Thomas Frieden, head of the US Centers for Disease Control and a 30-year veteran of public health work, can think of only one thing comparable with the dangers of the current Ebola epidemic: Aids.
Bruce Aylward, a fellow global health expert, likens the effort needed to deploy thousands of doctors and nurses in west Africa to the fight he led for the World Health Organisation against polio. With polio it took 10 to 20 years to mobilise medical staff; to respond to Ebola, the world has only “weeks”.
Drs Frieden and Aylward were voicing the alarm felt by medical and political leaders about the growing humanitarian crisis and the threat it poses to stability in Africa and beyond. Those global fears over the spread of the disease have intensified with the revelation that a Spanish nurse fell ill after being infected in Madrid and a man who had picked up the virus in Liberia died in Texas. Within 24 hours the US and UK had announced plans to screen incoming travellers for signs of Ebola, while governments around the world tried to calm a public panic that has seen patients tested for the virus in numerous countries outside west Africa.
The presidents of the three west African countries at the centre of the epidemic pleaded at a Washington summit on Thursday for the international community to speed up its response, warning that they needed far more medical assistance to contain the virus.
Ernest Bai Koroma, president of Sierra Leone, put his country’s needs in stark terms. To fight what he called an “evil virus”, he told the World Bank meeting, 750 more doctors and 3,000 more nurses were needed. Dr Aylward, who is co-ordinating the WHO’s Ebola campaign, said that was a reasonable assessment. The number of doctors in the country is “in double digits”, he said, and yet dozens of new patients are appearing every day.
Official figures from the World Health Organisation show 8,399 cases, including 4,033 deaths. The real toll is much higher because accurate reporting is impossible as the health infrastructure collapses in the worst affected areas.
“The situation in Guinea, Liberia and Sierra Leone continues to deteriorate, with widespread and persistent transmission of Ebola virus,” the WHO said in its latest report. “There is no evidence that the epidemic in west Africa is being brought under control.”
A shockingly large number of health workers have been infected by patients: 401 have contracted Ebola and 232 have died. The EU and US recognise that an influx of western doctors and nurses will be essential to supplement local staff if the fight is to be won; to reassure potential recruits, they are planning a medical evacuation system to fly out health workers for treatment overseas.
Even in well-equipped western hospitals, mistakes have been made, as the cases of Teresa Romero and Thomas Eric Duncan illustrate. Ms Romero was infected while caring for a missionary who had been repatriated after contracting Ebola in Africa. Reports suggest that, although she was wearing protective clothing, she did not follow proper safety procedures. She was sent home when she sought medical assistance after her symptoms first appeared, increasing the risk that she would infect others. Something similar happened in Dallas. Mr Duncan, who died on Wednesday, was sent home by Texas Health Presbyterian Hospital when he went to its emergency room on September 25 with early Ebola symptoms, even though he said he had recently visited west Africa. He was eventually admitted when he returned in a worse condition three days later, having been in contact with friends and family.
If such mistakes can happen in Europe and the US, the potential for things going wrong in the under- equipped chaos of west Africa is far greater. The WHO estimates that Guinea, Liberia and Sierra Leone – with a combined population of 20m people – need 4,300 beds to treat Ebola patients; they have fewer than 1,100.
The growing international concern over Ebola has largely been a public health debate but there is also anxiety over the broader economic fallout.
World Bank economists offer a grim view of what might happen over the next 15 months if the outbreak is not contained, with some calling for a “Marshall Plan” to help Guinea, Liberia and Sierra Leone recover once the immediate crisis is over.
Were Ebola to spread to neighbouring countries, the economic impact could reach $32.6bn in west Africa alone by the end of 2015, the economists wrote. Fear of the virus would cause workers to stay home and businesses to shut; transport costs would rise and trade slow; government revenues would dry up and a vicious economic cycle would render fragile governments even more so.
Everyone involved concedes that the international reaction has been far too slow and inadequate. “We are still way, way behind the curve,” said Jim Yong Kim, the infectious diseases specialist who is now the president of the World Bank. “We have to quickly speed up – scale up – the global response.”
The grim warnings appear to be prompting some action. The US, EU, China and others have pledged to speed up their response although the UN said on Friday it had only raised $250m of its $1bn target to combat the outbreak.
