How we treated Ebola patients with no drugs or vaccines – Prof. Akin Osibogun, CMD, LUTH
How was that possible without vaccines or drugs?
We needed to understand what was the pathophysiology of the virus. I mean what it causes in the body. Once there is a high fever, the patient starts losing water, fluid and electrolytes because the high fever drains the fluid. Once there is diarrhea and vomiting, the patient loses even more fluid and electrolytes and the patient starts going down. By the time it gets to the stage that the patient is bleeding, you have lost that patient, because he has lost so much. But if you catch them early and as they are losing the fluid, you are replacing the fluid, not necessarily IV, just put a lot of oral dehydration therapy with the patient and be encouraging him to be drinking it, you are replacing the fluid being lost and got them healed without vaccine.
The pri cipal thing is the fluid and electrolyte power which will buy the body sometime. The body itself is a soldier, fighting the virus, but it is at a disadvantage when it is losing fluid and electrolytes. You also need to encourage the patient, since it was not easy to ask somebody to be drinking, considering there is already fear, panic and so on. So, that is why we add the pyscho aspect to encourage the patient. Some patients may benefit from infusion but those are the extreme, if they start bleeding to see if you could win some of them. But the big lesson which I took away from the Ebola importation into the country is that if we are determined as a people, we will achieve results, and where we work as a team, we will achieve results.
Because you could see where the federal and states worked together with a common objective and leaving politics out of it and allowing the professionals to do their job, we were able to achieve results.
How many can you recall were saved at the end of the whole crisis?
I think about seven survived. I think five visited Governor Fashola recently. I think we also lost about five Nigerians and the index case.
More @ Stopped Ebola
With quick and coordinated action by some of its top doctors, Nigeria, Africa’s most populous country, appears to have contained its first Ebola outbreak, the United States Centers for Disease Control and Prevention said Tuesday.
As the epidemic rages out of control in three nations only a few hundred miles away, Nigeria is the only country to have beaten back an outbreak with the potential to harm many victims in a city with vast, teeming slums.
“For those who say it’s hopeless, this is an antidote — you can control Ebola,” said Dr. Thomas R. Frieden, director of the C.D.C.
Although officials are pleased that success was achieved in a country of 177 million that is a major transport and business hub — and whose largest city, Lagos, has 21 million people — the lessons here are not easily applicable to the countries at the epicenter: Guinea, Liberia and Sierra Leone. Public health officials in those countries remain overwhelmed by the scale of the outbreak and are desperate for additional international assistance.
Nigeria’s outbreak grew from a single airport case, while in the three other countries the disease smoldered for months in remote rain-forest provinces and spread widely before a serious response was mounted.
Ebola, Dr. Frieden said, “won’t blow over — you have to make a rapid, intense effort.”
While the danger in Nigeria is not over, the health minister, Dr. Onyebuchi Chukwu, said in a telephone interview that his country was now better prepared, with six laboratories able to make diagnoses and response teams and isolation wards ready in every major state.
After the first patient — a dying Liberian-American — flew into Lagos on July 20, Ebola spread to 20 other people there and in a smaller city, Port Harcourt.
They have all now died or recovered, and the cure rate — 60 percent — was unusually high for an African outbreak.
Meanwhile, local health workers paid 18,500 face-to-face visits to repeatedly take the temperatures of nearly 900 people who had contact with them. The last confirmed case was detected on Aug. 31, and virtually all contacts have passed the 21-day incubation period without falling ill.
The success was in part the result of an emergency command center financed in 2012 by the Bill & Melinda Gates Foundation to fight polio. As soon as the outbreak began, it was turned into the Ebola Emergency Operations Center.
Also, the C.D.C. had 10 experts in Nigeria working on polio and H.I.V., who had already trained 100 local doctors in epidemiology; 40 of them were immediately reassigned to Ebola and oversaw the contact tracing.
The chief of the command center, Dr. Faisal Shuaib, gave credit to a coordinated effort by the Health Ministry, the C.D.C., the World Health Organization, Unicef, Doctors Without Borders and the International Committee for the Red Cross.
Also, he noted, Nigeria has significant advantages over poorer countries where the outbreak is out of control.
It has many more doctors per capita, some educated abroad at top medical schools.
