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How Nigeria Stopped Ebola

128 points by davesque 12y ago

davesque 12y ago
This article set my mind at ease a bit. Hopefully it can do the same for others.
- cracell 12y ago
  The risk I'm concerned about is it evolving to be contagious prior to showing symptoms. Which becomes more likely the more it spreads. And of course seeing two US nurses get it from one patient illustrates that our healthcare system is not prepared to contain it. Hopefully that will be fixed within a couple of months.
  - throwaway5752 12y ago
    That's an odd thing to say. We have one of the top healthcare systems in the world, and it's not perfect. If Nigeria can contain Ebola, the US certainly can. There is no indication that it's changed to be more transmissible. Have you read the report that the Dallas nurses gave to the nurses union? Here it is, if you haven't: http://www.latimes.com/nation/la-na-ebola-dallas-20141014-story.html#page=1 http://www.latimes.com/nation/la-na-ebola-dallas-20141014-st... It's a private hospital and is self-policing when it comes to preparing for and implementing CDC protocols. Based on the allegations, they clearly had not made the necessary preparations, so the nurses were very poorly protected and almost certainly came into contact with excretions from the patient. The fact that the nurses had to release this information via a union that didn't represent them because of fear of whistleblowing probably has a lot to do with how this situation came about.
    - verroq 12y ago
      >top healthcare systems in the world Americans actually believe this.
      - elpachuco 12y ago
        Purely anecdotal. It is not bad. It could be better sure. The times that a family member has been sick and taken to an emergency room everybody has done their part to nurse them back to health. Unfortunately there are always incompetent nurses, staff, and probably even doctors that hide among the competent. You always find a couple of them in the hospital. Thankfully I've only ever encountered incompetent nurses, or nurse aids. Especially nurse aids. Doctors have been OK. They are really hard to get rid off because they do just enough to not get fired. They also work really hard to mask their mediocrity. Of course, I have not been able to experience the health care of other countries so there is a chance that USA's health care is worse than I think. I'll be extremely happy once we are able to automate health care.
      - penprog 12y ago
        Systems, maybe not, but we definitely have the best researchers and minds in the field.
    - marincounty 12y ago
      The U.S. is great in certain areas of Healthcare, but we have to look at our system with open eyes? What's surprised me for a long time is our hospitals are hotspots for the MRSA bacteria. Physicians, and nurses are still allowed to wear jewelry, and street clothes in most hospitals? I have seen doctors examining patients in three piece suits, with tie clips, wedding rings, watches, and that filthy iphone? I don't care how prestigious the Doctor is--change clothes. Personally, I think all hospital workers should be required to wear light weight disposable coveralls that are incinerated daily, or sooner? Plus, they should not wear their scrubs outside of the hospital. I have worn those disposable coveralls(like Painters, and Asbestos workers wear), and they are not as uncomfortable as they look. They are light weight and you forget you have it on. As to mucosal membrane protection, I wear a surgical mask while raking leafs--allergies. I wouldn't be offended if everyone entering a hospital was required to wear a surgical mask--including doctors, administration, janitors, and all visitors--Everyone--until they leave property grounds.
      - mercer 12y ago
        You're the second commenter I've seen today that seems to manually insert line breaks, resulting in what looks on my screen like a poem. I don't mean this as a criticism about the content of you're message, but I'm just wondering why this happens. Are you commenting from an unusual type of browser, or are you manually adding hard returns, not realizing that simply writing and adding hard returns at logical points (rather than screen positions) is the best approach? Either way, I strongly recommend you start avoiding the 'return' key except when you want to start a new line of thought (e.g. a paragraph). It would really make it easier for me and perhaps others to read your comment.
    - anigbrowl 12y ago
      Duncan's lab samples were sent through the usual hospital tube system “without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,” they said. /Facepalm
      - hga 12y ago
        Indeed. When Emory, one of the 4 specialist hospitals with 3 beds set up for pathogens like this, received their first Ebola patient, they quickly realized sending samples to their main lab was a non-stater. One "oops" and you'd have to shut it down for decontamination, while your other patients are left hanging. This Dallas hospital is rather large at 900 beds, so that would be ... bad.
    - patsplat 12y ago
      Great link, though it contradicts the assertion that we have one of the top healthcare systems in the world.
  - navait 12y ago
    There's no clear selective pressure on the virus, and there are no candidate proteins in the virus that would easily be changed to make it more contagious. I wouldn't worry about it.
- patsplat 12y ago
  Really? > During this contact tracing process, officials made a staggering 18,500 face-to-face visits. Who here thinks the CDC has done anywhere near the same level of review?
  - penprog 12y ago
    I think the CDC wouldn't even let it get to that point and if they had to we would have a bunch of soldiers in hazmat suits going door to door to find the people we need.
    - patsplat 12y ago
      The Nigerian response was in reaction to patient 0, just like here. The level of hubris is striking. "It won't happen here" is not a comfort when our hospitals can't contain an infection.
mikhailfranco 12y ago
... for now, and only until the next time.
- crpatino 12y ago
  The way you presented your message is not even trying to be polite, and I understand some people might be offended. However, it does not deserves the down-votes. Specially because it is probably correct. People tend to claim victory a bit too early.
OpenSourceRocks 12y ago
I wonder, did they really... One of the most corrupt government could easily control media.
- nwj 12y ago
  Your comment is baseless speculation and only serves to spread fear. There hasn't been a new reported case in Nigeria in 30 days. That data is coming from the WHO, which is not under the control of the Nigerian government.
  - trhway 12y ago
    >That data is coming from the WHO, which is not under the control of the Nigerian government. not really. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case... "*Case counts updated in conjunction with the World Health Organization updates and are based on information reported by the Ministries of Health"
- chc 12y ago
  What would be the point in reporting that there is ebola in your country and just suddenly lying that it's gone? The evidence does not indicate that the Nigerian government is unwilling to acknowledge ebola, so regardless of what you think of the Nigerian government, this just seems like FUD.
