More than a week after the first Ebola case was confirmed in Nigeria, pressing questions about how the virus arrived in Africa’s most populous nation remain unanswered.
The first case was a 42-year-old Ugandan woman living in Abuja, Nigeria’s capital, with her husband, a Swiss diplomat. She tested positive for the virus last week and was evacuated to Switzerland on Monday in stable condition.
It remains unclear where and how the patient was infected with Ebola. But she was in the Nigerian capital for 17 days before she tested positive for the virus.
According to Nigerian health officials, the patient had traveled to Uganda, where she stayed for two and a half weeks. She came back to Nigeria on Oct. 3 and reported to a health clinic on Oct. 6 with malaria-like symptoms. She went to a different clinic on Oct. 11 and was admitted for additional treatment. But it wasn’t until Oct. 20 at the second clinic that she was tested for Ebola. That test was positive, and the patient was isolated.
A team of scientists from the Africa Centers for Disease Control and Prevention arrived in Abuja last week. A key part of their investigation is to determine how far and how fast the virus might have traveled into and out of the city during that 17-day window, with daily flights to Europe, the United States and other parts of Africa.
“This is one of the most concerning aspects of the investigation,” said Dr. Jean Kaseya, director general of the Africa C.D.C.
Health officials are most concerned about when the patient started showing symptoms, because the virus is not thought to be contagious otherwise.
More than 50 people who may have come into direct contact with the patient have already been identified and isolated, said Dr. Jide Idris, head of the Nigeria Centre for Disease Control and Prevention.
Dr. Idris said that number may grow as more people are identified. So far, none of the contacts have tested positive, he said, but they will need to isolate for “at least 21 days.”
Until this month, the current Ebola outbreak, caused by the rare Bundibugyo virus, was largely confined to the Democratic Republic of Congo, where the World Health Organization declared a global health emergency in May.
Since then, cases have been reported in Uganda, Kenya and Nigeria. At least eight provinces in Congo have been affected. More than 10,000 cases have been reported, with up to 4,887 killed, as of Tuesday.
Uganda has reported no active Ebola cases since August, when it reopened its border with Congo. But that information is now in question, as investigators cast a wide net that includes the possibility the Nigerian patient contracted the virus in Uganda.
Chris Baryomunsi, Uganda’s health minister, announced on Sunday that citizens traveling from Congo would now face a 21-day mandatory quarantine. The Ugandan authorities have rejected the idea that the patient was infected in the country.
Kenya has confirmed nine Ebola cases and two deaths since its first case was reported in early October. In that case, the patient was a Congolese man who traveled to Kenya and was isolated upon arrival. The Nigerian patient did not fully isolate until she tested positive 17 days after her return from Uganda.
Both initial Ebola cases in Nigeria and Kenya came through Uganda’s Entebbe International Airport on Oct. 3. Both patients traveled through that airport on that day, though they departed from separate gates and took separate flights that were about 40 minutes apart, according to Reuters.
“We must establish whether the patients were at the airport at overlapping times, whether they had a plausible exposure interaction, whether either was symptomatic and whether there could have been an intermediary case,” said Dr. Kaseya.
In the meantime, Nigeria has not reported any additional cases.
“We can’t just have one case. Where is everybody else?” said Dr. Ayoade Alakija, a health expert with the Group of 7 Investment Initiative on Global Health. “There was far greater exposure to the general public in Nigeria than in Kenya because it was not known for two weeks.”
Yet life in Nigeria continues as normal. No restrictions have been placed on public gatherings, including campaign rallies for the upcoming presidential election in January.
Many Nigerians have expressed skepticism about Ebola, with some describing it as a government hoax meant to help those in power. Fatima Ahmad, 32, who runs a food business at the Garki Market in Abuja, said she had heard about the Ebola case in the city, but had not taken it seriously.
She believes Ebola is being used to help President Ahmed Tinubu win a second term in office, she said. “Honestly, if you hadn’t asked me about it today, I would have completely forgotten about it,” she said.
“I don’t know how, but that is what I believe because I don’t trust Nigerian politicians.”
Ismail Auwal contributed reporting from Kano, Nigeria.
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