TIME Infectious Disease

1,400 Are Dead From Ebola and We Need Help, Says Doctors Without Borders President

Workers prepare the new Doctors Without Borders (MSF), Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF.
Workers prepare the new Doctors Without Borders, Ebola treatment center on Aug. 17, 2014 near Monrovia, Liberia. Tents at the center were provided by UNICEF. John Moore—Getty Images

The epidemic won't be contained without more treatment centers, coordinated action, logistical assets and health workers 

Entire families are being wiped out. Health workers are dying by the dozens. The Ebola outbreak raging in Guinea, Liberia and Sierra Leone has already killed more people than any other in history, and it continues to spread unabated.

And the death toll is being exacerbated by an emergency unfolding within an emergency.

People are also dying from easily preventable and treatable diseases like malaria and diarrhea because fear of contamination has closed medical facilities, leading to the effective collapse of health systems. While I was in Liberia last week, six pregnant women lost their babies over the course of a single day for lack of a hospital to admit them and manage their complications.

Over the past two weeks, there have been some welcome signs but not enough action: the World Health Organization (WHO) declared the outbreak a “Public Health Emergency of International Concern” and announced additional funds to fight the disease; the World Bank announced a $200 million emergency fund; and the UN Secretary General appointed a special envoy for Ebola.

But 1,350 lives have already been lost. To prevent more deaths, these funding and political initiatives must be translated into immediate, effective action on the ground.

We need medical and emergency relief workers to trace those who may be infected, to educate people about protection measures and to work in treatment centers. Many more people are needed in the field, right now.

Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have treated more than 900 patients in Guinea, Sierra Leone and Liberia. We have 1,086 staff operating in these countries and we have just opened a 120-bed treatment center in Liberia’s capital, Monrovia, making it by far the largest Ebola center in history. But it is already overwhelmed with patients and we simply do not have additional response capacity. Others must enter the breach.

In Kailahun, Sierra Leone, 2,000 people who came into contact with Ebola patients must be urgently followed up. But we have only been able to trace about 200 of them.

Health promotion campaigns and body collections are stalled for lack of vehicles or fuel. Epidemiologists are unable to work because of a lack of logistical support. And pervasive fears among communities that had never encountered Ebola have provoked riots against health workers.

The epidemic will not be contained without a massive deployment on the ground. WHO in particular must step up to the challenge. And governments with the necessary medical and logistical resources must go beyond funding pledges and immediately dispatch infectious disease experts and disaster relief assets to the region.

Additional resources are needed to properly map the epidemic, implement efficient general hygiene measures in all medical and public places, run safe treatment centers, trace suspected cases, train health workers, set up functioning alert and referral systems and, crucially, spread accurate information about how people can protect themselves from infection.

Equally important is fighting fear. Quarantines and curfews will only breed more of it. People need to have access to information, otherwise distrust of health workers will only increase and provoke further violence. Communities and governments need to work together to control the epidemic and care for the sick.

Some measure of humanity must also be restored in the fight against Ebola.

As doctors, we have been forced to provide little more than palliative care because of the sheer number of infected people and lack of an available cure. The extreme measures needed to protect health workers, including wearing stifling protective suits, also means we cannot remain bedside with patients to ease their suffering, or allow family members to do so. In their final hours, many people are dying alone.

While we try to find creative solutions to enable families to communicate with their sick relatives, they should at minimum be supported to participate safely in the burials of loved ones. This would also help rebuild trust between communities and those trying to contain the epidemic.

At the same time, additional support is needed to prevent health systems in Liberia and Sierra Leone from further collapse. After years of civil war, these countries already struggle to meet the basic health needs of their people, let alone cope with a public health emergency of this magnitude. Sierra Leone and Liberia, for instance, have just 0.2 and 0.1 doctors per 10,000 people, respectively (a rate 240 times less than in the United States).

Last week, all of Monrovia’s hospitals were at one point closed. There is no surgical care available in the entire country right now. Pregnant women cannot receive emergency C-sections. Health facilities must be re-opened or established to treat common illnesses. We will otherwise face a second wave of this health catastrophe.

Slowing and then halting this outbreak requires much more than money and statements. The only way to contain the epidemic is to increase the response capacity in affected areas, not by closing borders and suspending air travel.

Meaningful and coordinated action is needed on the ground today if we don’t want to be reduced to counting the dead for many weeks to come, whether from Ebola or other far less sinister diseases.

