With Ebola continuing to spread in Guinea, Sierra Leone and Liberia, bringing the epidemic under control will require a massive deployment of resources by governments in West Africa and aid organizations, according to the international medical organization Médecins Sans Frontières/Doctors Without Borders (MSF), which also warned that it has reached the limits of what its teams can do.
Ebola patients have been identified in more than 60 separate locations across the three countries, complicating efforts to treat patients and curb the outbreak.
“The epidemic is out of control,” says Dr Bart Janssens, MSF’s director of operations. “With the appearance of new sites in Guinea, Sierra Leone and Liberia, there is a real risk of it spreading to other areas.”
'We have reached our limits'
MSF is currently one of the only aid organizations treating people affected by the virus, which can kill up to 90 per cent of those infected. Since the outbreak began in March, MSF has treated some 470 patients, 215 of them confirmed cases, in specialized centres set up in the region. However, MSF is having difficulty responding to the large number of new cases and locations.
“We have reached our limits,” says Janssens. “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.”
The scale of the current Ebola epidemic is unprecedented in terms of geographical distribution, people infected and deaths. There have been 528 cases and 337 deaths since the epidemic began, according to latest figures from the World Health Organization (WHO).
The challenge to raise public awareness
This is the first time that Ebola has broken out in the region, and local communities are still very frightened of the disease, viewing health facilities with suspicion. Meanwhile, a lack of understanding about how the disease spreads has seen people continue to attend funerals where infection-control measures are not implemented.
Despite the presence of a number of organizations working to raise awareness about the disease, their activities have not yet managed to reduce public anxiety about Ebola.
Meanwhile, civil society and political and religious authorities are failing to acknowledge the scale of the epidemic, with few prominent figures spreading messages promoting the fight against the disease.
“The WHO, the affected countries and their neighbouring countries must deploy the resources necessary for an epidemic of this scale,” says Janssen. “In particular, qualified medical staff must 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. Ebola is no longer a public health issue limited to Guinea: It is affecting the whole of West Africa.”
MSF on the ground
In Guinea, MSF is supporting the health authorities in delivering medical care for patients in Conakry, Télimélé and Guéckédou. Treatment units were built in Macenta, Kissidougou and Dabola. MSF teams are responding to alerts in villages, raising awareness in communities and offering psychological support to patients and their families. MSF is also giving support for epidemiological surveillance.
In Sierra Leone, working with the Ministry of Health, an MSF team is constructing a 50-bed Ebola treatment centre in Kailahun, due to open next week. Small transit care units have already been set up in Koidu and Daru, with a third to open soon in Buedu. MSF has also provided the Ministry of Health with supplies in order to support the construction of further treatment centres.
In Liberia, an MSF team has set up a treatment unit in Foya (in the north) and another in the JFK hospital in Monrovia in recent weeks. MSF has also organized training courses and donated equipment.
MSF currently has some 300 international and national staff working in Guinea, Sierra Leone and Liberia. It has sent more than 40 tons of equipment and supplies to the region to help fight the epidemic.
Ebola: the basics
Ebola refers to several strains of the same virus, first identified in humans in 1976 in Sudan and Democratic Republic of Congo (DRC), along the Ebola River. Ebola viruses produce devastating illnesses, most often leading to death. They cause hemorrhagic fevers, which lead to internal and external bleeding, similar to Marburg fever, which results from a related virus. There is no treatment and no vaccine.
Certain species of bats living in the tropical forests of Central and West Africa are thought to be Ebola’s natural reservoir. While they carry viruses, they show no symptoms and appear to contaminate large monkeys and humans through their droppings or bites. Humans can also catch the virus after contact with infected animals, dead or living, or from other infected persons.
The last Ebola epidemics killed several dozen people in late summer 2012 in Uganda and DRC. Although it is very dangerous, Ebola remains rare. Since the virus was discovered in 1976, approximately 2,200 cases have been recorded. Of those, 1,500 were fatal. However, sporadic cases and, even, epidemics have certainly gone undetected because they occur in very areas where people lack access to medical care.
Dr. Esther Sterk specializes in tropical diseases at Médecins Sans Frontières (MSF). She has worked on many missions, including several Ebola epidemics in Uganda and DRC, most recently in summer 2012.
What are Ebola’s distinctive features?
This is a rare disease. Epidemics are limited, but they create panic every time because Ebola is fatal in 25 to 90 per cent of cases. After an incubation period of two to 21 days, the virus causes a raging fever, headaches, muscle pain, conjunctivitis and general weakness. The next phase involves vomiting, diarrhea and, sometimes, a rash. The virus spreads in the blood and paralyzes the immune system. It is particularly formidable because the body does not detect these viruses right away. When the organism does respond, it is often too late. By then, the viruses have created blood clots, which block vital organs and cause major hemorrhages. Patients may have heavy bleeding, including from the nose or via their urine.
The disease is transmitted by contact with the fluids of infected people or animals, such as urine, sweat, blood or mother’s milk. Family members and healthcare workers treating patients are at great risk of infection. The high mortality rate and bleeding are so frightening that healthcare workers often flee, abandoning patients.
Funeral traditions in which family members wash the body of the deceased are also a major means of transmission in African communities.
How does MSF respond to Ebola epidemics, given that there is no treatment?
Although there is no cure for this disease, we can reduce its very high mortality by addressing the symptoms. This includes administering a drip to patients who have become dehydrated from diarrhea and by confirming that they do not have a different disease, such as malaria or a bacterial infection like typhoid. Vitamins and pain medication can also be useful. When the person loses consciousness and bleeds copiously, there is no hope. At that point, we ease the patient’s pain and stay with him until the end.
Once the first case is confirmed by a blood test, every person who cares for an infected patient must wear a hazardous materials ('hazmat') suit, gloves, a mask and protective goggles and exercise extreme caution when administering treatment. Decontamination chambers are generally installed between the isolated patients and the external environment. To confine the epidemic, it is critical to trace the entire transmission chain. All individuals who have had contact with patients who may be contaminated are monitored and isolated at the first sign of infection. The affected communities must also be informed about the illness and the precautions to be taken to limit risks of contamination. Basic hygiene – such as washing one’s hands – can significantly reduce the risk of transmission.
In recent years, MSF has been involved in nearly every Ebola epidemic.
What are the prospects for the fight against Ebola?
Although several countries are interested in it in connection with protecting against bacteriological warfare or bioterrorism, the research is limited. The small number of epidemics and patients restricts the investigations. To develop vaccines, you need a sufficient number of volunteers. Research is also underway on the origin of the virus and on bats, Ebola’s likely natural reservoir.
In recent years, MSF has been involved in nearly every Ebola epidemic. Other organizations have also been present, but we can provide our experience in treating cases. Considerable materiel is often required to isolate patients and prevent contamination among healthcare workers. We are also trying to improve our response to these epidemics. That is the key to success. You’ve got to act as quickly as possible as soon as the first case is confirmed. The challenge is that Ebola occurs in isolated areas and it takes time to identify the disease and alert the health authorities. In addition, the early symptoms resemble those of malaria. We are training healthcare workers so that they can respond quickly.