The lives of both local and international health care workers, as well as the lives of thousands of people in West Africa and possibly beyond, are at stake in the world’s largest Ebola epidemic to date. Organizations such as Samaritan’s Purse and Doctors Without Borders have taken the lead in combatting the disease, which has seen major outbreaks in Guinea, Liberia and Sierra Leone. They are underfunded and overstretched as the epidemic worsens. The international response to the epidemic has so far been insufficiently urgent.
Ebola hemorrhagic fever is spread through direct contact with the blood and body fluids of infected patients. After being exposed to the virus, infected individuals will manifest symptoms at some point between two and 21 days. Initial symptoms resemble those of a viral infection like the flu. The disease rapidly progresses to shortness of breath, agitation, and bleeding at injection sites and from the nose and mouth. Patients whose diseases prove to be fatal eventually succumb to multiple organ dysfunction, shock and coma. There is no vaccine, and there is no cure.
So far, the disease has infected 1,201 people and killed 672 in Sierra Leone, Liberia and Guinea. (A Liberian official who died of the disease in Nigeria will be included in the next update from the World Health Organization.) This number is almost half of all recorded Ebola infections in the past 38 years combined. Health care workers are among those at greatest risk, because of their close contact with patients. The WHO has reported that over 100 health care workers in Liberia, Sierra Leone and Guinea have been infected; over 50% of them have died. In Liberia, two health care workers from Samaritan’s Purse have contracted Ebola. The staff members have been isolated, are undergoing intensive supportive care and are said to be doing well.
As our physicians, nurses and public-health workers return from working in the “hot zone,” there is a concern that these individuals may be carrying the virus as well. Routine testing of health care workers is not practical because testing is done only in certain labs under the tightest biological containment conditions. Given the incubation period of up to 21 days, it would be possible for a Western health care worker to contract the virus and return home before experiencing any symptoms. That could put his or her family and colleagues at risk. The U.S.’s Centers for Disease Control and Prevention (CDC) notes that the risk of Ebola spreading outside West Africa is small. Though an infected person could, in theory, get on a flight home, the disease cannot easily be spread through the aerosolized droplets of a cough or sneeze—as is the case with the flu—meaning fellow passengers would likely be safe. The CDC is also educating U.S. health care workers on how to isolate patients, should an infected person arrive in the country.
Meanwhile, Liberia closed most border crossings on July 27, and Redemption Hospital in the capital, Monrovia, closed because of a lack of resources to care for those infected and under quarantine. Health care workers are unable to provide services because of a lack of protective equipment. This equipment is essential for health care workers and their patients.
While medical support is essential to treat those infected with Ebola, the key to stemming the epidemic is the education of frontline health care workers. There is an urgent need to scale up the educational support for doctors, nurses and village leaders to better recognize early signs and symptoms of Ebola and to take immediate precautions for isolation and treatment. Large NGOs, backed by experts from the CDC, have the ability to do this but need the appropriate financial support from international donors to scale up to train local providers and health educators. The under-resourced local health authorities and ministries of health must be equipped to provide safe and effective health care support and also promote public health messaging and epidemic-control measures.
The stakes for West Africa are high. An intensifying Ebola epidemic could create public mistrust of government and destabilize the fragile political structures in Sierra Leone and Liberia, countries that have recently emerged from conflict. An aggressive international response is needed to control an epidemic that may undermine the stability of a whole region.
VanRooyen is a professor in the department of global health and population at the Harvard School of Public Health.
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