Thursday, 16 October 2014

Of Ebola, Salt-bath and Bitter Kola…where are we?

Thursday-Friday night, last week, was one to remember. The whole nation was agog with the Ebola scare, leading to many consuming and bathing with salt solution. Funny though, it is serious. I thought I should do a piece on it, but decided to call my friend, Dr Ohanyido, being better qualified, to do it. Please do enjoy this very insightful piece of his, written last Saturday, August 9, 2014.
Of Ebola, Salt-bath and Bitter Kola…where are we?
By Francis Ohanyido | Public Health Physician
The Nigerian Minister of Health, Prof. Onyebuchi Chukwu, announced to a very scared country that Ebola Virus Disease (EVD) is now considered a national health emergency: a national position to officially deploy an action plan to contain it. By so doing, Nigeria had quickly followed precedents by Sierra Leonean and Liberian authorities without waiting for the cases to escalate to the level of those countries, a step which I scored highly.  A full EVD epidemic is beyond the capacity of any one African country to handle with its broad social, economic, psychological and security implications. It therefore behooves us to have a cogent action plan that cuts across international, national, interagency, states, and community levels.  To further emphasize the gravity of the situation, the World Health Organisation underscored this by declaring Ebola a global public health emergency.
The Ebola Viral Disease arrived Nigeria with Patrick Sawyer, an American-Liberian, who flew into Lagos and died a few days later, seeding Nigeria’s first documented infection. The deadly EVD had arrived a country challenged by a nationwide strike by physicians. It also arrived with its own ‘usual suspects’; rumours and conspiracy theories and all what not, mostly driven by our fear. It is however clear that this epidemic seed into Nigeria is traceable to the Zairian Ebola strain that broke-out in Guinea in February 2014. Since then, globally, out of about 1,700 cases that tested positive, more than 900 of them have died. This caused Doctors Without Borders (MSF) to admit this week that the virus is spreading more than predicted with more than 60 outbreak hotspots. The national EVD count by yesterday showed that the number of cases tied to this in Nigeria has reached nine from the mid-week count of seven positive cases. We still have only two mortalities; Sawyer and the hospital matron that nursed him. All the known cases have remained within Lagos. Initially, there were fears that two corpses that were flown to the Southeast from Ebola-struck Liberia were possibly mortalities from EVD. These speculations have been thrashed out.
 I recall that during an interview by Liberty FM Kaduna exactly a week ago on this subject, one of the callers had insisted that Ebola was ‘created by the Americans’. This thinking has become a common distractive thinking with almost any new disease of the epidemic proportion of the Ebola. There is also this belief in some quarters that Americans already have a secret cure.  I had to clearly trace the origin of the Ebola Virus Disease and all its known epidemics since the 1970s, and the challenges attendant to developing a vaccine or drug, as well as the clinical trial requirements for new drugs to debunk that line of thinking. However, what has really gotten most experts worried are two things: The recent spate of phone calls and SMS across the country encouraging people to bathe with warm water laced with some quantity of salt (unspecified) . The second being the so-called bitter cola remedy credited to Professor Maurice Iwu, the erstwhile INEC chairman and a professor of pharmacognosy. The saline bath seems to have emanated from statements accredited to a controversial Nigerian religious figure in the Southeastern Nigeria, while the bitter cola remedy was as a result of people picking up threads of laboratory research done years ago by Iwu which showed some antiviral properties of bitter cola on EVD, in the LAB and not in humans. So, both remedies do not meet concrete scientific requirements. Understandably, the price of bitter cola has quadrupled in and around Lagos! The International Public Health Forum (IPHF), in response to these rumours and misinformation sent out a public health advisory that Ebola threat is real and people should aspire to stay healthy with the ‘right information’ from credible sources. It has emphasized that EVD is a class IV containment disease, and as such, where patients are being treated of specimen from them are managed are high risk environment, and the disease portends a grave threat to the world if not dealt with effectively.   Good personal hygiene like regular hand washing and basic sanitation like household and facility cleaning with disinfectant, eating well cooked meat (especially wild animal), as well as non-body contact with a very sick Ebola victim or a corpse remain the key prevention . The main reservoir is the fruit bat.
In one of two interviews by CNBC Africa this week, I pointed out that the medical odyssey of the two Americans Dr. Kent Brantly and Nancy Writebol, who were infected in Liberia with EVD and being treated at Atlanta’s Emory Hospital by US Centers for Disease Prevention and Control (CDC), offer glimmers of hope for a disease that currently has no cure. This week did see massive movements in the biotech sector on early-stage Ebola drugs, galvanized by the good response of the two American to an experimental drug by Mapp Biopharmaceutical (zmapp). Another firm Tekmira has a drug that has gone further down the line of testing which the US Food and Drug Agency had initially put on full clinical hold, but last Thursday switched it to a partial hold, clearing the path to its possible use for EVD.
Even with admission by US health authorities that Ebola's spread beyond region of West Africa was ultimately inevitable, the CDC has deployed 31 disease control experts to Nigeria and three other countries affected by the disease in West Africa, and an additional 50 to be deployed in a month. Four of these experts would be in Nigeria. These experts would also use a tool to enhance the tracing of the contacts of those infected by EVD.  In the case of Sawyer’s contacts in Nigeria, we expect by next week the Nigerian Center for Disease Prevention and Control (NCDC) our counterpart of CDC would review the incubation periods of all Sawyer’s contacts and give us feedback.

BLUEPRINT Newspaper; August 14

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