Authorities on Monday confirmed a second case of Ebola in Nigeria, Africa's most populous country — an alarming setback as officials across West Africa battle to stop the spread of an outbreak that has killed more than 800 people.
In Nigeria, Health Minister Onyebuchi Chukwu said that test samples are pending for three other people who showed symptoms of Ebola and that authorities are trying to trace and quarantine others. The confirmed second case in Nigeria is a doctor who helped treat Patrick Sawyer, a Liberian-American man who died of Ebola on July 25, days after arriving in Nigeria from Liberia.
"Three others who participated in that treatment who are currently symptomatic have had their samples taken, and hopefully by the end of today we should have the results of their own test," Chukwu said.
Nigeria is the fourth country to report Ebola cases. At least 887 have died in Guinea, Sierra Leone and Liberia, the World Health Organization reported Monday.
It can take up to 21 days after exposure to the virus for symptoms to appear. They include fever, sore throat, muscle pains and headaches. Often nausea, vomiting and diarrhea follow, along with severe internal and external bleeding in advanced stages of the disease.
The fatality rate in the current outbreak has been about 60 percent. In past outbreaks the fatality rate has been up to 90 percent of those infected.
The emergence of a second case in Lagos raises serious concerns about infection control practices in Nigeria. The latest report is particularly worrisome because Lagos is home to some 21 million people — the largest city in Africa.
Doctors and other health workers on the front lines of the Ebola crisis have been among the most vulnerable to infection because they are in direct physical contact with patients. The disease is not airborne and is transmitted only through contact with bodily fluids such as saliva, blood, vomit, sweat or feces.
Sawyer, who was traveling to Nigeria on business, became ill while aboard a flight, and Nigerian authorities immediately took him into isolation after he arrived in Lagos. They did not quarantine his fellow passengers and have insisted that the risk of additional cases was minimal.
Nigerian authorities said that 70 people are under surveillance and that they hoped to have eight people in quarantine by the end of Monday in an isolation ward in Lagos.
Health officials rely on contact tracing — locating anyone who may have been exposed and then anyone who may have come into contact with that person. That may prove impossible, given that Sawyer's fellow passengers journeyed on to dozens of other cities and the health workers who treated them may have exposed their family members.
Also Monday, health authorities in Liberia, after communities opposed having the bodies of Ebola victims buried nearby, ordered that all those who die from the disease be cremated. Some victims’ bodies were left to lie in the streets for days. Over the weekend, health authorities in the country encountered resistance while trying to bury 22 bodies in Johnsonville, outside the capital, Monrovia. Military police helped restore order.
Lewis Brown, Liberia's information minister, made the announcement about cremations after an Aug. 3 emergency meeting, according to The Telegraph.
“From now on, victims will be cremated,” he said.
The U.S. Centers for Disease Control and Prevention (CDC) said in a statement on Monday that the handling of infected corpses should be minimized. "The remains should not be embalmed. Remains should be wrapped in sealed leak-proof material and cremated or buried promptly in a sealed casket," it read.
The Liberian government says that high levels of mistrust and resistance from some communities justified strict new measures designed to control the outbreak.
Liberians have been advised to call an emergency number to ask for the removal of the dead, but many have complained that overstretched health workers have been leaving bodies in the streets and in homes for days. Soldiers have been keeping streets clear of corpses. Liberians blocked major roads across the capital on Monday in protest the bodies’ slow removal.
Roadblocks sprang up across major routes over the weekend and have appeared in several Monrovia neighborhoods. Deputy Health Minister Tolbert Nyensuah said the government was doing its best to collect bodies as quickly as possible.
"We buried 30 people during the weekend in a mass grave outside the city. The government has purchased land from a private citizen, and that land will be used to bury bodies," he said.
Liberian President Ellen Johnson Sirleaf announced last week the closure of schools and placement of nonessential government workers on 30-day leave in a bid to halt the epidemic.
Compounding the problem is the withdrawal of some international staff after the infection of two U.S. health workers there. Liberia's overcrowded and understaffed Elwa Hospital had to turn away Ebola cases this week.
Kent Brantly, an American doctor who was infected in Liberia was evacuated to the United States over the weekend, is improving at Emory University Hospital in Atlanta, the CDC said on Sunday. A second American who was infected, Nancy Writebol, is to be flown to the U.S. on Tuesday for treatment. Both worked with the missionary organization Samaritan's Purse.