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It has standing teams of medical investigators, with vehicles and telephones, who normally trace outbreaks of other ills like cholera or Lassa fever.
Lagos University Teaching Hospital was able to do Ebola tests in six hours.
The hospitals where patients were isolated were equipped to do tests for electrolytes and blood proteins, both of which must be kept in balance as patients are fed orally or intravenously to replace fluids lost to diarrhea and vomiting.
And air-conditioned hospitals let people wearing protective gear work longer without overheating.
Nigeria also had some luck. Although the first patient, a businessman named Patrick Sawyer, was vomiting on his flight in, none of the roughly 200 others on the plane fell ill. Others did after helping him into a taxi to a hospital.
And a patient in Port Harcourt went to her church and became violently ill during a ceremony in which the congregation laid hands on her. But none became infected.
Dr. Sue Desmond-Hellmann, the Gates Foundation’s chief executive, said she was “heartened to see this positive result of the efforts of so many in Nigeria.”
On July 17, Mr. Sawyer defied medical advice and left a hospital in Monrovia, Liberia, where he was being held for observation after caring for his sister, who died of Ebola, although it was unclear whether he knew what she had.
Nigerian news reports said he used Liberian government contacts for permission to leave, flying to Lagos by way of Ghana and Togo. He planned to go to an economic development conference there and then fly back to Coon Rapids, Minn., for his children’s birthdays, according to media interviews with his widow.
Taken to a small private hospital after he collapsed, he denied any contact with Ebola victims and was initially treated for malaria. He died on July 25.
“That hospital had zero infection control,” Dr. Frieden said.
A nurse who helped reinsert an IV line when Mr. Sawyer was delirious and bleeding wore no gloves, had a cut on her hand and did not wash it, he said. She later died.
After malaria treatment failed, Ebola was “high on the index of suspicion,” Dr. Shuaib said.
He learned about Mr. Sawyer’s diagnosis as he sat chatting in his office with a colleague.
“I thought: ‘Oh, my God, not Nigeria. Not Lagos.’ I knew the potential for it to spread in a densely populated place.”
Even though the emergency center swung into action quickly and aggressive contact tracing was possible because Nigeria’s Port Health Services obtained records of Mr. Sawyer’s travel, there were still problems.
It took 14 days, Dr. Frieden said, for the first isolation ward to open in a former tuberculosis ward.
“Health workers initially wouldn’t go in,” he said. “They were afraid. We ultimately trained 1,800 staff.”
Wards were reconfigured to add space between beds, put in washing stations with chlorinated water and create rooms where doctors and nurses could carefully don and remove protective gear. The worked in teams of two so they could watch each other and prevent mistakes.
Also, according to a C.D.C. study released Tuesday in the Morbidity and Mortality Weekly Report, inaccurate news media reports before the government began offering official information “created a nationwide scare.”
Sales of false cures, including “Blessed Salt,” shot up, and two Nigerians died of drinking large amounts of saltwater.
But Dr. Shuaib emphasized that even terrified Nigerians did not deny the virus’s existence or attack health workers, as happened in the other countries. “No conspiracy theories entered the debate,” he said.
Nigeria’s success shows how important preparation is, said Dr. Frieden, adding, “Some countries that could well be the next Lagos still don’t have a clue about how to deal with this.”
http://www.nytimes.com/2014/10/01/health/ebola-outbreak-in-nigeria-appears-to-be-over.html?smid=tw-share&_r=0
What Texas can learn from Nigeria when it comes to containing Ebola
Sunday, 05 October 2014 21:30 Written by The Washington Post
Category: National
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WHILE devastating reports continue to stream out of West Africa, where the deadly virus has overwhelmed already weak public health systems and left thousands of people dead, and anxiety grips the United States over the first case of Ebola diagnosed in the country, one nation serves as an example of hope: Nigeria, which appears to have successfully contained Ebola.
As concerns spread over U.S. hospital readiness, there are some lessons to be learned from Nigeria, where officials managed to get ahead of the fast-moving virus after it was brought into Africa’s most populous country by an Ebola-infected man who’d flown into Lagos. This week, the U.S. Centers for Disease Control and Prevention reported that the outbreak could be coming to an end in Nigeria, with no new Ebola cases since August 31.