Dr. Joanne Liu is the international president of Doctors Without Borders/Médecins Sans Frontières (MSF).

 

TIME Infectious Disease

4 Injured in Violent Clashes as Liberians Storm Ebola Barricades

Liberia Battles Spreading Ebola Epidemic
A Liberian Army soldier, part of the Ebola Task Force, pushes back local residents while enforcing a quarantine on the West Point slum on August 20, 2014 in Monrovia, Liberia. John Moore—Getty Images

The clashes mark a deepening sense of mistrust at official responses to contain the Ebola outbreak

At least four people were injured in clashes with Liberian soldiers and police after the government laid barbed wire barricades around a densely populated slum in an attempt to contain the spread of Ebola.

Young men surged towards the barricades and hurled stones at troops, who responded by firing live rounds of ammunition, the New York Times reports. Agence France-Presse reports that at least four people were injured in the skirmish.

The unrest highlights a deepening sense of mistrust among residents of West Point, a district that government officials designated as a quarantine zone on Wednesday morning. Tensions flared in the area earlier in the week as the opening of an Ebola treatment clinic in a local school fueled fears that health officials were bringing in infected patients from other parts of the city. The clinic was ransacked on Saturday, enabling several quarantined patients to escape.

The death toll from suspected and confirmed cases of Ebola across west Africa climbed to 1,350 people, the World Health Organization said on Wednesday.

[NYT]

TIME Infectious Disease

Aid Group Slams Global Response to Ebola Outbreak

A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on Aug. 17, 2014 near Monrovia, Liberia.
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on Aug. 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Countries are securing their own borders and leaving West Africa to fend for itself

The main agency fighting the Ebola outbreak in West Africa is lashing out at the international response, calling it “non-existent.”

“We are completely amazed by the lack of willingness and professionalism and coordination to tackle this epidemic,” Brice de le Vingne, the operations director of Doctors Without Borders, told the Financial Times. “We have been screaming for months. Now the situation is even worse – we are today on the verge of seeing an entire country collapsing.”

An estimated 2,240 people have been infected with the virus in Guinea, Sierra Leone and Liberia since it first surfaced in March, and more than half of the afflicted have died. Doctors Without Borders (MSF) describes the current situation in Liberia as “catastrophic” and continuously deteriorating. The country has closed its borders, declared a state of emergency and on Tuesday it imposed a curfew on the main slum area in the capital of Monrovia, where Ebola panic has lead to public unrest.

Fear of infection has compounded the disaster, with workers and patients fleeing Monrovia hospitals in recent days, leading to an almost complete collapse of the health system and causing increased risks for other diseases such as malaria.

To be fair, many countries and organizations are sending aid to the affected region. The African Development Bank has pledged $56 million, the United Kingdom has increased its assistance to $8 million, China has sent supplies worth $4.9 million, E.U. support stands at $15.8 million, and the U.S. has pledged the same amount of aid as well as deployed a Disaster Assistance Response Team (DART). According to MSF, however, that’s far from enough.

“Leaders in the West are talking about their own safety and doing things like closing airlines – and not helping anyone else,” Brice de la Vingne told the Guardian, comparing it with the rapid international response to the earthquake in Haiti, where 300,000 people died. “You need very senior people with high profiles, the kind of people who can coordinate a response to a million people affected by an earthquake.”

A million people are currently residing in quarantined regions and are at risk of not receiving adequate supplies of food and water, although the World Health Organization said Tuesday that it had started delivering food aid to hospitalized patients and quarantined districts, in cooperation with the World Food Program. This aid will continue for another three months.

However, the biggest unmet need is for additional well-trained health workers. Professionals on the ground are exhausted, and several hundred have died in part because of a lack of training. MSF and other organizations are stretched to breaking point, some of them because of their involvement in other crises. USAID, for example, is responding to four humanitarian crises at the same time: South Sudan, Syria, Iraq and the Ebola outbreak. It must also weigh up whether to put people at risk.

“There may be a lot of well-intentioned medical staff in the world, but this is Ebola,” DART leader Tim Callaghan told the development web site Devex.

MSF president Dr. Joanne Liu told told the New York Times that it is also more difficult to recruit medical professionals to deal with Ebola than for any other emergency, because of the risk of infection and the dangers of giving constant care to the patients. “You have to learn to live with fear,” she said.

