Tough problems, like community resistance, persist in some Ebola outbreak nations, and another big response by the international community will be needed to get the countries back on their feet after the epidemic, speakers said today at an Ebola meeting in Brussels.
Leaders from African nations and their international partners involved in the Ebola response gathered at a 1-day conference sponsored by the European Union to get a fix on where the outbreak stands, what other steps are needed to get cases to zero, and what the long-term needs are for recovery.
Priorities: research, outreach, economic support
In her address to the group, Doctors without Borders (MSF) President Joanne Liu, MD, said that despite the fall in cases, the mortality rate in treatment centers is still a staggering 50%, a sign that the global response is still failing patients. She called on global experts to develop a practical plan to keep research going for Ebola vaccines, drugs, and diagnostic tests, with the outcome focused on benefits for the outbreak nations.
MSF has been at the forefront of the response since last March and has teams involved in all three countries.
Though fear is part of the normal reaction to such a lethal outbreak, it is still hampering the response, manifested by failed community sensitization and continued attacks on aid workers after a year of battling the disease, especially in Guinea, Liu said. She added that Ebola is being used as a political wedge in some areas and efforts require urgent improvement.
However, Liu warned that coercive measures such as sending armed guards out with response workers—a step under consideration in Guinea— could backfire, raising even more fears and suspicions.
She also aired concerns about the ongoing lack of cross-border information sharing on contact tracing, reminding the group that getting cases to zero requires identifying every contact and that one undetected case can lead to another surge of infections.
Liberian President Ellen Johnson Sirleaf also addressed the conference today, urging international partners to stay committed to the fight against the disease and asserting that rebuilding economies in the outbreak's wake will be a long-term and costly task, the Associated Press (AP) reported.
"This will require significant resources, perhaps even a Marshall Plan," she said.
MSF outlines evolving response in each country
In another development, MSF today posted an overview of where the outbreak stands, noting both similar and different challenges that each of the three countries face, requiring a flexible approach for responding to changing needs.
For example, MSF teams in Guinea have faced recent attacks, because many communities still resist public health messages about Ebola.
Claudia Evers, MSF's emergency coordinator for Guinea, said the attacks expose gaps in awareness, and despite the problems, MSF is increasing its capacity and has deployed mobile teams to Faranah and Boffa districts to assess the situation. She added that both areas have lacked surveillance and that community resistance to health messages is high. "We need to continue our work and hold discussions with all the influential people in the community in order to open up villages," she said.
Sierra Leone, like Guinea, is still seeing fluctuating Ebola levels, MSF said. It is still the most affected country, recording 63 confirmed cases in the week leading up to Feb 25, many of them in hot spots that persist in Freetown and in northwestern areas.
Decreasing activity in some parts of the country, with international partners taking on more of the treatment center load, has allowed MSF to focus on community activities, such as surveillance, addressing other health problems, and helping Ebola survivors. It said it has also deployed additional teams to new hot spots in Freetown and has sent a surveillance team to Kambia district near the border with Guinea, an area that sees 10,000 border crossings each week.
Liberia's steep drop in cases has allowed MSF to turn some of its attention to repairing the health system. A key goal is to improve infection control practices at health facilities to rebuild people's confidence in clinics and hospitals, many of which were shuttered during the outbreak.
MSF mobile teams are helping fill gaps in maternity care and emergency trauma treatment, and later this month it will open a 100-bed pediatric hospital in Monrovia for treating non-Ebola-related health conditions.
Restarting routine vaccinations is also a focus, especially with measles outbreaks recently reported in three of Liberia's districts and suspected pertussis cases in another district, according to MSF.
- Sierra Leone's vice president placed himself in quarantine after the Ebola death of one of his security guards, according to a Mar 1 Associated Press (AP) report. Vice President Samuel Sam-Sumana said in a statement that he would carry out his duties from home while the nation's president is in Belgium attending an international Ebola conference and that each person has the collective responsibility to break transmission chains. Sam-Sumana's security guard died on Feb 24. A few days later, President Ernest Bai Koroma reinstated public movement restrictions in response to a rise in new Ebola cases, according to the AP story.
- Nina Pham, the first of two Dallas nurses sickened with Ebola while treating a Liberian man who was the nation's first case-patient, yesterday filed a lawsuit against the parent company of the hospital, saying the facility doesn't adequately train and protect workers against Ebola and alleging that it violated her privacy when she became a patient. The Dallas Morning News, in a Feb 28 report, said Pham is also seeking unspecified damages for physical pain and mental anguish, medical expenses, and loss of future earnings. Pham's infection, and that of another nurse, became a rallying point on the need for US hospitals to better prepare and protect health workers. Wendell Watson, a spokesman for Texas Health Resources, told the paper that the company continues to support Pham and is optimistic that dialogue can resolve the matter.
- The World Health Organization (WHO) said yesterday that the outbreak total in the three hardest hit countries has grown to 23,913 confirmed, probable, and suspected cases and that the death toll has reached 9,714. The totals reflect cases reported as of Feb 28 in Guinea and Sierra Leone and Feb 23 in Liberia. Yesterday's total added 88 cases and 54 deaths to the WHO's last case update, which it posted on Feb 27.
Mar 3 Liu speech
Mar 3 AP story
Mar 3 MSE Ebola update
Mar 1 AP story
Feb 28 Dallas Morning News story
Mar 2 WHO update