When Liberian-American Patrick Sawyer collapsed at Lagos airport, he brought Ebola into a potentially ideal place for the deadly virus to spread – a vast, dirty, overcrowded city where tracing carriers and their contacts is a major problem.
Sawyer’s arrival last month from Liberia – which, along with Sierra Leone and Guinea, lies at the centre of an outbreak that has killed more than 1,000 people – caught authorities in the Nigerian commercial capital unprepared. By the time they realised where he was from or what illness he had, Sawyer had had contact with dozens of people. Lagos has now had 10 cases of Ebola, an illness spread by contact with the fluids of an infected person.
As Africa’s biggest economy, Nigeria has a better health system than the other West African countries which are among the poorest in the world, and Ebola doesn’t spread through the air or water supply as with many other epidemic diseases.
See the Ebola outbreak mapped
See the Ebola outbreak mapped
1/7 25 March 2014
This outbreak of the Ebola virus first emerged in the Guéckédou region of Guinea, at a crossroads with both Liberia and Sierra Leone
2/7 31 March
On 31 March the WHO confirmed the outbreak was now international, spreading first into Liberia's northern-most Lofa region
3/7 27 May
The virus spread to Sierra Leone at the end of May - just as agencies were hoping the worst was over
4/7 27 July
In Sierra Leone the virus boomed, and then it spread to Nigeria when the Liberian diplomat Patrick Sawyer flew from Monrovia to Lagos
5/7 9 August
The Nigeria cases sparked fears around the world, and there have now been deaths in Spain and Saudi Arabia involving people who had travelled to West Africa. The numbers of cases continue to rise
6/7 17-20 September
In mid-September, Senegal confirmed its first case linked to the Ebola outbreak, a development the WHO described as a top priority emergency. Numbers of cases continued to grow exponentially in Guinea, Sierra Leone and Liberia, as experts warned they could number one million by January if not contained
7/7 8 October
Two cases of Ebola have now been reported in the US and Europe - the first times the virus has been contracted among health workers outside Africa
But health experts – who are trying to overcome superstition and public ignorance about Ebola as well as the disease itself – say there is now only a short opportunity to find and lock down other infected people before the outbreak in the city of 21 million gets out of hand.
“Lagos is big, it’s crowded. It would make in many ways a perfect environment for the virus to spread,” said Nigerian epidemiologist Chikwe Ihekweazu, who runs website Nigeria Health Watch and worked on Ebola in South Sudan a decade ago. “In the heart of Lagos, people live on top of each other, sharing bedrooms and toilets. In densely populated communities infection control becomes almost impossible to do well.”
When Sawyer landed at Murtala Mohammed airport on July 20, none of the bystanders, airport staff or health workers who rushed to help him understood the danger they were in.
No one had the full body protection of mask, suit and gloves that are essential to prevent contagion, so his ill advised journey gave the world’s worst Ebola outbreak a foothold in Africa’s most populous nation.
Sawyer died five days later, followed by one of the nurses who first treated him. Eight others are confirmed infected and receiving treatment.
“Nobody knew the status of this person, no one knew the illness that he had, no one knew he was coming,” Lagos state health commissioner Jide Idris said.