The World Health Organization (WHO) and many partners are waging an all-out fight to stop an "ominous spike" in Ebola cases in a remote area of eastern Sierra Leone, the WHO reported today, a day after a top United Nations official said the UN is focusing special efforts on controlling the disease on the western side of the country.
In eastern Sierra Leone, the remote diamond district of Kono, bordering Guinea, is the scene of an outbreak that was overwhelming doctors, nurses, lab techs, and burial teams by the time a WHO rapid response team arrived recently, the WHO said in a press release.
Now the WHO, the US Centers for Disease Control and Prevention (CDC), and the Sierra Leonean government are "rallying all comers in a massive buildup to contain this burgeoning Ebola outbreak which ran the risk of continuing to grow and remaining hidden as world attention focuses on urban centers," the WHO said.
Meanwhile, total Ebola cases in Guinea, Liberia, and Sierra Leone crept up to 17,908, and the death toll reached 6,373, signaling respective increases of 108 and 42 since the last report 2 days ago, according to a separate WHO announcement today. But the numbers do not include any new data from Liberia.
As of Dec 7, Guinea had recorded 2,292 cases and 1,428 deaths, for increases of 9 and 16, while Sierra Leone had counted 7,897 cases and 1,768 deaths, up by 99 and 26, according to the WHO figures. The agency said Liberia has not provided data for Dec 4 to 7; the totals there stayed at 7,719 cases and 3,177deaths.
In the week that ended Dec 7, Sierra Leona had 397 new confirmed Ebola cases, according to the WHO update.
'The ears of the hippo'
In response to "intel" from Sierra Leone's Ministry of Health and Sanitation (MOHS), the WHO said it sent an epidemiologist to Kono district 10 days ago to find out if reported cases there told the whole story. Soon thereafter, the WHO and CDC sent more investigators, who found a "grim scene," the agency said.
"Our team met heroic doctors and nurses at their wits end, exhausted burial teams and lab techs, all doing the best they could but they simply ran out of resources and were overrun with gravely ill people,” said Dr. Olu Olushayo, WHO national coordinator for Ebola Epidemic Response in Sierra Leone, as quoted by the WHO.
In the 5 days before the WHO team arrived, 25 people had died in a part of the area's hospital serving as an Ebola holding center, the WHO said. Subsequently, two teams buried 87 bodies in 11 days, including a nurse, an ambulance driver, and a janitor who had helped remove bodies.
Olushayo said scattered villages in 8 of 15 chiefdoms in Kono have been hit by Ebola. He described the district as having "moderate transmission," the WHO reported.
However, the MOHS's director of disease prevention, Amara Jambai, MD, suggesting that the current picture of the situation is incomplete, commenting, "We are only seeing the ears of the hippo," the WHO said.
The agency said multiple response efforts in the area continue, with several nongovernmental organizations helping. The International Federation of the Red Cross plans to build a new Ebola treatment center while setting up a temporary safe holding unit, among other steps. The United States and United Kingdom are helping to pay for the efforts.
Western Sierra Leone worries Nabarro
Meanwhile, the UN is "focusing attention on bringing down the high levels of transmission in western Sierra Leone and ensuring that cases do not cross the border from Guinea into neighboring Mali," David Nabarro, MD, UN special envoy on Ebola, said yesterday, according to a UN News story.
In western Sierra Leone, the specific hot spots are Freetown (the capital) and Port Loko, where transmission is high and a much stronger response is needed, Nabarro told reporters in Geneva. He noted that the UN Mission for Ebola Emergency Response (UNMEER), the WHO, the national government, and other groups are already working in the area to make sure there are enough beds and burial teams.
A second area of concern, Nabarro said, is the northern part of Guinea's interior, known as Guinea Forestiere, according to the UN report. "UNMEER is also working very closely with Mali to ensure cases do not cross the border and if they do, that they could be dealt with very quickly,” he said, noting that he has been working on that effort with the president of Mali and UN peacekeepers stationed there.
The UN said Nabarro also briefed the Council on Foreign Relations via video link yesterday, telling them he believed that Guinea, Liberia, and Sierra Leone would have the needed response capacity by the end of January.
In other comments to reporters, Nabarro said the N'Zerekore Treatment Centre in Guinea, headed by a doctor from Niger, is "a truly extraordinary" example of international, African, and local cooperation. The center was built with funds from the European Union and constructed in 25 days of 24-hour shifts by the UN World Food Programme with Red Cross volunteers and others.
Mistrust for health systems
Also in Geneva today, WHO Director-General Margaret Chan, MD, MPH, opened a conference by saying that people in the Ebola-stricken countries still have a strong distrust for health systems, according to a WHO text of her talk. The conference focused on building resilient health systems in the three countries.
"Populations in all three countries remain deeply distrustful of health systems, especially Western medicine and foreign medical teams," Chan said. "Care from traditional healers is the preferred and, in rural areas, often the only option." She noted that weak health systems contributed to the 3-month delay in identification of the disease, from last December until March.
Among other suggestions for strengthening health systems, Chan commented, "Community confidence in traditional healers needs to be respected by giving these care-givers a place, with a clearly defined role, in the formal health system."
In other developments, the $1.1 trillion US spending bill unveiled by congressional negotiators last night includes nearly all of President Obama's $6.2 billion emergency funding request to fight Ebola, the Washington political newspaper The Hill reported today.
The story said almost $2.5 billon would go to the Department of Health and Human Services, and $2 billion would go to the US Agency for International Development to boost the international response. The State and Defense departments would get slightly over $100 million each.
Ebola fighters honored by magazine
Also today, Time magazine named "the Ebola Fighters" as its Person of the Year for 2014. The magazine released a large set of articles, including a lengthy lead report and personal accounts by several Ebola fighters in each of several categories: doctors, nurses, caregivers, scientists, and Ebola directors.
The directors included are UNMEER Director Anthony Banbury, CDC Director Tom Frieden, MD, MPH; and Joanne Liu, MD, international president of Doctors without Borders (MSF).
"Why . . . was the battle against Ebola left for month after crucial month to a ragged army of volunteers and near volunteers?" the lead article asks.
"For now, consider the stories of individuals who stood up to Ebola and, by doing so, raised hopes that victory is possible," it says. "In the memorable words of an essay by one volunteer, Ella Watson-Stryker, they found themselves 'fighting a forest fire with spray bottles.' They did not give up."
- UNMEER received 20,000 sets of personal protective equipment (PPE) from the Japan Disaster Relief Team on Dec 8, according to yesterday's UNMEER situation report. The equipment is the first batch of 700,000 sets of PPE promised by Japan for the three Ebola-hit countries.
- Two autoclaves for sterilizing and compressing medical waste have arrived in Freetown, the first autoclaves in any of the Ebola-affected countries, according to UNMEER. The machines will be used in Ebola treatment facilities in Freetown and Waterloo.
- President Ellen Johnson Sirleaf of Liberia launched an Ebola awareness campaign dubbed "Ebola Must Go," in the presence of Banbury, the US ambassador, and other senior officials, UNMEER reported.
- About 20 UN peacekeeping troops in Mali who were potentially exposed to Ebola more than 3 weeks ago have been released from quarantine, UNMEER reported in a Dec 8 situation report. The men were being treated at a Bamako hospital for injuries when a nurse working there died of Ebola, prompting the quarantine. They all remained free of illness, the agency said.
Dec 9 UN News story
Dec 10 WHO situation report
Margaret Chan's Dec 10 speech
Dec 10 Hill story on Ebola funding
Time magazine's "Person of the Year" lead article
Dec 9 UNMEER report
Dec 8 UNMEER report