Ebola is now exposing how hard it is to contain an outbreak, particularly in poor countries. Stopping Ebola should, in theory, be straightforward. There is no cure, but there are ways to treat victims that will maximise their chance of survival and help prevent transmission. Patients should be isolated and kept hydrated, their blood pressure monitored and secondary infections treated. Those who have come into contact with the infected should be watched to see if symptoms develop. If none emerge within 21 days, the person can be deemed virus-free.
But all this is labour-intensive. “You still have to have a cadre of people who at the end of the day are able to go out there,” explains Ian Lipkin of Columbia University. That depends on strong health systems or substantial international help. In this case, there was neither.
The outbreak began in three of the world’s poorest countries. Guinea spends $62 per person on health each year, compared with $3,364 in Britain. Sierra Leone has two doctors per 100,000 people, compared with 245 in America (see chart). Such health workers as are available in the countries affected by Ebola are under severe strain. About 150 have been infected and 80 have died, the WHO said on August 8th. Médecins Sans Frontières, a non-profit organisation that has 680 health workers in the region, now says that its staff “simply cannot do more”.
1. Karen B. wrote:
Just read another good Ebola article at Foreign Policy.
It brought home how the entire medical systems in Liberia and Sierra Leone are collapsing because of Ebola. Women dying in childbirth, people dying from normally treatable injuries from auto accidents, etc., because the entire medical system is overwhelmed treating Ebola - doctors & nurses fleeing hospitals, or patients staying away out of fear. Once you start adding these types of casualties (plus those dying of malaria, or Lassa fever who also are not getting needed treatment), the death toll is much much higher than the “mere” 1100 - 1200 confirmed “Ebola deaths.”
Also, yesterday or the day before, I read a good piece at CNN - a first hand account of someone from the CDC team working in Lagos Nigeria, which gives a good glimpse into the extremely important work of contact tracing necessary to control the spread of the disease.
Here’s an excerpt.
Inside the Ebola Outbreak in Lagos
A great deal has been accomplished in a short time. A Nigerian emergency operations center is up and running now, and we are about to move Ebola patients into a newly, remodeled treatment facility.
August 15, 6:59 pm | [comment link]
There are 60 folks on the contact tracing team, which has been tracking more than 200 people thought to have come in contact with the virus. These teams visit the contacts daily to take their temperatures and check to see if they have developed any symptoms. On Tuesday, 147 of the 152 contacts were visited and assessed. When difficulties arise locating contacts, additional teams are employed and efforts ramped up to conduct the tracing.
The Ebola response team in Nigeria recently saw 30 people finish the 21-day risk period—the longest time period during which Ebola symptoms have been known to be present. These 30 people were able to leave the contact tracing list, which is a hopeful sign.
There is a great deal of fear in Lagos as many worry about a virus of which they know precious little. CDC communicators like myself work to provide accurate information to the public and health care workers. Health care workers are critical as they are on the front lines of this battle; WHO says 10% of the deaths during this epidemic have been health care workers.
2. Karen B. wrote:
Here’s the latest Ebola update from WHO:
I don’t know how well I can reproduce the table here, but it is interesting:
The five columns of numbers are
New / Confirmed / Probable / Suspect / Totals
*New means new cases or deaths in the past 48 hours.
Cases 9 / 376 / 133 / 10 / 519
Deaths 3 / 245 / 133 / 2 / 380
Cases 116 / 190 / 423 / 173 / 786
Deaths 58 / 154 / 190 / 69 / 413
Cases 0 / 11 / 0 / 1 / 12
Deaths 1 / 4 / 0 / 0 / 4
Cases 27 / 733 / 38 / 39 / 810
Deaths 14 / 309 / 34 / 5 / 348
Cases 152 / 1310 / 594 / 223 / 2127
Deaths 76 / 712 / 357 / 76 / 1145
The situation in Liberia is alarming with 116 new cases in the past 48 hours (nearly 80% of all new cases).
It is a HUGE HUGE HUGE relief to see the Nigeria numbers remaining stable. From what I understand, there have been no cases at all among any of the secondary contacts, the only Ebola cases are those who had direct contact with Patrick Sawyer, the Liberian American who flew into Lagos while he was severely ill with Ebola. Most of the primary contacts are nearly out of their 21 day quarantine, and none of the 170 - 190 secondary contacts being monitored have shown signs of the disease if what I’ve read is correct.
If there are no new cases in Nigeria within the next few days, that will be wonderful news, meaning Nigeria has managed to contain the spread of the disease following the initial exposure. Of course others could still bring in the disease into the country, but Ebola on the loose in Lagos was a nightmare scenario, and it will make such a difference if Nigeria can show the disease CAN be contained. Keep praying for all who are working hard to make that happen!!
August 15, 7:15 pm | [comment link]
3. Karen B. wrote:
I hate to monopolize this comment thread, but since I’m following this situation so closely, being not so far away from where it’s happening, and being trained in international public health and epidemiology, I thought I’d post one more excerpt. It’s from the Foreign policy blog entry I linked in my first comment, and it’s basically a plea for help from the NGO Doctors without Borders (medecins sans frontieres = MSF) who have been on the frontlines of treating this disease. They need our prayers and support. (No MSF is not specifically a faith-based NGO, but a good proportion of their workers are believers. They are one of the best NGOs in the world at handling these kinds of emergencies… I have great respect and admiration for them.)