- NearAP 12y ago
  1) There are lots of privately owned and foreign media companies operating in Nigeria and they are not censored so the issue of Government controlling the media doesn't arise. 2) Secondly, what does the Government gain by saying they have controlled Ebola if in fact they haven't? People will still be dying and the news will leak. 3) I don't think it's proper to use a blanket statement such as 'one of the most corrupt government...'. You are simply tarring everybody who works in Government as being corrupt
  - JamesSwift 12y ago
jgale 12y ago
This is the country that still can't find over 200 abducted school children. I'm surprised to hear good news.
NathanCH 12y ago
Have they really stopped it if there are still 20 active cases?
- nostrademons 12y ago
  There aren't 20 active cases - there were 20 active cases at the beginning of September. There have been no active cases of Ebola in Nigeria since 22 September, but the incubation period for the disease is 21 days, and so they wait until 42 days after the last person gets sick (in case they infect an unknown person who then infects someone else) before declaring the country Ebola-free.
  - deleted 12y ago
    [deleted]
  - ncallaway 12y ago
    My understanding of the 42 day waiting period was slightly different. I didn't think it was 21*2 to allow for an intermediate unknown person. I thought it was that the 21 day incubation period is something like the 95th percentile, and the 42 day period is the 98-99th percentile. From the article: "The 42-day period is twice the generally accepted maximum incubation period of the virus. However, some incubation periods are longer - that WHO said that in 95 percent of cases the incubation period was between one and 21 days. In 98 percent it was no longer than 42 days."
    - nostrademons 12y ago
      Wikipedia has the incubation period listed as 2-21 days: http://en.wikipedia.org/wiki/Ebola_virus_disease http://en.wikipedia.org/wiki/Ebola_virus_disease That's backed up by two citations, from the CDC and WHO. I think I'd also read something, before this epidemic started, that said the longest known incubation period was 21 days. I've since found a bunch of articles, and one WHO press release, that say the 95th percentile was 21 days and 98th was 42 days. I'm a little skeptical of them, though: they all trace back to that one WHO press release, which is based on the West Africa epidemic, where (because transmission is endemic) it's quite possible that a patient was re-infected at a later date and that's why the incubation period seems longer. Unless I see evidence from a country where the cases are all contact-traced, I'd be inclined to believe the earlier studies about the virus and not the latest articles.
deleted 12y ago
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DanielBMarkham 12y ago
I hate to play Negative Ned, but some observations are in order. Contact Tracing works when you have one guy that you know has it -- and you fan out like wildfire to catch all the people exposed. It'll probably work for the one U.S. case. It does not work when you have tens of thousands of people infected, like we do in other African countries. People who are dying at home. People who have been in contact with who-knows-whom. So we're entering a new phase of Ebola: places where the disease is everywhere and we have no contact tracing, and places that can catch one or two cases as they appear. Nigera is currently in the latter camp. I hope they stay there. This is why scientists think the U.S. and other more advanced countries will do better: we'll be able to stomp on new cases, track the contacts down, and catch the secondaries. This will continue to work -- until it doesn't. That is, if the disease can be contained elsewhere, a low volume of cross-border transmission should be manageable. If, however, it continues to spread to unknown places, and grows in immeasurable ways? Then at some point the trickle of cases overloads any healthcare system.
- a8da6b0c91d 12y ago
  If it spreads to central american slums a panicked wave of people will rush the US border. The current authorities are insane enough to not stop them.
  - cdelsolar 12y ago
    Really?
    - a8da6b0c91d 12y ago
      I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case a of a global pandemic, but the recent experience of the enterovirus epidemic being brought here by central american teens who were not deported really makes things clear.
      - macspoofing 12y ago
        >I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case Like with scotch tape?
durandal1 12y ago
This process sounds way too effective to be executed by a US agency.
NearAP 12y ago
2 important factors which helped were 1) The health workers who treated the index patient were a major factor in preventing the spread of Ebola to the rest of the city. This is because the index patient initially lied he had been in contact with an Ebola patient, the Liberian Ambassador tried to pressurize the hospital into releasing the patient to attend a conference in another state. The doctors treating him refused and 2 of them died after contacting the virus. 2) A group of volunteers set up a website [1] to pass across information to the public. Their aim was to stop the spread of false information, reduce panic and help socialize government message about Ebola. Stars of the Nigerian film industry (AKA Nollywood) also helped in the media campaign. http://www.ebolaalert.org/ http://www.ebolaalert.org/
- segmondy 12y ago
  You will be right if the disease never left the hospital. The disease did leave the hospital, some people that got it, ran off to other cities and they had to be found and brought back. http://www.reuters.com/article/2014/08/13/us-health-ebola-nigeria-enugu-idUSKBN0GD1F220140813 http://www.reuters.com/article/2014/08/13/us-health-ebola-ni... The group/government working on this really did their part.
  - tadeoyerinde 12y ago
    NearAP is right- information is and was key, and Guinea, Liberia, and Sierra Leone would do well to follow suit. An alarming amount of people think that bathing with saltwater prevents infection. http://www.npr.org/blogs/goatsandsoda/2014/08/12/339638348/pray-over-hot-salt-water-then-bathe-in-it-an-anti-ebola-ritual http://www.npr.org/blogs/goatsandsoda/2014/08/12/339638348/p...
  - NearAP 12y ago
    1) In my comment, I was referring to the index patient who wanted to be discharged but the hospital refused to. 2) The person referred to in the article was one of the nurses who attended to the index patient. After it was confirmed that the index patient had Ebola, all those who came into contact with him (including the medical personnel who treated him) were isolated. One of them (the nurse in the article)'broke off' and went to another city. When the Government found out, they brought her back to Lagos in a 'special vehicle'. Some of the other medical personnel (who were in isolation) later tested positive for the virus and some of them died.
OoTheNigerian 12y ago
Irrespective of some cynical comments below, I am happy to see rare good news from my country make it to the front page. The nation worked together in conjunction with some foreign health workers to aggressively tackle the spread. We were quite lucky that the first known case occurred in Lagos and the doctors at the hospital (on of whom died) were very proactive.
