The Ebola outbreak ravaging West Africa is “totally out of control,” according to a senior official for Doctors Without Borders, who says the medical group is stretched to the limit in its capacity to respond.
More than 500 cases have been reported in three West African countries (Guinea, Sierra Leone and Liberia), and the death toll has risen to 337, the World Health Organization said Wednesday. That’s up from 208 cases reported two weeks ago, a 60 percent spike. (Update: As of October 12, 2014, there have been 8,997 cases and 4,493 deaths).
International organizations and the governments involved need to send in more health experts and increase public education messages about how to stop the spread of the disease, Bart Janssens, the director of operations for the group in Brussels, said on Friday.
“The reality is clear that the epidemic is now in a second wave,” Janssens said. “And, for me, it is totally out of control.”
The outbreak, which began in Guinea either late last year or early this year, had appeared to slow before picking up pace again in recent weeks, including spreading to the Liberian capital for the first time.
“This is the highest outbreak on record and has the highest number of deaths, so this is unprecedented so far,” said Armand Sprecher, a public health specialist with Doctors Without Borders.
Deadliest Outbreak Challenges Experts
Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.
According to a World Health Organization list, the highest previous death toll was in the first recorded Ebola outbreak in Congo in 1976, when 280 deaths were reported. Because Ebola often touches remote areas and the first cases sometimes go unrecognized, it is likely that there are deaths that go uncounted, both in this outbreak and previous ones.
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal viral illness in humans. It is characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes. Currently, there are no vaccines and no specific treatments available.
Ebola usually kills around two-thirds of the people it infects, but it has a case fatality rate of up to 90 percent — meaning that up to 90 percent of those who contract Ebola die as a result. And it kills quickly, sometimes within days, sometimes within weeks. Experts say that actually makes outbreaks easier to stop.
But the pattern is different in West Africa. The virus continues to pop up in new locations. It has swept through Guinea, jumped across the border into Sierra Leone and, most recently, killed seven people in Liberia’s capital, Monrovia — a dense metropolitan area with nearly a million people.
Why has Ebola been so hard to stop in West Africa? No one is sure, but there are probably several issues.
This is the first outbreak in this part of Africa. The region isn’t as well-equipped to handle Ebola as Central Africa, where the virus is more common. Health officials still don’t know how people are getting sick. In the past, people have caught Ebola from eating monkey meat or from bat bites. Then the virus spreads from person to person through bodily fluids.
Travel has become easier and easier in West Africa over the past few decades, making person-to-person transmission is a major concern.
The multiple locations of the current outbreak and its movement across borders make it one of the “most challenging Ebola outbreaks ever,” Fadela Chaib, a spokeswoman for the World Health Organization, said earlier in the week.
The outbreak shows no sign of abating and that governments and international organizations were “far from winning this battle,” Unni Krishnan, head of disaster preparedness and response for Plan International, said Friday.
‘This is a very big emergency’
But Janssens’ description of the Ebola outbreak was even more alarming, and he warned that the governments affected had not recognized the gravity of the situation. He criticized the World Health Organization for not doing enough to prod leaders and said that it needs to bring in more experts to do the vital work of tracing all of the people who have been in contact with the sick.
“There needs to be a real political commitment that this is a very big emergency,” he said. “Otherwise, it will continue to spread, and for sure it will spread to more countries.”
But Tolbert Nyenswah, Liberia’s deputy minister of health, said that people in the highest levels of government are working to contain the outbreak as proved by the fact that that Liberia had a long period with no new cases before this second wave.
The governments involved and international agencies are definitely struggling to keep up with the severity of the outbreak, said Krishnan of Plan, which is providing equipment to the three affected countries and spreading information about how people can protect themselves against the disease. But he noted that the disease is striking in one of the world’s poorest regions, where public health systems are already fragile.
“The affected countries are at the bottom of the human development index,” he said in an emailed statement. “Ebola is seriously crippling their capacities to respond effectively in containing the spread.”
The situation requires a more effective response, said Janssens of Doctors Without Borders. With more than 40 international staff currently on the ground and four treatment centers, Doctors Without Borders has reached its limit to respond, he said.
“It’s the first time in an Ebola epidemic where (Doctors Without Borders) teams cannot cover all the needs, at least for treatment centers,” he said.
It is unclear, for instance, if the group will be able to set up a treatment center in Liberia, like the ones it is running in in Guinea and Sierra Leone, he said. For one thing, Janssens said, the group doesn’t have any more experienced people in its network to call on. As it is, some of its people have already done three tours on the ground.
Janssens said this outbreak is particularly challenging because it began in an area where people are very mobile and has spread to even more densely populated areas, like the capitals of Guinea and Liberia. The disease typically strikes sparsely populated areas in central or eastern Africa, where it spreads less easily, he said.
By contrast, the epicenter of this outbreak is near a major regional transport hub, the Guinean city of Gueckedou.
He said the only way to stop the disease’s spread is to persuade people to come forward when symptoms occur and to avoid touching the sick and dead.
“There is still not a real change of behavior of the people,” he said. “So a lot of sick people still remain in hiding or continue to travel. And there is still news that burial practices are remaining dangerous.”
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