Nigeria's First Ebola Patient Went 13 Days Without a Test — and Officials Say the 44 Contacts Traced So Far Are 'Bound to Rise'

ABUJA

Thirteen days is a long time for Ebola to move through a capital city unrecognized. Nigeria's first Ebola patient in more than a decade — the Ugandan-born wife of a Swiss diplomat, who arrived in Abuja on October 3 after a two-week holiday in Uganda — fell ill three days after landing, sought treatment at several facilities where malaria was initially suspected, and was not tested for Ebola until October 19, Dr. Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention, told Reuters, citing the account given by Nigerian authorities. The case was confirmed on Tuesday. By then, the woman had been in contact with health workers, family members and friends across a major international travel hub, and officials had identified 44 contacts — a figure Kaseya and other Ebola experts told Reuters was bound to rise.

Kaseya was blunt about what the case does to the continental map. Nigeria had not been on the Africa CDC's list of at-risk countries, he told Reuters. It is now, and the list itself will have to be redrawn, with North and Southern Africa also potentially at risk. Nigeria is the fourth country reached by an outbreak first detected some 3,000 kilometres away in the Democratic Republic of Congo in May — after Congo, Uganda and Kenya — making it, in Reuters' account, the widest known spread of Ebola on the continent. The Africa CDC has described the Bundibugyo outbreak as the most geographically widespread Ebola outbreak in history, AFP reported.

A strain with no vaccine and no treatment

The Nigeria Centre for Disease Control and Prevention (NCDC) confirmed through three levels of molecular testing that the infection is the Bundibugyo strain, its public health laboratory director Olajumoke Babatunde said, in remarks carried by AFP. The World Health Organization also confirmed the strain. Bundibugyo is the detail that frightens specialists most: for this species of Ebola there is still neither an approved vaccine nor a specific treatment, the WHO noted. Care is supportive, outcomes depend heavily on how early a patient is found, and the outbreak strain has been killing at a rate fast approaching 50 percent in Congo, Kaseya warned on Tuesday, calling it an extremely serious threat.

The scale in Congo alone is historic. Reuters reported the outbreak has infected more than 9,500 people and killed more than 4,600 there, making it the second-largest Ebola epidemic on record. AFP, citing Congolese health authorities, put the toll at 4,381 deaths from more than 9,000 confirmed cases since mid-May — the deadliest Ebola epidemic in the country's own history. Kenya, in the east, has reported nine cases since October 6, all linked to a single cluster. The Nigerian patient has deteriorated into multi-organ failure, another official told AFP, and is in isolation receiving care.

The unanswered question: where was she infected?

Where the woman contracted the virus is now an open dispute between two governments, and the answer matters far beyond diplomacy. Ugandan authorities have said she had travelled to eastern Congo before transiting through Uganda, and Uganda — which recorded about 20 cases in May and June, mostly imported, before the WHO declared it Ebola-free in August — insists it has no confirmed active cases. Nigerian officials said they have not confirmed the Congo travel. Health Minister Muhammad Ali Pate told state television on Tuesday that the case had no confirmed travel to Congo, and that officials presume the infection was likely picked up in Uganda.

Marion Koopmans, a Dutch virologist who sits on the WHO's Ebola emergency committee, explained to Reuters why the distinction is critical. If the woman was infected in Congo, it reinforces worries about the efficacy of screening at borders and airports. If she was infected in Uganda, it raises the possibility of undetected transmission in a country declared Ebola-free two months ago. Either way, Koopmans said, it confirms the outbreak is far from over. Kaseya said the Africa CDC is seeking clarification from both countries and from the patient herself. The agency has called a high-level meeting of health ministers for next Wednesday to assess the outbreak, coordinate cross-border efforts and strengthen preparedness, AFP reported.

Nigeria's 2014 memory cuts both ways

Nigerian officials have pointed to 2014, when the country contained an imported Ebola case during the West African epidemic — an outbreak that ultimately killed more than 11,000 people across the region — within 21 days, with 19 infections and seven deaths, according to AFP. Former NCDC director Abdulsalami Nasidi told AFP that Nigeria controlled that outbreak because it took the right actions at the right time with strong command structures, and that success this time would depend on funding and commitment from the presidency. A presidential task force said Wednesday it was confident Nigeria would be able to dent this outbreak.

But the comparison has a sharp edge. Dr. Ayoade Alakija, a Nigerian physician and co-chair of a G7 committee for investment in global health, noted to Reuters that the first case to reach Nigeria in 2014 involved a patient who flew in from Liberia and was immediately hospitalized. This time, the patient spent nearly two weeks moving through a capital of millions while her illness was read as malaria — a very different scenario, Alakija said. Ebola spreads through direct contact with the bodily fluids of someone showing symptoms, which means every day of that window multiplied the tracing task now facing Nigerian teams: flight passengers, clinic staff at several facilities, household contacts and friends all have to be found and monitored through the virus's incubation period.

On the streets of Abuja on Wednesday morning, at least one resident voiced the confidence officials are counting on. Civil servant Anthony Ojogho, 42, told AFP he was shocked by the news but believed authorities could contain the spread, citing Nigeria's record against Ebola and coronavirus. Whether that confidence is justified will be decided in the next two weeks — by how completely the 44 known contacts, and the still-unknown ones from those 13 untested days, are found. Previously has followed this outbreak's spread east: the U.S. travel advisory raised as Kenya's cases grew. More on the Previously news front.