- a8da6b0c91d 12y ago
  I think credit is due to the Nigeria Center for Disease Control and Prevention. They are putting out great public education materials: http://i.imgur.com/PY9cZy2.jpg http://i.imgur.com/PY9cZy2.jpg
  - peteretep 12y ago
    Save someone else the trouble of Googling it: http://en.wikipedia.org/wiki/Nigerian_Pidgin http://en.wikipedia.org/wiki/Nigerian_Pidgin
    - smtddr 12y ago
      Thank you. I'm pretty sure a8da6b0c91d was counting on people not googling it.... I've seen his posts before.... He knows what people will assume.
tiatia 12y ago
Did they scam ebola? ;-)
mathattack 12y ago
I'm still very concerned by problems like this which have exponential growth rates. Eventually they get out of hand. It's not like we can write off an entire quarter of a continent.
- dredmorbius 12y ago
  The passengers of the Titanic on the morning of April 14, 1912, would likely have considered writing off two thirds of their number in the event of a maritime mishap equally unacceptable. However that's precisely what happened within 24 hours. Ebola is spreading and doubling rapidly -- every 20 days with the most recent data I've seen, and the case count in both Liberia and Sierra Leone exceeds that of the early-September projection made in the New England Journal of Medicine. It's not only well above the _median_ prediction, but it exceeds the 95% confidence bound. UN WHO have stated flatly that we've got to achieve a 70% effective containment to stop spread of the disease or we're entering a stage for which they have no plan. Not only is the prospect of failed containment concerning, but so is the fact that there's currently no contingency plan should that occur. It strikes me as an epic failure of imagination. Given growth rates and prospects for loss of containment, it could be far more than a quarter of a continent at stake.
mmcclellan 12y ago
But this article is already out of date. Only hours after this article was published we learn that the second nurse to test positive was allowed to fly commercial a day before her diagnosis and after the first nurses diagnosis. We definitely can't compare our response to Nigeria's.
- anigbrowl 12y ago
  With the CDC's OK because her fever was only 99.5 degrees F instead of 100.4. What idiot at the CDC made that decision? Did nobody, including the nurse, consider the idea that the fever might progress and that it would be better to be safe than sorry? When did so many people become so deficient in common sense?! http://dfw.cbslocal.com/2014/10/15/ebola-patient-traveled-day-before-diagnosis/ http://dfw.cbslocal.com/2014/10/15/ebola-patient-traveled-da...
  - ceejayoz 12y ago
    According to Wikipedia, 99.5 isn't a fever. http://en.wikipedia.org/wiki/Fever http://en.wikipedia.org/wiki/Fever > characterized by an elevation of body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F)
    - hga 12y ago
      If you've nursed a terminal Ebola patient 99.5 may indeed not technically be a fever, but it's something you should pay attention to. Heck, more to the point, she should know her normal temperature range at the various times in the day and if that's a fever for her. In the morning it would be a fever for me, I run a bit cool. Also note even the professional WelchAllyn units are not 100% accurate, they're rated for 0.2 F plus or minus (I bought one not long ago after my old el-cheapo BD one died and Amazon reviews revealed today's el-cheapo ones are by and large worthless. Heck, 3M even created a new consumer brand, no doubt to avoid brand damage to BD).
      - diltonm 12y ago
        In bootcamp I once had a temperature around 97 something. The doctor took it with two different thermometers not believing it. I felt fine. Apparently that temperature's not considered abnormal: http://www.webmd.boots.com/a-to-z-guides/normal-body-temperature http://www.webmd.boots.com/a-to-z-guides/normal-body-tempera...
steven2012 12y ago
I don't think the US has a problem with an ebola pandemic. I do believe that the governments around the world are understating how contagious this disease is. I wonder how many of those 19 infected people died? Did they attempt to save them, or did they essentially wait for them to die? Depending on the answer, it could make the reaction of health workers and patients in Nigeria behave very differently.
- maxerickson 12y ago
  The linked WHO pdf (at the point in the article mentioning the 19 confirmed cases) states that there were 8 deaths in Nigeria (the other 12 have recovered). One of those is a death that is only listed as a probable Ebola case. Normally, we have to complain that news articles don't link to their sources!
- segmondy 12y ago
  They were treated, all of them got treatments.
vonnik 12y ago
Can we please not use a Business Insider reporter strapped to a desk in New York as our source of truth on Ebola in Nigeria? Nigeria can't even recover the school girls kidnapped by Boko Haram. I hardly think it's up to the challenge of Ebola, and this story isn't over yet...
robomartin 12y ago
As it pertains to what's going on in the US, there is a question nobody in the media is asking and frankly, I don't understand why. It's very simple: What have you been doing since 9/11? Context: It was fair to assume, after 9/11 that some kind of a bio or chemical attack could have been in the cards for the future. Such weapons had been used in the Middle East. As various agencies were realigned in order to deal with the new threats and Homeland Security was created it only stands to reason that some of the objectives had to be to engineer, plan, drill and prepare for quick and effective response to a wide range of potential attacks. I am not a biologist or chemist nor do I have any real experience or knowledge dealing with these kinds of attack scenarios. This is going to sound really weird, but, well, I have three large German Shepherd Dogs and I've had cases of all three coming down with diarrhea. Having to clean up such a mess teaches you a thing or two about the spread and handling of bodily fluids. After experiencing that just once I put into place a system and a kit to be able to deal with the situation more effectively. It's nasty and I really didn't want to suffer like I did the first time. I am happy to say that my planning worked well. Now, using that example, had I been involved with DHS and CDC back in 9/11 I would have devoted serious time and resources to creating and equipping rapid response teams to deal with chemical and bio attacks in all major cities. I would have designed and tested container-based (as in converted cargo containers) emergency response systems. I would have developed a set of isolation environments within containers. I would have staged these in every major city in the country at appropriate locations. And, of course, I would have conducted quarterly drills in order to ensure that everyone who might potentially have to be involved in dealing with a chemical or bio attack was trained to the best of our abilities. I probably would have included both civilian and military personnel in this system. All that would be missing would be that music that plays in the Transformers movies when the trucks, planes and ships deploy to do battle. In other words, I would require a system that was that ready to go into action. Just like the movies. So far, I've watched every CDC conference