Wednesday, October 1, 2014

It's Just Africa: Ebola Ravages West Africa

 The World Health Organization (WHO) was notified of the first cases of Ebola in Guinea, West Africa in March 2014. Since then, the virus has spread past Guinea, thanks to the region’s porous borders, into Sierra Leone, Liberia, Senegal, and Nigeria. With a fatality rate of 70%, slightly lower than the 90% fatality rate of past outbreaks, Ebola has had a chance, due to unprepared public health systems and poorly informed citizenry, to spread steadily through the region. Ebola is thought to have spread to humans through fruit bats, which are considered a delicacy for some West Africans, as well as through other types of bush meat such as small rodents.

While Ebola does not spread quite as quickly as the Spanish flu or pre-vaccination days measles, efforts to contain the disease have already exceeded the capacity of public health systems in West Africa. The total case count of the disease has reached 6,574, as of September 29th, according to the US Centers for Disease Control and Prevention (CDC). According to the CDC, the total number of laboratory confirmed cases is 3,626 and the total number of deaths is 3,091. The overwhelming majority of these cases have been documented in Liberia (3,458 total cases, 914 laboratory confirmed cases, and 1,830 deaths), with Sierra Leone running a close second (2,021 total cases, 1,816 laboratory confirmed cases, and 605 deaths). In Senegal, no new cases have been reported since August 29, and in Nigeria, no new cases have been reported since September 5. In Guinea, the infection rate seems to have stabilized.

How many people are or will be affected?

Gaining an accurate total of the number of Ebola cases has been complicated by several factors, the first being simply that many cases of Ebola are going unreported. The CDC estimates that for each reported case of Ebola, another 1.5 cases are not documented. Part of this is caused by understaffed clinics and hospitals that lack the resources to admit and treat everyone who shows up, leading to an incomplete total count of afflicted persons. A failure to self-report further compounds the problem. In many communities, there is a stigma attached to Ebola, and people are unwilling to admit that someone in their family or household is showing symptoms of or has Ebola. The threat of quarantine or restrictions on freedom of movement also make it less likely that people will self-report, further hindering efforts to stamp out the disease.

Creating a predictive model to project the potential impacts of Ebola before the epidemic ends has also proven difficult. The CDC is working with data being reported from disconnected streams, which increases the possibility for duplicate reports of the same cases. Differences in reporting reliability and variations in levels of underreporting make it difficult to apply accurately one predictive model across all of West Africa.

The efforts to combat and contain the spread of Ebola have been hampered not only by a lack of resources available to the local governments and medical centers, but also by the general distrust that Western medical response teams have encountered. Rumors that Ebola is a conspiracy by the Americans or the Western world to kill the locals have led to tense relationships between local communities and aid workers, escalating in one publicized instance to the incident in Guinea this past month in which the members of a health delegation were actively targeted and killed by the local community. Such beliefs also dampen the likelihood that people will seek professional medical attention or follow proper sanitation protocols if and when they begin to show symptoms, thus increasing the risk to their family members, close friends, and untold others.

Local Efforts and Challenges

In Liberia, Médecins Sans Frontières (MSF) is attempting to double current capacity to 400 beds at its facility in the capital city of Monrovia by the end of the month. To ensure adequate treatment, the facility is increasing staff as well. MSF’s Monrovia facility currently has 617 health care workers for the 200 beds. However, death toll for Ebola victims is rising rapidly in Liberia mostly due to the lack of access to medical care. Most infected people are treated in their homes by family members who then contract the disease. Even when ambulances and response teams make it to the countryside, they do not have the capacity to transport all of the infected people back to a hospital or mobile clinic. They also face resistance from people who are afraid to leave their families to go, very likely, to their deaths in a cold hospital room surrounded by foreign health workers covered head-to-toe in protective gear. The country does not have the resources to force infected or potentially infected persons into treatment in isolation units in hospitals.

In Sierra Leone, where about 600 people have died of Ebola, a quarantine and curfew have been imposed on five of the 13 counties, affecting mobility for a third of the country’s 6 million citizens. Quarantine has led to riots and frustration as people are disappointed with the lack of progress in ridding the country of this disease. Further frustrating efforts to combat the spread of the disease, funeral customs and traditions in the region run counter to the safe burial and disposal protocols necessary to prevent infection.

