Ebola Part 2: Conditions in West Africa Dramatically Different From U.S.

This is the second of two posts on Ebola by Peter Swann, M.D., Associate Medical Director, WorkCare.

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In my first post on Ebola, I discuss the current (and likely future) direct impact of Ebola virus in the U.S. It’s important to read that post first to help you put the situation in perspective, because what’s happening in West Africa is rapidly evolving and differs dramatically from the U.S. medical system.

The following facts and figures are meant to give you a “snapshot” of what has occurred. Please refer to the resources at the end of this post for the most current information.

1. Ebola cases have been reported in at least five African countries – Liberia, Sierra Leone, Guinea, Nigeria and Senegal.

2. As of September 18:

  • 5,335 people were infected in the current outbreak; 2,622 (49 percent) of those infected have died.
  • 40 percent of all cases were diagnosed in the last three weeks of August and 50 percent of cases in the three weeks ending Sept 18 (i.e., the infection rate is accelerating at a fast pace).
  • 301 health care workers were infected and 144 of them died, including a number of prominent physicians. This is particularly worrisome because health care worker infections and fatalities discourage other international health care personnel from traveling to regions where their presence is desperately needed.
  • Infections were reported as follows:

Senegal: No evidence of spread since Sept. 5; no new cases since then.
Nigeria: Infection rate stabilizing; no new cases since Aug. 29.
Guinea: Response having an impact, though new cases continue to  be reported.
Sierra Leone: Infection rate worsening.
Liberia: Infection rate “out of contol”

3. The world is mobilizing a response, but it is late in coming:

  • The U.S has spent roughly $100 million so far and has plans to contribute an additional $763 million, 3,000+ military troops, ambulances and supplies.
  • The largest CDC international effort ever mobilized is part of the response.
  • The United Kingdom is setting up a hospital.
  • China set up a lab with more than 150 personnel.

As alarming as the situation may be, it will probably get worse before it gets better. In a study published online Sept. 13, 2014, in the New England Journal of Medicine, the authors estimate more than 20,000 people will be infected by November unless control measures are quickly enhanced. The study also notes a current fatality rate of almost 71 percent overall, though the percentage of deaths for hospitalized patients was somewhat less, emphasizing the importance of getting patients to good, supportive health care as quickly as possible.

All of this started with a few cases in December 2013 in the forest areas of Guinea. By March, when the government of Guinea sent alarming reports to the World Health Organization, cases had already spread to the capital of Conakry. In May, cases were expanding in Sierra Leone, and in June Ebola took hold in Liberia.

The authors go on to explain: “We infer that the present epidemic is exceptionally large, not primarily because of biologic characteristics of the virus, but in part because of the attributes of the affected populations, the condition of the health systems, and because control efforts have been insufficient to halt the spread of infection.”

The health care systems in this part of the world have been largely decimated by years of war and conflict. That fact, coupled with a chronic lack of skilled health care workers, has made affected countries particularly vulnerable to infectious disease spread.

Further complicating the matter, these areas are highly interconnected with extensive cross-border traffic and relatively easy connection by road among towns, villages and heavily populated cities. All of these factors have played a role in slowing the critical response needed to blunt outbreak size and implement rigorous infection control measures.

Finally, the World Health Organization notes: “Experimental therapeutics and vaccines offer promise for the future, but are unlikely to be available in the quantities needed to make a substantial difference in control efforts for many months, even if they are proved to be safe and effective. The risk of continued expansion of the Ebola outbreak is real. This study provides the evidence needed for an urgent wakeup call requiring intensive scaling up of control measures while working towards rapid development and deployment of new medicines and vaccines.”

Resources:

  1. Centers for Disease Control and Prevention
  2. World Health Organization

 

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