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Wednesday, September 24, 2014

New effort to fight Ebola in Liberia would move infected patients out of their homes




September 22 
Looking for a new approach to blunt the Ebola epidemic sweeping West Africa, the Liberian government, the World Health Organization and their nonprofit partners here are launching an ambitious but controversial program to move infected people out of their homes and into ad hoc centers that will provide rudimentary care, officials said Monday.
The effort, which is expected to begin in the next few weeks, is an intermediate step, officials said. The goal is to reduce the chances that Ebola patients will infect their own families and others while ensuring that they receive basic care — such as food, water and pain medicine — at a time when many hospitals and treatment centers are closed.
The initiative also is a tacit acknowledgment that it could be weeks, even months, before new treatment facilities promised by the United States and others are operational. Continued reliance on home-based care doesn’t do much good, officials said, in taming a devastating epidemic in a country where large groups of people live in crowded, urban settings.
The proposed community care centers, as they are dubbed by officials, would have between 15 to 30 beds. Ultimately, as many 70 centers could be set up across Liberia, if the strategy proves successful. Such a program has never been tried on such a large scale.
A similar effort is being discussed for Sierra Leone.
The 10 Ebola treatment centers in West Africa are based on a design of three wards, which help separate patients suspected of having the disease from patients with a certain diagnosis. Ebola care units would have two wards (one each for both suspected and confirmed cases), with a few beds per ward and a triage zone.
The total number of cases of Ebola in West Africa is doubling every three weeks, with each person with the virus infecting as many as two other people, health officials say. That high rate of transmission is making it impossible to contain the worst Ebola outbreak on record.
The new treatment beds promised by Washington and others “are not coming fast enough,” Peter Graaf, the WHO’s country representative in Liberia said Monday. “We have to get to the point where every Ebola patient infects less than one [other person]. You have to get out of your house.”
The community care centers are supposed to complement the recently announced U.S. military effort to build facilities for 1,700 Ebola patients across Liberia, as well as ongoing efforts by other groups to provide several hundred beds. There are now slightly more than 380 beds in Monrovia, which has a population of 1.5 million people.
One of the main organizations involved in fighting the outbreak, Doctors Without Borders, is dubious about the new effort and has decided not to take part. Brice de le Vigne, the group’s director of operations, warned that the proposed community care centers could worsen the situation.
“This is not going to work,” he said. “To move people in an epidemic is a big responsibility, and it requires huge logistical capabilities” that the affected countries simply don’t have.
To be effective, he said, these care centers need to have strict infection control, adequate supplies, trained staff, regular supervision, the ability to diagnose and refer patients, and proper burial methods. Otherwise, they could turn into “contamination centers,” he said.
De le Vigne said the top priority should be deploying more trained staff to run the higher-level treatment centers in hospitals and clinics.
Nearly 6,000 people in West Africa have been infected with the virus, and 2,833 have died, the WHO says. Liberia, the hardest-hit nation, has had more than 3,000 infections and 1,578 deaths, according to the latest WHO data.
But this laboratory-confirmed case count is well below the actual number of people infected, according to the WHO and global health experts. Doctors Without Borders, for example, has said that number represents only 20 percent of the current caseload, meaning the true number of cases could be in the tens of thousands.
“I think the message is that this outbreak isn’t going to turn around until we get people out of their homes and into safe places,” said Frank Mahoney, who is leading the team from the U.S. Centers for Disease Control and Prevention here.
No one would be relocated to the community care centers against his or her will. A draft report by the WHO stresses the need to work cooperatively with communities that want to isolate individuals who are infected or suspected of being infected. The project is aimed at people who are showing symptoms of the disease but are not in the later stages of the illness. Patients would get food, water, sanitation, analgesics and other necessities.
The care centers would be located in former health clinics or other medical facilities, many of which have closed, according to the WHO’s Graaf.
In contrast to the basic-care community centers, the medical facilities that provide special Ebola treatment — including the ones the United States and others will be setting up — provide a higher level of care and a better-trained staff.
Because many people with Ebola are being cared for at home, efforts are underway to distribute as much chlorine and as many rubber gloves, buckets and other hygiene items as possible. But officials say such steps don’t go far enough.
In a few locations here, residents already have started a version of the community-care program on their own, moving infected people into, for example, a shuttered school and attempting to feed and care for them without becoming infected themselves.
As envisioned, the new plan would be a somewhat more sophisticated alternative to that, including testing to determine whether a person has Ebola, anti-malarial drugs, infection control and body removal and cremation or burial. Each person moved into the center would be accompanied by a family member or friend charged with taking care of him or her; that relative would be supplied with protective gowns and gloves and taught their proper use.
Graaf said setting up the facilities, supervising them and getting the word out will be labor-intensive. He declined to say how much the plan would cost, saying those figures have not been finalized.
De le Vigne of Doctors Without Borders said the hardest-hit countries don’t have the infrastructure to put in place the logistics, discipline and clear chain of command needed for the community centers to work properly, especially when patients become sicker and need the higher level of medical care available at treatment centers.
“Once you start to vomit blood or have bloody diarrhea, you need to have properly trained medical staff and sanitation to be able to handle these super-infected cases,” he said...  http://www.washingtonpost.com/national/health-science/new-effort-to-fight-ebola-in-liberia-would-move-infected-patients-out-of-their-homes/2014/09/22/f869dc08-4281-11e4-b47c-f5889e061e5f_story.html

Liberians Explain Why the Ebola Crisis Is Way Worse Than You Think

Liberians Explain Why the Ebola Crisis Is Way Worse Than You Think

What life is like at the epicenter of the outbreak.

| Wed Sep. 24, 2014 11:52 AM EDT


Health workers in Liberia haul away the body of a person suspected of dying of Ebola
As of this week, the Ebola outbreak in West Africa is known to have infected more than 5,700 people and taken more than 2,700 lives. Yet those figures could be dwarfed in the coming months if the virus is left unchecked. On Tuesday, the Centers for Disease Control and Prevention reported that the total number of infections could reach 1.4 million in Liberia and Sierra Leone by January 2015. Though cases have been reported in five countries, nowhere has been harder hit than Liberia, where more than half of the Ebola-related deaths have occurred.
More MoJo coverage of the Ebola crisis.

