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With Ebola Cases Still Few, Populous Nigeria Has Chance to Halt Its Outbreak – New York Times



Health workers have fought the Ebola outbreak to a tentative standstill in Nigeria, Africa’s most populous nation, offering at least a chance to eradicate the disease there before it spins out of control, as it has in Guinea, Liberia and Sierra Leone, where a sluggish response failed to halt it early.

Nigeria’s small number of cases — 11 confirmed and one suspected — provides a brief window in which to wipe out Ebola. If these efforts fail, the death toll could be horrific. The cases have occurred in Lagos, a city with 20 million people, many of them jammed into teeming slums where the virus could become unstoppable.

Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, said health officials were watching Nigeria with intense interest, because of its huge population and because it is much more of a crossroads than the other three countries, in much closer touch with the rest of Africa.

“We’re waiting for the other shoe to drop,” he said.

The World Health Organization said on Thursday that staff members on the front lines of the outbreak across the region had warned that the nearly 2,000 reported cases and the more than 1,000 reported deaths “vastly underestimate the magnitude of the outbreak.” And Doctors Without Borders said on Friday that the disease was still spreading faster than the efforts of governments and health workers to keep up with it, calling ground conditions “like a war.”

About 200 people who had contact with the infected patients in Lagos are receiving daily visits from health workers for 21 days, the incubation period of the disease, to check for fever or other symptoms, said David Daigle, a spokesman for the team in Nigeria from the Centers for Disease Control and Prevention. So far, 61 have finished the follow-up and are in the clear, he said. About 60 Nigerian health workers have been trained to trace contacts, and more are being taught, to bring the total to 200, Mr. Daigle said.

Ebola arrived in Nigeria on July 20, carried by Patrick Sawyer, a native Liberian and naturalized American citizen. He contracted the disease in Liberia, flew to Lagos while he was ill and died on July 25. Health officials say he was vomiting during the flight. [eap_ad_1] Every case in Nigeria has been traced to him. Some victims had helped him when he arrived at the airport, and others were health workers who had treated him without gloves or other protection because they did not realize he had Ebola. President Goodluck Jonathan has been widely quoted in Nigerian newspapers as calling Mr. Sawyer “a madman.”

Four Nigerian patients have died, and the mood among the rest is somber, said Dr. Maurizio Barbeschi, a scientist from the World Health Organization who is working on the outbreak.

“They think it is a death sentence,” he said. But he said they were getting good care, and he doubted that their death rate would reach that of the other countries, where about 60 percent of the cases have been fatal in some locations.

Patients who are health workers are caring for others, helping with tasks like changing bags of intravenous medicines.

Last Saturday, Dr. Barbeschi said, he stepped outside the ward where patients are being treated and asked if anyone had a book so he could read to the patients. Mr. Daigle pulled a beat-up copy of Shakespeare’s “Henry IV” from his backpack.

Back inside, speaking through a surgical mask, Dr. Barbeschi acted out scenes from the play for a patient fighting for his life.

Nigeria has some advantages over other West African countries in dealing with the disease: It has a better health system, and it was on alert for Ebola because the illness had struck the other nations first. Doctors detected it there before a large number of people fell ill. Dr. Frieden said that it took too long to isolate the first person infected from contact, but that the ability to respond had improved tremendously.

But Lagos is a huge city. The outbreaks in the other countries have mostly struck villages and towns.

“An Ebola outbreak in a dense urban setting is very different from what we know already,” said Dr. Benjamin J. Park, an infection control specialist from the C.D.C. who is working on the outbreak in Lagos.

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