The Guardian (Lagos)

7 August 2014

Nigeria: Ebola Virus - Air Passengers Now Mandated to 'Self-Declare' Health Status

Photo: Premium Times
Ebola Virus.

DIRECTOR of Port Health Services, member of the Incidence Management Centre (IMC) for the Ebola Virus Disease and head the Committee on points of entry, Dr Sani Gwarzo, told The Guardian in an exclusive telephone interview yesterday that it is now mandatory for pilots to declare any event in the air in case one of the passengers vomited or passed diarrhoea or was bleeding or was sick or had high fever, or whatever event that occurs in the air; and also the passengers are mandated to self declare their health status before disembarking.

Gwarzo said the Federal Ministry of Health (FMoH) has specially trained personnel at the airports that screen passenger's temperature with handheld infrared device and there are plans to procure equipment that can mass screen passengers' temperatures.

Amid concerns of possible outbreak of EVD in country, the Lagos University Teaching Hospital (LUTH) has raised a special team and unit to contain the situation.

Chief Medical Director of LUTH, Prof. Akin Osibogun, told journalists that the Hospital has the capacity to diagnose Ebola virus and has so far tested over 20 samples from persons that had contact with the first victim of EVD in the country.

Osibogun also commended First Consultants Medical Centre for 'excellent' handling of the case.

Osibogun said: "LUTH has the capability to make the diagnosis and that was why the specimen was sent here. We are prepared to deal with any possible outbreak of the disease. We have already set in motion our preparedness team to be able to handle any eventuality. We have put in place isolation and barrier nursing mechanism.

"With regards to enlightenment of the public, the Lagos state government and the federal government are doing that.

"I think we should commend that private hospital for handling the case with high professionalism. They were able to raise suspicion and immediately barrier nursed the patient and alerted the Lagos and federal ministries of health.

"So far we have over 20 different specimens of persons that had close contact with the victim being sent to us for testing and we are expecting more. The facility is available to test. So far we are dealing with specimens not patients."

On what is IMC team is doing to check the spread of EVD, Gwarzo said: "Several things. One of them is that ports entry, we are the ones that documented the chronology, the story, and how the patient came into Nigeria, at what hour? What he did and what he did not do, how he was sent to the Hospital, whatever contact he had in the country as he came. It is the responsibility of the Ports Health Authority and we did that and then we contacted the Airline to give us the manifest and all those that were on board.

"We also have to monitor all those people who took the same plane with the index case. We have also have educated the Airport community not only the Airport staff from Federal Airport Authority of Nigeria (FAAN) management to their staff to Civil Aviation Authority (CAA) and we had to do consultations with all agencies working at the Airport and train them. The personnel are being trained across the country. We have also developed standard operating procedure for every workstation: If you are handling passports, if you are handling baggages, if you are handling travellers.

"We have activated our centres not only in the airports but also in the seaports and also on the ground crossings. On a daily basis we screen travellers. Right now what we are doing is to use a handheld device, which we call infrared thermometer. It can point a laser-guided ray to the forehead or temple of a person and from a short distance we can check the temperature without touching the person. So as every passenger is passing by we check the temperature and if we see your temperature is elevated we pull the person aside and do further evaluation.

"This is cumbersome because we have to do it manually one by one and we are also in the process of acquiring an equipment that can mass scan people as they are passing immigration. We are also introducing new regulations I am sure passengers will be telling you as they travel and if you do travel you will also see it yourself.

"We want every passenger to declare his or her health status. In the past we ask the aircraft to declare its health situation, which we call the general declaration. Pilots as they land in Nigeria the first person to handover document are the Port Service staff. As soon as we are okay with that we now declare the aircraft safe to open its doors in Nigeria for people to come out. But right now because of the Ebola issue events can occur in the air even after the health status of the aircraft has been declared. The pilot is mandated to declare any event in the air in case one of the passengers vomited or passed diarrhoea or was bleeding or was sick or had high fever, or whatever event that occurs in the air. The pilot is mandated to report that to us and also the passengers are mandated to self declare."

By filling a form? Gwarzo said: "Yes the form is so detailed enough to track somebody even several weeks after in their hometown."

The World Health Organisation (WHO) has asked countries to set up their own Ebola Virus Disease response plan. What level of support are you getting from WHO and the United States government? Gwarzo said: "In fact I must say that these two agencies stand out in terms of their support to Nigeria; they have sent in experts in person, they have sent in equipment and rapid response things and they are keeping tab on what we are doing and supporting us as we go along. It is very impressive so far."