The outbreak has crippled Liberia's economy. Its neighbors have sealed their borders and shipping has all but ceased, causing food and gas prices to skyrocket. Schools and businesses have closed down, and the country's already meager health care system has been taxed to the breaking point. Meanwhile, as panic grips the country, crime has risen steadily and some reports suggest that Liberia's security forces are among the perpetrators. To get a picture of how dire the situation is on the ground, we got in touch with Abel Welwean, a journalist and researcher who lives outside of Monrovia. He conducted a handful of interviews with Liberians in his neighborhood in the second week of September and also provided his own harrowing story of what life is like in the country.
The outbreak has forced many Liberians to stay indoors and avoid interacting with other people. Since the virus can be caught merely by touching the sweat of an infected person, once-common forms of physical contact, like handshakes, have become rarer.
Frances (a university student): Football has been suspended in our country. We are sitting at home just doing nothing—all in the name of protecting ourselves. It is hurting us, but we have to play the safe rules, because we value our own lives.
Abel: I don't wear short sleeve shirts to step outside my house. I keep my children in my yard throughout the day. I make sure we wash our hands periodically. We do not shake hands with anybody outside of our house. We do not entertain visitors in our house… These behaviors are very strange amongst Liberians… Shaking hands is our one of the cultural values that we have. Liberia may be poor and not willing to be developed, but we are friendly people who believe in shaking hands in a special way, and eating together from the same bowl.
Frances: Schools are closed for time indefinite. We don't know when schools will open. We are sitting at home, watching and praying that school will open sooner. Rumors are coming that schools will open next year— we don't know. What I think the youth can do now is to get on our feet and educate the common man, those that are still in the denial stage, to sensitize them, give them the actual information about this Ebola virus, let the youth get on their feet from house to house, door to door, and try to inform the populace about the deadly Ebola virus, and how it can be prevented.
Abel: I worry a lot about the future of our children's education. I was at the verge of paying my children's tuition when the government announced the closure of all schools in the country. For now, I am my children's tutor at home.
"We are urging the international community to come to our rescue, for the downtrodden, because pretty soon there will be another war, and that will be the hunger war."
When the epidemic struck Liberia, a number of hospitals closed, often because their staffs had fled in fear. Adding to the problem, Ebola's symptoms mimic other, still common diseases, but treating anything that resembles Ebola necessitates protective gear that's not always available outside the quarantine centers. That means that many people who are suffering non-Ebola illnesses are going untreated.
Esther (a nurse and midwife): Before, August, September were months we had diarrhea cases in Liberia. But right now, the symptoms of Ebola and malaria are all the same. It's very, very difficult to know an Ebola patient from malaria, so it's very, very difficult to treat any patient in that direction.
Frances: Many were afraid that if you have malaria, you have common cold, you have fever, you go to the hospital, they would diagnose you as an Ebola patient... I even got sick during the outbreak. I was afraid to go to the hospital. I had to do my own medication, but God looked out for me. I'm well. But these were the messages that were going around, that once you have this, they will confine you to a place, they will quarantine you for 21 days, they will inject you. So many Liberians were afraid to go to hospitals. But now the message has spread out. We now know people are surviving of Ebola. Even if it is not Ebola, you just have malaria, you go there, you are treated. They get you tested; they release you on time.
Brooks (an American who was working at the Accountability Lab, an anti-corruption NGO, in Monrovia and has since left the country): Even in July, you heard stories of pregnant women going into labor, bleeding profusely, and not being tended do because people were afraid of Ebola.
Esther: As a midwife, most of the time I have to do deliveries. But right now, as we sit here, this clinic is closed. These are cases that could be treated, but since we don't have the proper equipment, the proper outfits to wear and treat our patients and do tests [for Ebola], we decided to stay away from treating patients, because you don't know who you are touching. Obviously, it's a kind of embarrassment, but we have to go through with it for now.
Before it spread to Monrovia, Ebola struck in Lofa County, Liberia's rice-producing center. Many farmers avoided their fields, severely hurting domestic food production. Food imports (the country imports about two-thirds of its grain supply) have also been hampered because of the crisis. Borders with neighboring countries have been closed, and shipping companies have avoided the nation's ports. All of that has led to the biggest increases in food prices since the nation's civil war, which ended in 2003. In a country where 84 percent of everyone lived on less than $1.25 per day in 2011, this shock has become its own crisis.
Esther: There were times, we were paying, for a 25-kilo [55 pound] bag of rice, we were paying something like 1,150-1,250 [Liberian dollars, or $14 to $15], but right now it's like 1,500 [$18].
John (a Liberian employee of the International Committee of the Red Cross): I see so many people, sometimes they are walking to town [about six miles]. Even if they have money, they prefer walking a distance and saving the money to buy food so they will eat for the day. We tend to be afraid to assist someone from the vehicle, even to tell them the distance they are going, because we don't know who is carrying the virus.
Lawrence (the Liberia country director for Accountability Lab): Hunger is really hitting the country… If the ships are not coming, [farmers] are not making rice, the stockpiles are depleted…the animals are eating the crops, what happens then? The production will decrease, the price will increase, and if you don't have money, what is going to happen? Hunger is going to strike… This is a serious war, without bullets.
It's not just a rise in food prices that Liberians are struggling with; transit costs have increased as well, partly because the government has forbidden commercial vehicles from carrying large numbers of people. Markets have been shut down; NGOs and companies are asking employees to stay at home; schools are closed so teachers are not working. On September 17, the World Bank warned that Ebola could cut Liberia's GDP by 3.4 percentage points, costing $228 million by 2015.
Esther: In my own clinic, I have a staff of twelve. But right now, everybody has to be home until otherwise. Since we don't have protective gear, we don't have anything to work with, we cannot risk our own lives, because if you are not able to protect yourself, you will not able to work with other people. It will be difficult for their families.
Frances: It is better for us to stay at home, but we need, also, to have our daily bread. The international community, international donors, need to come to our rescue, because hunger is taking over Liberia, gradually.
Abel: I have gone out of job because of the Ebola outbreak. Before the outbreak, I had contracts with Princeton, PBS Frontline, Nursing For All, and the Gender Ministry. All of my contracts are on hold until the crisis is over.
The statistics are unreliable, but many report that violent crime is rising since the outbreak began. Even more troubling: some of these crimes have reportedly been at the hands of police and soldiers in uniform. Some Liberian's blame the government's curfew for the problem.
John: Armed robbery is increasing because the government placed this curfew from 9 [p.m.] to 6 AM. Before, there used to be community watch teams. At that time, there was no curfew.
Abel: Our lives were relatively peaceful before the deadly outbreak of the Ebola virus. We could go out any hour and return any hour. There were robberies once in a while, but not compared to the recent ones… I do not know if the proliferation of robberies was political or some criminals just decided to take advantage of the situation.
There have been numerous cases of armed robberies since the curfew was announced… There was one in my community and my neighbors were badly affected. I was really afraid that night when I heard the bullet sound. At that time my family and I were watching movie in the living room. We got scared so much that we couldn't continue the movie. We turned the video off, turned all the lights in the rooms off and went to bed. Fortunately for me, those police officers that came to rescue my neighbors were my friends. They came to my house that night to see how my family and I were doing. [Later, I learned] the robbers wore police uniforms and were fully armed.
Esther: I was a victim about four days ago. I just left my back door open to hang clothes in the front. By the time I was back in, someone had snuck in and took the two phones I had charging. Because the children are not in school, most of the young ones are turning to crime—and not just the young ones, even people who were working and they are not able to work now, some of them are thinking, how do they maintain their families? They are collaborating with some of these criminals to get their way through.
Frances: Liberia is declining, the economy is declining, and things are just getting difficult on a daily basis. We are not free to move around, we are not free in our own country because of this deadly Ebola virus. We are urging the international community to come to our rescue, for the downtrodden, because pretty soon there will be another war, and that will be the hunger war. http://www.motherjones.com/politics/2014/09/ebola-crisis-liberia-way-worse-you-think

