TIME ebola

NYC Doctor With Ebola Described As a ‘Dedicated Humanitarian’

Doctor Quarantined At NYC's Bellevue Hospital After Showing Symptoms Of Ebola
A health alert is displayed at the entrance to Bellevue Hospital October 23, 2014 in New York City. Bryan Thomas—Getty Images

Friends and colleagues have high praise for Dr. Craig Spencer as he begins a fight for his life

The New York City-based doctor who tested positive for Ebola Thursday after working with virus patients in the West African country of Guinea is a high achiever and a “dedicated humanitarian,” the hospital where he works said in a statement.

Dr. Craig Spencer “is a committed and responsible physician who always puts his patients first,” said a statement from New York Presbyterian/Columbia University Medical Center, where Spencer serves as an emergency room doctor. Before being diagnosed with Ebola, Spencer had been working with humanitarian aid group Doctor’s Without Borders fighting the virus’ outbreak in West Africa.

Spencer, 33, left Guinea, one of the countries hardest hit by the recent Ebola outbreak, on Oct. 14. Spencer returned to the U.S. via New York’s John F. Kennedy International Airport on Oct. 17. He began showing symptoms on Thursday, Oct. 23, when his temperature was recorded at a slightly elevated 100.3 degrees fahrenheit, New York Gov. Andrew Cuomo said Friday morning, clarifying widespread reports Thursday that Duncan’s temperature was above 103 degrees. Ebola can incubate undetected in the body for up to 21 days before an infected person shows symptoms. Ebola patients are not contagious until they show symptoms, and they become increasingly contagious as they get more sick.

Spencer graduated from Baltimore’s Johns Hopkins University, studied Chinese language and literature at Henan University in China, earned a medical degree from Detroit’s Wayne State University School of Medicine and, in 2008, started his residency in New York, becoming a fellow at the Columbia University Medical Center’s International Medicine Program, according to information drawn from his LinkedIn profile by The Wall Street Journal. Spencer’s LinkedIn page has since been taken down.

“He was an outstanding student, humanitarian, excellent physician,” one of Spencer’s professors told the Journal. “He’s done a lot of good international work. He had been to parts of the world—marginalized, disenfranchised—working to improve the human condition.”

According to a friend who met Spencer through the website Couchsurfing, which connects travelers with free places to stay, he’s a runner who plays the banjo and speaks French, Chinese and Spanish.

TIME ebola

Mali Minister of Health Confirms First Ebola Case

First case is a 2-year-old

Mali’s Minister of Health said the country has its first case of Ebola in a tweet Thursday.

The patient is reportedly a two-year-old girl who recently came into the country from Guinea, Reuters reported. The country borders Guinea, where the Ebola outbreak started. Mali is one of the first countries to start experimental vaccine trials.

TIME ebola

Why Ebola Hasn’t Really Spread Across West Africa

A burial team in protective gear carry the body of woman suspected to have died from the Ebola virus in Monrovia, Liberia, Oct. 18, 2014.
A burial team in protective gear carry the body of woman suspected to have died from the Ebola virus in Monrovia, Liberia, Oct. 18, 2014. Abbas Dulleh—AP

Experts point to strong national health systems and proper contact tracing

Though a few cases of Ebola in the U.S. and Europe have sparked panic that the deadly virus is spreading far and wide, a closer look at the outbreak in West Africa tells a slightly different story. The epidemic, which the World Health Organization reports has claimed at least 4,877 lives, largely in West Africa, has so far been mainly confined to three countries: Guinea, Sierra Leone and Liberia. But why have others like Guinea-Bissau, Mali and Côte d’Ivoire — which all share at least one border with a badly afflicted country — so far managed to avoid any cases of the virus?

“Part of it is still luck of the draw, due to movement of people and the relatively porous nature of borders,” says Aboubacry Tall, West Africa Regional Director for Oxfam. And the threat seemingly posed by open borders has led to the affected countries gradually sealing themselves off to prevent Ebola from being passed on to neighbors. When the first cases were confirmed in March by Guinea’s Ministry of Health, Senegal decided to close its southern border with the country. As the outbreak spread to Sierra Leone and Liberia, more border closures followed: Sierra Leone shut its borders on June 11 and Liberia did the same on July 27, with the exception of a few major entry points (such as the main airport) where screening centers would be set up.