TIME Liberia

Liberia President Declares Ebola Curfew

Liberia says escaped Ebola patients returned to quarantine
Liberian nurses retrieve a looted generator stolen from the M V Massaquoi Elementary school that was used as an Ebola isolation unit in West Point, Monrovia, Liberia, Aug. 19, 2014. Ahmed Jallanzo—EPA

(MONROVIA, Liberia) — Liberia’s president has declared a curfew and is imposing a quarantine of a major slum in the capital Monrovia as the death toll mounts from Ebola.

President Ellen Johnson Sirleaf announced late Tuesday that movements now would be restricted between 9 p.m. and 6 a.m.

The country is already under a state of emergency, and the latest action also will block all movement in and out of West Point, home to at least 50,000 people.

Over the weekend, residents angered over the placement of an Ebola center in West Point looted the facility and 37 patients left who were supposed to be under surveillance. Health officials said that all of those later returned.

At least 466 people have died from Ebola in Liberia, and panic already has led to social unrest.

TIME Infectious Disease

Doctors Without Borders Opens New Ebola Ward in Liberia

Liberia Battles Spreading Ebola Epidemic
A Doctors Without Borders staffer supervises as construction workers complete the new Ebola treatment center on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Doctors Without Borders just opened a new ward in Monrovia, Liberia to care for the growing number of patients suffering from the virus

In its latest move to combat a growing outbreak of the deadly Ebola virus in West Africa, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a new ward in Liberia this week to accept more people confirmed or suspected to be infected with the disease.

“There are some really urgent needs here, and much more needs to be done,” says Tim Shenk, lead field communications officer for MSF, speaking to TIME from nearby the new ward.

The new Ebola management center, called ELWA 3, took just two weeks to build, with the help of MSF staff members and local workers hired by the organization. It opened on Aug. 17, and as of Tuesday, it had 32 patients. MSF’s plan is to gradually increase the number of patients in the facility, as the ward is using a novice staff. MSF will slowly accept more patients as the workers get used to the procedures they must go through to protect themselves from contracting the Ebola virus.

The ward has 120 beds, and its layout is meant to reduce risk of exposure to other victims and those treating them. There’s a low-risk area where physicians and workers put on their protective equipment. After that, they can move on to the high-risk area, which is separated into two parts. Each side has four tents with 15 beds each. One side is for suspected cases, and the other is for confirmed cases. The ward is staffed by some of the MSF’s international staff members as well as local health care workers. The new facility has two doctors, with a third on the way.

The new facility’s first batch of patients are people with suspected Ebola who could not be admitted to a facility run by the Ministry of Health due to lack of space. Liberia has 834 confirmed cases of Ebola, with 466 deaths, per the World Health Organization. Worldwide, there have been 2,240 cases with 1,229 deaths.

“The needs of Ebola patients are greater than our capacity and it’s likely it will remain that way for quite some time,” says Shenk. “That’s why the center was constructed, and it’s certainly the case that there are few places where people can be admitted as Ebola patients in this city.”

Over the weekend, reports came out of Monrovia that patients in a temporary holding and quarantine center were missing as members of the community raided the facility. Shenk says that’s not the type of reaction they are experiencing, but that the event proves there needs to be more international support for educating and sensitizing communities on what Ebola is and how it can be prevented.

“Now, not only do we need to contain the outbreak, but we need to respond to the urgent needs of people affected, like kids,” says Shenk. “Schools have shut down, family members have died. These are very urgent social needs. It’s a disaster, and it’s in need of a greater response.”

TIME Infectious Disease

WHO: Ebola Casualties Top 1,200

A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia.
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Another 84 deaths reported in just three days

The World Health Organization has tallied another 84 deaths from confirmed or probable cases of Ebola virus over the past three days, bringing the death toll in West Africa to 1,229 people.

The WHO released the updated figures on Tuesday and announced an increase in food and aid shipments to roughly 1 million people living within the quarantined areas of Guinea, Liberia and Sierra Leone.

“It is essential that people in those zones have access to food, water, good sanitation and other basic supplies,” the WHO said in a statement, adding that it had partnered with the United Nations World Food Programme to scale up its aide shipments to affected areas and target its deliveries to hospitals and quarantined homes. “Providing regular food supplies is a potent means of limiting unnecessary movement,” the organization said.

Liberia’s information minister said Tuesday that three Ebola-stricken African doctors who were treated with a regimen of the experimental drug, ZMapp have shown “remarkable signs of improvement,” Reuters reports. The minister also confirmed that 17 Ebola patients who escaped from a quarantine center in Monrovia had been found and transferred to a treatment center.

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