Ebola Cases Could Reach 1.4 Million Within Four Months, C.D.C. Estimates


By DENISE GRADYSEPT. 23, 2014

Yet another set of ominous projections about the Ebola epidemic in West Africa was released Tuesday, in a report from the Centers for Disease Control and Prevention that gave worst- and best-case estimates for Liberia and Sierra Leone based on computer modeling.

In the worst-case scenario, the two countries could have a total of 21,000 cases of Ebola by Sept. 30 and 1.4 million cases by Jan. 20 if the disease keeps spreading without effective methods to contain it. These figures take into account the fact that many cases go undetected, and estimate that there are actually 2.5 times as many as reported.

In the best-case model, the epidemic in both countries would be “almost ended” by Jan. 20, the report said. Success would require conducting safe funerals at which no one touches the bodies, and treating 70 percent of patients in settings that reduce the risk of transmission. The report said the proportion of patients now in such settings was about 18 percent in Liberia and 40 percent in Sierra Leone.

The caseload projections are based on data from August, but Dr. Thomas R. Frieden, the C.D.C. director, said the situation appeared to have improved since then because more aid had begun to reach the region.

“My gut feeling is, the actions we’re taking now are going to make that worst-case scenario not come to pass,” Dr. Frieden said in a telephone interview. “But it’s important to understand that it could happen.”

Outside experts said the modeling figures were in line with estimates by others in the field.

“It’s a nice job,” said Ira Longini, a professor of biostatistics at the University of Florida who has also done computer modeling of the epidemic. “It summarizes the extent of the problem and what has to happen to deal with it.”

Bryan Lewis, an epidemiologist at the Virginia Bioinformatics Institute at Virginia Tech, agreed that the estimates were reasonable, perhaps even a bit low compared with those generated by other models. He said that if some of the latest data from the World Health Organization is plugged into the C.D.C. model, “the very large numbers of estimated cases are, unfortunately, even larger.”

The current official case count is 5,843, including 2,803 deaths, according to the W.H.O.

The C.D.C. estimates omit Guinea, which has been hit hard, because the epidemic struck in waves that could not be modeled.

The W.H.O. published its own revised estimates of the outbreak on Monday, predicting more than 20,000 cases by Nov. 2 if control does not improve. That figure is more conservative than the one from the C.D.C., but the W.H.O. report also noted that many cases were unreported and said that without effective help, the three most affected countries would soon be reporting thousands of cases and deaths per week. It said its projections were similar to those from the C.D.C.

The W.H.O. report also raised, for the first time, the possibility that the disease would not be stopped but could become endemic in West Africa, meaning that it could become a constant presence there.

President Obama’s promise last week to send 3,000 military personnel to Liberia and to build 17 hospitals there, each with 100 beds, was part of the solution, Dr. Frieden said. But it was not clear when those hospitals would be ready, or who would staff them.

Dr. Frieden said the Defense Department had already delivered parts of a 25-bed unit that would soon be set up to treat health workers who become infected, a safety measure he said was important to help encourage health professionals to volunteer. He said that more aid groups were also arriving in the region to set up treatment centers, and that a “surge” of help would “break the back of the epidemic.”

Monrovia, the Liberian capital, is facing a widespread Ebola epidemic, and as the number of infected grows faster than hospital capacity, some patients wait outside near death.
Dr. Jack Chow, a professor of global health at Carnegie Mellon University and a former W.H.O. official, said, “The surge only becomes realized when those beds are up and operating and the workers are delivering care.”

He added, “If even the medium case comes to pass, with, say, 700,000 cases by January, the epidemic will quickly overwhelm the capabilities that the U.S. plans to send.”

The W.H.O. reported that a new center had just opened in Monrovia, the Liberian capital, with 120 beds for treatment and 30 for triage. Patients were already lined up at the door.

The report from the C.D.C. acknowledged that case counts were rising faster than hospital beds could be provided. It said that in the meantime, different types of treatment would be used, based in homes or community centers, with relatives and others being given protective gear to help prevent the disease from spreading.

The United States government is also sending 400,000 kits containing gloves and disinfectant to Liberia to help families take care of patients at home.

At least one aid group in Liberia is already shifting its focus to teaching people about home care and providing materials to help because there are not enough hospital beds for the sick. Ken Isaacs, a vice president of the group, Samaritan’s Purse, said, “I believe inevitably this is going to move into people’s houses, and the notion of home-based care has to play a more prominent role.”

