…Warns against complacency
By Sola Ogundipe
Renowned Virologist and chairman of the West African National Academy of Scientists, Professor Oyewale Tomori, has raised concerns over the time it took Nigerian health authorities to confirm the country’s Ebola case, warning that delays in diagnosis and incomplete public information could undermine confidence in the national response.
Tomori’s concerns come amid questions about the circumstances surrounding the confirmed case, the patient’s travel history and the adequacy of Nigeria’s preparedness to contain the Bundibugyo strain of Ebola virus disease.
He warned that Nigeria must combine transparent communication with effective surveillance, rapid diagnosis, comprehensive contact tracing and adequate treatment and isolation capacity to prevent the outbreak from escalating.
Speaking during a television interview, the virologist said he was more confident about Nigeria’s preparedness after hearing the health minister outline measures being taken to contain the outbreak, but stressed that the country must not become complacent.
Tomori said the interval between the time the patient’s reported onset of symptoms and confirmation of the infection was a cause for concern, stressing that Nigeria must strengthen its disease surveillance, improve early diagnosis and prepare for the possibility of additional cases.
He called on the Federal Government to provide comprehensive information about the case, including the patient’s movements before diagnosis and the extent of contact tracing, warning that gaps in official communication would inevitably fuel rumours.
“The government must be completely transparent about matters like this. We don’t want to hear information in bits and pieces from different sources. Initially, we were told that the woman came from Uganda, later I heard the Ugandan authorities say she was a transit passenger. We need complete information, and when the government fails to provide it, the gaps are filled with rumours.
“Tell us where the samples were tested and provide the relevant details. We are now hearing that the woman is a diplomat’s wife, among other reports. Certain information may need to remain confidential, but this is a national emergency, it concerns all of us, and we need the facts. We also need a clearer explanation of how the woman entered the country and what happened after her arrival.
“Where did she stay? Where did she go? How many people did she come into contact with?” he asked, stressing that these details were essential to establishing the extent of possible exposure and reassuring the public,” he queried.
Tomori warned that the time taken to confirm the infection highlighted the need for healthcare workers to maintain a high index of suspicion when treating patients who have travelled from areas experiencing Ebola outbreaks.
On the timeline, Tomori said the period was still within the incubation period. “However, the fact that it took until the 20th (October) to confirm the case is a concern and we need to improve on that. By the time the woman had moved between different locations, the opportunity for further exposure might already have arisen.
“We faced a similar problem in 2014, when Patrick Sawyer arrived in Nigeria. It took about three or four days to diagnose him. Samples were initially being sent for malaria testing. When someone arrives from an area experiencing an outbreak, our level of awareness should be much higher.
“The first disease that should come to mind is the one circulating in the area from which the person has travelled, not malaria, which is common in our environment. Our healthcare workers need to understand this. Their own lives are also at risk, so they must remain alert.
“If I hear that someone has arrived from a country experiencing an Ebola outbreak, or from an area close to one, my first question would be whether the person could have Ebola before considering other possibilities.
“We need to move beyond routine thinking before concluding that someone has malaria, healthcare workers should be up to date on diseases circulating in the places from which their patients have travelled,” he noted.
On contact tracing Tomori said the health authorities need to gather more information and identify as many contacts as possible.
“We should have more details than we currently have. For now, there is no reason to panic, the authorities are putting the necessary measures in place. What we need to do is prepare for the worst-case scenario. Suppose two or three of those contacts test positive. What happens next?
“Do we have the hospitals, isolation facilities and other resources needed to manage additional cases? Those are the questions we should be asking now, rather than assuming that everyone will die because Ebola has entered the country. There are 44 people reportedly under quarantine. If one, two or three become infected, we must be ready to respond.
According to him, healthcare workers must look beyond common illnesses such as malaria when a patient’s travel history suggests possible exposure to a dangerous infectious disease.
“When someone arrives from an area experiencing an outbreak, our level of awareness should be much higher. The first disease that should come to mind is the one circulating in the area from which the person has travelled, not malaria, which is common in our environment.”
He warned that failure to recognise the possibility of Ebola early could expose healthcare workers and other patients to infection.
“I think the authorities need to gather more information and identify as many contacts as possible. We should have more details than we currently have,” he said.
He said Nigeria should plan for the worst-case scenario without creating unnecessary public alarm. “For now, there is no reason to panic. The authorities are putting the necessary measures in place,” he said, adding that preparedness would be critical if the outbreak expanded.
Further, Tomori also cautioned against relying exclusively on geographical distance to assess Nigeria’s risk. He said although the World Health Organisation had reportedly classified the country as being at low risk, he argued that regular travel between Nigeria and affected regions needed to be considered.
“Hundreds of Nigerians travel to the region for business and other activities before returning home. That makes the risk more complicated than simply measuring the distance between two locations,” he said.
On the strain responsible for the outbreak, Tomori explained that Ebola viruses differ in their characteristics and severity, even though they belong to the same broader group.
“The Zaire strain has recorded fatality rates approaching 90 per cent in some outbreaks, while the Sudan strain has recorded rates of around 60 per cent. Bundibugyo has recorded fatality rates of about 50 per cent in some outbreaks,” he said.
He cautioned against interpreting the comparatively lower fatality rate as evidence that the strain was harmless. “When we say Bundibugyo is less severe, however, that does not mean it is harmless or that it cannot kill people,” he said.
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