Greg Rose, a health advisor at the British Red Cross, says that while border controls may have had “a small effect” on the situation in West Africa, a key difference “was that that other countries had been forewarned,” which allowed them to “set up systems to prevent further infections.” Moreover, Tall says that “in neighboring countries like Côte d’Ivoire, Senegal and Mali, the health systems were in a slightly better shape.” In comparison, the three most-affected countries already had overburdened health care infrastructure before the Ebola outbreak. Sierra Leone and Liberia had not yet fully recovered from the damaging effects of long civil wars — Sierra Leone had two doctors per 100,000 people and Liberia had only one, whereas Mali had eight and Côte d’Ivoire had 14. (The U.S. has 242.) With a lack of staff and resources, Tall says, “Ebola came in and rapidly overwhelmed the health systems” in the three countries, which have now collectively seen more than 9,900 cases of the virus.

Tall adds that two key elements in containing the spread in neighboring countries are community mobilization and the preparedness of the public health system. He highlights the importance of “raising public awareness on Ebola” and of putting the medical system “on high alert all the way to border areas, so that anything that looks like a suspect case has a higher chance of being picked up.” The difference made by a rapid response can be seen in Senegal’s success with its one Ebola case. Despite closing its border, Senegal reported its first case on Aug. 29, after a a Guinean university student traveled by road to Dakar, the capital. He was treated and recovered, and his contacts were traced and monitored. On Oct. 17, WHO declared the outbreak in Senegal officially over, saying the “most important lesson for the world at large is this: an immediate, broad-based, and well-coordinated response can stop the Ebola virus dead in its tracks.”


Though not a bordering country, Nigeria suffered an outbreak of 20 cases — including eight deaths — after a Liberian-American man died of Ebola after arriving at the main airport in Lagos. However, the government of Africa’s most populous nation was able to successfully trace those in contact with him and has since been declared Ebola-free. Nigeria has kept its borders open to travelers from the most affected countries, but increased surveillance. Dr. Faisal Shuaib, of the country’s Ebola Emergency Operation Center, recently told TIME that “closing borders tends to reinforce panic and the notion of helplessness. When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.”

Shuaib pointed out that closing borders has another unwelcome effect: it stifles commercial activities in countries whose economies are already struggling because of the Ebola crisis. “Access to food has become a pressing concern for many people in the three affected countries and their neighbors,” Bukar Tijani, a U.N. Food and Agriculture Organization representative, said in September. In Liberia, for example, the collapse of cross-border trade meant that the price of cassava — a food staple — jumped 150% in early August. Another immediate consequence of travel restrictions, says Tall, is that “most airlines have stopped flying to these countries, which makes it more difficult for humanitarian personnel to get in and out.”

The most effective way to contain the spread of Ebola is in “proper tracing of the epidemic, containment within communities and caring for those infected,” says Rose, the Red Cross advisor, who believes “this problem is not going to be solved by closing borders.” And though Ebola has not spread quickly beyond Guinea, Liberia and Sierra Leone, it’s clear that neighboring countries in West Africa need to remain vigilant. As Tall says, “we’re not out of the woods yet.”

Read next: Nigeria Is Ebola-Free: Here’s What They Did Right

TIME ebola

All Travelers Coming to U.S. From Ebola-Hit Countries Will Be Monitored

New York's JFK Airport Begins Screening Passengers For Ebola Virus
People arrive at the international arrivals terminal at New York's John F. Kennedy Airport (JFK ) airport on October 11, 2014 in New York City. Spencer Platt—Getty Images

Travelers will be monitored for 21 days upon arrival in the U.S.

All travelers entering the United States from Liberia, Guinea, and Sierra Leone will now be actively monitored for Ebola-like symptoms by state and local health officials for 21 days upon landing in the U.S., the Centers for Disease Control and Prevention announced on Wednesday. Those three West African countries are the hardest-hit by a recent outbreak of the deadly disease, and about 150 people travel from them to the U.S. every day.

CDC Director Dr. Tom Frieden announced the new program as the U.S. began requiring travelers from those three countries to arrive in the country through one of five airports performing intensive screening procedures. The new monitoring program will start on Monday in New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia, the six states where most travelers from the three countries end their trips.