“Where are they going to go?” he said.


Though providing home-care kits may seem like a pragmatic approach, some public health authorities said they were no substitute for beds in isolation or containment wards.

But Dr. Frieden said that home care had been used to help stamp out smallpox in Africa in the 1960s. The caregivers were often people who had survived smallpox themselves and were immune to it. Some experts have suggested that Ebola survivors might also be employed to care for the sick.

Dr. D. A. Henderson, who led the W.H.O.’s smallpox eradication program, said that local people had been paid to help in the campaign.

“We recruited a lot of people to stand guard at huts with smallpox,” said Dr. Henderson, a professor at the Johns Hopkins Bloomberg School of Public Health and the University of Pittsburgh. “The important thing was to know they got paid.”

He added: “We gave money and food to families who had smallpox so they didn’t have to go out and beg, and they didn’t have to go to the market and potentially infect people. What can you do? If you don’t have food, you’ve got to leave the house and go out. Money can play a useful role.”


Donald G. McNeil Jr. contributed reporting.

http://www.nytimes.com/2014/09/24/healt ... .html?_r=0

Local hospital puts Ebola action plan in place

 Tue 6:48 PM, Sep 23, 2014
By: Laura Warren

News 12 at 6 o' clock/ September 23, 2014
AUGUSTA, Ga. (WRDW) -- The head of the CDC says the Ebola epidemic is spiraling out of control in Africa. Now, the organization is asking US hospitals to prepare in the event of an Ebola outbreak where you live.
Georgia Regents Medical Center is waiting for a shipment of protective goggles, boot covers, and hoods. It's one of the precautions they're taking in case the CDC's fears become reality.
"It's spiraling out of control. It's bad now, it's going to get worse in the very near future," Dr. Thomas Frieden, the CDC director, said.
That's why they're urging hospitals around the country to prepare in case Ebola spreads to our borders.
"Before we actually had our plan in place, we were seeing patients who had spent time in Africa, including West Africa, who had returned with symptoms, just not fever," Dr. Peter Rissing, the Epidemiologist at Georgia Regents Medical Center, said.
So far, there have not been any confirmed cases of Ebola at GRU, but Dr. Rissing says, their team now has a plan in place.
"It was actually put together in conjunction with the same emergency room physicians who had to deal with the first couple of patients without a plan," Dr. Rissing said.
And, after treating Ebola patients in a trial by fire style, the doctors at Emory had a few suggestions.
"Additional insight from folks inside that system would suggest it wasn't all quite as well organized as it might have seemed," Dr. Rissing said.
GRU's plan begins with identifying patients with Ebola symptoms quickly, and getting those patients isolated as soon as possible. It also covers everything from containing blood samples, to training staff how to handle contaminated gear.
GRU is sharing the plan with first responders, like Gold Cross, all to be prepared, no matter what comes our way.
GRU says they've shared their plan with several other area hospitals who have asked for it. Dr. Rissing also says some local doctors have been asked to head to Africa to help fight the outbreak. http://www.wrdw.com/home/headlines/Local-hospital-puts-Ebola-action-plan-in-place-276838511.html

These Maps Show How Ebola Spread In Liberia


| Wed Sep. 24, 2014 6:00 AM EDT
Last Tuesday, the White House announced plans to send 3,000 US troops to the country to coordinate medical care and deliver humanitarian aid. Their command center, and much of their work, will be in Monrovia. But as the maps below show, controlling the disease in and around the sprawling city will not be an easy task. This first map shows the spread of the disease in the capital region as of September 11 (areas colored in darker shades of blue have reported more Ebola infections):
Liberian Ministry of Health and Social Welfare
This second map shows the spread of the disease in the capital region as of September 20—just nine days later. Note the spread of the dark blue:
Liberian Ministry of Health and Social Welfare
When the current outbreak of Ebola first reached Liberia, there were only two known cases of the disease anywhere in the country. Both infections were far from the West African nation's capital, Monrovia. But the virus spread rapidly. In mid-June, health workers discovered the first evidence the disease had spread to the capital: the bodies of seven people, including a nurse and four of her family members.
As of Sunday, 1,232 people are believed to have been infected in Monrovia's Montserrado County— more than a third of Liberia's total cases to date, according to Liberia's health ministry. The disease is believed to have killed 758 people in the county, including 33 health workers. Conditions will almost certainly get worse. On Tuesday, the US Centers for Disease Control and Prevention issued a report stating that a worst-case scenario for the disease could bring the number of infected in Liberia and Sierra Leone to 1.4 million by January 2015.  http://www.motherjones.com/mojo/2014/09/these-maps-show-ebolas-spread-in-around-liberias-capital

DRC: Ebola cured 27 patients

| Last Update September 24, 2014 at 8:32

Minister Kabange Numbi and his delegation visited the General Referral Hospital Wangata Mbandaka to talk with health professionals | Photo: WHO / Eugene Kabambi. Minister Kabange Numbi and his delegation visited the General Referral Hospital Wangata Mbandaka to talk with health professionals | Photo: WHO / Eugene Kabambi.
Twenty-seven people with Ebola virus Djera (Ecuador) are cured, said Tuesday, Sept. 23 medical advisor to the Minister of Health, Dr Roland Shodu Lomani Radio Okapi. "In 68 cases, if you subtract 41, we have 27 cases were treated by us and heal," said he said. Medical adviser to the Minister of Health explained that the problem [the epidemic] is not as strong in the DRC "because the country has the mastery of the situation. The government has put substantial resources to start the response, he said.
Dr. Roland Shodu Lomani also regretted "the lack of interest in the international community about the epidemic [Ebola] raging in the DRC." He still hopes that the international community "will change his mind to return to the Congo" to support the efforts of the government. Dr. Roland Shodu Lomani recognizes, however, that some donors have helped to combat Ebola outbreak.
The Ebola outbreak was declared last August. 68 cases have been recorded since the beginning of the disease, including 41 deaths including 8 health workers. 
 https://translate.googleusercontent.com/translate_c?depth=1&hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=auto&tl=en&u=http://radiookapi.net/actualite/2014/09/24/rdc-27-malades-debola-gueris/&usg=ALkJrhhFiOjEUJV3qajvWQubWefyhZd57w#more-191560

