Ebola activity escalates over large part of epidemic region

Isolation unit in Freetown, Sierra Leone

An isolation unit in Freetown, Sierra Leone., CDC / Flickr

With the case numbers still rising briskly, the Ebola virus disease (EVD) situation in Sierra Leone and Liberia continues to deteriorate, though activity in Guinea appears to have stabilized, the World Health Organization (WHO) said in its latest outbreak update.

West Africa's illness total grew to 6,263 as of Sep 21, while the number of deaths reached 2,917, the WHO said. The numbers reflect an increase of 420 infections and 114 deaths since the 'WHO's last update on Sep 22. Health officials have warned that reported cases and deaths underestimate the true burden of the disease, thought to be two to three times higher than official figures.

In Sierra Leone, the number of newly confirmed cases has increased over each of the past 5 weeks, a pattern driven by a sharp increase in the number of infections in Freetown, the country's capital, along with those in three neighboring districts. New cases in two ongoing hot spots—Kailahun and Kenema—seem to have stabilized, but the WHO said more investigation is needed to confirm that trend.

The WHO said cases identified during a 3-day house-to-house sensitization campaign recently conducted in Sierra Leone aren't reflected in its latest update.

Sierra Leone today started quarantining three areas in addition to Kailahun and Kenema, which will affect about 1.2 million additional people, Agence France-Presse (AFP) reported today. The new areas include Port Loko and Bombali districts in the northern part of the country and Moyamba in the south. Combined with the quarantines already in place, roughly a third of Sierra Leone's population will now be under quarantine, according to the report.

Though the official numbers from Liberia show a fall in new cases, the WHO said a lack of new confirmed cases from the capital, Monrovia, where a surge of new infections was recently reported, is at odds with reports on the ground from responders, who have said the situation is deteriorating.

In other parts of Liberia, the number of new cases is increasing in Grand Bassa county in the west central part of the country and Nimba county, located in north central Liberia.

In its assessment of treatment beds, the WHO said there are still significant gaps in capacity in Sierra Leone and Liberia. A new treatment unit opened in Monrovia last week, while a new tent clinic opened in Liberia's Bong county.

Response teams are still meeting resistance from some local populations, the WHO said. For example, it has received reports that communities near Fassankoni, Guinea, have set up roadblocks to screen response teams. It added that social mobilization teams are targeting young people in the region, many of whom resist traditional leaders and government authority.

Pleas for help at UN meeting, World Bank ups commitment

A high-level meeting about Ebola today at the United Nations general assembly prompted some new announcements on response commitments, including another large one from the World Bank, and pleas for countries to do more, so the magnitude resources can match the enormity of West Africa's epidemic.

World Bank president Jim Yong Kim, MD, an infection disease specialist, said the World Bank will put $170 million more toward the effort, nearly doubling its contribution, which now stands at $400 million. He warned that the epidemic could roll back the economic growth African countries have experienced in recent years.

"It would be a mistake to settle for a response that we are comfortable with, but won't stop the disease," he said at the meeting.

President Barack Obama also spoke at today's UN Ebola meeting, repeating his call for other countries to make major commitments to the response. He said recent progress in the region is encouraging, but 'it's clear that it's not enough. "Right now, everybody has the best of intentions, but people are not putting in the kinds of resources that are necessary to put a stop to this epidemic," he said.

"We know from experience that the response to an outbreak of this magnitude has to be fast and it has to be sustained. It's a marathon, but you have to run it like a sprint," Obama said. "And that's only possible if everybody chips in, if every nation and every organization takes this seriously. Everybody here has to do more."

He said he is hosting 44 nations in Washington, D.C., tomorrow to advance the US Global Health Security Agenda and added that the United States is interested in working with any country that shares a commitment to battle biological threats, including Ebola.

Yesterday, US Secretary of State John Kerry announced the appointment of Ambassador Nancy Powell to lead the agency's Ebola Coordination Unit, which is responsible for outreach to international partners to speed epidemic response.

WHO Director-General Margaret Chan, MD, MPH, also pressed for urgent actions from the international community at today's UN meeting but warned that she expects the outbreak to get worse before things improve.

"In a human world, we cannot allow the people of West Africa to suffer so much," she said. "Excellencies, you have the power to turn this horrific epidemic around."

Basic treatment questioned, travel grants for health providers, infected doctor recovers

In other outbreak developments:

  • Basic interventions such as correcting electrolyte imbalances with intravenous therapy can save more lives in West Africa's Ebola treatment centers but are being underused, according to an international team of doctors who have been serving in the region with teams from the WHO and Doctors Without Borders (MSF). They aired their view today yesterday in a New England Journal of Medicine article. They said volume depletion is a key clinical feature of EVD and that intravenous catheters, fluids, and electrolyte replacement are readily available but are underused. They noted that extreme serum sodium and potassium abnormalities are commonly found in the rare instances where basic blood biochemistry tests are done. The team pointed out that if clinicians can test for Ebola viral loads in care settings, basic biochemical and hematologic testing should be possible. They acknowledged that the number of clinicians is insufficient, but they added that the skills needed to care for Ebola patients are fundamental ones. "We believe we can and must do better in providing supportive care," they wrote.
  • The International Society for Infectious Diseases (ISID) is offering travel grants for healthcare workers who are attending the 3-day US Centers for Disease Control and Prevention (CDC) Ebola safety training course, with sessions starting Oct 6 at a Federal Emergency Management Agency center in Anniston, Ala. The course is for health providers who will be traveling to West Africa to help care for Ebola patients. The amount of each grant is $500 for US residents and $1,000 for residents of other countries.
  • Rick Sacra, MD, a SIM missionary who was infected with EVD while working in Liberia, is being discharged from Nebraska Medical Center, where he had been treated since Sep 5, according to a statement from the facility. It said tests by the CDC on two blood samples taken 24 hours apart show that the virus is no longer in his bloodstream. During his stay his doctors treated him with an experimental antiviral, TKM-Ebola, and convalescent serum from Kent Brantly, MD, another American doctor who survived EVD. In a statement today, Sacra praised the hospital staff, colleagues in Liberia, and other groups involved in his care and thanked people who prayed for him. He also urged people to keep their focus on West Africa. "Though my crisis has reached a successful end here, unfortunately the Ebola crisis continues to burn out of control in West Africa," he said. "Please continue to join us in prayer and in providing resources to the people of Liberia, Sierra Leone, and Guinea."
  • India's government today announced a $12 million contribution to help battle Ebola, Press Trust of India (PTI) reported. The health ministry said $10 million is earmarked for the UN director-general's fund for Ebola and $2 million will go toward the purchase of more personal protective equipment

See also:

Sep 24 WHO Ebola roadmap situation report

Sep 25 AFP story

Sep 25 World Bank press release

Sep 25 Obama speech before high-level UN meeting

Sep 24 US State Department press release

Sep 25 Margaret Chan comments

Sep 24 N Engl J Med perspective

ISID statement

Sep 25 Nebraska Medical Center press release

Sep 25 PTI story

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