US Efforts

Local governments in West Africa unfortunately lack the capacity to combat this epidemic on their own. The US has taken the lead in a four-pronged effort, with the support of the international community. The strategy commits the expertise of the US military to coordinate and facilitate international relief efforts by expediting the transportation of supplies, medical equipment and personnel, to build Ebola Treatment Units in hard hit areas, to set up facilities to train an additional 500 medical staff per week. USAID, along with other US Government agencies, is spearheading efforts to disseminate awareness and protection kits primarily in Liberia, as well as across the region. Complete details on the US strategy can be found here.

The Pentagon announced yesterday that it would be bolstering its existing efforts to combat Ebola in West Africa by deploying the 101st Airborne Division. The 1,600 US troops will be assisting in coordinating the global response to the Ebola epidemic. In addition to these troops who will be trained on the particulars of the disease and personal protective equipment, there is also a team of 700 engineering troops en route to the region tasked with the building treatment centers desperately needed to treat infected people. These engineers will be joining the US Navy’s construction arm, which began assisting crews in Monrovia, Liberia last week in the development of treatment and training centers.

International Efforts

With infection numbers surpassing 6,500 by the end of last month, and reported numbers estimated to be about half or ⅓ of total infections, the international community has been quick to make promises of much needed aid. Making good on those promises with efficiency will be imperative to the success of containment efforts. This past week, UN Secretary General Ban Ki-moon set up the UN Mission on Ebola Emergency Response, and the UN opened up a regional headquarter in Accra, Ghana to assist regional efforts in affected countries.

Global health experts estimate that in order to make real progress on stemming the tide of Ebola in the next two months, at least 70% of those infected should be receiving treatment and 70% of burials should follow safety protocols. This ambitious goal will require significant assistance from the international community in terms of money, infrastructure and health personnel. The 800 additional beds promised by the international community fall woefully short of the 3,000 beds estimated by the WHO as needed to meet current demands. Cuba has sent 461 doctors and nurses, China has sent a 59-person team and a mobile lab to Sierra Leone, and Britain has promised facilities for 700 new beds.

Economic Impact

The Ebola epidemic certainly poses a genuine threat to international public health and security, which has galvanized the international community into acting, but the epidemic has already devastated the economies of the hardest hit countries. Though Guinea has been able to stabilize Ebola infection rates, the country is facing significant economic losses. $30 billion worth of infrastructure and mining construction have come to a halt, and the country faces a loss of up to 2.5 percentage points of estimated GDP growth. Multiple industries have been impacted in Liberia by decreased worker mobility due to internal travel and public transport restrictions: fuel sales have dropped 20 to 35%, and rubber and palm oil production and distribution have been disrupted. Misconceptions about Ebola transmission has fueled beliefs that the disease can spread through crops, water or food, leading to communities abandoning agricultural production, which is only compounding existing food shortages from transportation disruptions.

What’s Next?

The reach and intensity of this Ebola epidemic remains to be seen, but efforts to contain and quash the disease are likely to ramp up as the CDC confirmed yesterday the first ever case of Ebola diagnosed on US soil. The patient, a man who traveled from Liberia to Dallas, is in serious condition and is being treated in isolation at Texas Health Presbyterian Hospital. Some people who came into contact with the man after he became symptomatic, including school-age children, are being monitored for symptoms as well, while a CDC team has been dispatched to Dallas to investigate and monitor for 21 days any other persons who might have come into contact with the patient.

The hysteria has already begun to spread in light of the Texas diagnosis, with Americans unnecessarily panicking that there will be an Ebola epidemic in the US. Hopefully, this incident will increase pressure on the pharmaceutical companies currently testing and producing the Ebola vaccine. The CDC has increased ongoing efforts to raise awareness about affected countries, important travel precautions, and the symptoms and transmission of the disease. Ebola doesn’t spread until a person is symptomatic, therefore proper steps should be taken to investigate travel histories of all those entering the US in order to monitor those who have traveled to West Africa. If medical teams are able to isolate and treat those who show the slightest symptoms, as well as any persons who have had recent contact with the infected person, there shouldn’t be an Ebola epidemic in the US.

As for West Africa, let’s hope the international community musters up the resources and efficiency needed to contain the disease before too many more people die.

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