Nigeria beat Ebola in 2014. Could it do it again?

On 20 October, Nigeria confirmed its first Ebola case in 12 years: a woman who had travelled from Uganda to Abuja. On Monday, she and her husband were medically evacuated to Switzerland.

Nigeria now has no confirmed case, but WHO has been clear that this does not mean it is Ebola-free. A country can only be declared free after a 42-day countdown, and the government says the earliest possible date is 7 December.

Then: 2014

Nigeria’s 2014 outbreak began with Patrick Sawyer, a Liberian-American who fell ill on arrival in Lagos and died five days later. Rapid contact tracing and isolation contained it, and on 20 October 2014 WHO declared Nigeria Ebola-free, calling it a “spectacular success story.”

Now: what has improved

NCDC now runs a digital platform, SORMAS, for surveillance and contact tracing, and says about 12 public and private laboratories can test for Ebola. Hospitals have been told to isolate suspected cases without waiting for lab confirmation.

Contacts are monitored for 21 days, and each person placed in isolation or quarantine gets ₦100,000 a week so they can cooperate without losing income. The government also approved ₦10 billion in June for Ebola preparedness and other health threats.

Where the gaps are

The patient arrived on 3 October and fell ill on 7 October, but Ebola was confirmed only on 20 October. Virologist Oyewale Tomori says she was sick for 12 days and would have met many people in that time. Contacts rose from 44 to 53 to 54 within days, and NCDC says secondary contacts haven’t been counted yet.

Screening is another weak point. Experts say temperature checks can’t catch people who aren’t yet symptomatic, and an AFP reporter at the Benin land border saw generic forms with no mention of Ebola and no temperature checks. Tomori has asked whether the ₦10 billion was released and used in time, and Atiku has demanded an audit.

So, are we better prepared?

On tools, yes. On speed of detection, the jury may be out. The real test is the next six weeks: 21 days to monitor contacts, and 42 before the outbreak can be declared over. Tomori’s advice is preparedness, not panic.

Rumour check

• “Nigeria is Ebola-free.” False. WHO says it hasn’t declared this and asked for the headlines to be corrected.
• “Ebola has spread to Lagos.” The government says there is no case in Lagos. A suspected case in Rivers State tested negative.
• “Any fever means Ebola.” No. Many illnesses cause fever. Tell health workers your travel and contact history, and call NCDC’s toll-free line, 6232.
• “Where did she catch it?” Unresolved. NCDC says she travelled from Uganda via Addis Ababa, while Ugandan authorities have denied reports of an outbreak there. Treat travel-history claims as unconfirmed until NCDC and WHO publish findings.
• “The numbers keep changing.” They do, and that’s expected: NCDC says contact totals can change as teams get more information.

Nigeria has better tools than it did in 2014: digital contact tracing, more laboratories and a plan to support people in quarantine. What it still has to show is that it can spot the next case quickly. The patient has left the country, but the countdown has not ended.

Contacts must be watched for 21 days, and the outbreak can only be declared over after 42 days without a new case, with the government’s earliest date set at 7 December. Until then, the sensible response is the one virologist Oyewale Tomori urges: preparedness, not panic.