With her feet in disinfected white clogs and her green medical suit already on, head nurse Josephine Funmilola Alabi helps two colleagues in their hazmat suits. Zipping up this all-covering ‘moon suit’ isn’t an easy job if you’re already wearing a pair of medical gloves. Then Alabi also exchanges her clogs for rubber boots and puts on the white overalls. Two pairs of gloves, a surgical cap, a mask and a face shield complete her ensemble; not a millimeter of skin is uncovered. Only then does she step through the door to the ‘red zone’ where the patients lie.
The nurse works in a special ward of the public hospital in Owo, southwest Nigeria, where patients are treated who have contracted a particularly deadly virus. But this is not about the coronavirus; Lassa virus is prevalent in southwestern Nigeria. This virus causes Lassa fever, an acute illness with fever and severe bleeding, similar to Ebola. This year there was a serious outbreak of this infectious disease in this part of Nigeria, resulting in at least 150 deaths. Four of those killed were medical personnel and there was an acute shortage of beds and manpower.
It is May 2022* and Alabi and her colleagues have been working overtime for several months. With its 38 beds, the center in Owo is the only treatment center for lassa fever in Ondo, a Nigerian state half the size of Belgium with about 3.5 million inhabitants. Alabi walks past the patients, asks how they are doing and checks an IV here and there. She doesn’t have much time, she explains. Officially, staff are not allowed to stay in the red zone for more than an hour to limit the risk of contamination. But during an outbreak, such as this year, that does not always work. “With an overcrowded ward, it takes two hours alone to distribute medicines. You can’t let the patients suffocate, so you take that risk.”
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Work material is disinfected and dried with chlorine throughout the day.
Image by:
Femke van Zeijl
Twice as deadly as corona
The lassa virus was discovered in 1969 in the northern Nigerian town of Lassa, about a thousand kilometers from Owo. Since then, it has been known as endemic in five countries in West Africa: Lassa fever always occurs to a greater or lesser extent in these areas. Nigeria, the country with the most inhabitants in Africa, registers the highest number of cases. Although 80 percent of people do not get sick from the virus, the death rate among those who do get sick is high: 15 to 40 percent of them do not survive the infection. Since 2020, ondo, the state in which Owo is located, has recorded at least twice as many deaths caused by the lassa virus as by corona. It cannot be ruled out that both diseases have caused more victims, because by no means all cases are registered.
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In addition, lassa fever is not always noticed. The symptoms of an infection vary widely, from headaches and muscle aches to a sore throat and nausea. At first glance, they are indistinguishable from the wide range of symptoms of malaria. A good test can, but the lab at this hospital in Owo is the only one in the state that performs the PCR tests for the lassa virus. The federal hospital may do that for free, but it’s a hassle to send a blood sample from a remote village to Owo. A doctor will therefore first want to rule out other diseases. Due to the similarities with malaria and the few laboratories, lassa fever is often only discovered at a late stage.
All in all, the lassa virus in West Africa is a bigger problem than corona. The African Center of Excellence for Genomics of Infectious Diseases (ACEGID), the Nigerian lab that made the first rapid test for Ebola, is currently investigating the virus. ACEGID director and microbiologist Christian Happi states that Africa itself should take the lead when it comes to fighting Lassa fever. “This continent has the most experience with infectious diseases. We got through the covid pandemic better than Europe,” said Happi, referring to the corona death rates in West Africa that are much lower than in Europe.
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Chief nurse Josephine Funmilola Alabi: ‘Because of corona, nobody talks about lassa anymore.’ 
Image by:
Femke van Zeijl
‘Competition’ with corona
The lassa virus is mainly spread by rodents, such as rats and many nipple mice. This rodent normally lives in nature, but migrates to humans in the dry season in search of food. Therefore, lassa fever always peaks between the rainy seasons in Nigeria, from November to April. Since the corona pandemic, doctors have to ‘compete’ in that period with attention to corona.
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Alabi explains that raising funds to fight other diseases is becoming increasingly difficult due to all the attention for corona. The bottled water that allowed staff to freshen up after hours in sweaty suits has already been cut, and the delivery of personal protective equipment is slowing down. Without these resources, the personnel is at risk to their lives. Alabi is afraid that eventually the free treatment will also be endangered. Most Nigerians cannot afford the thousand euros that an admission costs per patient.
The region does not want unilateral aid from wealthy countries, says Happi: “The world must cooperate with Africa and show more solidarity than before. If we map the DNA of a virus variant and share that data, how is it possible that others keep a resulting vaccine for themselves? That happened, for example, with corona. Countries think they are protecting themselves by acting unilaterally, but that is a fatal mistake. If you allow a dangerous virus to flourish anywhere in the world, that’s a risk for all of us.”
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Material that has been in the ‘red zone’ is incinerated. 
Image by:
Femke van Zeijl
Intensive care in the hallway
In the corridor of the center in Owo are old-fashioned hospital beds with bars. The stands next to it hang like a Christmas tree full of IV bags. Here lie the seriously ill; they move slowly and hardly look up when the head nurse walks across the ward. Alabi explains why these patients are located here, and not in a room with more privacy: “We don’t have intensive care, and these people are too weak to call us from a room. Here in the hallway we can hear them better.” Posters with hygiene and waste disposal regulations hang on the wall. Alabi: “Material that goes into the red zone doesn’t come out anymore. That is all burned.”
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The only drug that seems to have success against lassa fever has never been sufficiently tested
In the department, only Victory Ovuoreoyen (48) is strong enough for a chat. The food merchant was brought in deadly ill four days ago. He hadn’t been himself for some time, he says, he had a headache, was shivering and short of breath. At first Ovuoreoyen was treated for malaria. When there was no improvement after a week, his blood was sent to the lab in Owo and the verdict came. “When I heard it was lassa, I thought: this is the end of the story,” he says in a soft tone that betrays his shortness of breath.
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The ‘red zone’, or the improvised intensive care unit in the corridor. 
Image by:
Femke van Zeijl
But his story is not over yet. He received a blood transfusion and is now being treated with ribavirin. This drug is the only drug that currently seems to have some success against lassa fever, if you catch it in time. The effect of ribavirin, which is mainly used to fight hepatitis C, against lassa fever has never been sufficiently clinically tested. Doctors prescribe it because there is little else available.
In any case, Ovuoreoyen is feeling much better and is hopeful that he will recover. Five days later he can indeed go home, but in the coming months he still has to come back regularly for check-ups: lassa fever is a disease with a tail. For example, the lassa virus was found in the semen of some men two years later – couples are therefore advised to use a condom – and patients can continue to suffer from bleeding for a long time.
In the Lassa ward, head nurse Alabi steps from the red zone into the undressing station, where plastic barrels are placed to disinfect footwear and face shields that are reused. Across the road, diagonally opposite the lassa clinic, is the corona ward, which was built two years ago. All the beds there are empty because there have been no corona infections for weeks, says Alabi. “But throughout the corona pandemic, there were patients with lassa fever here. Because of corona, nobody talks about lassa anymore. While the next deadly Lassa outbreak is only a matter of time.”
* A longer version of this article appeared in OneWorld Magazine in the summer of 2022. It will be published as a diptych on OneWorld.nl in October.
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