Ebola: Interview with the Lagos State Commissioner for Health

To be clear, with a 90% mortality rate, the Ebola virus is unquestionably one of the deadliest viruses known to man. It first appeared in Zaire (Democratic Republic of Congo) and Sudan in 1976 and has reemerged 14 times (1977, 1979, 1994, 1995, 1996, 2000, 2001, 2002, 2003, 2004, 2007, 2008, 2012 and 2014). At least four Ebola virus strains (Zaire, Sudan, Cote d’Ivoire and Uganda or Ebola-Bundibugyo) have been identified on the African continent. The history and pathology of the Ebola virus is perplexing, having one additional strain/mutation (Reston virus), which appeared in the United States (1989, 1990, 1996), the Philippines (1989, 1996, 2008, 2009) and Italy (1992), but is believed to be nonpathogenic. The current Ebola virus outbreak began in Guinea (March 2014) and has subsequently spread to Liberia, Sierra Leone and most recently to Nigeria. Most alarming, as the virus arrives in Lagos, this Ebola outbreak is the largest on record, producing the highest number of infections (1,975) and deaths (1,145) juxtaposed with all previous outbreaks. Paradoxically, this Ebola outbreak reveals a fatality rate of about 60%.

Surprising, in the wake of seeming ineptitude exhibited by the Nigerian federal government in rescuing the abducted “Chibok girls” and apparent failing in thwarting regular occurring Boko Haram militants terror bombings, the Lagos State Health Service Commission, its officials and personnel have all performed admirably in response to the introduction of the Ebola virus into megacity Lagos, once authorities realized the magnitude of what was occurring. The decision not to take preventive action before the virus arrived is an altogether different matter.

Before the first reported death in Lagos

Radio and television broadcasts have been dispensing voluminous amounts of information and featuring interviews of medical professionals regarding prevention, transmission, recognition and reporting of suspected Ebola virus infections. Healthcare workers, physicians and officials have been laboring continuously to equip the Nigerian people with facts, to dispel myths and to curtail panic surrounding the Ebola virus. Prior to Ebola reaching Lagos, my greatest concern as a recent expatriate to the city was contracting malaria from an opportunist mosquito. Although malaria, typhoid, hepatitis, tuberculosis and innumerable other illnesses germane to West Africa remain legitimate and pervasive sources of anxiety, Ebola is the purveyor of a stark and sobering fear. I reached out to Dr. Jide Idris, Lagos State Commissioner for Health, in search of clarity on the presence and containment of the Ebola virus in Lagos.

How it all began here. Men read newspapers on a street with headlines about Ebola virus killing a Liberian in Lagos, Nigeria, July 26, 2014. Photo: AP

On the 17th of August, a bright Sunday afternoon in a quite Lagos suburb, I join Dr. Idris and several esteemed Nigerian physicians informally discussing the nation’s most recent and most unwelcome visitor—the Ebola virus. I’m an invited guest amongst this distinguished assemblage and at a break in the conversation I hurriedly interject from the table’s far end, “Dr. Idris, would you be willing to take a few minutes and answer some questions for This Is Africa about the Ebola virus?” To my surprise, he generously invites me to sit adjacent to him, so that we may have a more personal exchange. His peers look on intently, as I anxiously fumble the cords and connections of my mobile phone and laptop preparing to question, arguably, the most popular man in Lagos—second only to the late American-Liberian purveyor of the Ebola virus into the nation’s commercial capital, Patrick Sawyer. I begin by asking Dr. Idris, what does he wants the world to know about the Nigerian health sector’s response to the Ebola virus reaching megacity Lagos. He begins with a frank and candid statement, “The case that came into Lagos took us unawares because nobody knew he was an Ebola patient.” He goes on explaining that fortunately, because Sawyer was promptly placed in isolation, “. . . all the cases that eventually tested positive were those frontline workers who had contact with him in the hospital, apart from one or two of them that helped him at the airport.”