When travelers from the three West African countries arrive in the U.S., they will be given an explanatory kit that includes a thermometer and will be asked to provide two email addresses, two telephone numbers, a home address and an address for the next 21 days. They will also need to provide the same information for a family member or friend. Travelers will be asked to report to a public health worker from a state or local health department daily, providing a temperature as well as well reporting any symptoms. They must also inform officials if they plan to travel, and if so, they must coordinate their tracking their symptoms with health officials.

“We have to keep up our guard against Ebola,” said Frieden, adding that it’s the “CDC’s mission is to protect Americans.”

 

TIME ebola

This Is How Ebola Patients Are Equipping Their Homes

A Doctors Without Borders, worker displays a family and home disinfection kit which MSF distributed on Oct. 4, 2014 in New Kru Town, Liberia.
A Doctors Without Borders, worker displays a family and home disinfection kit which MSF distributed on Oct. 4, 2014 in New Kru Town, Liberia. John Moore—Getty Images

"It’s dangerous, but there are not many other options”

When his wife grew sick with Ebola, Alex T. Kamanda didn’t have the option of sending her to one of Monrovia’s Ebola Treatment Centers. They were all full. But he knew how contagious the disease could be, and how risky it was to come in contact with her bodily fluids. So he did the best he could to protect himself while caring for her, wrapping his hands in plastic garbage bags until members of his church were able to bring him supplies. He mixed chlorine powder with water to make a disinfecting solution for his skin and a stronger version to clean up her vomit and diarrhea. It was a solution that almost certainly saved his life.

Caring for Ebola patients at home is a practice that is becoming more common in a region with not enough Ebola Treatment Units (ETUs), supplies or personnel to treat the sick—a stop-gap solution that is now being standardized in Liberia. But it’s not without controversy.

The United States has pledged to send up to 400,000 so-called “home treatment kits” to Ebola-stricken households in Liberia; some 9,000 have already been distributed, according to USAID. Each kit contains gloves, masks, disposable gowns and plastic aprons, along with chlorine powder, buckets, spray bottles and plastic bags to safely dispose of infected items.

This is not the gold standard infection control, but overcrowding in Liberia’s Ebola treatment centers leaves little choice. Government health officials and NGOs have already started door-to-door training so that affected families know how to use the equipment properly.

“’Perfect’ cannot be the enemy of ‘good’ in this case,” says Stephan Monroe, the deputy director of the Centers for Disease Control and Prevention’s (CDC) National Center for Emerging Zoonotic and Infectious Diseases. “Perfect is having patients in isolation centers with health care workers treating them, but we cannot build them fast enough.”

Treatment at home carries risks. Even fully trained and equipped health-care workers in isolation wards are getting sick. And there are concerns that providing the protection kits may encourage families to keep their loved ones at home, under the assumption that it is safe.

According to Amanda McClelland, the senior officer coordinating the Ebola response for the International Red Cross, the organization is starting to attempt safe home-based care training in Monrovia, and other groups are trying a variation of it in other locations. “We are really in this gray phase. We have to do extraordinary measures to do the best we can until the isolation centers have met the demand in the next few weeks,” says McClelland. “There’s a lot of pressure on us and other organizations to undertake things like home-based care. Which is shifting the risk from health workers to families. It’s dangerous, but there are not many other options.”

The Red Cross will have volunteers in every affected community, and if they get a suspected case they will try to transfer the patient to a treatment center, but if they can’t, they will help the family isolate the patient in the home, even if it is just a mattress tucked behind a makeshift drape. They will also train a family member to care for the patient as safely as they can until admission into a treatment center can be arranged. “It is quite a reasonably controversial idea. It’s really the measures of last resort that we are in at the moment,” says McClelland.

The missionary group Samaritan’s Purse announced on October 7 that it has also launched home-based intervention training in the most remote areas of Liberia by instructing caregivers in infection control and giving families home care kits. The Samaritan Purse kits, in addition to the basic protective gear, also include medicine to treat Ebola’s side effects, like pain, dehydration and diarrhea. So far they’ve been equipping families in an area along the River Gee in southern Liberia where cases have been on the rise, but there are no Ebola treatment centers nearby.