As in the U.S. case, Ebola arrived in Nigeria by passenger plane. But unlike Thomas Eric Duncan — who arrived in Dallas before he became symptomatic and was therefore not contagious during his flights from Liberia to Texas through Brussels and Dulles International Airport — Patrick Sawyer was already symptomatic when he landed in Lagos on July 20. At that point, Sawyer, Nigeria’s Patient Zero, was contagious and dying.
It was a nightmare scenario with the potential to spiral out of control, given the bustling city of Lagos, Africa’s largest, is a major transportation hub. As Sawyer was placed in isolation, public health officials had to track down every single person who’d come into contact with him, from the flights he’d boarded to the Lagos airport and the private hospital where he went after landing. And they had to do so quickly, making the process known as contact tracing a priority.
“In the whole system approach in beating the war on Ebola, contact tracing is the key public health activity that needs to be done,” said Gavin MacGregor-Skinner, who helped with the Ebola response in Nigeria with the Elizabeth R. Griffin Research Foundation. “The key is to find all the people that patient had direct close contact with.”
From that single patient came a list of 281 people, MacGregor-Skinner said. Every one of those individuals had to provide health authorities twice-a-day updates about their well-being, often through methods like text-messaging. Anyone who didn’t feel well or failed to respond was checked on, either through a neighborhood network or health workers.
Nigeria took a “whole community approach,” with everyone from military officials to church elders in the same room, discussing how to handle the response to the virus, MacGregor-Skinner said.
Such an approach, and contact tracing in general, requires people be open and forthright about their movements and their health, he said. Stigmatisation of patients, their families and contacts could only discourage that, so Nigerian officials sent a message to “really make them look like heroes,” MacGregor-Skinner said.
“This is the best thing people can do for Nigeria: They are going to protect and save Nigeria by being honest, by doing what they need to do, by reporting to the health commission,” he said. This made people feel like they were a part of something extremely important, he said, and also took into account real community needs. “You got real engagement and compliance from the contacts. They’re not running and hiding.”
Sawyer had come into contact with someone who ended up in Port Harcourt. That person, a regional official, went to a doctor who ended up dying from Ebola in August. Within a week, 70 people were being monitored. It ballooned to an additional 400 people in that one city.
Success stories of people coming through strict Ebola surveillance alive and healthy helped encourage more people to come forward, as they recognized that ending up in a contact tracer’s sights didn’t mean a death sentence.
In the end, contact tracers — trained professionals and volunteers — conducted 18,500 face-to-face visits to assess potential symptoms, according to the CDC, and the list of contacts throughout the country grew to 894. Two months later, Nigeria ended up with a total of 20 confirmed or probable cases and eight deaths.
The CDC also pointed to the robust public health response by Nigerian officials, who have had experience with massive public health crises in the past — namely polio in 2012 and large-scale lead poisoning in 2010.
When someone is on a contact list, that doesn’t mean that person has to stay at home for the entire incubation period of 21 days from the last contact with someone who had Ebola. People on contact lists are not under quarantine or in isolation. They can still go to work and go on with their lives. But they should take their temperature twice a day for 21 days and check in with health workers.
Officials in Texas began with a list of about 100 names; they have whittled the list down to 50 people who had some contact with Duncan. Of those, 10 are considered high-risk.
The CDC recommends that people without symptoms but who have had direct contact with the bodily fluids of a person sick with Ebola be put under either conditional release, meaning that they self-monitor their health and temperature and check in daily, or controlled movement. People under controlled movement have to notify officials about any intended travel and shouldn’t use commercial planes or trains. Local public transportation use is approved on a case-by-case basis.
When symptoms do develop, that’s when the response kicks into high gear. People with Ebola are contagious only once they begin exhibiting symptoms, which include fever, severe headaches and vomiting.
While four people in Dallas are under government-ordered quarantine, that is not the norm. Those individuals “were non-compliant with the request to stay home. I don’t want to go too far beyond that,” Dallas County Judge Clay Lewis Jenkins said Thursday.
On Friday, the four people were moved to a private residence from the apartment where Duncan had been staying when he became symptomatic.
A law enforcement officer will remain with them to enforce the order, and none of the people are allowed to leave until October 19.
Duncan is the only person with an Ebola diagnosis in Dallas, and no one else is showing symptoms at the moment. But, as Nigeria knows, the work in Dallas has just begun.
• Culled from The Washington Post.