Ebola: Health workers must maintain high index of suspicion, experts declare

Following Nigeria’s confirmation of an imported case of Ebola Bundibugyo virus disease, leading virologists have asserted that healthcare workers must maintain a high index of suspicion for Ebola, especially in patients with a recent travel history to Ebola-hit areas and presenting with fever of unknown origin.

The experts stressed the need for prompt patient assessment, careful review of travel and exposure histories, laboratory testing, effective contact tracing and isolation of confirmed cases to prevent further transmission.

They said early recognition of suspected cases was important, as patients could initially present with symptoms resembling other common illnesses, including malaria.

In exclusive interviews with PUNCH Healthwise, the virologists urged hospitals to strengthen screening and triage at their emergency and outpatient departments, while warning against indiscriminate quarantine measures across healthcare facilities.

They also called for adequate personal protective equipment for frontline health workers, regular handwashing and sustained surveillance of people who had contact with the confirmed case.

The experts further raised concerns about the shortage of healthcare personnel, warning that the pressure on an already stretched workforce could affect the country’s ability to respond effectively to the outbreak.

They called for better support and incentives for health workers involved in managing suspected and confirmed cases.

PUNCH Healthwise reports that Nigeria confirmed an imported case of Ebola Bundibugyo virus disease in the Federal Capital Territory after a woman with a recent travel history to Uganda developed symptoms and sought care at a private health facility in Abuja.

The Nigeria Centre for Disease Control and Prevention has activated its incident management system to coordinate the response, while the Federal Government has placed high-risk contacts in designated quarantine facilities and is tracing potential exposures.

The World Health Organisation describes Bundibugyo virus disease as a severe and often fatal form of Ebola disease caused by the Bundibugyo virus.

The WHO stated that the average case fatality rate for Ebola virus disease is 50 per cent, with historical rates ranging from 25 per cent to 90 per cent, depending on the virus strain, patient health and access to medical care. It, however, noted that the Bundibugyo ebolavirus has an approximately 32.8 per cent fatality rate.

Providing expert insight on the matter, the Director of the Centre for Human and Zoonotic Virology at the Lagos University Teaching Hospital, Professor Sunday Omilabu, said hospitals had been directed to remain on high alert and strengthen screening procedures to identify suspected infectious disease cases.

The medical virologist of more than four decades said emergency departments should use triage to assess patients based on their symptoms, travel histories and possible exposure to infectious diseases.

He explained that healthcare workers should ask patients about recent travel and other relevant details before determining the next steps, adding that laboratory testing was necessary to confirm Ebola infection.

He noted that although teaching hospitals and federal medical centres had been placed on alert, the discovery of a confirmed case meant surveillance activities needed to continue to identify people who might have been exposed.

Omilabu said the 44 contacts initially identified by health authorities would need to be monitored, while efforts to trace other people who might have been exposed, including passengers on the same flight as the index case, should continue.

He said contacts should restrict their movements as advised, monitor their temperatures and promptly notify health authorities if they develop symptoms.

The virologist stressed that isolation was essential for people who tested positive to prevent further transmission, adding that health authorities were working to ensure appropriate facilities were available to manage cases.

On the symptoms that should prompt medical attention, Omilabu identified fever, headache, sore throat and diarrhoea as common signs that could require investigation, particularly among people with a history of possible exposure.

He urged anyone who developed such symptoms after a possible exposure to contact a hospital for assessment and testing, rather than attempting to determine the cause of the illness on their own.

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Omilabu also called for regular handwashing, warning that contaminated hands and surfaces could contribute to the spread of infection.

The medical virologist advised Nigerians to wash their hands after handling money or touching potentially contaminated surfaces, and before eating or touching their faces.

“Now that we have a confirmed case, we have to go back to our usual hand cleaning. Whatever we touch, we have to wash our hands,” he said.

The virologist further warned that the shortage of healthcare personnel could put additional pressure on hospitals during the outbreak, noting that the workforce was already stretched by routine healthcare demands.

He called for incentives to encourage more healthcare workers to participate in the response, particularly at facilities designated to manage suspected and confirmed cases.

“They need to encourage the healthcare givers. Just as they did in Lagos State, you know, they give them special allowances to motivate them to come to the centres where they are managing the cases,” Omilabu said.

He said additional allowances could help attract more health workers to treatment centres and strengthen the country’s capacity to respond to the outbreak.

Also, a Professor of Virology and former President of the Nigerian Academy of Science, Oyewale Tomori, said health workers should be particularly cautious when assessing patients with fever of unknown origin, stressing that Ebola should be considered among the possible causes before proceeding with treatment.

“The first group of people to be exposed to this are the health workers. So, we need to protect them. Provide them with personal protective equipment, and they too should be very cautious, particularly at this time. Any fever of unknown origin should first be considered possible Ebola before you go on in treating the person,” Tomori said.

The former Regional Virologist for the World Health Organisation Africa Region explained that the symptoms of Ebola could initially go unnoticed, making travel history and the timing of symptom onset important in identifying suspected cases.

Tomori noted that while people who had not developed symptoms might not know they were infected, transmission was associated with close contact with an infected person, especially through blood and other bodily discharges.

“With Ebola, those who get it have to be in very close contact with the patient. That is why they don’t talk about a six-feet safe distance,” he said, distinguishing the mode of transmission from that of COVID-19 that is airborne.

The renowned virologist said contact tracing should focus on people who had interacted closely with the index patient after she became ill, including members of her household, friends, relations and healthcare workers who attended to her.

He said the first hospital where the patient sought care would be among the key places for investigation, as health authorities would need to identify staff and other patients who might have had close contact with her while she was symptomatic.

Tomori, however, cautioned against using the outbreak as a reason to impose blanket quarantine measures across hospitals, saying such an approach could be counterproductive.

He said while overcrowding in hospitals remained a concern because it could increase opportunities for the spread of infectious diseases, the response should focus on identifying suspected cases and assessing the nature of their contact with others.

The seasoned academic urged Nigerians to take the confirmed case seriously and comply with public health advice, warning that distrust of the government could put people at risk if it discouraged them from taking precautions.

He also advised the public not to panic, saying the outcome of contact tracing would help determine whether further cases had occurred.

“No need to panic. The government is doing its best to contain it. Let us keep our fingers crossed until we have results of the contact tracing. If there are no more cases, then of course, there’s nothing to worry about,” he said.