Let’s start with simple, on-the-ground manpower. All three countries desperately need doctors, nurses, medical technicians, ambulance drivers, Red Cross volunteers, epidemiologists, and health logistics experts. They do not need novice do-gooders from the wealthy world, but people experienced in working under the stifling conditions of tropical heat, the desperation of supplies deficits, and the fearfulness of epidemics. The lion’s share of care to date has been provided by one group—Médecins Sans Frontières—which is pleading for others to relieve their exhausted ranks—600 people who have been fighting for months on the front lines in this war.
Nothing could be clearer than this MSF press release, dated Aug. 8:
Dr. Bart Janssens, MSF Director of Operations
“Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak; but statements won’t save lives. Now we need this statement to translate into immediate action on the ground. For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to saves lives and reverse the course of the epidemic. Lives are being lost because the response is too slow.
Countries possessing necessary capacities must immediately dispatch available infectious disease experts and disaster relief assets to the region. It is clear the epidemic will not be contained without a massive deployment on the ground from these states.
In concrete terms, all of the following need to be radically scaled up: medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community mobilisation and education.
MSF currently has 66 international and 610 national staff responding to the crisis in the three affected countries. All our Ebola experts are mobilized, we simply cannot do more.”
Pray for God to raise up more workers to help in this effort that lives might be saved.
August 15, 7:25 pm | [comment link]
5. Katherine wrote:
Karen, thanks for the many updates. The excellent work being done in Nigeria is very good news indeed. I read somewhere that Dr. Brantly may soon be release from the isolation ward; whether he can go home or will go to a regular ward to treat continuing side effects, I don’t know.
The horror in Liberia is terrible reading, though. Without a good medical system and with few doctors the outlook there is grim for the next few months.
August 16, 11:36 am | [comment link]
6. Katherine wrote:
A less than optimistic report on the ebola epidemic in the NY Times.
August 16, 4:42 pm | [comment link]
7. Karen B. wrote:
Thanks for that link, Katherine. It was sad to read of the treatment center in Liberia where family members were mingling with patients and health workers had no gloves.
Units for Ebola patients at ELWA Hospital, just outside Liberia’s hard-hit capital, overflowed with around 70 patients, more than twice as many as the units were designed to hold. On Saturday, a Getty Images photographer found patients mixed with healthy family members at a school in Monrovia, where health workers had no gloves. People stormed the school and urged those inside to flee.
No wonder the cases in Liberia are skyrocketing!
The graphics accompanying the article you linked - particularly the graphs showing the timeline of cases in the 4 countries - are striking.
Sobering as well to see that the ENTIRE country of Sierra Leone is affected - all regions have confirmed or suspected cases - while in Liberia and Guinea there are at least still some Ebola free areas.
August 16, 5:44 pm | [comment link]
8. Katherine wrote:
Karen B., it seems that many of the citizens of these afflicted countries do not understand the science of ebola transmission and resort to more ancient practices which of course do not address how the disease is spread. It would be very hard indeed to refrain from trying to soothe and tend an afflicted family member. I was touched to the core by the photo of a distressed woman standing near, but not touching, her fallen husband.
August 17, 12:23 pm | [comment link]
9. Karen B. wrote:
Katherine, your points in #8 are very true. Apparently two of the main reasons Ebola has spun so out of control are families not trusting medical workers to care for their loved ones, so hiding them at home, and then insistence on observing traditional burial practices, with the extended family washing the body, hugging and kissing the deceased. Apparently corpses are even more contagious than living patients infected with Ebola because of all the fluid seepage from every pore. Funerals have become one of the main ways the virus is spreading.
Horrifying news today from Monrovia Liberia - an Ebola quarantine center in a very densely populated slum attacked and looted by protesters unhappy the center was there. The 20 or so patients have fled, and the looters took the patients’ highly infectious sheets and mattresses. Incredible that bloody mattresses would be looted from a quarantine center…. Truly a desperate desperate situation in Liberia now.
August 17, 1:36 pm | [comment link]
10. Karen B. wrote:
The news from Nigeria continues to be quite encouraging:
August 17, 1:42 pm | [comment link]
Nigeria appears to be making progress in containing the disease. The country has 12 confirmed cases of Ebola, all of which stem from direct contact with the Liberian-American man who flew to Nigeria late last month while ill. He infected several health workers before dying.
Since then three others have died in Nigeria from Ebola, according to figures released over the weekend.
One Nigerian doctor has survived the disease and was sent home Saturday night and five others confirmed with Ebola have almost fully recovered, said the Health Minister Onyebuchi Chukwu in a statement Saturday night.
The most important part of containing the disease is to track all those who had contact with Ebola patients and to closely monitor them in order to quarantine if they show any symptoms. Nigeria had 242 people under surveillance but now 61 have been cleared and released, after completing the 21-day period without showing any signs of Ebola, said the health ministry.
11. Katherine wrote:
Karen B., Nigeria appears to be doing a very competent job. Also, their death rate is lower apparently because people being monitored are hospitalized (under safe conditions) as soon as their symptoms show.
The horrifying situation is that the three countries where the disease is rampant (Sierra Leone, Guinea, Liberia) are now essentially behind a cordon sanitaire and at the mercy of the disease within it.
August 17, 2:57 pm | [comment link]
12. Katherine wrote:
A religious angle: Catholics and Anglicans in Nigeria will not exchange the peace at Mass/Holy Communion, and Anglicans will receive from the cup by intinction only.
When I was in India I attended a Catholic Mass (in English). At the sing of the peace they all put hands in front, palms together, and bowed Hindu-style, saying, “Peace be with you.” I liked that better than all the hugging that goes on here, and it’s more hygienic.
August 17, 4:50 pm | [comment link]