Ebola: 20,000 cases in November if the situation remains the same

In a study published by the "New England Journal of Medicine", the World Health Organization (WHO) warned on September 23 that over 20,000 people will be infected with Ebola virus in early November if the control measures the epidemic are not reinforced in West Africa.
"Assuming there is no change in measures of controlling the epidemic", there will be 9,939 cases in Liberia, Guinea in 5925 and 5063 in Sierra Leone, experts say the WHO.
"Without a drastic improvement measures", there will be in the coming months, not "hundreds" of cases and deaths each week, but "thousands" they added, noting that the fatality rate of people with virus stands at 70.8%. If nothing is done, Ebola likely to settle in the area for many years and become "endemic", according to experts.
Last week, the UN said 20,000 people rely on infected end of 2014 but the rate of exponential growth of the epidemic has worsened the forecast Scientists Call for More "quick" control measures, especially at funerals and to enhance early detection of cases.


Towards a "catastrophe" if nothing changes
"We are in a third phase of growth of the epidemic" that is "explosive," said Dr. Christopher Dye, one of the co-authors of the study and director of strategy at WHO, during a press conference in Geneva.
"If we do not stop the epidemic quickly, it will not be a disaster but a disaster," he said, adding that if the situation remains the same, Ebola could reach "hundreds of thousands" in the coming months.
He stressed that this epidemic, the worst in the history of this hemorrhagic fever identified in 1976, is "quite similar" to other epidemics have affected other African countries in recent years, such as the DRC and Sudan. "What is different, it is not the characteristics of the virus, but the nature of the affected people," he argued, pointing in particular as a factor in the contamination highly mobile populations.
>> Access our interactive map of 40 years of Ebola outbreaks in Africa by clicking on the video below:
The rapid transmission rate is also due to the slow response to Ebola early in the epidemic that the poor state of the health systems of the three main affected countries, he has acknowledged.
"In Nigeria, where the health system is stronger, the number of cases has been limited to date," said Christl Donnelly, a professor at Imperial College London and co-author of the study.
Dr. Christopher Dye also explained that it was difficult for the moment to take stock of the epidemic, since it appears to be stabilizing in some areas but has appeared in other districts that were spared far.
The experts also noted that the virus does not seem to know of mutation that could facilitate its spread by air, but Christopher Dye said it was "possible that this type of change can happen."  https://translate.google.com/translate?sl=auto&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=http%3A%2F%2Fwww.jeuneafrique.com%2FArticle%2FJA2802p014.xml0%2Fsante-oms-virus-epidemie-sante-ebola-chronique-d-une-panique.html&edit-text=

Double Blow Again: Two More Deaths in Shu-rina Chain


MonroviaTwo more relatives of the late Miss Liberia 2009/2010 Shu-rina Rose Wiah have succumbed to death just a week after she died of circumstances related to the deadly Ebola virus. Shu-rina died just few days after her sister, Sieanyene Toose Yuoh- Katty, lost her life to what family sources say, was complications from an appendix surgery.

The deaths are heightening calls for authorities to do speedy tests of corpses prior to cremating bodies amid growing fears that corpses from several suspected cases of Ebola are being cremated without actual confirmation that they died of the deadly Ebola virus.

The issue is poised for even more complications after Toose’s son, Kelvin Kels Toure, who has been quarantined along with his brother at the ELWA 3 MSF Ebola treatment facility, was reported dead Sunday. Oxford Wiah, a brother of Shu-rina who was quarantined along with Kels and Toose’s second son, also died Monday. Both deaths have not yet been confirmed to be Ebola by authorities and it is unclear whether the corpses would be or have already been cremated.

Toose died on Sunday, August 31, 2014 at about 5:28 PM and her remains deposited at the Samuel A. Stryker Funeral Home in Monrovia. A funeral was held on Thursday, September 11, 2014 at 10:00 am and she was buried at the 1st Baptist Church cemetery, oldest Congo Town Back Road.

Although there have been fears that her death was related to Ebola, that has not been proven as there has not been any incident at the Stryker Funeral Home which processed Toose’s body.

Her Sister, Shurina shockingly died on Tuesday, September 15, 2014. Shurina’s mother Rev. Mother Rosie Dillon-Wiah told FrontPageAfrica Tuesday that her daughter had not died from Ebola as was widely speculated on the social media Facebook and in Monrovia. “She did not die from Ebola.”

‘This is Depressing’

The mother explained that "Shurina had not eaten for a week, that’s why she was weak and she died. When they came for the body, they asked whether she had sore mouth, I said no. She was not vomiting, not bleeding. Then they told us that we had called the wrong rescue team and they took the body away, but there was no sign of Ebola on Shurina, I swear. They collected the body and never tested the body. They said we called the wrong team, the burial team when we should have called the testing team first,” Mother Rosie lamented.


A relative citing one of the nurses, posted on Facebook Monday that Kelvin, whose aunt, is the late Shu-rina, was not responding to treatment at ELWA and kept saying he was getting ready for his mom’s funeral. “This is depressing. RIP Family!”

Some family members have suggested that Kelvin was depressed over his mother’s loss and are ruling out Ebola as a cause of death. Others are not so sure. “They (authorities are not communicating with the families. So they do not know whether they died from Ebola or whether their bodies have been cremated already. We don’t know.”
But even if Kelvin did die of Ebola, family members continue to scramble for answers as to where he may have gotten infected amid uncertainty over how Shu-rina died as no tests were done prior to her cremation and her mother’s insistence that she did not die of the deadly virus.

">Another sister of Shu-rina has since been discharged from JFK treatment facility after showing no signs of Ebola. Rev. Mother Rose Wiah, Shu-rina’s mom and several other family members, including Toose’s second son, are still under quarantined.

Several dignitaries, family and friends who attended Toose’s funeral have been concerned amid fears that family members were quarantined after Shu-rina’s death.

The deaths of a further two family members are triggering more fears. Associate Justice Sieanyene G. Yuoh, Toose’s aunt is still in good spirits and said she is showing no signs of the Ebola virus as is being widely speculated in Monrovia.

