It is too early to make a conclusive judgment, but at present there is a drop in Ebola numbers. Does it mean that Ebola is beginning to go away, or is it simply a lull as Ebola numbers have done so in the past, or is it worse– the true numbers are not revealed because they are hidden by victims’ families? Here is the link to the WHO’s take on the Ebola data from west Africa: Home> Health WHO: Ebola Decline in Liberia Could Be Real Trend
Health workers place the body of a man into a grave, as he is suspected of contracting and dying from the Ebola virus on the outskirts of Monrovia, Liberia, Monday, Oct. 27, 2014. The United States will help fight Ebola over “the long haul,” the American ambassador to the United Nations said on a trip to the West African countries hit by the outbreak.(AP Photo/Abbas Dulleh)
GENEVA — A month after declaring the Ebola outbreak in West Africa a global health emergency, the World Health Organization warned on Friday that the disease is still outpacing the international response to contain it.
“The Ebola outbreak that is ravaging parts of West Africa is the largest, most severe and most complex in the nearly four-decade history of this disease,” Margaret Chan, the health organization’s director general, said at a news conference. “The number of new cases is moving far faster than the capacity to treat them.”
So far, 4,784 Ebola cases have been reported and more than 2,400 people have died in the outbreak, which is concentrated in Guinea, Liberia and Sierra Leone, Ms. Chan said on Friday, citing the latest data available. But she made clear the figures were “an underestimate.”
A surge of 400 new cases in Liberia in the past week, double the number of new cases in the preceding week, was “a particular cause for concern,” the health organization said. Sierra Leone reported 200 new cases in the past week and a high rate of transmission in the capital, Freetown, the W.H.O. said. Nearly half the total number of infections in West Africa and just over half the deaths occurred in the last 21 days, it said.
Releasing a road map to guide the international response to the crisis two weeks ago, the health organization said some 20,000 people could ultimately be affected, but Ms. Chan said Friday that the estimate could change as the epidemic evolves.
The outbreak has already stricken more people than all other outbreaks of the disease combined, Sarah Crowe, a staff member for the United Nations children’s fund, Unicef, told reporters in a telephone briefing from Monrovia, the capital of Liberia.
Ms. Chan’s comments came at a joint news conference with Cuba’s public health minister, Roberto Morales Ojeda, to announce that Cuba would send 165 doctors and nurses to Sierra Leone, the biggest commitment of personnel to the health crisis so far by any country, Ms. Chan said.
The new team, now receiving specialist training in Cuba, will deploy in the first week of October and will stay six months, the health organization said in a statement.
“I’m quite positive more support will be forthcoming,” Ms. Chan said, noting assistance offered by Britain, Canada, the Democratic Republic of Congo, the European Union, France, Uganda and the United States.
The World Health Organization has said it will earmark $100 million to fight the outbreak. Other commitments include $200 million from the World Bank, $181 million from the European Union, $75 million from the United States and $50 million from the Gates Foundation.
Among other aid commitments, the United States said this week that it would send a 25-bed military field hospital to Monrovia to treat health care workers infected by the virus, and Britain has promised to provide a 62-bed unit for Sierra Leone.
But despite the efforts to scale up the response, World Health Organization data makes clear that the resources available to date are a small fraction of what is needed. In Liberia, which accounts for roughly half the number of cases and more than half the number of deaths reported so far, not a single hospital bed is available to receive people infected, Ms. Chan said.
Liberia has a total of 314 beds in centers for treating Ebola patients, but Monrovia alone needs another 760 beds, the W.H.O. said this week.
“The thing we need most of all is people, health care workers,” Ms. Chan said, citing the urgency of providing pay and hazard allowances to get national staff in the affected countries back to work.
Already fragile health services in countries that rank among the world’s poorest have been weakened by the effect of the Ebola epidemic on medical staff, who have lacked sufficient supplies of the materials and equipment needed to protect themselves.
In Sierra Leone, where health care workers have died in disproportionate numbers since the epidemic began, officials said on Friday that a fourth doctor, Olivette Buck, had become infected with the virus and that the three other doctors to contract the disease had died.
The authorities in Sierra Leone were urgently attempting on Friday to evacuate Dr. Buck for treatment abroad, saying the loss of another prominent doctor would be disastrous for the country’s already battered morale.
In Liberia, where 153 health workers have become infected and 79 have died, Unicef said it had delivered nearly 248 metric tons of personal protection equipment, hygiene kits and the chlorine needed for routine hand washing, but it reinforced the warning that the international efforts still fell far short of what was needed.
“We don’t have enough partners,” Ms. Crowe said in her telephone briefing. “Many Liberians say they feel abandoned.”
“Ebola has turned survivors into human booby traps, unexploded ordnance — touch and you die,” Ms. Crowe said in an article published by the BBC. “Ebola psychosis is paralyzing.”
“It’s quite surreal,” she added in her briefing. “Everywhere you go there’s a sense of this virus taking over.”
The outbreak is deeply disturbing for children who “are seeing family members and relatives taken away by people in astronaut suits,” Ms. Crowe said. They live in a “twilight zone” where normal play with their peers is a risk. “It’s almost as if they have to unwire their normal human ways,” she said.
Aid agencies are also concerned that the impact of the epidemic is collapsing the ability of health services to address other medical needs. Unicef said children were dying from measles because they had not been vaccinated, and pregnant women had few places where they could safely deliver children.
