In the last two weeks in Nigeria, a lot has been said and written about the deadly Ebola virus which has hit at least four West African nations. One man – a Liberian – has died in Nigeria as a result of the virus. Nigerians are understandably scared about the repercussions of an Ebola epidemic in the country and are learning more daily about the virus and what to do to protect themselves from it.
The Scoop’s Femi Owolabi had a conversation with Olumide Adenmosun, and Foluke Adeosun. Adenmosun is currently a Visiting Associate Lecturer to Bowen University from the Florida Atlantic University, USA, and has worked with renowned medical institutions and international organizations such as the World Health Organization as a research scientist. Adeosun is a Medical Sociologist and an Assistant Lecturer at the college of Social and Management Sciences, Afe Babalola University Ado-Ekiti(ABUAD), Nigeria, where her teaching focus includes Social and clinical Epidemiology, sociology. He spoke with them about Ebola.
Q: Olumide, given the rapid spread of Ebola, doesn’t it bring to the fore, the need to multiply WHO-standard lab testing centers? Taking into consideration, how, last week, the FG ordered Liberians living in Calabar to go to Lagos for screening.
OA: Yes there is the need to multiply such testing centres across the country. While it may be difficult to start erecting entirely new structures solely for this purpose, already functional laboratories in major tertiary health institutions may be upgraded to handle such tests. For primary or secondary health care centres which are mostly the first responders to unidentified asymptomatic patients, routine immunologic testing kits may be deployed to their laboratories for initial provisional diagnosis.
Q: Is there any place for preventive testing in the fight against Ebola?
OA: Occasional preventive screening tests in high risk areas may help fish out potentially infective individuals who may yet be asymptomatic. If they are found in time, their chances of survival may be slightly increased and the possibility of an outbreak may be curbed.
Q: So far, what is your review of the steps taken by the authorites? What things are being done right, and what further steps need to be taken?
OA: I think the medical team of the clinic at Obalende, Lagos where the first Ebola victim in Nigeria was treated did a very good job in identifying and containing the case – with their resource-limited setting. I believe the Lagos State government is also towing the right course at ensuring the containment of a possible outbreak with the currently installed emergency care centres. This can also be replicated in major cities across the country.
Q: Dr Sheik Umar Khan, while leading the National response on Ebola in Sierra Leone, was infected and eventually died. In the light of this rising exposure of direct healthcare givers to the Ebola virus, how do we best limit the Ebola threat to health workers to the barest minimum, if not eliminate it completely?
OA: Since it is a first time Nigeria will be recording an Ebola virus case, it is pertinent that health workers be trained and re-trained on precautionary measures and other best practices when attending to at-risk patients. Same applies to other African countries facing such health challenges. More Personal Protective Equipment and disinfecting materials with associated technologies required to protect attending physicians and other health workers should be procured or made available – by the overseeing institutions. This may help limit the trend of rising exposure of healthcare givers to the highly infective Ebola virus.
Q: Apart from the health sector, what other agencies should be actively involved in the spread of Ebola?
OA: All health and allied-health agencies including NGOs in the country should be involved. The telecoms sector can also play a major role – as a fast and furious town crier since a larger percentage of the country’s population have access to mobile phones. By now – a massive prevention campaign against Ebola should be hitting all media houses and other network frequencies. An expansive training on patient care and handling should also be urgently conducted for all primary and secondary health care workers – who are often the first responders when an outbreak is imminent.
Q: We heard Ebola is not airborne. The Federal Ministry of Health, however, in its recently released Ebola Disease Fact Sheet, says Ebola could spread through “Inhalation of contaminated air in hospital environment.” What do you think about this?
OA: Yes it may not be airborne if you are far away from an infected patient. The virus particles may however be propelled by air lifted aerosols a few feet away from an infected patient through sneezing or from squirts of vomits or contact with other body fluids that lands on a broken skin or epithelial linings of an uninfected individual. That is why healthcare givers attending to Ebola patients have to be gear-up from head to toe – not giving chances to the slightest projectile of virus in a patient’s saliva hurled at them when carrying out their duties.
Q: In a 2013 paper titled “Review of Ebola virus infections in domestic animals” by Weingartl HM, et al., we read that “while fruit bats are considered a natural reservoir, the involvement of other species in the Ebola transmission cycle is unclear, especially for domesticated animals. Dogs and pigs are so far the only domestic animals identified as species that can be infected with Ebola.” The misconception, however, is on the rise in Nigeria. A lot of people have stopped eating suya (made mostly from cow meat), because they think one could get infected by eating suya.
