EpidemicsEbola epidemic in West Africa is “out of control”

Published 25 June 2014

Médecins Sans Frontières (MSF) has warned that the ebola epidemic in west Africa is “out of control” and will not be contained unless politicians, religious leaders, and aid agencies urgently improve their response to the unprecedented outbreak. The deadly disease is continuing to spread through Guinea, Sierra Leone, and Liberia, and the World Health Organization (WHO) says the outbreak has so far claimed 337 lives. WHO says that the confirmed, probable, or suspected cases stands at 528, with the disease identified in more than sixty locations across the three west African countries. The WHO said on Saturday that a failure by the authorities in Guinea to gauge the severity of the initial outbreak, and a subsequent relaxation of counter-measures, had created a “second wave” of the disease.

Médecins Sans Frontières (MSF) has warned that the ebola epidemic in west Africa is “out of control” and will not be contained unless politicians, religious leaders, and aid agencies urgently improve their response to the unprecedented outbreak.

The deadly disease is continuing to spread through Guinea, Sierra Leone, and Liberia, and the World Health Organization (WHO) says the outbreak has so far claimed 337 lives. WHO says that the confirmed, probable, or suspected cases stands at 528, with the disease identified in more than sixty locations across the three west African countries. Ebola kills up to 90 percent of those infected, and was first reported in Guinea in March.

“This is the tip of the iceberg,” said Robert Garry, a microbiology professor at the Tulane University School of Medicine who has been leading relief and investigation efforts in Sierra Leone for the Viral Hemorraghic Fever Consortium.

Dr. Mwayabo Kazadi, from the health unit for Catholic Relief Services, agreed that many cases could go uncounted and undiagnosed in the region, where Guinea, Sierra Leone and Liberia come together.

“When you don’t have a proper health system in place, it is pretty difficult,” Kazadi said.

Dr. Bart Janssens, MSF’s director of operations, said the organization had already treated 470 patients and was struggling to cope. “The epidemic is out of control,” he told the Guardian. “We have reached our limits. Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites.”

MSF said that civil society organizations and political and religious authorities in the three countries have so far failed to recognize the scale of the epidemic, and that prominent figures in those countries should do more to alert people about the disease and promote the fight against it.

These three countries have little if any public health, so infected individuals are cared for by their families, thus exposing family members to the infection. Moreover, as most of those infected die, their funerals become another source of infection since these traditional funerals, attended by hundreds of people each, have no infection-control measures in place.

Janssens said ebola now had to be viewed as a public health issue throughout west Africa. “The WHO, the affected countries and their neighboring countries must deploy the resources necessary for an epidemic of this scale,” he said. “In particular, qualified medical staff need to be made available, training in how to treat ebola needs to be organized and, contact tracing and awareness-raising activities among the population need to be stepped up.”

The WHO said on Saturday that a failure by the authorities in Guinea to gauge the severity of the initial outbreak, and a subsequent relaxation of counter-measures, had created a “second wave” of the disease.

When the epidemic started, it was a little underestimated, so that the states took a while to really prepare themselves,” said Pierre Formenty, a WHO specialist.

At the end of April, we started to see a decrease in the number of cases and we maybe saw a relaxation by the teams in the three countries, and this relaxation allowed things to restart. In addition, there were some problems with the affected populations which were sometimes not fully listened to.”

In an interview with AFP, Formenty said that the WHO, MSF, and others had enlisted dozens of experts but doctors alone would not be able to contain the epidemic.

The most important things are monitoring and communication,” he said. “States are getting better but the problems of communication continue. The medical corps on their own cannot stop this epidemic. It is only with the help of the population that we can fight this epidemic and stop it.”

Formenty admitted that more had to be done to explain the dangers of infection to those attending funerals or caring for the sick.

One case can restart an entire epidemic,” he said. “In an area where the quality of health services is not optimal, the populations have struggled to understand why we were asking them to make such an effort and probably we have not been able to explain both the disease and the means of control to the populations.”