Dr. Idris continues, “When the guy died, the game plan changed. We had to deal with his body first and foremost. We decontaminated the body, bagged him according to WHO (World Health Organization) protocol and cremated him that same night. Then, we decontaminated the hospital and started contact tracing. Every single person he had contact with from the airport and the hospital, we traced, and we were able to effectively contact about 70 of them, which we started following up one by one according to the protocols and guidelines of the WHO. That’s how we were able to trace the people who developed symptoms. On the whole, since we started, we have 15 confirmed cases—we have three new suspected cases that we have yet to test—out of them four have died, including Sawyer himself. This has been a test of the preparedness of the state government. Luckily, because we have infrastructure in place, with respect to our disaster preparedness, we were able to mobilize a lot of things early enough, although it may have been much quicker. The ambulance service, our environmental monitoring units, the waste management team, and of course the epidemiology unit; working in concert with the staff of the federal ministry of health . . . we were able to quickly set up some strategies on how to contain the virus.” In this regard, Dr. Idris explains that the Lagos State Health Service Commission developed four units to (1) trace and quarantine all known contacts; “a mainstay of containing the virus,” the Commissioner emphasizes; (2) case manage those individuals who test positive and isolate them so as not to further infect the populace; (3) secure the port of entry: seaports, airports and ground border crossings, whereby passengers entering and existing are all screened. “The final unit deals with sensitization of the public,” the Commissioner Idris explains; “the public needs to know what the disease is all about, how to prevent it, how it’s contacted and how we can control the thing.” Dr. Idris says that rumors and fear are the greatest contributors to high deaths rates. As well, the Lagos State Health Service Commission is reaching out to churches, mosques and other mass gatherings to sensitize them, as the disease may potentially spread through contact with infected persons in large groupings.

Despite the extent of structures and safeguards actively in place, Commissioner Idris admits that there are still measures to be implemented. He warns that we must be careful, because it’s the first time Ebola has surfaced in an urban setting and more so in a city the size of Lagos with an enormous population. As such, the Doctor assures, “Every single primary contact with an infected person is followed up with secondary contacts, now totaling 259 on the commission’s contacts list.” Although, ideally the contact rate should be 100%, it’s an impressive 93%. The numbers reflect a need for individuals to serve as contact persons and other personnel with specific expertise and isolation ward protocol experience in case management, infectious disease and intensive care. “We are asking for volunteers,” Dr. Idris acknowledges, “because, unfortunately, everyone is abandoning their posts.” He further states, “We’re all learning the process and it’s a test of the system. If we did not have some of the structures in place . . . we would have serious challenges, there’s no doubt about that. The biggest one is personnel; human resources.”

A Nigerian health official wearing a protective suit waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Photo: AP Photo/Sunday Alamba

In response to the Commissioner’s comments concerning the shortage of personnel, I move to a question about the National Medical Association (NMA) strike and the controversial decision of President Jonathan to suspend the entire national training program for 16,000 resident doctors during a critical moment. Dr. Idris responds without equivocation, “It’s a federal issue . . . In the state we want to focus on Ebola. This is an emergency and I think the focus should be on addressing the emergency first, because if we are not careful, most of us will not be alive . . .”

I now ask, “Being confronted at point-blank range with the Ebola virus, what specific policies have Nigerian health authorities implemented regarding air-travel and border crossings?” Again the Commissioner responds with certainty, “The federal government has decided not to shut our boarders, but structures are in place to screen passengers and people are being trained on the process and procedures. I know for sure, air travelers from those West African areas where this thing has ravaged; they screen virtually everybody on those flights. I think the more important thing is that people need to be sensitized on the nature of how Ebola presents and how it is spread. The spread of this disease is through contacts of secretions from an infected person; it’s not airborne. Again, the person does not become contagious until visibly sick and that starts with an increase in body temperature. That’s why we monitor temperature and anybody above 38.5° Celsius is to be put into isolation.” Dr. Idris completes his answer with a clear and simple message, “The people need to understand that one of the major sources of spreading this disease is panic and fear . . . the focus of the government is to enlighten the public, because we want to reduce the fear.”

A woman, wearing a protective face mask and gloves, arrives at the Murtala Muhammed Airport in Lagos on Monday. Nigeria confirmed a new case of Ebola on Thursday, Aug 14th. Photo: PIUS Utomi Ekpei / AFP/Getty Images

My next question concerns Africa’s dependence on western humanitarian aid and Nigeria’s absence, the self-proclaimed “African Giant,” at the forefront of research on tropical diseases ravaging the continent. As though he’s reminiscing about better days, the distinguished Doctor answers, “I believe it’s a reflection of the deterioration of the system. Some years back Nigeria was at the forefront of research . . . The Lagos State government is trying again to stimulate research by having a research fund; it’s about time that we develop that culture. It’s a pity that everything seemed to have deteriorated over a period of time; it’s nobody’s fault . . . people are beginning to wake up now.”