Emerging from years of brutal conflict, Liberia had achieved the fastest rate of decline in child mortality in Africa, Sheldon Yett, Unicef’s representative in Liberia, said in a statement. “Now Ebola is threatening to wipe out all those hard-earned gains for children and for Liberia,” he said.
The deadly Ebola outbreak sweeping across three countries in West Africa is likely to last 12 to 18 months more, much longer than anticipated, and could infect hundreds of thousands of people before it is brought under control, say scientists mapping its spread for the federal government.
“We hope we’re wrong,” said Bryan Lewis, an epidemiologist at the Virginia Bioinformatics Institute at Virginia Tech.
Both the time the model says it will take to control the epidemic and the number of cases it forecasts far exceed estimates by the World Health Organization, which said last month that it hoped to control the outbreak within nine months and predicted 20,000 total cases by that time. The organization is sticking by its estimates, a W.H.O. spokesman said Friday. Dr. Margaret Chan, director general of the W.H.O., which has stood by its lower projections of the toll of the Ebola outbreak.Credit Martial Trezzini/KEYSTONE, via Associated Press
But researchers at various universities say that at the virus’s present rate of growth, there could easily be close to 20,000 cases in one month, not in nine. Some of the United States’ leading epidemiologists, with long experience in tracking diseases such as influenza, have been creating computer models of the Ebola epidemic at the request of the National Institutes of Health and the Defense Department.
The Centers for Disease Control and Prevention declined to comment on the projections. A spokesman, Tom Skinner, said the agency was doing its own modeling and hoped to publish the results soon. But the C.D.C. director, Dr. Thomas R. Frieden, has warned repeatedly that the epidemic is worsening, and on Sept. 2 described it as “spiraling out of control.”
While previous outbreaks have been largely confined to rural areas, the current epidemic, the largest ever, has reached densely populated, impoverished cities — including Monrovia, the capital of Liberia — gravely complicating efforts to control the spread of the disease. Alessandro Vespignani, a professor of computational sciences at Northeastern University who has been involved in the computer modeling of Ebola’s spread, said that if the case count reaches hundreds of thousands, “there will be little we can do.”
What worries public health officials most is that the epidemic has begun to grow exponentially in Liberia. In the most recent week reported, Liberia had nearly 400 new cases, almost double the number reported the week before. Another grave concern, the W.H.O. said, is “evidence of substantial underreporting of cases and deaths.” The organization reported on Friday that the number of Ebola cases as of Sept. 7 was 4,366, including 2,218 deaths.
“There has been no indication of any downturn in the epidemic in the three countries that have widespread and intense transmission,” it said, referring to Guinea, Liberia and Sierra Leone.
The scientists who produced the models cautioned that their dire predictions were based on the virus’s current uncontrolled spread and said the picture could improve if public health efforts started to work. Because conditions could change, for better or for worse, the researchers also warned that their forecasts became shakier the farther into the future they went.
Dr. Lewis, the Virginia Tech epidemiologist, said that a group of scientists collaborating on Ebola modeling as part of an N.I.H.-sponsored project called Midas, short for Models of Infectious Disease Agent Study, had come to a consensus on the projected 12- to 18-month duration and very high case count.
Another Midas participant, Jeffrey L. Shaman, an associate professor of environmental health sciences at the Columbia University Mailman School of Public Health, agreed.
“Ebola has a simple trajectory because it’s growing exponentially,” Dr. Shaman said.
Lone Simonsen, a research professor of global health at George Washington University who was not involved in the modeling, said the W.H.O. estimates seemed conservative and the higher projections more reasonable.
“The final death toll may be far higher than any of those estimates unless an effective vaccine or therapy becomes available on a large scale or many more hospital beds are supplied,” she said in an email.
Dr. Vespignani said that the W.H.O. figures would be reasonable if there were an effective campaign to stop the epidemic now, but that there is not.
The modeling estimates are based on the observed growth rate of cases and on factors like how many people each patient infects. The researchers use the past data to make projections. They can test their methods by, for instance, taking the figures from June, plugging them into the model to predict the number of cases in July, and then comparing the results with what actually happened in July.
Dr. Shaman’s research team created a model that estimated the number of cases through Oct. 12, with different predictions based on whether control of the epidemic stays about the same, improves or gets worse. If control stays the same, according to the model, the case count by Oct. 12 will be 18,406. If control improves, it will be 7,861. If control worsens, it will soar to 54,895.
Before this epidemic, the largest Ebola outbreak was in Uganda from 2000 to 2001, and it involved only 425 cases. Scientists say the current epidemic surged out of control because it began near the borders of three countries where people traveled a lot, and they carried the disease to densely populated city slums. In addition, the weak health systems in these poor countries were not equipped to handle the disease, and much of the international response has been slow and disorganized.
But questions have also been raised about whether there could be something different about this strain of Ebola that makes it more contagious than previous ones.
Researchers are doubtful, but Thomas W. Geisbert, an Ebola expert at the University of Texas Medical Branch in Galveston, said it was important to keep an open mind about the possibility. During vaccine tests expected to start next month in monkeys, he said, he and his colleagues will monitor infected animals to see if they develop unusually high virus levels early in the disease that might amplify its infectiousness.
Some scientists have also suggested that as the outbreak continues and the virus spreads from person to person, it will have more opportunities to mutate and perhaps become even more dangerous or contagious. But Stuart T. Nichol, chief of the C.D.C.’s Viral Special Pathogens Branch, said that so far, researchers monitoring the mutations had seen no such changes.