hospital six days after
the Liberian's arrival in Dallas. Amid
questions about whether medical
personnel were properly trained to treat
the disease, two nurses who treated
Duncan, Nina Pham and Amber Joy Vinson,
contracted it. Vinson was allowed to travel
round-trip to Cleveland, despite reporting a
fever to the CDC, which has been on its
heels since Ebola arrived in America.
Meanwhile, the political efforts to reassure
the American public have been
inconsistent; on Friday, President Barack
Obama appointed Ron Klain, a political
operative with no public-health
experience, to coordinate the government's
response. The Pentagon created a 30-
person medical personnel team to train
people to treat the virus. Politicians
continue to call for a travel ban, while
cable news covers the three cases as if they
represent a national outbreak.
Nigeria's success "is a first-class effort,"
Downie said. "There's a lot here for other
countries to learn, including the United
States."
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