Posted on 08/11/2014 1:38:29 PM PDT by dynachrome
The outbreak of Ebola virus disease in west Africa continues to evolve in alarming ways, with no immediate end in sight. Many barriers stand in the way of rapid containment.
The most severely affected countries, Guinea, Liberia, and Sierra Leone, have only recently returned to political stability following years of civil war and conflict, which left health systems largely destroyed or severely disabled.
Lack of capacity makes infection control difficult
This lack of capacity makes standard containment measures, such as early detection and isolation of cases, contact tracing and monitoring, and rigorous procedures for infection control, difficult to implement. Though no vaccine and no proven curative treatment exist, implementation of these measures has successfully brought previous Ebola outbreaks under control.
The recent surge in the number of cases has stretched all capacities to the breaking point. Supplies of personal protective equipment and disinfectants are inadequate. The outbreak continues to outstrip diagnostic capacity, delaying the confirmation or exclusion of cases and impeding contact tracing.
Diagnostic capacity is especially important as the early symptoms of Ebola virus disease mimic those of many other diseases commonly seen in this region, including malaria, typhoid fever, and Lassa fever.
Some treatment facilities are overflowing; all beds are occupied and patients are being turned away. Many facilities lack reliable supplies of electricity and running water. Aid organizations, including Médecins Sans Frontières (Doctors without Borders), which has provided the mainstay of clinical care, are exhausted.
Managerial framework for Ebola
Last week, the WHO Director-General, Dr Margaret Chan, announced a new managerial framework designed to ensure that WHO’s emergency response is fully staffed, drawing on personnel in all WHO regional and country offices, for an around-the-clock response.
The Ebola virus is one of the world’s most virulent pathogens. Personal protective equipment is essential, but in short supply. It is also hot and cumbersome, severely limiting the number of hours that medical and nursing staff can work on an isolation ward. On present estimates, a facility treating 70 patients needs a minimum of 250 health-care staff.
Fear is hard to overcome
Six months into the outbreak, fear is proving to be the most difficult barrier to overcome. Fear causes contacts of cases to escape from the surveillance system, families to hide symptomatic loved ones or take them to traditional healers, and patients to flee treatment centres. Fear, and the hostility it can feed, have threatened the security of national and international response teams.
Health-care staff fear for their lives. To date, more than 170 health-care workers have been infected and at least 81 have died.
Outbreak control is further compromised when fear causes airlines to refuse to transport personal protective equipment and courier services to refuse to transport properly and securely packaged patient samples to a WHO-approved laboratory.
Fear has spread well beyond west Africa, leading some to suggest that imported cases, also in wealthy countries, could ignite widespread infections in the general population. In countries with well-developed health systems, such a scenario is highly unlikely, given the epidemiology of the Ebola virus and experiences in past outbreaks.
Transmission
The Ebola virus is highly contagious, but is not airborne. Transmission requires close contact with the bodily fluids of an infected person, as can occur during health-care procedures, home care, or traditional burial practices, which involve the close contact of family members and friends with bodies. In Guinea, around 60% of cases have been linked to these burial practices, with women, who are the principal care-givers, disproportionately affected.
The incubation period ranges from 2 to 21 days, but patients become contagious only after the onset of symptoms. As symptoms worsen, the ability to transmit the virus increases. As a result, patients are usually most likely to infect others at a severe stage of the disease, when they are visibly, and physically, too ill to travel.
Vigilance means better detection
On the positive side, fear has led to a very high level of vigilance and clinical suspicion worldwide, as seen in the number of false alarms at airports and in emergency rooms. Such a high level of alert further increases the likelihood that any imported case will be quickly detected and properly managed, limiting onward transmission.
This pattern was clearly seen during the 2003 SARS outbreak. Of the total number of cases during that outbreak, 98% occurred in the four countries affected prior to the WHO global alert issued on 15 March. The high level of vigilance and preparedness that followed that alert helped the additional 26 outbreak sites with imported cases to prevent onward transmission or hold it to just a handful of cases.
Also on the positive side, the presidents of the hardest-hit countries have made outbreak containment a top national priority. Several extraordinary measures have been introduced over just the past few days, though it is too early to assess their impact.
In some areas, the inclusion of social anthropologists on outbreak teams is helping to reduce fear and change behaviours. The fact that no effective medical treatment exists has enforced the desire of families to care for patients in their homes or turn to traditional healers. Many communities now understand the importance of managing symptoms through supportive care. Evidence that early detection and supportive care greatly improve prospects for survival is a powerful incentive to seek medical care.