surrounding this Ebola business. It's embarrassing. It's scary. It is absolutely astounding to me that no reporter is asking this simple question: What have you been doing since 9/11? And I say so because the story coming out of the CDC sure sounds like, well, amateur hour is too harsh, but let's just say it is obvious they were not ready for this. When you have the director of the CDC on camera saying things like "We now have two teams supervising operations at the hospital so we can make improvements". In other words, one team wasn't enough, you guys didn't have your act together, you have left the response to these kinds of incidents to the random training, equipment and judgement of any random hospital in the US (because there was no way to know where the index patient might land, right?). Why weren't these drills, supervised by not one, but five teams of observers and experts conducted five or ten years ago. Why now? Why do you have to figure it out now? To say that it is obvious that these people have squandered 13 years is a grotesque understatement. What would happen if we had twenty patients arrive into twenty different cities? Was there a plan? Is there a plan? No. Of course not. I am trying like hell to not get political here. But, you know, every corner we turn we see example after example of just how bad big government can be. They can't manage building a website that a team of five college dropouts could have aced in six months. And we trust them to protect us from bio hazards? What have they been doing during the last thirteen years? If they are not incompetent, what are they? Here's reality, going back to my dog example. I take a nice large building and spray the interior with liquefied dog shit. I then take a group of engineers and task them with cleaning said building. They have all the tools they need to develop protective gear, tools, equipment and procedures to do it quickly, safely and thoroughly. And they are also tasked with developing these systems and procedures such that we could easily containerize them and scale them to be able to instantly deal with liquefied dog-shit attacks anywhere in the US. How long do you think it would take to have an absolutely amazing system in place if we took that away from government and held a contest open to any and all private entrepreneurs? Each of 100 teams gets a ten million dollar grant from the US government. The winning team walks away with a contract and a $100 million dollar prize. A year? At the most? I would think so. The CDC and DHS have had 13 years to accomplish exactly this and prepare for the potential of a massive chemical or biological attack in the US and the best they can do is what we are seeing now? With sick nurses getting on planes? And television anchors breaking quarantine? And "breaches of protocol"? What protocol? Unbelievable. In my world this isn't about firing someone it goes way beyond that. This is criminal. This isn't even political as it spans administrations controlled by both major political parties. Now, don't get me wrong, I happen to think that this is reasonably unlikely to fully derail here in the US. Not because the CDC and DHS have it together. Nope. Simply because Ebola doesn't is hard to transmit and we don't have a ten, twenty or a hundred cases spread all over the place. We had ONE guy that got through. And that was enough to expose just how fucked the response system happens to be. I really hope nobody else dies. It might get a little scarier before it gets better, but I think we will be OK. What's got me rattled is that we are watching our response system engage in real time experiments with people's lives in front of the entire world when the fundamental procedural aspects having to do with responding to something like this should have been fully worked out, tested, verified, re-tested and forward deployed years ago. Not now. Years ago. Dealing with fighting a specific virus is a different story, that's biology, that's not procedure and readiness in terms of forward deployment of resources to deal with containment, etc. Again, simple question: What have they been doing since 9/11? Are we ever going to hold any of these people accountable? Why doesn't anyone ask the right questions?
ballstothewalls 12y ago
Does anyone know the details behind the 21 day time period for declaring someone to be infection free? Is that some kind of biological max for how long the virus can live or is it a statistics thing where the virus is not there 95% of the time?
- tjohns 12y ago
  Statistics. There have been rare cases of the incubation period being longer than 21 days, but most people will get sick much sooner. (95th percentile) That said, there was a recent PLOS article that suggested that a longer waiting period might be called for: http://currents.plos.org/outbreaks/article/on-the-quarantine-period-for-ebola-virus/ http://currents.plos.org/outbreaks/article/on-the-quarantine... There's also a cost-benefit analysis involved here. More transmissible/serious diseases call for a larger margin of safety, while at the same time enforcing a longer quarantine takes a toll on total available infrastructure.
  - ballstothewalls 12y ago
    Thank you for the link!
bvrlt 12y ago
Nigeria didn't actually do an awesome job: http://www.slate.com/blogs/the_world_/2014/10/15/nigeria_and_senegal_on_the_verge_of_being_declared_ebola_free_can_we_learn.html http://www.slate.com/blogs/the_world_/2014/10/15/nigeria_and... (published 3 hours after BI)
- NearAP 12y ago
  1) Interesting.., that is the only article so far that I've seen that is actually playing down what was achieved by the Nigerian Government and its citizens. 2) The article says '....A single Liberian man, who traveled to Nigeria in July, infected 11 hospital staff in the time between his admission to a hospital and when his test results were received...' What that statement failed to point out was that a) Nobody initially knew the guy had been in contact with an Ebola patient because the guy lied serially about it - [1]. Because of this, the man had initially been treated for Malaria and so the hospital staff did not wear protective gear. When they finally discovered he was from Liberia and suspected Ebola, his diagnosis came fairly quickly. b) The article also failed to say that the man once yanked out his 'drip tubes' spilling his blood, and peed in the room forcing the health workers to flee [2]. 3) WHO says on their website [3] - '...In a piece of world-class epidemiological detective work, all confirmed cases in Nigeria were eventually linked back to the Liberian air traveller who introduced the virus into the country on 20 July. [1] http://allafrica.com/stories/201408261017.html http://allafrica.com/stories/201408261017.html [2] http://www.frontpageafricaonline.com/index.php/news/2506-sawyer-s-final-hours-in-lagos-indiscipline-rage-strange http://www.frontpageafricaonline.com/index.php/news/2506-saw... [3] http://www.who.int/mediacentre/news/ebola/14-october-2014/en/ http://www.who.int/mediacentre/news/ebola/14-october-2014/en...
NearAP 12y ago
Just watched Ambassador Robin Sanders (former US Ambassador to Nigeria) on MSNBC. She says in addition to screening people at the airports, Nigeria was screening folks at the Harbor/Ports. She says the US is not doing any screening at the Harbor/Ports and she wants the US to start doing that.