Speaking to FrontPageAfrica Friday from Nashville, Tennessee, the United States of America, Associate Justice Yuoh, who was among several dignitaries who attended Toose’s funeral, said she reported herself to the hospital as soon as she learned of Shurina’s death.

"I reported myself when I got here and I have no symptoms for ten days. I’m running no fever, my life is not at risk, and my children’s lives are not at risk. I have been walking every hour by the grace of God, I am fine."

Fresh Graves Point to Undercount of Ebola Toll


Photo
James Hamilton said of burying Ebola victims in Sierra Leone, “We will need much more space.” Credit Samuel Aranda for The New York Times
FREETOWN, Sierra Leone — The gravedigger hacked at the cemetery’s dense undergrowth, clearing space for the day’s Ebola victims. A burial team, in protective suits torn with gaping holes, arrived with fresh bodies.
The backs of the battered secondhand vans carrying the dead were closed with twisted, rusting wire. Bodies were dumped in new graves, and a worker in a short-sleeve shirt carried away the stretcher, wearing only plastic bags over his hands as protection. The outlook for the day at King Tom Cemetery was busy.
“We will need much more space,” said James C. O. Hamilton, the chief gravedigger, as a colleague cleared the bush with his machete.
The Ebola epidemic is spreading rapidly in Sierra Leone’s densely packed capital — and it may already be far worse than the authorities acknowledge.
Since the beginning of the outbreak more than six months ago, the Sierra Leone Health Ministry reported only 10 confirmed Ebola deaths here in Freetown, the capital of more than one million people, and its suburbs as of Sunday — a hopeful sign that this city, unlike the capital of neighboring Liberia, had been relatively spared the ravages of the outbreak.
Video
Play Video|4:51

Burial Boys of Ebola

Burial Boys of Ebola

In Sierra Leone, a group of young men take on the dirtiest work of the Ebola outbreak: finding and burying the dead.
Video Credit By Ben C. Solomon on Publish Date August 23, 2014.
But the bodies pouring in to the graveyard tell a different story. In the last eight days alone, 110 Ebola victims have been buried at King Tom Cemetery, according to the supervisor, Abdul Rahman Parker, suggesting an outbreak that is much more deadly than either the government or international health officials have announced.
“I’m working with the burial team, and the first question I ask them is, ‘Are they Ebola-positive?’ ” said Mr. Parker, adding that the figures were based on medical certificates that he had seen himself. The deaths are carefully recorded by name and date in a notebook headed “Ebola Burials.”
A burial team supervisor who drove up with fresh bodies echoed Mr. Parker’s assertion. “Any body we collect is a positive case,” said Sorie Kessebeh. “All the bodies that we are bringing in are positive.”
Beyond the many worrisome trends in the Ebola epidemic seizing parts of West Africa — the overflowing hospitals, the presence of the disease in crowded cities, the deaths of scores of health workers trying to help — another basic problem has stymied attempts to contain the disease: No one seems to know how bad the outbreak really is.
The World Health Organization acknowledged weeks ago that despite its efforts to tally the thousands of cases in the region, the official statistics probably “vastly underestimate the magnitude of the outbreak.”
Photo
The grave of Marion Seisay at King Tom Cemetery in Freetown, Sierra Leone. Area residents say animals dig near the graves, creating dangers for the living. Credit Samuel Aranda for The New York Times
Here in Sierra Leone, the government just finished an aggressive national lockdown to get a handle on the epidemic, ordering the entire country to stay indoors for three days as an army of volunteers went door to door, explaining the dangers of the virus and trying to root out hidden pockets of illness.
Still, the Health Ministry spokesman insisted that the epidemic was not as bad as the flow of bodies at the cemetery suggested.
“It is not possible that all of them are Ebola-related deaths,” said Sidie Yahya Tunis, the Health Ministry spokesman, saying the corpses included people who died of other causes.
But as the cemetery records show, the challenge facing the government might be of a different magnitude than previously thought.
The majority of the recent deaths recorded at the cemetery were young people — young adults, people in early middle age, or children — with very few elderly people on the list. Several of the deaths also occurred in a concentrated area, sometimes in the same house, suggesting that a virulent infection had struck.

King Tom Cemetery
1 Mile
Kolleh Town
Kroo Bay
SIERRA
LEONE
Freetown
Atlantic
Ocean
Freetown
At the house of Marion Seisay — the third name on the list — her son acknowledged she was a secretary at Wilberforce Hospital, had died of Ebola and was buried on Sept. 14. The house was now under quarantine, with some of its eight residents lingering on the cinder-block porch.
“The way my Mummy died was pathetic,” said the son, Michael Foday, clearly frustrated by the quarantine. “How do you expect us to get food?”
Other houses in Wilberforce Barracks, the village-like compound surrounding the hospital, were on the list of the dead and placed under quarantine, marked off from the surrounding jumble of shacks and cinder-block houses by a thin line of red or blue string.
In one of them, the house of Momoh Lomeh, the residents said that a total of five people who lived there had died of Ebola — yet four of them did not even appear on the cemetery list. At another, the house of Andrew Mansoray, a family member said that the disease had been ruthless and unrelenting.
“It wouldn’t stop,” Abdul R. Kallon said of the diarrhea that Mr. Mansoray, his brother-in-law, had endured before dying. “They took him to the hospital, and they wouldn’t let him out.”
Photo
A burial team removed the body of a man in Freetown believed to have died from Ebola. Credit Samuel Aranda for The New York Times
At another six households on the cemetery supervisor’s list of the dead, residents gave similar accounts. One family said the victim had definitely died of Ebola, while five others described Ebola-like symptoms — vomiting, diarrhea, fever — though none had been given an official cause of death.
International health experts here had no explanation for the striking discrepancy between the government’s tally of the dead in the capital and the cemetery crew’s statistics. Several of them noted the general confusion surrounding official statistics here from the beginning, with one leading international health official saying: “We don’t know exactly what is going on.”
But nobody disputed that things appear to be getting worse. The W.H.O. has shown a sharp increase in new cases in Freetown in recent weeks, rising from almost none early in the summer to more than 50 during the week of Sept. 14.
Various models of the growth of the epidemic here “all show an exponential increase,” said Peter H. Kilmarx, the head of the Centers for Disease Control and Prevention team in Sierra Leone. “The conditions are amenable to Ebola spread.”
The goal of the government’s national lockdown was to reach every household in the country, and officials claimed success in doing so on Monday, saying that progress had been made in the fight against the disease.
OPEN Graphic