Jiayi Zou, director-general of China’s finance ministry, said Beijing had sent 200 medical workers to the affected countries and offered support and equipment worth $200m. “China is ready to do more as needed,” she added. A 165-strong Cuban team has already arrived in Sierra Leone.
But the scale of the response needed remains daunting and the cost is rising daily. The epidemic “could have been prevented by spending less than 1 per cent of what is needed now”, said Dr Frieden. David Nabarro, the UN’s special co-ordinator for the international response to Ebola, said: “Every dollar spent now may well be worth more than $20 or $30 spent in a few months’ time.”
Outside Africa the latest developments have led to widespread public fear. Julian Hiscox, professor of infection and global health at Liverpool university, commented: “We shouldn’t panic as if it’s going to be Ebolageddon within 30 days.”
UK media reported a primary school headteacher in Manchester cancelled a placement for a boy from Sierra Leone even though officials insisted he posed no risk to pupils or staff. The decisions by the US and UK governments to introduce screening at some airports for signs of Ebola are seen by medical experts as a gesture to calm public fears.
“I don’t think there is a strong scientific case that airport screening will help keep Ebola out of the UK, but it’s a step that will reassure some people,” said Ben Neuman, a virologist at Reading university. “Screening sounds like a good idea but most people who are well enough to travel on a plane would pass the new screening measures regardless of whether they were infected.”
The virus is spread mainly through physical contact with infected body fluids, particularly blood, faeces and vomit. It may also be picked up from contaminated surfaces and objects, although this low risk can be eliminated by cleaning and disinfection.
Virologists say Ebola cannot pass through the air in tiny particles or droplets, as the flu, measles and chickenpox viruses do. Although it is mutating constantly, like any pathogen passing from person to person, there is no precedent for any virus undergoing such a big genetic change as airborne transmission would require.
Most, if not all, of the Ebola outbreaks recorded in central Africa since the first one in 1976 are believed to have started when the virus moved into people from fruit bats, its animal host.
Peter Piot, head of the London School of Hygiene and Tropical Medicine, co-discovered the virus. He says the most likely change in the disease, if it becomes endemic in human populations is that it will become less virulent. Even a less lethal Ebola, however, would be a global health catastrophe if it becomes an endemic human disease.
But President Koroma has more urgent concerns. “Our people are dying,” he said in Washington. “Without you we cannot succeed.”
Pharma: A possible cure flowing through the veins
Has the cure for Ebola been under our noses for nearly 20 years? In June 1995, eight patients infected with the virus in the Democratic Republic of Congo – then known as Zaire – were transfused with blood from survivors of the disease. The fatality rate during the six-month outbreak was 80 per cent. But of those eight people who received survivors’ blood, only one died.
In an account of the case published in The Journal of Infectious Diseases, the authors speculated that the transfusions may have boosted patients’ immune response by exposing them to antibodies from those who fought off the disease.
Two decades later, their theory is being hurriedly put to the test as medics scramble for a response to the worst Ebola epidemic in history.
When Kent Brantly, right, a US aid worker, was flown back to Atlanta in June after contracting Ebola in Liberia, much of the focus was on his treatment with an experimental drug called ZMapp. However, he also received blood donated by a 14-year-old male Ebola survivor he had cared for. Dr Brantly survived and has since donated his blood to two other infected Americans: Rick Sacra, a fellow aid worker, and Ashoka Mukpo, a photojournalist.
“We’re trying to jump-start the immune system, and hopefully just buy some time,” says Phil Smith, the lead doctor treating Mr Mukpo in a biocontainment unit at an Omaha hospital.
If all three men survive it will add to the evidence in support of using survivors’ blood as a cure for Ebola. But it will be impossible to know for sure whether it was the transfusion, various experimental drugs or sheer good luck that saved them.
Carrying out clinical trials would be fiendishly difficult in a fast-moving Ebola outbreak in some of the world’s poorest countries. That is why the World Health Organisation gave its blessing to experimental treatments, including transfusions, to be used without formal testing.
But such an approach is not without risks. There have been reports of a black market developing in the blood of Ebola survivors, opening a range of health risks if patients receive a type that is incompatible with their own or infected with another disease such as HIV. Andrew Ward
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