128 points by davesque 12y ago

davesque 12y ago

This article set my mind at ease a bit. Hopefully it can do the same for others.

cracell 12y ago
The risk I'm concerned about is it evolving to be contagious prior to showing symptoms. Which becomes more likely the more it spreads. And of course seeing two US nurses get it from one patient illustrates that our healthcare system is not prepared to contain it. Hopefully that will be fixed within a couple of months.
- throwaway5752 12y ago
  That's an odd thing to say. We have one of the top healthcare systems in the world, and it's not perfect. If Nigeria can contain Ebola, the US certainly can. There is no indication that it's changed to be more transmissible. Have you read the report that the Dallas nurses gave to the nurses union? Here it is, if you haven't: http://www.latimes.com/nation/la-na-ebola-dallas-20141014-story.html#page=1 http://www.latimes.com/nation/la-na-ebola-dallas-20141014-st... It's a private hospital and is self-policing when it comes to preparing for and implementing CDC protocols. Based on the allegations, they clearly had not made the necessary preparations, so the nurses were very poorly protected and almost certainly came into contact with excretions from the patient. The fact that the nurses had to release this information via a union that didn't represent them because of fear of whistleblowing probably has a lot to do with how this situation came about.
  - verroq 12y ago
    >top healthcare systems in the world Americans actually believe this.
    - elpachuco 12y ago
      Purely anecdotal. It is not bad. It could be better sure. The times that a family member has been sick and taken to an emergency room everybody has done their part to nurse them back to health. Unfortunately there are always incompetent nurses, staff, and probably even doctors that hide among the competent. You always find a couple of them in the hospital. Thankfully I've only ever encountered incompetent nurses, or nurse aids. Especially nurse aids. Doctors have been OK. They are really hard to get rid off because they do just enough to not get fired. They also work really hard to mask their mediocrity. Of course, I have not been able to experience the health care of other countries so there is a chance that USA's health care is worse than I think. I'll be extremely happy once we are able to automate health care.
    - penprog 12y ago
      Systems, maybe not, but we definitely have the best researchers and minds in the field.
  - marincounty 12y ago
    The U.S. is great in certain areas of Healthcare, but we have to look at our system with open eyes? What's surprised me for a long time is our hospitals are hotspots for the MRSA bacteria. Physicians, and nurses are still allowed to wear jewelry, and street clothes in most hospitals? I have seen doctors examining patients in three piece suits, with tie clips, wedding rings, watches, and that filthy iphone? I don't care how prestigious the Doctor is--change clothes. Personally, I think all hospital workers should be required to wear light weight disposable coveralls that are incinerated daily, or sooner? Plus, they should not wear their scrubs outside of the hospital. I have worn those disposable coveralls(like Painters, and Asbestos workers wear), and they are not as uncomfortable as they look. They are light weight and you forget you have it on. As to mucosal membrane protection, I wear a surgical mask while raking leafs--allergies. I wouldn't be offended if everyone entering a hospital was required to wear a surgical mask--including doctors, administration, janitors, and all visitors--Everyone--until they leave property grounds.
    - mercer 12y ago
      You're the second commenter I've seen today that seems to manually insert line breaks, resulting in what looks on my screen like a poem. I don't mean this as a criticism about the content of you're message, but I'm just wondering why this happens. Are you commenting from an unusual type of browser, or are you manually adding hard returns, not realizing that simply writing and adding hard returns at logical points (rather than screen positions) is the best approach? Either way, I strongly recommend you start avoiding the 'return' key except when you want to start a new line of thought (e.g. a paragraph). It would really make it easier for me and perhaps others to read your comment.
  - anigbrowl 12y ago
    Duncan's lab samples were sent through the usual hospital tube system “without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,” they said. /Facepalm
    - hga 12y ago
      Indeed. When Emory, one of the 4 specialist hospitals with 3 beds set up for pathogens like this, received their first Ebola patient, they quickly realized sending samples to their main lab was a non-stater. One "oops" and you'd have to shut it down for decontamination, while your other patients are left hanging. This Dallas hospital is rather large at 900 beds, so that would be ... bad.
  - patsplat 12y ago
    Great link, though it contradicts the assertion that we have one of the top healthcare systems in the world.
- navait 12y ago
  There's no clear selective pressure on the virus, and there are no candidate proteins in the virus that would easily be changed to make it more contagious. I wouldn't worry about it.
patsplat 12y ago
Really? > During this contact tracing process, officials made a staggering 18,500 face-to-face visits. Who here thinks the CDC has done anywhere near the same level of review?
- penprog 12y ago
  I think the CDC wouldn't even let it get to that point and if they had to we would have a bunch of soldiers in hazmat suits going door to door to find the people we need.
  - patsplat 12y ago
    The Nigerian response was in reaction to patient 0, just like here. The level of hubris is striking. "It won't happen here" is not a comfort when our hospitals can't contain an infection.

mikhailfranco 12y ago

... for now, and only until the next time.

crpatino 12y ago
The way you presented your message is not even trying to be polite, and I understand some people might be offended. However, it does not deserves the down-votes. Specially because it is probably correct. People tend to claim victory a bit too early.

OpenSourceRocks 12y ago

I wonder, did they really... One of the most corrupt government could easily control media.

nwj 12y ago
Your comment is baseless speculation and only serves to spread fear. There hasn't been a new reported case in Nigeria in 30 days. That data is coming from the WHO, which is not under the control of the Nigerian government.
- trhway 12y ago
  >That data is coming from the WHO, which is not under the control of the Nigerian government. not really. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case... "*Case counts updated in conjunction with the World Health Organization updates and are based on information reported by the Ministries of Health"
chc 12y ago
What would be the point in reporting that there is ebola in your country and just suddenly lying that it's gone? The evidence does not indicate that the Nigerian government is unwilling to acknowledge ebola, so regardless of what you think of the Nigerian government, this just seems like FUD.
NearAP 12y ago
1) There are lots of privately owned and foreign media companies operating in Nigeria and they are not censored so the issue of Government controlling the media doesn't arise. 2) Secondly, what does the Government gain by saying they have controlled Ebola if in fact they haven't? People will still be dying and the news will leak. 3) I don't think it's proper to use a blanket statement such as 'one of the most corrupt government...'. You are simply tarring everybody who works in Government as being corrupt
- JamesSwift 12y ago

jgale 12y ago

This is the country that still can't find over 200 abducted school children. I'm surprised to hear good news.

