Ebola: fear and loathing in west Africa

2014-08-03 15:00

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As the death toll mounts from the worst outbreak of the Ebola virus in history, west African leaders have quickened the pace of emergency efforts this week, deploying soldiers and authorising house-to-house searches for infected people in an effort to combat the disease.

International efforts to contain the virus also gained momentum.

The World Health Organisation (WHO) announced a $100?million (R1?billion) plan on Thursday to get more medical experts and supplies to the overwhelmed region, as the head of the Centers for Disease Control and Prevention (CDC) in the US committed the agency to sending 50 more experts there in the next few weeks.

The WHO is in urgent talks with donors and international agencies to send more medical staff and resources to the region, it said during a regional crisis meeting on Friday.

First recognised in March in Guinea, the Ebola outbreak has surged through porous borders to invade neighbouring countries, quickly outstripping fragile health systems and forcing health officials to fight the battle on many fronts. Past outbreaks have been more localised, but this one has spread extensively over a vast region.

The stepped-up effort is long overdue, according to some analysts. They say the initial response was inadequate on both the national and international level and allowed the disease to mushroom from a local outbreak to an international threat.

The viral illness has exacted a terrible toll, killing at least 729 people, including top physicians in Liberia and Sierra Leone, nations that already faced an acute shortage of doctors. The outbreak has also sickened two American aid workers, who were being rushed back to the US for treatment.

“The whole thing has been very incompetently handled,” said Lansana Gberie, a historian from Sierra Leone. “If the government had quarantined this area”, where the outbreak started, in the remote northeast, “they could have contained it. Instead they opened a treatment centre in Kenema, a major population centre.”

Dr Thomas R Frieden, the director of the CDC, warned on Thursday that it could take at least three to six months to bring the worsening outbreak under control, “even in a best-case scenario”. Hostility and violence directed at health workers are making the job harder, he said.

The CDC has advised Americans to avoid all non-essential travel to the three countries hardest hit by the virus: Guinea, Sierra Leone and Liberia.

The agency issued a Level 3 travel warning, reserved for grave situations. It was also used for the outbreak of the highly contagious respiratory disease SARS.

Frieden said a major concern is that travellers who become ill or injured and need medical care may risk being exposed to Ebola at hospitals in the region. When infection-control measures are poor, hospitals become “amplification points”, spreading the disease they are supposed to contain, he said.

The WHO said the tally of deaths from Ebola rose after 56 more people died during the four days to last Sunday in Guinea, Liberia and Sierra Leone. Nigeria had one fatality. In the same period, 122 new cases were detected, bringing the total of confirmed and suspected cases to 1?323.

The virus causes high fever, vomiting, diarrhoea and, in some cases, bleeding. In the current outbreak, about 60% of the cases have been fatal. It is transmitted by contact with bodily fluids from someone who is ill.

There is no vaccine to prevent the illness, and no specific treatment for it, only care to try to nurse people through the worst of the fevers, bleeding and other symptoms.

The only way to stop an outbreak is to isolate each infected patient, trace all their contacts, isolate the ones who get sick and repeat the process until, finally, there are no more cases.

President Ernest Bai Koroma of Sierra Leone has declared a public health emergency. He said security forces would be deployed to support health professionals, and that “all epicentres of the disease will be quarantined” along with “localities and homes where the disease is identified”. The measures would be enforced for 60 to 90 days.

“Sierra Leone is in a great fight. Failure is not an option,” he said.

Public meetings will be restricted, houses will be searched for infected people, Parliament will be recalled and top officials will be obliged to cancel all but essential overseas travel.

Liberia has announced steps to close schools, put nonessential government workers on compulsory leave for 30 days and order the deployment of security forces to combat the outbreak.

The Liberian Observer newspaper reports that the department of justice has authorised the country’s police to arrest anyone found with bush meat.

The newspaper reported that a bush meat ban was being enforced because it is suspected that some of the animals eaten as delicacies by Liberians carry the Ebola virus.

As part of the crackdown, the Observer reported, police are also pulling over overcrowded vehicles – the virus can be contracted by close contact with a carrier’s bodily fluids, including sweat.

Nigeria recorded its only known death from Ebola when an American citizen working in Liberia, Patrick Sawyer, died there after flying into Lagos late last month.

Fear of the disease is so great that courier companies have refused to transport a blood sample from the patient to a laboratory in Senegal for testing, according to the WHO.

Koroma, who had planned to attend a US-Africa summit meeting in Washington, instead travelled to Guinea on Friday to discuss a regional response to the outbreak.

“The disease is beyond the scope of any one country, or community, to defeat,” he said.

Sierra Leone said passengers arriving and departing Lungi International Airport would be subject to new measures, including body temperature scans.

Two regional airlines, Nigeria’s Arik and Asky, cancelled all flights to Freetown and Monrovia after Sawyer died in Lagos last week. He had arrived on an Asky flight from Liberia.

The WHO said authorities in Nigeria had identified 59 people in the airport and hospital who had come into contact with Sawyer, whose flight also stopped in Ghana and Togo.

Nigeria’s Civil Aviation Authority suspended Asky for bringing Ebola to Lagos, a city of 21?million people and the continent’s biggest metropolis.

Health officials are scrambling to avoid an Ebola outbreak in Lagos, but say there are so far no signs of further cases.

Ghana is introducing body temperature screening of all travellers from west African countries at Accra airport and other entry points. Authorities there are monitoring 11 passengers who disembarked from Sawyer’s flight.

The US Peace Corps said it was withdrawing 340 volunteers from Liberia, Sierra Leone and Guinea after two of them came in contact with a person who later died of the virus.

The condition of a US physician and a missionary who contracted Ebola while helping fight the outbreak in Liberia has worsened. They will be transferred back to the US and treated in a high-security ward at Emory University Hospital in Atlanta, hospital officials said on Thursday.

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