On Oct. 3, USAID administrator Dr. Raj Shah said in a press conference that USAID is offering support in the distribution of hygiene and protective equipment kits “so families can protect their patients in their families.” USAID, along with UNICEF and the World Health Organization, has already distributed 9,000 of those kits. According to Shah, another 10,000 are on their way, and are being distributed throughout Liberia.

According to U.S. ambassador to Liberia, Deborah Malac, home care is a short-term solution. “Until you have some place to take someone to receive further treatment, you need to protect yourself and family members as much as possible,” she says. “So [the kits are for use] in the home, but not for long term care, [and only] if there is no other alternative.” That kind of temporary solution to a vexing public health problem is also likely to be well received on the ground. The ETUs are simply taking too long, says Kenneth Martu, a community organizer in Westpoint, one of the hardest hit areas of Monrovia. “You call for an ambulance, and they say there are no beds available [in the treatment centers]. So home care is one of the best approaches in the fight against Ebola. It’s what we can do in the absence of beds. We need to prevent Ebola’s spread.”

With reporting by Aryn Baker / Monrovia

TIME ebola

Ebola Cases Surpass 8,000

WHO stresses cases are being underreported in Liberia

Over 8,000 people in Liberia, Guinea and Sierra Leone have been infected with Ebola, according to new data from the World Health Organization (WHO).

The numbers show there were 2,799 new cases in the last 21 days. Of the 8,011 people infected, 3,857 people have died. “The situation in Guinea, Liberia, and Sierra Leone continues to deteriorate, with widespread and persistent transmission of [Ebola],” says the WHO in a statement.

The WHO cites problems gathering data in Liberia, and says it should be emphasized that “the reported fall in the number of new cases in Liberia over the past three weeks is unlikely to be genuine. Rather, it reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data.”

This happened before in Guinea, when it appeared cases had slowed, but in reality cases went unreported or were hidden. The WHO says there is likely a lot of underreporting in Liberia, as fears and distrust of government grow, and that official estimates are likely lower than Liberia’s actual number of cases.

“There is no evidence that the [Ebola] epidemic in West Africa is being brought under control,” the WHO says. “Though there is evidence of a decline in incidence in the districts of Lofa in Liberia, and Kailahun and Kenema in Sierra Leone.”

TIME ebola

Ebola Vaccines Are Being Expedited

Professor Adrian Hill, Director of the Jenner Institute, and Chief Investigator of the trials, holds a phial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine (CCVTM) in Oxford, southern England on Sept. 17, 2014.
Professor Adrian Hill, director of the Jenner Institute and chief investigator of the trials, holds a vial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine in Oxford, southern England, on Sept. 17, 2014 Steve Parsons—Reuters

"Nothing can be allowed to delay this work"

International experts want a fully tested and licensed Ebola vaccine scaled up for mass use in the near future, according to a recent World Health Organization (WHO) meeting.

WHO organized a panel of more than 70 experts, from scientists to medical ethicists, to reach consensus over the status of Ebola vaccines currently being tested. WHO released news from the meeting on Wednesday, the day after the U.S. confirmed its first patient with Ebola. According to the WHO statement, the mission is to “accomplish, within a matter of months, work that normally takes from two to four years, without compromising international standards for safety and efficacy.”

Two vaccines have great potential and are ready for safety testing. The first vaccine is developed by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline. That vaccine is currently undergoing a human-safety trial at the National Institutes of Health (NIH) campus in Bethesda, Md., as well as at the University of Oxford. The second vaccine is under development by the Public Health Agency of Canada in Winnepeg. That vaccine will start a human-safety trial in early October. Canada has already donated 800 vials of their vaccine to WHO, the organization says. Once more data is available on what dosing should be used, WHO says these vials could translate to around 1,500 to 2,000 doses of the vaccine.

The goal of the safety trials is to confirm that the vaccines are safe enough to move on to a larger human trial. Dr. Anthony Fauci, director of NIAID and the lead on the NIH vaccine, tells TIME the safety trial is so far “uneventful,” which is a good thing. “There really [are] no red flags so it seems to be going along quite well,” he says. The vaccine had already been tested in monkeys and showed very promising results.