President Obama all but refused to send ZMapp to Ebola affected West Africa and was quoted as saying, “I don’t think all the information is in on whether this drug is helpful.” All the while, three westerners were being treated with the drug. I present to the Commissioner that some interpret the US president’s stance and the WHO delay in approving experimental drugs for African’s infected with Ebola as a humanitarian betrayal of the continent. Dr. Idris replies diplomatically, “We’ve made contact with the manufacturers and other countries have placed orders; definitely they have a shortage, because this drug has not passed through the research processes and they just approved it because of the nature of this disease. Of course those countries that have been ravaged at the forefront will be getting it first. What we’ve found out is that it’s a huge line of people and a shortage of it. I’m not too sure Obama would prevent it from coming here. It’s not what we’ve independently found out regarding the availability of this drug.”

Regarding Nano silver, I ask Dr. Idris to share what Nigerian health officials know about it and the Nigerian scientist who is said to have developed it. “What I know about Nano Silver is that it’s not a drug; it’s a supplement. We, in Lagos have rejected it . . . we will not use it as a drug, because it has not been approved by the research ethics committee.”

A Nigerian port health official speaks to a passenger at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Aug. 6, 2014. Photo: Sunday Alamba/AP

There are many, in a heavily religious country like Nigeria that faithfully rely only on divinely ordained medicine and unproven traditional remedies. As such, there is an equal number seeking to exploit these beliefs. I ask Dr. Idris, what precisely is the Lagos State Health Service Commission’s official stance regarding unproven treatments, as well as his views on conspiracy theorists’ claims that Ebola is manmade. Forthrightly, Commissioner Idris states, “Anything that is not scientifically proven, I would not recommend. It’s part of the public enlightenment, because people can use it and you don’t know what the side effects are. Nobody knows what the effects of Nano Silver are; all the traditional remedies that have been claimed, we don’t know the side effects. I, as Commissioner, would not recommend anything that’s not scientifically proven to be beneficial. I have a responsibility to enlighten the public on this. With respect to spiritual healing, yes, people have their beliefs, but again, our duty is to enlighten even the pastors. As long as you adhere to what we’ve said: proper personal hygiene, hand washing regularly, ensure that you reduce conditions that can increase contamination and spread the disease, you can now add your spiritual beliefs, I have no objection to it, but again, do the physical first. Regarding conspiracy theorists, the Doctor puts it bluntly, “Personally, I don’t believe in that in this day and age.”

The Lagos state government had to warn Prophet TB Joshua of Synagogue Church of All Nations not to accept Ebola victims into his church for healing after he’d made a proclamation urging stricken patients to do so.

I present to the Commissioner that international health agencies say it will take upwards to six months to gain control of this Ebola outbreak. I want to know from him as a public health official at the forefront in the battle against Ebola, how he sees the situation ultimately unfolding. “Looking at the epidemiology of the disease,” the Commissioner informs, “. . . right now, we are looking at primary contacts; we are presuming we are going to have secondary contacts; we don’t know if we have tertiary contacts. So, until we are sure, we have projected that if we are going to contain this thing, it’s going to take that period of time. Yes, I agree with them.”

My final question for the Commissioner was regarding the International Olympics Committee and the Chinese organizer’s decision to bar young West African athletes from participating in the Youth Olympics because of Ebola fears? Dr. Idris is considerate in his view. “It’s a reflection of the confidence they have in our health system. So I will not generally blame those countries. I think they adopted that stance to protect their own people. I think it’s a wakeup call for ourselves to build up our system locally; to build more confidence that people can rely on . . . If the reverse were the same, we probably would have done the same thing, because the interest of your people is first and foremost.”

With 21 million inhabitants, Lagos is Africa’s most populous city. The Ebola virus, with a typical fatality rate of 90%, could not have arrived in a more ideal city for causing the maximum number of deaths.

I thank Dr. Idris again for talking with me on behalf of TIA. The cadre of physicians remaining at the table continues discussing Ebola in a technical jargon unfamiliar to me. The discussion ebbs and flows from the grim to roaring laughter; as with us all, levity often serves as a coping mechanism enabling us to continue with the regularities of life when confronted with perilous thoughts. As medical terminology and local idioms escape my comprehension, I retreat inward and reflect on both the ominous and comforting words that Dr. Idris shared only moments earlier. As he related, the Ebola outbreak is a critical situation with the potential of becoming disastrous in a megacity like Lagos. However, accurate information, modifications in personal hygiene and vigilance combine as a powerful weapon in the containment and eventual triumph over this horrible virus devastating West Africa. Despite the analyses, prognoses, hypotheses and conspiracies, one thing is for certain, the Ebola virus is a lone merciless killer that can be defeated through our collective actions. Stay informed, change your behaviour and most important, be smart.