But the exhaustion of the Ebola gravediggers at King Tom Cemetery, who dig as many as 16 graves a day, indicated that the disease was far from being contained.
“It’s a herculean task,” said Mr. Hamilton, the chief gravedigger. “It’s only out of patriotism that we are doing it.”
The Ebola victims were buried in an expanding stretch of fresh muddy graves under a giant cotton tree, and the makeshift arrangements are seen as a looming threat by the residents of the slum next to it. No barrier stops the pigs rooting in the adjoining trash field from digging in the fresh Ebola graves, which residents say they often do.
“We have creatures in the community, and they dig in the graves,” said Henry S. Momoh, who lives in the adjoining slum, which residents call Kolleh Town. “They are burying the Ebola patients in there, but not in the proper manner.”
Five yards from where the new graves begin, a well-used path connects the slum to the main road. Residents all use it, passing close to the freshly dug graves, and are frightened by the intensifying activity in the cemetery.

“Since last month, it’s every day, any minute and hour, and often, they are coming” to bury the Ebola dead, said Desmond Kamara, a police officer.
A cloudy stream drains from the area of the new graves into the slum, further frightening the residents.
“We are at risk, big risk,” said Ousman Kamara, a resident. “We have made many complaints.”
But the bodies, he said, keep coming.
“Even at night,” he said. “You stand here, and you see them coming.”
Correction: September 22, 2014
An earlier version of a picture caption with this article referred incorrectly to a possible victim of Ebola whose body is shown being removed from a house in Freetown, Sierra Leone. The body is that of a man, not a woman.  http://www.nytimes.com/2014/09/23/world/africa/23ebola.html?_r=1

Monday, September 22, 2014

"Ebola now in the Netherlands'

22 September 2014 to 13: 42

"Ebola now in the Netherlands'


A man from Eindhoven was recently hit by Ebola Sierra Leone.
A man from
Brabant Eindhoven may have the Ebola virus incurred. He volunteered Monday with the symptoms with a doctor in his hometown.

The man, according to the Eindhoven Dagblad been in Sierra Leone recently. That country has often to do with the virus. The doctor found that the symptoms of the man pointed to the infectious disease.


Nijmegen

Monday afternoon the man by ambulance to a hospital in Nijmegen transferred for further investigation.

http://www.powned.tv/nieuws/binnenland/2014/09/brabander_mogelijk_besmet_met.html

Dozens flock to new Liberia Ebola treatment center


September 22, 2014
Associated Press
MONROVIA, Liberia (AP) — Liberia's largest Ebola treatment center is already handling 112 patients, a day after it opened, though not all of are confirmed to have the dreaded disease.
Health officials said Monday that 46 people admitted to the Island Clinic Treatment Center have tested positive for Ebola. The remaining patients are being held for further observation and are being treated for other diseases, like malaria.
The 150-bed center opened Sunday, and ambulances rushed to its doors immediately. Liberia has been hardest hit by the Ebola outbreak sweeping West Africa.
According to new figures released Monday, the U.N. health agency says Ebola is believed to have sickened more than 5,800 people in Liberia, Sierra Leone, Guinea, Nigeria and Senegal. It is blamed for more than 2,800 deaths.  http://www.miningjournal.net/page/content.detail/id/611359/Dozens-flock-to-new-Liberia-Ebola-treatment-center.html?isap=1&nav=5016

Ebola Doctor Says Border Controls Critical


Here’s Where We Stand With Ebola


Even experienced international disaster responders are shocked at how bad it’s gotten.