NathanCH 12y ago

Have they really stopped it if there are still 20 active cases?

nostrademons 12y ago
There aren't 20 active cases - there were 20 active cases at the beginning of September. There have been no active cases of Ebola in Nigeria since 22 September, but the incubation period for the disease is 21 days, and so they wait until 42 days after the last person gets sick (in case they infect an unknown person who then infects someone else) before declaring the country Ebola-free.
- deleted 12y ago
  [deleted]
- ncallaway 12y ago
  My understanding of the 42 day waiting period was slightly different. I didn't think it was 21*2 to allow for an intermediate unknown person. I thought it was that the 21 day incubation period is something like the 95th percentile, and the 42 day period is the 98-99th percentile. From the article: "The 42-day period is twice the generally accepted maximum incubation period of the virus. However, some incubation periods are longer - that WHO said that in 95 percent of cases the incubation period was between one and 21 days. In 98 percent it was no longer than 42 days."
  - nostrademons 12y ago
    Wikipedia has the incubation period listed as 2-21 days: http://en.wikipedia.org/wiki/Ebola_virus_disease http://en.wikipedia.org/wiki/Ebola_virus_disease That's backed up by two citations, from the CDC and WHO. I think I'd also read something, before this epidemic started, that said the longest known incubation period was 21 days. I've since found a bunch of articles, and one WHO press release, that say the 95th percentile was 21 days and 98th was 42 days. I'm a little skeptical of them, though: they all trace back to that one WHO press release, which is based on the West Africa epidemic, where (because transmission is endemic) it's quite possible that a patient was re-infected at a later date and that's why the incubation period seems longer. Unless I see evidence from a country where the cases are all contact-traced, I'd be inclined to believe the earlier studies about the virus and not the latest articles.

deleted 12y ago

[deleted]

DanielBMarkham 12y ago

I hate to play Negative Ned, but some observations are in order. Contact Tracing works when you have one guy that you know has it -- and you fan out like wildfire to catch all the people exposed. It'll probably work for the one U.S. case. It does not work when you have tens of thousands of people infected, like we do in other African countries. People who are dying at home. People who have been in contact with who-knows-whom. So we're entering a new phase of Ebola: places where the disease is everywhere and we have no contact tracing, and places that can catch one or two cases as they appear. Nigera is currently in the latter camp. I hope they stay there. This is why scientists think the U.S. and other more advanced countries will do better: we'll be able to stomp on new cases, track the contacts down, and catch the secondaries. This will continue to work -- until it doesn't. That is, if the disease can be contained elsewhere, a low volume of cross-border transmission should be manageable. If, however, it continues to spread to unknown places, and grows in immeasurable ways? Then at some point the trickle of cases overloads any healthcare system.

a8da6b0c91d 12y ago
If it spreads to central american slums a panicked wave of people will rush the US border. The current authorities are insane enough to not stop them.
- cdelsolar 12y ago
  Really?
  - a8da6b0c91d 12y ago
    I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case a of a global pandemic, but the recent experience of the enterovirus epidemic being brought here by central american teens who were not deported really makes things clear.
    - macspoofing 12y ago
      >I know it's almost inconceivably stupid that the feds wouldn't seal the border in the case Like with scotch tape?

durandal1 12y ago

This process sounds way too effective to be executed by a US agency.

NearAP 12y ago

2 important factors which helped were 1) The health workers who treated the index patient were a major factor in preventing the spread of Ebola to the rest of the city. This is because the index patient initially lied he had been in contact with an Ebola patient, the Liberian Ambassador tried to pressurize the hospital into releasing the patient to attend a conference in another state. The doctors treating him refused and 2 of them died after contacting the virus. 2) A group of volunteers set up a website [1] to pass across information to the public. Their aim was to stop the spread of false information, reduce panic and help socialize government message about Ebola. Stars of the Nigerian film industry (AKA Nollywood) also helped in the media campaign. http://www.ebolaalert.org/ http://www.ebolaalert.org/

segmondy 12y ago
You will be right if the disease never left the hospital. The disease did leave the hospital, some people that got it, ran off to other cities and they had to be found and brought back. http://www.reuters.com/article/2014/08/13/us-health-ebola-nigeria-enugu-idUSKBN0GD1F220140813 http://www.reuters.com/article/2014/08/13/us-health-ebola-ni... The group/government working on this really did their part.
- tadeoyerinde 12y ago
  NearAP is right- information is and was key, and Guinea, Liberia, and Sierra Leone would do well to follow suit. An alarming amount of people think that bathing with saltwater prevents infection. http://www.npr.org/blogs/goatsandsoda/2014/08/12/339638348/pray-over-hot-salt-water-then-bathe-in-it-an-anti-ebola-ritual http://www.npr.org/blogs/goatsandsoda/2014/08/12/339638348/p...
- NearAP 12y ago
  1) In my comment, I was referring to the index patient who wanted to be discharged but the hospital refused to. 2) The person referred to in the article was one of the nurses who attended to the index patient. After it was confirmed that the index patient had Ebola, all those who came into contact with him (including the medical personnel who treated him) were isolated. One of them (the nurse in the article)'broke off' and went to another city. When the Government found out, they brought her back to Lagos in a 'special vehicle'. Some of the other medical personnel (who were in isolation) later tested positive for the virus and some of them died.

