LAGOS, Nigeria – Nigerian authorities rushed to obtain isolation tents Wednesday in anticipation of more Ebola infections as they disclosed five more cases of the virus and a death in Africa's most populous nation, where officials were racing to keep the gruesome disease confined to a small group of patients.
The five new Nigerian cases were all in Lagos, a megacity of 21 million people in a country already beset with poor health care infrastructure and widespread corruption, and all five were reported to have had direct contact with one infected man.
Meanwhile, the World Health Organization began a meeting to decide whether the crisis, the worst recorded outbreak of its kind, amounts to an international public health emergency. At least 932 deaths in four countries have been blamed on the illness, with 1,711 reported cases.
In recent years, the WHO has declared an emergency only twice, for swine flu in 2009 and polio in May. The declaration would probably come with recommendations on travel and trade restrictions and wider Ebola screening. It also would be an acknowledgment that the situation is critical and could worsen without a fast global response.
The group did not immediately confirm the new cases reported in Nigeria. And Nigerian authorities did not release any details on the latest infections, except to say they all had come into direct contact with the sick man who arrived by plane in Lagos late last month.
With the death toll mounting in the region, Liberia's president announced a state of emergency late Wednesday and said it may result in the suspension of some citizens' rights. She lamented that fear and panic had kept many family members from sending sick relatives to isolation centers.
"Ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease," President Ellen Johnson Sirleaf said.
And in Sierra Leone, where enforcing quarantines of sick patients also has been met with resistance, some 750 soldiers deployed to the Ebola-ravaged east as part of "Operation Octopus."
Ebola, which causes some victims to bleed from the eyes, mouth and ears, can only be transmitted through direct contact with the bodily fluids of someone who is sick – blood, semen, saliva, urine, feces or sweat.
Millions in Lagos live in cramped conditions without access to flushable toilets. Signs posted across the city warn people not to urinate in public.
Kenneth Akihomi, a 47-year-old worker installing fiber-optic cable, said he was carefully washing his hands to avoid infection. But he said most people were relying on faith to stay healthy.
"They're not panicking. They are godly people," he said. "They believe they can pray, and maybe very soon there will be cure."
The revelation of more infections also came amid a public-sector doctors' strike in Nigeria that began in early July. So far, health workers monitoring the latest Ebola patients are still on the job.
Nigeria is the fourth West African country to be hit by the Ebola outbreak since it first emerged in March in the remote tropical forests of Guinea. The disease then spread to neighboring Sierra Leona and Liberia before reaching Nigeria, where it surfaced shortly before the government drew criticism for its response to the abduction of more than 200 schoolgirls by Islamic militants back in April. The girls are still missing.
Nigerian authorities said Tuesday that doctors did not suspect Patrick Sawyer was suffering from Ebola when the 40-year-old Liberian-American arrived by plane late last month in Lagos, where the streets are a bewildering mix of wealth and abject poverty, awash in luxury SUVs and decrepit buses.
Sawyer, who worked for the Liberian government in Monrovia and had a wife and three young daughters in Minnesota, was on a business flight to Nigeria when he fell ill. Officials say a nurse who treated him has died and five others are sick with Ebola, including a doctor involved in his care.
West African countries pledged at a meeting in July to step up their surveillance at airports and borders following the start of the outbreak. But the early symptoms of Ebola – fever, muscle aches and vomiting – are similar to much more common tropical diseases such as malaria.
The specter of the virus spreading through Nigeria is particularly alarming, said Stephen Morse, an epidemiology professor at Columbia University's Mailman School of Public Health.
"It makes you nervous when so many people are potentially at risk," he said.
Authorities in Liberia said Sawyer's sister had recently died of Ebola, though Sawyer said he had not had close contact with her while she was ill.
In announcing Sawyer's death, Health Minister Onyebuchi Chukwu maintained late last month that Nigerian officials had been vigilant in isolating him.
"It was right there [at the airport] that the problem was noticed because we have maintained our surveillance," he told reporters. "And immediately, he went into the custody of the port health services of the federal ministry of health so there was no time for him to mingle in Lagos. He has not been in touch with any other person again since we took him from the airport."
Chukwu's comments were at odds with remarks made Tuesday by the Lagos state health commissioner, who said doctors did not suspect Ebola immediately and identified Sawyer as a possible case only after he had been hospitalized for about a day.
Sawyer, who had a fever and was vomiting on the plane, was coming from the infected country of Liberia but had a layover in Togo. As a result, officials may not have initially known his original point of departure, and it was unclear whether he was traveling on a Liberian or American passport.
Experts say people infected with Ebola can spread the disease only after they show symptoms. Since the incubation period can last up to three weeks, some of the Nigerians who treated Sawyer are only now showing signs of illness.
The national health minister on Wednesday said special tents would be used to establish isolation wards in all of Nigeria's states. Authorities were setting up an emergency center in Lagos to deal with Ebola and expected the facility to be "fully functional" by Thursday, he said.
Also Wednesday, the Spanish Defense Ministry said a medically equipped plane was ready to fly to Liberia to bring back a Spanish missionary priest who has Ebola. At the same time, Saudi officials reported a suspected Ebola death, underscoring the risk of the disease spreading by air travel even as many airlines curtail their flights to the most infected cities.