Last week, an Emergency Committee, convened under the provisions of the International Health Regulations, met to consider all the evidence and unanimously agreed that this outbreak meets the criteria for declaring it a public health emergency of international concern (PHEIC). On Friday, 8 August 2014, Dr Margaret Chan accepted that advice and declared the outbreak a PHEIC. The committee also advised Dr Chan that:
the Ebola outbreak in west Africa constitutes an ‘extraordinary event’ and a public health risk to other States; the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries; a coordinated international response is deemed essential to stop and reverse the international spread of Ebola. Emergency meeting on the role of experimental therapies in outbreak response
On Monday 11 August, WHO is holding an emergency meeting with ethicists, scientific experts and lay people from affected countries to assess the role of experimental therapies in the Ebola outbreak response. Issues to be considered include the ethics surrounding use of therapies when safety is unproven, ethics governing priority setting for access to these therapies and principles for fair distribution.
ping
Didn’t most news organizations last week tell us that Ebola was NOT very contagious? (ie high fatality rate, but low contagious rate?)
It’s West Africa. WaWa
No, not good news. WHO continues to demonstrate their incompetence. They still think fear of ebola is worse than ebola itself.
Instead of setting up a lab in the containment area, they insist on sending samples airborne to “WHO approved laboratories”. Get off your ass and approve a local laboratory.
They still haven’t called for a quarantine, while many of the surrounding countries and the infected countries themselves, have finally started the process of quarantines.
Having an authority that refuses to take the necessary steps to contain is far worse than having no authority at all.
No, not good news. WHO continues to demonstrate their incompetence. They still think fear of ebola is worse than ebola itself.
Instead of setting up a lab in the containment area, they insist on sending samples airborne to “WHO approved laboratories”. Get off your ass and approve a local laboratory.
They still haven’t called for a quarantine, while many of the surrounding countries and the infected countries themselves, have finally started the process of quarantines.
Having an authority that refuses to take the necessary steps to contain is far worse than having no authority at all.
Very good post; Thanks for posting. Health/life BUMP!
Ping...
There have been indications that this virus may be able to be transmitted prior to the onset of symptoms.
If motorcycle cab drivers who make physical contact with their passengers are coming down with the disease, then non-intimate (no mucous membrane to mucous membrane contact or blood exchanged) contact might be able to transmit this variant as well. Think crowded subways, buses, and the like--or just getting jostled by that sweaty person in line next to you in a crowd.
Yes, it would be decidedly irresponsible to have people panic and literally break down entire economies out of fear, but at the same time the single greatest danger I see is in underestimating how well the disease might be transmitted in urban and other random contact settings. How 'casual' is 'casual'? Not only would that be difficult to predict, it would be nearly impossible to track in larger populations.
Obama is more worried if an obscure aids stricken african nation is not going to repress sexual gay promiscuity and keep open borders despite ebola and the evil of islam.
And the genocide program goes on.
Post to me or FReep mail to be on/off the Bring Out Your Dead ping list.
The purpose of the “Bring Out Your Dead” ping list (formerly the “Ebola” ping list) is very early warning of emerging pandemics, as such it has a high false positive rate.
So far the false positive rate is 100%.
At some point we may well have a high mortality pandemic, and likely as not the “Bring Out Your Dead” threads will miss the beginning entirely.
*sigh* Such is life, and death...
That’s true. Caged pigs with the virus 4 years ago, transmitted it to caged monkey’s with no physical contact. Paper’s author says, yeah but pigs sneeze and cough a lot with the virus, and human’s don’t.
Maybe, he’s right, but it sure sounds like they are betting on human’s not coughing.
Add cultural conditioning to the barriers list. Animist beliefs twist perceptions in the affected areas. All too many in the poorest sections believe that Ebola is caused by witchcraft, a curse placed on the victim.
There is fear of the doctors and nurses at the ebola treatment centers. People are seen entering with seemingly minor symptoms and then within a short time dying in horrific condition. Health workers have been stoned.
As the epidemic spreads more western repoters have arrived and started posting of their encounters and those accounts at times erode hopes for a quick curtailment of this outbreak.
Didn’t most news organizations last week tell us that Ebola was NOT very contagious?
***
Picky, picky. /s
+1
It would seem these west African countries could be quarantined if not easily at least reasonably well. It's not like is a lot of travel to and from them and their seacoasts are a long way from most other countries except remote basket cases like themselves.
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