OoTheNigerian 12y ago

Irrespective of some cynical comments below, I am happy to see rare good news from my country make it to the front page. The nation worked together in conjunction with some foreign health workers to aggressively tackle the spread. We were quite lucky that the first known case occurred in Lagos and the doctors at the hospital (on of whom died) were very proactive.

a8da6b0c91d 12y ago
I think credit is due to the Nigeria Center for Disease Control and Prevention. They are putting out great public education materials: http://i.imgur.com/PY9cZy2.jpg http://i.imgur.com/PY9cZy2.jpg
- peteretep 12y ago
  Save someone else the trouble of Googling it: http://en.wikipedia.org/wiki/Nigerian_Pidgin http://en.wikipedia.org/wiki/Nigerian_Pidgin
  - smtddr 12y ago
    Thank you. I'm pretty sure a8da6b0c91d was counting on people not googling it.... I've seen his posts before.... He knows what people will assume.

tiatia 12y ago

Did they scam ebola? ;-)

mathattack 12y ago

I'm still very concerned by problems like this which have exponential growth rates. Eventually they get out of hand. It's not like we can write off an entire quarter of a continent.

dredmorbius 12y ago
The passengers of the Titanic on the morning of April 14, 1912, would likely have considered writing off two thirds of their number in the event of a maritime mishap equally unacceptable. However that's precisely what happened within 24 hours. Ebola is spreading and doubling rapidly -- every 20 days with the most recent data I've seen, and the case count in both Liberia and Sierra Leone exceeds that of the early-September projection made in the New England Journal of Medicine. It's not only well above the _median_ prediction, but it exceeds the 95% confidence bound. UN WHO have stated flatly that we've got to achieve a 70% effective containment to stop spread of the disease or we're entering a stage for which they have no plan. Not only is the prospect of failed containment concerning, but so is the fact that there's currently no contingency plan should that occur. It strikes me as an epic failure of imagination. Given growth rates and prospects for loss of containment, it could be far more than a quarter of a continent at stake.

mmcclellan 12y ago

But this article is already out of date. Only hours after this article was published we learn that the second nurse to test positive was allowed to fly commercial a day before her diagnosis and after the first nurses diagnosis. We definitely can't compare our response to Nigeria's.

anigbrowl 12y ago
With the CDC's OK because her fever was only 99.5 degrees F instead of 100.4. What idiot at the CDC made that decision? Did nobody, including the nurse, consider the idea that the fever might progress and that it would be better to be safe than sorry? When did so many people become so deficient in common sense?! http://dfw.cbslocal.com/2014/10/15/ebola-patient-traveled-day-before-diagnosis/ http://dfw.cbslocal.com/2014/10/15/ebola-patient-traveled-da...
- ceejayoz 12y ago
  According to Wikipedia, 99.5 isn't a fever. http://en.wikipedia.org/wiki/Fever http://en.wikipedia.org/wiki/Fever > characterized by an elevation of body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F)
  - hga 12y ago
    If you've nursed a terminal Ebola patient 99.5 may indeed not technically be a fever, but it's something you should pay attention to. Heck, more to the point, she should know her normal temperature range at the various times in the day and if that's a fever for her. In the morning it would be a fever for me, I run a bit cool. Also note even the professional WelchAllyn units are not 100% accurate, they're rated for 0.2 F plus or minus (I bought one not long ago after my old el-cheapo BD one died and Amazon reviews revealed today's el-cheapo ones are by and large worthless. Heck, 3M even created a new consumer brand, no doubt to avoid brand damage to BD).
    - diltonm 12y ago
      In bootcamp I once had a temperature around 97 something. The doctor took it with two different thermometers not believing it. I felt fine. Apparently that temperature's not considered abnormal: http://www.webmd.boots.com/a-to-z-guides/normal-body-temperature http://www.webmd.boots.com/a-to-z-guides/normal-body-tempera...

steven2012 12y ago

I don't think the US has a problem with an ebola pandemic. I do believe that the governments around the world are understating how contagious this disease is. I wonder how many of those 19 infected people died? Did they attempt to save them, or did they essentially wait for them to die? Depending on the answer, it could make the reaction of health workers and patients in Nigeria behave very differently.

maxerickson 12y ago
The linked WHO pdf (at the point in the article mentioning the 19 confirmed cases) states that there were 8 deaths in Nigeria (the other 12 have recovered). One of those is a death that is only listed as a probable Ebola case. Normally, we have to complain that news articles don't link to their sources!
segmondy 12y ago
They were treated, all of them got treatments.

vonnik 12y ago

Can we please not use a Business Insider reporter strapped to a desk in New York as our source of truth on Ebola in Nigeria? Nigeria can't even recover the school girls kidnapped by Boko Haram. I hardly think it's up to the challenge of Ebola, and this story isn't over yet...