Also, the Special Adviser on Public Affairs to the Lagos State Governor, Dr Yewande Adeshina, in a ChannelsTV interview, advised those who prepare bush meat to boil it above 60 degrees “because such temperatures can kill the virus. What’s your take in all of these?
OA: An infected food handler regardless of whatever kind of food he or she serves or sells can surely shed residues of the virus. Other than primary hosts which are chiefly known to be fruit bats, monkeys, domestic animals such as dogs and pigs, there is still the place of a secondary infection mode from infected humans to other non-infected humans or complex secondary transmissions from humans to animals to humans. The key is, irrespective of whatever kind of animals infected, the virus has an unusual knack for immune cells – like the HIV virus. Once it finds the suitable receptors for its antigenic epitopes in any living host whatsoever, then it can begin its pathogenic cycle and multiply as much as it can in that host – which can as well be communicated by the next vulnerable host. Even in its un-infective stage on a dead host, the virus particles may just be re-activated when they find their way into a living host. Like Dr. Yewande Adeshina explained – the virus particle can be deactivated at temperatures above 60 degrees Celsius. There is however something called nucleic acid thermodynamics, specific melting temperatures have to be achieved to get all the viral RNA entirely degraded; if you’re not very sure about the heating technique sufficiently neutralising all the infectives, then it is highly recommended that you stay away from such exotic meat at this time.
Q: Realistically speaking, should we be scared?
OA: Well, I’d say we should rather be aware and cautious!
Q: Foluke, giving the rather contained stake of Ebola in Nigeria at the moment, what should we continue to do to prevent an outbreak?
FA: The first thing to do is to create awareness and get people informed about Ebola disease. Why? It is because it is so difficult to prevent and treat what we have absolutely no idea about. The Government, media houses, media networks including bloggers, the learned, the public health experts and all health workers should be mandated to swing into action immediately. People must be told what the disease is, the risks attached, and the preventive measures to be taken.
Q: Should there be an outbreak, nonetheless, how can we best manage it?
FA: Since there is no standard treatment for Ebola HF. Patients receive supportive therapy. This consists of balancing the patient’s fluids and electrolytes, maintaining their oxygen status and blood pressure, and treating them for any complications. CDC has developed a set of tools to meet health-care facilities’ needs. In conjunction with the World Health Organization, CDC has developed practical, hospital-based guidelines, entitled Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting . The manual describes how to recognize cases of viral hemorrhagic fever, such as Ebola HF, and prevent further nosocomial transmission by using locally available materials and few financial resources. This manual should be circulated among the health workers. Similarly, a practical diagnostic test that uses tiny samples from patients’ skin has been developed to retrospectively diagnose Ebola HF in suspected case-patients who have died. I do hope our health workers are familiar with this.
Q: Can you suggest emergency medical response plans that best suit this environment?
FA: Hmmm! Where do we start from? Fine, if we have emergency medical response in cities, what happens to the villages if there is any incidence? There are lots of challenges that would be faced by health workers considering the present state of the Nigerian health sector. Who is meant to respond? The doctors that are on strike? Or the health workers who have not even been informed as a result of erratic power supply,inability to access the internet, inability to afford data plan or phones with such functions etc. Anyway, I believe that immediate plans must be made such that health workers will have the capability to perform diagnostic tests and be ready to employ practical viral hemorrhagic fever isolation precautions, or barrier nursing techniques. These techniques include the wearing of protective clothing, such as masks, gloves, gowns, and goggles; the use of infection-control measures, including complete equipment sterilization; and the isolation of Ebola HF patients from contact with unprotected persons. The aim of all of these techniques is to avoid any person’s contact with the blood or secretions of any patient. If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented
Q: Soon, people may be scared of exchanging handshakes and hugs. Some family members would even great themselves at a considerable distance. What’s the sociological impact of this?
FA: People are already afraid. Ebola disease would not only cause ripples in families but also break into a chain reaction. As it affects people’s perceptions of members of households, so also is the case of international relationships. These perceptions will affect migration statistics, economic and social relationships.
Q: Your teaching focus includes Social and clinical Epidemiology. Have you developed any study design that would identify risk factors for this disease and targets for preventive healthcare?
FA: Since the first case has just been recorded, research is in progress and I’m sure that by the time the new session begins in October, our students will be fully engaged with our academic arrow pointing in the right direction.