WHO and other organizations have been expediting the testing and approval processes for these drugs since early summer, but the NIH’s vaccine has been under development since 2003. At the time, it did not have the pharmaceutical funding to move forward. “[In 2003] there was very little interest for the obvious reasons that there was no disease around,” says Fauci. “Recently, we now have a much more vigorous interest from pharmaceutical companies.”

WHO hopes that in October and November, the vaccines will make it through their safety trials and into next-stage human testing. Between January and February 2015, the goal is to have next-phase human trials approved and initiated in countries affected with Ebola. People at a higher risk for the disease, like health care workers, are a priority.

The meeting did not highlight ZMapp, the drug given to two American patients who were evacuated from Liberia to Emory University in Atlanta. Mapp Biopharmaceutical, the company that produces ZMapp, is a small team that says its resources are now exhausted. Their drug is grown in tobacco plants and requires waiting for a crop in order to produce more of it.

One of the ways trials could be quickened is if the researchers take a “wedge” approach, which means that a wedge or slice of the study population is selected for a first step in the trial, and what is learned in that step is then used on the next slice of the participants. While trials are ongoing, there are still significant technical obstacles that need to be addressed once a vaccine is ready for mass use: how vaccines will be distributed, for instance, and how low-resource health systems can ensure that vaccines are stored below –100 degrees.

In the WHO meeting, the phrase “Nothing can be allowed to delay this work” was repeated multiple times, and since Ebola has now infected more than 7,000 people and even made it to the U.S., the race to develop an effective vaccine is becoming all the more frantic.

TIME ebola

The 5 Biggest Mistakes in the Ebola Outbreak

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

Experts weigh in on how the outbreak got this out of control

The U.S. Centers for Disease Control and Prevention (CDC) recently projected that if trends continue unimpeded, cases of Ebola could pass the million mark by January. While that’s an unlikely scenario, many are still wondering: How on earth did it get this bad? We canvassed experts for some clues.

1. The response was far too slow
There was a period in April when it appeared that the Ebola outbreak had subsided, prompting a collective sigh of relief. Guinea’s Ministry of Health even said that country’s caseload appeared to be under control. But the outbreak didn’t subside. Instead, it barreled through interconnected towns and villages in more-populated areas of Guinea, Liberia and Sierra Leone. And after the outbreak’s perceived lull, however, came one of the largest flare-ups. Some scientists say that during that time, their warnings were ignored.

One such scientist is Robert Garry, a Tulane University virologist who had visited a hospital in Sierra Leone caring for some of his colleagues, including Dr. Sheik Humarr Khan — one of the first doctors to die of the disease in Sierra Leone. Garry then warned various groups, including the State Department, that the outbreak was highly concerning. No one, he says, really listened to him. “Their response was cordial, but nothing really happened,” says Garry. “I was really concerned about the lack of attention. I caught a lot of flack for saying I didn’t think the numbers [of reported cases and deaths caused by Ebola] were accurate. Some of us realized this was not going to be controlled.”

In a recent paper published in the New England Journal of Medicine, Peter Piot, director of the London School of Hygiene and Tropical Medicine and one of the original researchers to discover Ebola in 1976, writes: “Ebola has reached the point where it could establish itself as an endemic infection because of a highly inadequate and late global response … It was not until five months and 1,000 deaths later that a public health emergency was declared, and it was nearly another two months before a humanitarian response began to be put in place.”

2. A lack of cultural sensitivity
Patricia Omidian, a medical anthropologist, was sought by the World Health Organization (WHO) to spend time in Liberia to help Ebola response workers better understand the communities they were serving. “I think the biggest mistake that occurred very early was that primary health care was ignored and communities were not included in their own health issues,” she says. “Programs were rolled out and people were told what not to do. No effort was made to ensure engagement and increase trust.”

Omidian’s work included explaining some of the cultural practices among Liberians, including burial rituals that involve a lot of physical contact, putting mourners at risk of contracting the virus. “This disease attacks the best of [Liberians'] culture — that of touching and caring and kindness,” says Omidian.

3. We don’t have deployable medical teams
The CDC, WHO and U.N. have important jobs when it comes to containment practices like tracking down people who may have come in contact with infected patients, and using technology to predict disease spread. However, none of those groups actually treat patients, or have doctors and nurses they can deploy. This is something that Dr. Jack Chow, professor of global health at Carnegie Mellon University and a former WHO assistant director general, says needs to change.