How about the national response? Gwarzo said: "The Presidential Committee, which is Inter Ministerial Committee, is dealing beyond the health sector. All that I have described to you is health sector response, but remember it is not just a health issue. The Aviation ministry, Agriculture because animals are involved, Federal Capital Territory (FCT) because it is a state on its own, Information, which is the key where people need to know what to do and it is chaired by the Minister of Information. That Inter Ministerial Committee is aimed at harmonizing government response so that we will not be talking about different things.

"The Ministry of Health has the greater burden with the Secretariat. Now in addition to this, there is a Ministerial Response, which is headed by the Incidence Management Centre (IMC). The IMC by and large is in charge of all the health sector responses that focuses more on health and at the end of the day is coordinating all the state governments not just Lagos. IMC is working with Lagos state governments and is also activating other state governments."

What other things constitutes the response plan? Gwarzo said: "The response plan when you talk about it constitutes several levels. At the national level is the Inter Ministerial Committee, which harmonises national response. IMC intensifies health sector response and also every state and Local Government Areas (LGAs). Even Non Governmental Organisations (NGOs) are supposed to come up with their own responses relevant to their immediate mandate and immediate location of response.

"I advise the media to also come together and do a joint media response so that you can harmonise your work. It pays to harmonise your work."

How far have you gone in monitoring the persons that came in contact with the first victim? Gwarzo said: "We are monitoring the entire person not just the blood tests. If the person has headache, fever, or any symptom you just have to document it. Even some of them that had blood contact. We divided them into risk levels- high risk, medium risk and low risk- especially those who were in directly contact with patient, the Hospital. We will continue to administer a protocol for the management of these groups. Tests have been done on all of them and so far nobody has tested positive for Ebola virus."

Going forward because of the anxiety and fears, what message are we sending out to Nigerians as regards to what government is doing and what they should do? Gwarzo said: "You see like any other epidemic of high intensity like this there is bound to be a dual epidemic: epidemic of the disease itself and epidemic of fear. Right now we are dealing with two situations: fear and rumours. People are coming out with stories and escalating them beyond measures and people getting worried and sending out email and text messages that the epidemic is out of control and that bitter kola treats, cures the disease.

"Those are rumours that we are also contending with and for us we are being proactive by educating the populace through several fora in radio, television, jingles, posters, handbills and also we have commissioned an IT experts to help with the social media aspect of outreach."

How far with the treatment? Is there any treatment yet? If no what are we doing about the treatment? Or how do we intend treat the disease? Gwarzo said: "What we have now is supporting treatment to address the fluid loss, balance the blood loss; the electrolyte replacement, if there is any super imposed infection they are treated and the patients are counseled. A complete set of things including psychosocial support.

"The worst-case scenario that has been reported was one out of ten died one survived. There are other better situation where six out of ten died and four survived. We do hope that with improved care there will be better chances of survival for the patients. You see one of the America doctors taken back to the United States is improving, not that he is cured, but I learnt that he is improving medically."

Based on our culture that when you meet people you either shake hands or hug them. In the light of Ebola virus are you recommending that people should stop shaking hands? Gwarzo said: "No! I can be faulted. I can be diplomatically wrong to say so. Be careful, do it in a polite way and let everybody understand that times have changed and now we have Ebola virus in our hand and suspend a few things for the purpose of preventing the epidemic. We are not saying stop handshake but it will be nice. But as much as possible in high intensity places like hospitals, airports where people meet from different locations people should even be more careful with handshake and as much as possible with soap and water. Also, people can use hand sanitisers."

How about the scare in Anambra state? I learnt that a corpse brought from Liberia was deposited in one of the morgues there and there are fears? "Yes the Incident Management Centre must treat all the fears that arise swiftly. We do send teams out to investigate no matter the location or whatever state it is. With all the investigation done so far at the centre, no the case of Ebola has been documented. So I it remains an unfounded rumour," he said.

What are the chances of these people being monitored for being in close contact with victim testing positive or negative to the Ebola virus disease? Gwarzo said: "You see in science we do not predict, we deal with evidence. All we know is that within two to 21 days most cases of Ebola manifests. So if beyond 21 days the patients are not manifesting any symptoms, we can take it that they have tested negative, then we celebrate it but for now nobody can tell you otherwise because it is not scientific."

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