A surge of fresh Ebola cases in Guinea's hot spots and continued widespread transmission in Sierra Leone have stopped a decline in cases, revealing persistent response challenges such as overcoming community resistance and tracing contacts, the World Health Organization (WHO) said today.
Global health officials have warned that the encouraging drop-off in Ebola cases over the past several weeks will be long and bumpy, and leaders of the US response to the outbreak today outlined changes that include a steep reduction in military involvement.
With 144 new Ebola cases reported last week, the overall incidence increased for a second week in a row, led by Guinea's large increase but moderated by a slight decrease in Sierra Leone and very few cases in Liberia. The WHO said the total number of confirmed, probable, and suspected cases in the three countries is 22,859, with the death toll rising to 9,162.
Response obstacles persist
Guinea reported 65 confirmed Ebola cases last week, up from 39 the week before. Cases increased for the third week in a row and were at their highest point since the first week of the year, the WHO said. Throughout the outbreak Guinea's patterns have been much more volatile than the other two countries.
The country's surge last week was led by cases in the western district of Forecariah and the capital, Conakry. Seven new cases were reported from Lola district near the border with Ivory Coast, which prompted the dispatch of a team to assess preparedness efforts in the western border area of that country.
Another case was detected in Guinea's northern Mali district, which borders Senegal. The patient is the aunt of the case-patient recently detected there, adding to a string of cases reported along Guinea's northern border over the past 3 weeks, the WHO said.
Community resistance continues to hamper response efforts in Guinea, and a third of its Ebola-affected districts reported at least one security incident over the past week. Responders in Guinea are also grappling with many community deaths and unsafe burials.
Sierra Leone's decline in cases, underway since December, seems to have flattened out, the WHO said. The country reported 76 confirmed Ebola cases last week, slightly down from 80 reported the week before. The western part of the country, including the capital, Freetown, is still the main hot spot, with a resurgence of cases still occurring in neighboring Port Loko.
However, with new cases reported in 7 of 14 districts, Ebola transmission in Sierra Leone is still widespread. Another area of concern is Kambia district, which borders Guinea's Forecariah hot spot. Kambia reported 11 confirmed cases last week.
Deaths in the community, a factor that fuels transmission, are still being reported in Sierra Leone, with 10 occurring last week. The WHO also said 41 unsafe burials were reported. It added that two of Sierra Leone's districts have reported recent instances of community resistance.
Meanwhile, Liberia reported only three confirmed cases last week, all in Montserrado County, which includes Monrovia. The WHO said all three cases were linked to a single chain of transmission.
US scales back military involvement
With overall case numbers dropping quickly over the past few months, especially in Liberia, US officials are announcing their plans for the next phase of the response, which will include a large reduction in military personnel.
In a statement yesterday, Rajiv Shah, administrator of the US Agency for International Development (USAID), which has led the US response in West Africa, said that with more than 10,000 US-supported civilian responders in the outbreak region, most troops are returning home.
At the outbreak's peak about 2,800 Department of Defense (DoD) personnel were deployed, he said. About 1,500 have already returned to the United States, and all but 100 will be home by April 30. The DoD will keep about 100 people in the region to help governments improve their preparedness and surveillance capacities and partner with Liberian forces to boost their Ebola response capacities, such as training lab technicians.
"Yet, we know that our work is far from over. Even as we have dramatically slowed the rate of new cases, USAID's efforts will not cease until we get to zero," Shah said, outlining the group's new response phase, which will revolve around building sustainable progress and boosting capacities for local communities to prevent, detect, and respond to future outbreaks.
USAID will continue to develop new data and diagnostic tools to manage the epidemic, help mobilize and equip healthcare workers, and assist with social mobilization efforts, he said. Ebola treatment units built and run by US government teams have been transitioned to civilian operators, and the DoD will leave behind medical equipment to help communities blunt the impact of future outbreaks.
USAID announces more innovation awards
In a related development, USAID today announced a second round of awards for the Ebola innovation challenge that it rolled out in October, which netted 1,500 submissions from around the world. In a statement it said a review identified 12 innovations that can help with the Ebola epidemic and future outbreaks.
The first round of awards focused on improving healthcare worker safety, and the second round is targeted to a broader range of tools for responders. Examples include wearable devices for monitoring the vital signs of Ebola patients, a low-cost battery-powered intravenous infusion monitor, and modular treatment units that are more comfortable and easier to decontaminate.
Lawmakers question US officials
At an oversight hearing today before a House appropriations subcommittee, officials from USAID and Ambassador Stephen Browning, special coordinator for Ebola, told lawmakers that progress has made, but the battle is far from over.
Jeremy Konyndyk, who directs USAID's office of foreign disaster assistance, said the response has made the shift from exponential growth to getting cases to zero. "It's a long and bumpy road to get to zero," he said.
Lawmakers roundly praised the US-led efforts in West Africa, but raised some concerns about the WHO's early response, the involvement of the military, and funds targeted to battle the outbreak.
Dirk Dijkerman, executive coordinator of USAID's Ebola task force, said funding decisions were made with a worst-case scenario in mind and predicted that there will likely be money left over. However, he cautioned that some expenditures are still needed to improve emergency response capacity in the region.
Feb 11 WHO Ebola situation report
Feb 10 USAID statement
Feb 11 USAID press release
US House of Representatives Committee on Appropriations hearing background