140919_MEDEX_Ebola
Health workers push an Ebola patient who escaped from quarantine from Monrovia's ELWA Hospital into an ambulance in the center of Paynesville, Liberia, on Sept. 1, 2014. The patient, who wore a tag showing he had tested positive for Ebola, held a stick and tried to get away from doctors when they arrived on the scene attempting to catch him.
Photo by Reuters
It’s nine months into the biggest Ebola outbreak in history, and the situation is only going from bad to worse. The outbreak simmered slowly in West Africa from December 2013, when the first case was retrospectively documented, through March, when it was first recognized by international authorities. It began gaining momentum in June and throughout July. Now, terms like “exponential spread” are being thrown around as the epidemic continues to expand more and more rapidly. Just last week, an increase of 700 new cases was reported, and the case count is now doubling in size approximately every three weeks.
Already, the number of cases (approximately 5,300 as of Sept. 18) and deaths (2,630) has dwarfed the total number of cases and deaths from every reported Ebola outbreak in history—and those are only the cases that we know about. Here’s where we stand with Ebola right now.
The situation on the ground
By all accounts, it’s understandably miserable everywhere Ebola has hit, but even experienced international disaster responders have been shocked at how bad it has gotten. A Doctors Without Borders worker in Monrovia, Liberia, named Jackson Naimah describes the situation in his home country, noting that patients are literally dying at the front door of his treatment center because it lacks patient beds and assistance; the sufferers are left to die a “horrible, undignified death” and potentially infect others as they do so:
One day this week, I sat outside the treatment center eating my lunch. I saw a boy approach the gate. A week ago his father died from Ebola. I could see that his mouth was red with blood. We had no space for him. When he turned away to walk into town, I thought to myself that this boy is going to take a taxi, and he is going to go home to his family, and he will infect them.
When health care workers aren’t available, or when patients are too fearful to take loved ones to a clinic, it falls to those closest to the ill to nurse them. This has wiped out entire families, “prey[ing] on care and love, piggybacking on the deepest, most distinctly human virtues,” turning caregivers into victims as the virus passes among siblings and parents, from one generation to the next.
Health care workers who are treating the sick are dying because they also lack basic protective equipment, or because they have been so overwhelmed by taking care of the ill and dying that they begin to make potentially fatal errors. They have gone on strike in Liberia because they are not being adequately protected or even paid for their risky service. Hearses have been commandeered as ambulances; motorcycles are used to transport patients long distances, putting drivers at risk of becoming the next victim.
Fear and misinformation are as deadly as the virus itself. Eight Ebola workers were recently murdered in Guinea, in the area where the virus first came to the world’s attention in March. Liberia’s largest newspaper featured a story describing Ebola as a man-made virus being purposely unleashed upon Africans by Western pharmaceutical companies. Reports abound of doctors and other workers being chased away, sometimes violently, by fearful families. A second outbreak was triggered in Nigeria after an infected diplomat broke quarantine and fled from Liberia to Port Harcourt.
So far, other West African countries have been largely spared. Senegal experienced one imported case in late August, but to date other contacts have tested negative for the virus. Ivory Coast is watching closely and working to keep the virus out of the country. Perhaps the most extreme measures are currently being taken in Sierra Leone, where the country has been under a lockdown for three days to track cases of infection and minimize transmission. The country’s 6 million residents were ordered to stay indoors while volunteers went door-to-door to educate citizens, document new cases, and remove bodies.
The response
To date, nongovernmental organizations have largely been leading the fight against Ebola in West Africa. Doctors Without Borders (also known by its French name, Médecins Sans Frontières, or MSF) has led the international battle against Ebola, and where its workers have had success in the past, they have been completely overwhelmed now for months. MSF International President Joanne Liu has made multiple appeals to the United Nations, begging for additional assistance, noting on Sept. 16:
As of today, MSF has sent more than 420 tonnes of supplies to the affected countries. We have 2,000 staff on the ground. We manage more than 530 beds in five different Ebola care centres. Yet we are overwhelmed.  We are honestly at a loss as to how a single, private NGO is providing the bulk of isolation units and beds.
The plea has fallen on sympathetic ears, but the response has been slow and insufficient. The United States has answered the call to some extent, promising 3,000 military personnel and up to $750 million in aid. Even this massive amount is less than what the World Health Organization has called for: a minimum of $1 billion, and even that will only keep infections contained to the “tens of thousands.”
No one has sounded the alarm more clearly or critically than journalist Laurie Garrett, who wrote about Ebola in her 1995 book The Coming Plague. Writing for Foreign Policy, she has denounced the international response and lack of coordination, criticizing individual countries as well as the United Nations, World Health Organization, and the World Bank, noting that the world “just doesn’t get it” when it comes to Ebola.
The virus
If there can be a faint silver lining to this outbreak, it’s that researchers have been able to study the evolution of the virus in a way no previous Ebola epidemic has allowed. With thousands of cases documented to date, investigators have been able to track mutations in the virus’ RNA genome—and they found hundreds of mutations just in viruses examined before the publication of a paper in Science in August. In a tragic footnote, five of the authors of this paper died of Ebola during this outbreak.
While we do know that the virus is mutating, what remains murky is what those mutations are actually doing in patients. Genomic data itself is really only as good as the epidemiologic information that goes along with it, such as patient location, outcome of infection, symptoms exhibited, familial transmission patterns so it can be traced back between family members or members of the same geographic area, etc. Given that the outbreak has been so explosive and understaffed, much of this data may be lost, and it’s estimated that almost half of all those infected probably aren’t even reporting to hospitals—unfortunately limiting the conclusions of some of these genetic studies.
However, we do know that the risk that this outbreak may spawn an airborne Ebola virus is still incredibly tiny. Virologist Vincent Racaniello sums up the history of viruses mutating to a novel route of transmission, noting, “There is no reason to believe that Ebola virus is any different from any of the viruses that infect humans and have not changed the way that they are spread,” and that “the likelihood that Ebola virus will go airborne is so remote that we should not use it to frighten people.”
The big concerns
Even without an airborne form of Zaire Ebolavirus, we still have plenty to be concerned about. Models have suggested that this outbreak could go on for several more months at a minimum. The worst-case situation suggests that half a million cases are possible before the outbreak is finally brought under control. New research proposes that the current outbreak is so different from past Ebola epidemics that modeling is simply not informative, and “as a result, we are not in a position to provide an accurate prediction of the current outbreak.”
Besides the incredible potential number of lives lost, a huge concern is the destabilization of the affected countries—and even of those around them that have not shown any cases of Ebola. WHO Director-General Margaret Chan noted that this outbreak “is a social crisis, a humanitarian crisis, an economic crisis, and a threat to national security well beyond the outbreak zones.” Partly in response to the testimony of Chan and others, the United Nations announced the establishment of an emergency mission to fight Ebola. Countries were also asked to lift travel bans to the affected countries, which have made it more difficult to move supplies in and out of the area.
While 5,300 cases may not be a lot in the grand scheme of things, hospitals and clinics have been crippled, and mortality rates in these countries may be affected beyond just the Ebola virus. Patients who have other ailments, pregnant women looking to enter hospitals and clinics to give birth or to bring in ill children with non-Ebola-related diseases have been turned away. Crops are not being harvested or transported, making hunger an issue equal or greater to Ebola in many areas.
Finally, all of this is only examining the West African Ebola outbreak. Ebola also re-emerged in the Democratic Republic of the Congo in August; to date, there have been at least 60 cases in that country and 35 deaths. With all of the concern about West Africa, much less attention and aid has been given to the DRC, which has a much more extensive history of Ebola epidemics, mainly in rural areas. It is hoped that history and experience will more quickly bring the outbreak there under control.
The coming months
Even with massive international intervention, the situation will still worsen before it improves. The influx of funds and assistance from the United States and other countries is certainly welcome news, but it remains to be seen exactly how that will be allocated, who will be in charge, and how coordination will be established. This will be a long-term effort, and even after this Ebola outbreak has been extinguished, additional doctors and nurses will need to be trained to replace those that have been tragically lost in this epidemic. Some of Ebola’s victims will survive, but they and their families may face harsh stigma in their hometowns. It may take a year, but this fire from the pit of hell will eventually be extinguished. At what cost to human life, we do not know yet.  http://www.slate.com/articles/health_and_science/medical_examiner/2014/09/ebola_outbreak_status_and_predictions_the_virus_the_response_the_biggest.single.html