The moment Victory Ovuoreoyen heard he had Lassa virus, he thought it was the end. The tradesman could barely walk and feared for his life when admitted to the Federal Medical Centre in the city of Owo in southwestern Nigeria. He ran a fever, was vomiting and had severe diarrhoea.
But after four days in an isolation ward, the emaciated patient can now sit upright on his hospital cot, one of the few patients in the infirmary strong enough to speak. “Before I fell ill, I could not count my bones like this. I lost so much weight,” he says, pointing at his clavicles clearly showing under his loose mustard-coloured shirt.
Doctors have assured the 48-year-old man that he will recover from the illness, an acute haemorrhagic disease similar to Ebola. He is lucky. Although 80 percent of those infected do not get very ill from the virus and most cases go undiagnosed, the death rate among those who end up in hospital is 15 percent, according to the World Health Organization. With an incubation period of between two and 21 days, severe symptoms can start showing a week into the illness. By then it could be too late.
Lassa fever lowers the platelet count in the blood and its ability to clot, causing internal bleeding. Fatal organ failure can follow within days.
Early symptoms include head and muscle aches, sore throat, nausea and fever. Initially, they are indistinguishable from the symptoms of malaria, a common disease in the region. The laboratory of this hospital in Owo is the only one in the state that performs the Lassa diagnostic blood tests and the results are only available after two days. This combination of factors often leads to Lassa being discovered at a late stage, which makes it harder to treat.
Owo, an agricultural market centre 300 kilometres (186 miles) from the Nigerian capital Abuja, is the epicentre of the Lassa outbreak that began early this year, causing more than 160 deaths. At its height in March, the 38 beds in the isolation ward did not suffice and 10 more cots were added for suspected cases. In this part of Nigeria, people fear the Lassa virus far more than the coronavirus. With good reason: Ondo, the state where Owo is located, has since 2020 recorded 171 deaths caused by Lassa, versus 85 from COVID-19, according to the Infection Control and Research Centre at the hospital.
‘It is so contagious’
Head nurse Josephine Funmilola Alabi checks the intravenous drip that administers Ovuoreoyen’s antiviral medication and treats dehydration, an issue severely ill Lassa fever patients must battle. Alabi is dressed in a white hazmat suit, surgical cap, face mask and face shield. Only dressed like this may she enter the “red zone”, as the isolation ward for highly contagious patients is called. She also wears disinfected rubber boots and two pairs of surgical gloves. Not a millimetre of her skin is left uncovered. “We take this virus very seriously. It is so contagious that we are only allowed to enter the ward with full PPE,” Alabi says, referring to the personal protective equipment that medical personnel caring for patients with highly infectious diseases wear. Four of the Lassa deaths in Nigeria this year were of medical workers.
Despite its widespread presence in West Africa, the disease remains little known in much of the world. The virus was discovered in 1969 in the northern Nigerian town of Lassa, about 1,000km (621 miles) from Owo. Since then, it has become endemic in at least five countries in West Africa. Nigeria, Africa’s most populous nation, registers the highest number of cases, up to 1,000 a year. This year, in January alone, Nigeria recorded 211 confirmed cases, of which 40 patients died.
Lassa fever infects an estimated 100,000 to 300,000 Africans each year, of which thousands die, according to the Africa Centres for Disease Control and Prevention.
Infected people can infect others through bodily fluids. The fever often causes miscarriages and can be passed from mothers to babies. It can remain in breast milk for up to six months. Like other viruses causing haemorrhagic fevers that have no cure and are easy to reproduce, scientists have warned that the Lassa virus could be used as a biological weapon.
‘Diseases don’t have boundaries’
The fever tends to strike in impoverished rural areas and food contaminated with rat droppings or urine is often the source of infection. Roasted game, known locally as bushmeat, can also be tainted if the slaughtered animal has been in contact with the rodents. The rats often enter people’s houses in search of something to eat when the rains stop. That is why Lassa fever typically peaks in Nigeria’s dry season, from November to April, although cases persist all year round.
It is not spreading over the world as rapidly as COVID-19 did, says clinical microbiologist Adebola Olayinka. But she warns that this may change. She is an expert in infectious hazardous diseases and coordinates Lassa fever research for the Nigeria Centre for Disease Control. “Look at the story of Ebola,” she says. “This existed in the Democratic Republic of Congo for decades, but in 2014 very quickly reached West Africa and then England and the US.”
No proven drugs or vaccines protect against Lassa fever, Olayinka says. Currently, the only pharmaceutical used against Lassa fever is ribavirin, an antiviral drug commonly used to treat Hepatitis C. But its effectiveness against the Lassa virus has not been thoroughly researched, and pre-clinical studies and expensive clinical trials are needed to prove the efficacy of the drug. She believes the lack of research into Lassa is because the virus rarely appears in the West.
