INTERVIEW: Cholera: Many people don’t know they have been infected – Scientist, Umeh

Following the recent outbreak of cholera in Nigeria and the upsurge of its confirmed cases and fatalities in many states of the federation, a pharmacist, Umeh Camillus Chibueze, MD/CEO of Camillus Pharmaceuticals, says most people are unaware they have been infected. He adds that the government is not doing enough to stem the tide. In this interview with DAILY POST, he x-rays the dangers of the epidemic, causes, symptoms, mode of transmission and the preventive measures to curb its spread. Excerpts:

What is the cholera epidemic all about?

Cholera is an epidemic or infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if left untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

The disease is most common in places with poor sanitation, crowding, war, and famine and where there are poor latrines and no proper mode of defecation like using a pit toilet. Contaminated hands, eating contaminated vegetables, fruits and drinking from well or tap water are major spreads of cholera.

So, in other words, cholera is an epidemic that spreads very fast and the common symptoms have to do with diarrhea and vomiting and the person that suffers cholera will have what we call dehydration; that is lack of water in the body.

Is cholera currently driven by climate change?

The answer is no. As a scientist, I don’t believe that climate change has to do with cholera. Cholera has no business with climate change whatsoever. Climate change could be as a result of solar radiations which are quite different. Climate change is caused as a result of depletion of ozone layers which is caused by deforestation; that is the reduction of the number of trees that absorbed carbon monoxide and because of the absorption of carbon monoxide, they now go to the ozone layer and cause depletion.

So if you watch, there is no connection whatsoever between cholera and climate change. Though both of them are environmental hazards, cholera is caused by microorganisms while climate change is caused by an inanimate object which is carbon monoxide. Major causes of climate change is carbon monoxide as a result of deforestation. So there is no relationship between the two.

What are the root causes of cholera?

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by faeces (excreta) from a person with the infection. However, common sources include: municipal water supplies, ice made from municipal water, foods and drinks sold by street vendors, vegetables grown with water containing human wastes and raw or undercooked fish and seafood caught in waters polluted with sewage.

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

What are the common symptoms of cholera?

Most people exposed to the cholera bacterium (Vibrio cholerae) don’t become ill and don’t know they’ve been infected. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

Most cases of cholera that cause symptoms cause mild or moderate diarrhea that’s often hard to tell apart from diarrhea caused by other problems. Others develop more-serious signs and symptoms of cholera, usually within a few days of infection.

Diarrhea is one of the common symptoms of cholera. Cholera-related diarrhea comes on suddenly and can quickly cause dangerous fluid loss. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed.

Nausea and vomiting are other symptoms of cholera. Vomiting occurs especially in the early stages of cholera and can last for hours.

Another symptom of cholera is dehydration. Dehydration can develop within hours after cholera symptoms start and range from mild to severe. A loss of 10% or more of body weight indicates severe dehydration.

Signs and symptoms of cholera dehydration include irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that’s slow to bounce back when pinched into a fold, little or no urinating, low blood pressure, and an irregular heartbeat.

Dehydration can lead to a rapid loss of minerals in your blood that maintain the balance of fluids in your body. This is called an electrolyte imbalance.

How long does cholera symptoms take to manifest?

If an individual is infected with vibrio cholerae; that is the organism that causes cholera or the bacterium that causes cholera, it stays within 12 hours to five days before the symptoms manifest themselves. That is the duration. And as a scientist, we call this an incubation period.

How can someone take care of a cholera patient without being infected?

First of all, you cannot share the same food with a person suffering from cholera. You have to put on gloves while taking care of someone infected with cholera because there may be a drop of faeces from the body of the infected person. So you trying to clean him up can contract it and you have to avoid sharing raw food with him.

It is not that you are trying to avoid him completely, but be aware of safeguarding yourself. So you have to protect yourself by wearing hand gloves and possibly, face masks because it is not air-borne. Avoid drinking from the same cup until the person gets well. So these are the precautions you as a caregiver have to observe while taking care of a cholera-infected person.

What are the preventive measures of cholera disease?

Cholera can be prevented. There are so many measures you will use to prevent cholera. One of the measures is you have to avoid tap water, well water, raw food or undercooked seafood. People contract cholera from food like fresh fish. These are the measures you can use to avoid a cholera outbreak.

Another measure to prevent cholera is drinking bottled water that is treated with chlorine, then eating prepackaged food. Foods that are well packaged, well sanitized by a standard restaurant. Then consider disinfecting your water. Boil it, disinfect your water for at least one minute before you eat any food. Wash your fruits and vegetables with clean water. If possible, add salt. If you are to use vegetables to cook, you have to wash it with clean water.

The reason for the outbreak of cholera, I will tell you that the government policy has not been effective. Primary healthcare has not been effective. The necessary awareness is not there. Because ignorance is a disease, most of the people that suffer cholera, if you watch very closely they don’t even know what the mode of transmission is. Some people today still defecate in an open place. They still drink well water and some people still eat raw food without washing it. Some people feed on raw vegetables. Some people today still use all kinds of contaminated or poorly prepared food as their meal.

So these are the reasons that the epidemic of cholera disease is quickly spreading. One factor is ignorance and the second one is government policy. The government is not doing much about it. In advanced countries like the US, there is what we call the Center for Disease Control, CDC. What these people do is to create much awareness. They provide people with the most basic awareness they need.

When there is an outbreak of cholera, there is always bottled water but in this part of the world, how many people can afford bottled water? How many Nigerians can prepare a very good dish for their breakfast, lunch and dinner? How many Nigerians can live in a decent environment that has a good toilet? Because we know that the mode of transmission of cholera is mainly through poorly prepared food, vegetables, raw fruits and drinking from well water.

In a nutshell, cholera can be prevented when you wash your hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren’t available, use an alcohol-based hand sanitizer.

Also, drink only safe water, including bottled water or water you’ve boiled or disinfected by yourself. Use bottled water even to brush your teeth.

Similarly, hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Don’t add ice to your drinks unless you made it yourself using safe water.

Eat food that’s completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it’s cooked in your presence and served hot.

Avoid raw or improperly cooked fish and seafood of any kind. Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can’t be peeled, such as grapes and berries.