Lessons of Ebola’s spread to Port Harcourt

Last Wednesday, August 27, dawned with the hope of a quick end to the Ebola Virus onslaught in the country. Health Minister, Onyebuchi Chukwu, had been in an upbeat mood a day earlier as he told the nation that only three patients were left at the Ebola treatment centre in Lagos, and two of them had virtually recovered and were likely to be discharged before the end of last week. That piece of good news had indicated that if the two almost fully recovered patients were discharged, only one Ebola patient would remain in the country, and Nigerians could hope to start looking at the end of the dark tunnel of the Ebola problem in the country.
For all Nigerians, that was very good news, indeed. It was heartwarming to receive the news that the curtain may soon be drawn on the Ebola episode in the country, if the last three patients are cured and none of the other persons under surveillance test positive to the infection. Many well-meaning Nigerians were already beginning to sound the death knell of the virus, and singing its nunc dimitis.
I had mentally calculated that Nigeria’s last Ebola patient would probably be discharged this week, the hundred or so persons under surveillance in Lagos would be found to be Ebola-free, so that Nigerians, sometime this September, would be able to celebrate the end of the disease.
But, that victory song was not to be. At least, not yet. The expected victory party to celebrate the end of Ebola in Nigeria was stillborn, kept on hold, and in abeyance, as the minister, the very next day, announced that the evil virus had found its way to Port Harcourt, via an official of the Economic Community of West African States (ECOWAS) who had primary contact with Patrick Sawyer who brought the virus to the country.
As it has now turned out, the official who was supposed to be under surveillance in Lagos and had been warned not to travel, escaped quarantine and travelled to Port Harcourt to receive treatment from one Dr. Enemuo, who subsequently caught the disease and died.
That singular irresponsible decision of the ECOWAS official to seek treatment in Port Harcourt has unleashed the virus on that town. Already, the wife of the late doctor and an heart patient at the hospital where he received treatment  have been confirmed to have contracted the virus, while another doctor and a pharmacy technician working in  his hospital have been said to be showing symptoms of the Ebola Virus Disease although tests  conducted on them turned out negative. Results of the confirmatory test on the two to ascertain that they have truly not contracted the Ebola virus were being awaited at the time of writing this column. In addition, about 199 people who have been identified as contacts of the dead doctor have now been placed under surveillance in Port Harcourt, while the number of people now under surveillance in Lagos has reduced to 72. A total of 278 persons in Lagos have completed the 21 days surveillance that is the maximum period for persons infected with the Ebola Virus to become symptomatic, and have been declared free of the disease.
As Nigerians rue the spread of the infection to Port Harcourt by the ECOWAS official, it is important that the country learns the lessons of the development. The number one lesson is that the virus is so infectious that the very best thing that anyone who is infected can do is to immediately go to an Ebola treatment centre. Failure to do this will only place the life of that person and those of everyone who comes in contact with him or her at risk.
This much is obvious from the spread of the infection to the Port Harcourt doctor’s wife, and the heart patient who was on admission at the hospital where he received treatment.This virus also calls for greater circumspection on the part of doctors when dealing with cases.  The decision of Dr. Sam Enemuo to take up the treatment of the ECOWAS official in a hotel room, which placed his life and those of others around him at risk, is unprofessional. His decision to take on an Ebola patient in a town that was, before then, totally free of the virus, is very bad, and it is good that the medical school where he trained has been reported to be looking into how he could be sanctioned, posthumously, for placing his family, friends, workers and virtually everyone in Port Harcourt in danger. This is more so as he was also reported to have arranged a party for his newborn child to which he hosted persons from some other states.
These steps of the late doctor have now taken the pandemic to Port Harcourt. It is unfortunate that the stubbornness of both Patrick Sawyer and the ECOWAS staff has brought Nigeria so much pain.   It is good that the government is looking into ways in which the official could be sanctioned to deter other persons under surveillance from travelling to other parts of the country.
One thing that has however become clear is that the placement of contacts of Ebola victims under surveillance may not be enough to stop them from spreading the infection to other parts of the country. Even though issues relating to human rights and the freedom of movement of contacts of Ebola victims may be involved in this case, it is really not sufficient to simply advise contacts of Ebola victims to stay under surveillance in the towns where they reside, while the nation and the health system hopes that they will abide by such restriction. They may not, as we have seen it with Patrick Sawyer, the ECOWAS official who took the virus to Port Harcourt, and the nurse who took it to Enugu, and had to be rushed back to Lagos before the disease had a chance to get a foothold in the city.
What these three cases show is that advising the primary and secondary contacts of Ebola patients not to travel out of their bases is not enough to keep them from spreading it around, or even travelling to other parts of the country. If the hope of  containing Ebola Fever rests solely on exposed persons obeying the advice of health officials not to travel, that would be a very forlorn hope, indeed, as they may not obey.
What this indicates is the need for a move from ordinary surveillance of close contacts to quarantine, or an actual physical restriction of exposed persons from travelling and certain public interactions. This will certainly take a lot of money, time and effort. But, it may be the only way to ensure that the world does not rely on the goodwill of exposed persons alone to ensure that they do not carry the virus around the world.
This should be food for thought, not only for the government and health authorities in Nigeria, but the World Health Organisation (WHO) and other global health authorities.
The battle against the spread of this deadly virus should not be rested on the assumption that the contacts of victims will obey instructions not to travel. It will be foolhardy to rest the health and fate of persons in affected countries on such feeble hope.