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01 Aug 2014 00:00
Medical staff in protective gear prepare to take food to patients in an isolation area at the Médecins Sans Frontières Ebola treatment centre in Kailahun, Sierra Leone. (Tommy Trenchard/Reuters)
Authorities across West Africa announced a series of measures this week aimed at stopping the spread of the Ebola virus, which reached a fourth country last week with a death in Lagos, Africa’s most populous city.
Nigeria closed and quarantined the hospital where a man died last Friday in the country’s first recorded case of the deadly and highly contagious pathogen.
The closure of the clinic in one of the city’s most densely populated districts came as police were called in to guard Sierra Leone’s main Ebola treatment centre, while Liberia shut almost all its borders and banned public gatherings. Attempts to halt the world’s biggest and most widespread outbreak of Ebola have been hampered by a lack of resources and poor understanding in a region which has never experienced an Ebola epidemic.
Ebola has killed 672 people in Guinea, Liberia and Sierra Leone since it was first diagnosed in February.
The pathogen is passed through contact with bodily fluids of infected patients or eating infected meat and has no known cure, although chances of survival improve dramatically with early detection and treatment.
“We have shut the hospital to enable us to properly quarantine the environment.
Some of the hospital staff who were in close contact with the victim have been isolated,” Lagos state health commissioner Jide Idris said on Monday.
Authorities set up an isolation ward and began tracing those who had been in contact with Patrick Sawyer, a 40-year-old civil servant whose flight from his home in Monrovia, Liberia’s capital, stopped over in Togo and Ghana.
Derek Gatherer, a virologist at the University of Lancaster, said anyone on the plane near the infected man could be in “pretty serious danger”.
But he said Nigeria was richer than the other countries in the region, so could more easily mobilise resources to tackle an outbreak.
“Nigerians have deep pockets and they can do as much as any Western country could do if they have the motivation and organisation to get it done.”
Liberian and Nigerian airports and seaports began screening international arrivals for Ebola symptoms, which can take up to 21 days to appear. Arik Air, a major carrier for the region, has suspended flights between Nigeria, Liberia and Sierra Leone, as travel peaked this week during the Muslim holiday of Eid.
Sawyer is believed to have contracted the virus from his sister, who died of Ebola earlier this month. But his travelling despite not feeling well has angered many.
“One of our compatriots met his untimely death and put to risk others across borders because of indiscipline and disrespect for the advice that had been given by health workers,” Liberian President Ellen Johnson Sirleaf said during the country’s independence day celebrations on Saturday.
She announced stringent new measures after two American volunteer doctors tested positive for Ebola, and the lead medical doctor at the country’s largest hospital died. Samuel Brisbane had treated himself at home in an attempt not to infect other health workers, many of whom have been ostracised by their communities.
In Sierra Leone, where 454 have died, angry crowds gathered outside Kenema Government Hospital in the country’s remote east, where dozens are receiving treatment for the virus, and threatened to remove the patients and burn it down.
Many communities have been left bewildered and angered by the deaths, and a belief that health workers living among them are spreading the disease. – © Guardian News & Media 2014
What is Ebola?Ebola virus disease, which used to be called Ebola haemorrhagic fever, was named after the river in the Democratic Republic of the Congo where one of the first two villages to report cases in 1976 was located. The other was in Sudan.
Ebola is a severe viral illness with a sudden onset that comes from direct contact with infected living or dead rainforest animals, including chimpanzees, gorillas, monkeys, fruit bats, forest antelope and porcupines. It kills up to 90% of those infected.
How is it transmitted?The virus is passed from one human to another via blood and body fluids, but also through bedsheets, clothes and other surfaces that a sick person has touched. Burial ceremonies that involve touching the dead are also a risk.
The virus enters the body through broken skin or mucous membranes. The group at highest risk are health workers caring for those with Ebola. They have to wear full protective clothing, including face masks and goggles, and should change their gloves between each patient.
What are the symptoms?Early signs are sudden fever, intense weakness, muscle pain, headache and a sore throat. Diarrhoea and vomiting follow, increasing the risk of infecting others. The kidneys and liver are affected and there can be both internal and external bleeding, which is why it was originally called Ebola haemorrhagic fever.
Victims are infectious from the onset of symptoms, which start two to 21 days after contracting the virus.
What is the treatment?There is very little treatment. Patients will need intensive supportive care, with intravenous fluids and oral rehydration salts. They must be kept in isolation. If people are to be nursed at home, their carers need instructions and equipment to safeguard themselves. There are no drugs to treat the disease and no vaccine to prevent it, although research for one is under way.
Why is there no cure?It has proved very hard to find drugs to treat viral diseases that cross to humans from animals, from influenza to HIV.
Although the death rate is high, outbreaks of Ebola are infrequent and have so far been contained each time. As with many of the so-called neglected tropical diseases, the lack of a potentially lucrative market makes drug companies reluctant to invest in research and development.
If outbreaks can be contained, why do they return?Ebola can be contained in human populations but the viral reservoir still exists in animals. There will always be a risk that hunters will kill infected animals, or that people will pick up animals that have died of the infection in the forest and reintroduce it to the human population.
Will closing borders help?Closing borders may not help because these are permeable in much of Africa.
The World Health Organisation says closures may hinder travel and trade without detecting cases.
However, containment is a key strategy against Ebola. Quarantine has been used in some outbreaks for relatives of those who become sick.
Because people are not infectious until they become obviously ill, it should in theory be possible to focus efforts on the community where the outbreak began. This has usually been villages in close proximity to rainforests. Confirmation of a case in a city such as Lagos is a real concern, but transmission requires direct contact with a sick individual, so is more likely in a family setting or a hospital.
The biggest worry is probably that somebody showing symptoms will be taken to a hospital where nursing staff are unprotected, because the disease is not recognised, sparking an outbreak that spreads to nursing staff and their families in turn.
Is the rest of the world at risk?Clearly somebody infected with the virus could theoretically get on a plane and spark an outbreak – probably in a hospital – anywhere in the world. However, as with Middle East Respiratory Syndrome, which arrived in the United Kingdom through a patient who was taken to London’s St Thomas’ Hospital, with stringent infection control measures in more affluent countries it is probable the virus would be very rapidly contained. – Sarah Boseley © Guardian News & Media 2014
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