“Look at the speed with which the COVID vaccine has been developed,” she says. “But if an infectious disease doesn’t affect the wealthy, it won’t get the same amount of attention.” A year after the outbreak of the pandemic in 2020 the Access to Medicine Index compiled an inventory of the research and development efforts of the 20 largest pharmaceutical companies. It counted 63 projects concerning coronaviruses, five covering Ebola and zero for haemorrhagic viruses spread by rodents like Lassa, mostly found in Africa and Latin America.
Yet the West is not invulnerable to Lassa. Earlier this year, a couple in England was diagnosed with the disease. The husband contracted it during a visit to Mali and then infected his pregnant wife. Their premature baby died of the virus in a Bedfordshire hospital. “The West needs to realise that a disease anywhere could be a disease everywhere,” warns Olayinka. “Diseases don’t have boundaries.”
‘They caught it on time’
In Owo, head nurse Alabi continues her rounds. On this particular day in April, 20 of the 38 beds are filled. This is the only treatment centre for Lassa fever in Ondo, a state half the size of Belgium with about 3.5 million inhabitants. A month earlier the ward was filled to the brim. And a couple of years ago so many people were infected that tents for patients were put up on the open grounds next to the bungalow where the Lassa ward is located.
Alabi asks patients how they are doing and checks an intravenous (IV) drip here and there. Apart from anti-viral drugs, patients also are treated with vitamins, antibiotics for additional bacteria infections and malaria medications if they also test positive for that disease. The staff is not supposed to stay in the “red” isolation zone for more than an hour at a stretch, to limit the risk of infection. But during an outbreak such as this year’s, doing rounds in an overcrowded ward can take two hours. “It is a risk you take, for the sake of the patients,” she says matter-of-factly.
Hospital beds with chipped enamel bars line the corridors of the “red zone”. IV bags hang next to the cots. Alabi explains that the patients lie in the hallway so that the staff can hear them when they weakly call for help. Disinfecting the medical staff’s protective boots and face shields occurs around the clock. Used gear goes into large vats of chlorinated water and is then put on wooden stands to dry in the tropical sun.
Around the corner, under the marquee covering the path to the clinic’s entrance, Dr Sampson Omagbemi Owhin holds a consultation with a patient, Olaide Akinyola. Seated on plastic chairs in the open air they discuss her recovery.
Akinyola, a 38-year-old primary school teacher, returned to the Lassa ward this morning for a check-up. She ended up in the treatment centre a month and a half ago after feeling ill for a couple of days. She originally thought the bleeding was from a heavy menstrual flow, but when she felt too dizzy to stand upright, she got tested for Lassa. Within hours of receiving a positive result, she was admitted to the clinic.
Akinyola was lucky, says her doctor: “They caught it on time”. She received a blood transfusion and was treated with ribavirin, which in this case appeared to have helped.
Information is a weapon
Being a teacher, Akinyola has easy access to information about the virus, she says. “That’s why I was not too scared when I was admitted here,” she explains. “I knew my chances were good since they caught the virus early.”
Information is an important weapon in the fight against Lassa fever, her doctor affirms. Even after a patient has been discharged from the ward, they can continue to suffer from bleeding for a long time. Haematologist Ohwin explains that, aside from persistent blood disorders, the virus has been found in semen two years later – a reason why recovered male patients are advised to use condoms during sex.
Later that day, 42-year-old Kayode Omolayo shuffles out of the patient exit of the Lassa clinic and heads towards the visitors’ area, a concrete floor covered by an orange aluminium roof shelter. The platform underneath is bisected by a ditch, separating the ill from the healthy. A metal sign in the grass directs visitors to the fenced-off area where, from a safe distance, they can greet the sick who have recovered enough to get out of bed.
After 10 days in the Lassa department, Omolayo is keenly aware of the need for hygiene at home. “The first thing I’ll do is clean everything from top to bottom and check for rat droppings,” she says.
At the Lassa ward, head nurse Alabi steps out of the red zone into the station where protective gear comes off and plastic barrels are placed to disinfect footwear and face shields that will be reused. As she carefully peels off the layers, the 50-year-old shares her concerns about the future.
According to the nurse, NGOs supporting the fight against diseases like Lassa fever are finding it increasingly difficult to raise funds. That means the bottled water for the staff to rehydrate after hours in sweaty moon suits has been cut. The delivery of personal protective equipment is slowing down. Most Nigerians cannot afford the $1,000 fee for treatment, and she fears that the medical centre might run out of money to offer the current free care.
In the meantime, the staff is gearing itself up for another wave. The smile on Alabi’s face disappears as she squints through her rectangular glasses and states solemnly: “The next deadly Lassa outbreak is only a matter of time.”
By Femke van Zeijl
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