“The Obama mission to Liberia, which is relying on the military at the last minute, shows that the U.S. and other industrial countries haven’t built up comparable deployable medical units on the civilian side, and need to do so to prepare against future ‘flashdemics’ — high-velocity, high-lethality outbreaks,” says Chow. “In addition to building an international epidemic response force, we need to conceptualize ‘global health defense’ to include bolstering the health systems of the poorest countries.”

4. A lack of approved drugs and cures
The scarcity of drugs and vaccines is not due to a lack of innovation. Drugs have been in development for years, but since pharmaceutical companies have had no financial incentive to fund them, researchers have hit walls. “People like me and others who have worked for years in vaccines and countermeasures are frustrated,” Thomas Geisbert, a professor of microbiology and immunology at the University of Texas Medical Branch in Galveston, said in an earlier TIME article. The supply of ZMapp, the drug that was given to a few health care workers, is exhausted. It comes from a small pharmaceutical company with nine employees, and the drug grows in a tobacco plant — requiring scientists to wait for a new crop to grow just for a new batch. Thankfully, clinical trials for other drugs have kicked off.

5. Treating Ebola as a “West Africa” problem
“It’s crucial countries not be lumped together,” says Nigerian Minister of Economy and Minister of Finance Ngozi Okonjo-Iweala. “The media writes about Africa and West Africa, but there needs to be differentiation. This will end up hurting the economies of countries that have no problems. Ghana never had any cases, Burkina Faso never had any cases.” Okonjo-Iweala was also the former managing director of the World Bank, and has seen how stigma damages economies.

“We should stick to the specific countries so as not to cause massive economic damage,” says Okonjo-Iweala. “We have worked very hard to get the private sector to invest in Africa for the continent to grow based on the fact that we are a continent with a lot of vigor and good rates of return on investment. If you scare away investors by lumping the continent into one big mass, what good does it do? It will take another decade to recover.”

Nigeria has had 19 cases, seven deaths and everyone else survived. As of Tuesday, the 21 days of incubation expired for people who treated the infected, so currently no one is being monitored. “We’ve worked hard as a continent to overcome this kind of stigma of disease,” says Okonjo-Iweala.

TIME ebola

CDC: Cases of Ebola Could Double Every 20 Days

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

A new CDC report predicts the enormous cost of delayed response to Ebola

If Ebola conditions continue without a scaled-up effort, the CDC estimates that cases of Ebola in West Africa will double every 20 days — and in an absolute worst-case scenario without any intervention, numbers could reach 1.4 million by Jan. 20.

Using a new Ebola Response prediction tool, the CDC has published results that show that if current trends continue unimpeded, Liberia and Sierra Leone will have approximately 8,000 total Ebola cases, or 21,000 if the tool accounts for underreporting, by Sept. 20. Liberia will account for about 6,000 of those cases.

The numbers are frighteningly high, but it should be noted that it’s a prediction of a hypothetical situation in which absolutely no intervention were to happen. That won’t be the case if many countries and the UN keep their promises. The model also shows that a big response could turn the outbreak around. In another hypothetical situation, the outbreak could ease up and eventually end if 70% of people with Ebola are placed in medical care facilities, Ebola treatment units, or somewhere where transmission could be contained.

“The model shows that a surge now can break the back of the epidemic,” said Dr. Tom Frieden, director of the CDC, in a press conference. “The importance of implementing effective programs rapidly cant be over-emphasized. The cautionary finding of the modeling is the enormous cost of delay.”

During the press conference, Dr. Frieden said the outbreak is very fluid and changing, but that he does not think West Africa will meet their worst case scenario predictions. “If you get enough people effectively isolated, the epidemic can be stopped…Even in dire scenarios, if we move fast enough we can turn it around. I do not think the most dire circumstances will come to pass,” he said.

The CDC report comes out on the same day the World Health Organization released their reports on the outbreaks at six months in all affected countries, and it appears that cases in Nigeria and Senegal have stabilized “for the moment.” Last week, President Obama announced a deployment of 3,000 U.S. military personnel and over $500 million in defense spending to go to West Africa, and the UN announced a new task force called the U.N. Mission for Ebola Emergency Response. The hope is that an exponentially increased response will prevent these possible scenarios.

TIME ebola

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

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