robomartin 12y ago

As it pertains to what's going on in the US, there is a question nobody in the media is asking and frankly, I don't understand why. It's very simple: What have you been doing since 9/11? Context: It was fair to assume, after 9/11 that some kind of a bio or chemical attack could have been in the cards for the future. Such weapons had been used in the Middle East. As various agencies were realigned in order to deal with the new threats and Homeland Security was created it only stands to reason that some of the objectives had to be to engineer, plan, drill and prepare for quick and effective response to a wide range of potential attacks. I am not a biologist or chemist nor do I have any real experience or knowledge dealing with these kinds of attack scenarios. This is going to sound really weird, but, well, I have three large German Shepherd Dogs and I've had cases of all three coming down with diarrhea. Having to clean up such a mess teaches you a thing or two about the spread and handling of bodily fluids. After experiencing that just once I put into place a system and a kit to be able to deal with the situation more effectively. It's nasty and I really didn't want to suffer like I did the first time. I am happy to say that my planning worked well. Now, using that example, had I been involved with DHS and CDC back in 9/11 I would have devoted serious time and resources to creating and equipping rapid response teams to deal with chemical and bio attacks in all major cities. I would have designed and tested container-based (as in converted cargo containers) emergency response systems. I would have developed a set of isolation environments within containers. I would have staged these in every major city in the country at appropriate locations. And, of course, I would have conducted quarterly drills in order to ensure that everyone who might potentially have to be involved in dealing with a chemical or bio attack was trained to the best of our abilities. I probably would have included both civilian and military personnel in this system. All that would be missing would be that music that plays in the Transformers movies when the trucks, planes and ships deploy to do battle. In other words, I would require a system that was that ready to go into action. Just like the movies. So far, I've watched every CDC conference surrounding this Ebola business. It's embarrassing. It's scary. It is absolutely astounding to me that no reporter is asking this simple question: What have you been doing since 9/11? And I say so because the story coming out of the CDC sure sounds like, well, amateur hour is too harsh, but let's just say it is obvious they were not ready for this. When you have the director of the CDC on camera saying things like "We now have two teams supervising operations at the hospital so we can make improvements". In other words, one team wasn't enough, you guys didn't have your act together, you have left the response to these kinds of incidents to the random training, equipment and judgement of any random hospital in the US (because there was no way to know where the index patient might land, right?). Why weren't these drills, supervised by not one, but five teams of observers and experts conducted five or ten years ago. Why now? Why do you have to figure it out now? To say that it is obvious that these people have squandered 13 years is a grotesque understatement. What would happen if we had twenty patients arrive into twenty different cities? Was there a plan? Is there a plan? No. Of course not. I am trying like hell to not get political here. But, you know, every corner we turn we see example after example of just how bad big government can be. They can't manage building a website that a team of five college dropouts could have aced in six months. And we trust them to protect us from bio hazards? What have they been doing during the last thirteen years? If they are not incompetent, what are they? Here's reality, going back to my dog example. I take a nice large building and spray the interior with liquefied dog shit. I then take a group of engineers and task them with cleaning said building. They have all the tools they need to develop protective gear, tools, equipment and procedures to do it quickly, safely and thoroughly. And they are also tasked with developing these systems and procedures such that we could easily containerize them and scale them to be able to instantly deal with liquefied dog-shit attacks anywhere in the US. How long do you think it would take to have an absolutely amazing system in place if we took that away from government and held a contest open to any and all private entrepreneurs? Each of 100 teams gets a ten million dollar grant from the US government. The winning team walks away with a contract and a $100 million dollar prize. A year? At the most? I would think so. The CDC and DHS have had 13 years to accomplish exactly this and prepare for the potential of a massive chemical or biological attack in the US and the best they can do is what we are seeing now? With sick nurses getting on planes? And television anchors breaking quarantine? And "breaches of protocol"? What protocol? Unbelievable. In my world this isn't about firing someone it goes way beyond that. This is criminal. This isn't even political as it spans administrations controlled by both major political parties. Now, don't get me wrong, I happen to think that this is reasonably unlikely to fully derail here in the US. Not because the CDC and DHS have it together. Nope. Simply because Ebola doesn't is hard to transmit and we don't have a ten, twenty or a hundred cases spread all over the place. We had ONE guy that got through. And that was enough to expose just how fucked the response system happens to be. I really hope nobody else dies. It might get a little scarier before it gets better, but I think we will be OK. What's got me rattled is that we are watching our response system engage in real time experiments with people's lives in front of the entire world when the fundamental procedural aspects having to do with responding to something like this should have been fully worked out, tested, verified, re-tested and forward deployed years ago. Not now. Years ago. Dealing with fighting a specific virus is a different story, that's biology, that's not procedure and readiness in terms of forward deployment of resources to deal with containment, etc. Again, simple question: What have they been doing since 9/11? Are we ever going to hold any of these people accountable? Why doesn't anyone ask the right questions?

ballstothewalls 12y ago

Does anyone know the details behind the 21 day time period for declaring someone to be infection free? Is that some kind of biological max for how long the virus can live or is it a statistics thing where the virus is not there 95% of the time?

tjohns 12y ago
Statistics. There have been rare cases of the incubation period being longer than 21 days, but most people will get sick much sooner. (95th percentile) That said, there was a recent PLOS article that suggested that a longer waiting period might be called for: http://currents.plos.org/outbreaks/article/on-the-quarantine-period-for-ebola-virus/ http://currents.plos.org/outbreaks/article/on-the-quarantine... There's also a cost-benefit analysis involved here. More transmissible/serious diseases call for a larger margin of safety, while at the same time enforcing a longer quarantine takes a toll on total available infrastructure.
- ballstothewalls 12y ago
  Thank you for the link!

bvrlt 12y ago

Nigeria didn't actually do an awesome job: http://www.slate.com/blogs/the_world_/2014/10/15/nigeria_and_senegal_on_the_verge_of_being_declared_ebola_free_can_we_learn.html http://www.slate.com/blogs/the_world_/2014/10/15/nigeria_and... (published 3 hours after BI)

NearAP 12y ago
1) Interesting.., that is the only article so far that I've seen that is actually playing down what was achieved by the Nigerian Government and its citizens. 2) The article says '....A single Liberian man, who traveled to Nigeria in July, infected 11 hospital staff in the time between his admission to a hospital and when his test results were received...' What that statement failed to point out was that a) Nobody initially knew the guy had been in contact with an Ebola patient because the guy lied serially about it - [1]. Because of this, the man had initially been treated for Malaria and so the hospital staff did not wear protective gear. When they finally discovered he was from Liberia and suspected Ebola, his diagnosis came fairly quickly. b) The article also failed to say that the man once yanked out his 'drip tubes' spilling his blood, and peed in the room forcing the health workers to flee [2]. 3) WHO says on their website [3] - '...In a piece of world-class epidemiological detective work, all confirmed cases in Nigeria were eventually linked back to the Liberian air traveller who introduced the virus into the country on 20 July. [1] http://allafrica.com/stories/201408261017.html http://allafrica.com/stories/201408261017.html [2] http://www.frontpageafricaonline.com/index.php/news/2506-sawyer-s-final-hours-in-lagos-indiscipline-rage-strange http://www.frontpageafricaonline.com/index.php/news/2506-saw... [3] http://www.who.int/mediacentre/news/ebola/14-october-2014/en/ http://www.who.int/mediacentre/news/ebola/14-october-2014/en...

NearAP 12y ago

Just watched Ambassador Robin Sanders (former US Ambassador to Nigeria) on MSNBC. She says in addition to screening people at the airports, Nigeria was screening folks at the Harbor/Ports. She says the US is not doing any screening at the Harbor/Ports and she wants the US to start doing that.