The US Centers for Disease Control and Prevention (CDC) have been working to track at least 77 individuals who came into contact with Thomas Eric Duncan, the Ebola patient who died last week in Dallas, and a nurse who contracted the virus while treating him. This number is only projected to rise in the coming days after confirmation that a second health care worker — who also treated Duncan, a Liberian national — has tested positive for the hemorrhagic fever that has killed at least 4,493 people in the outbreak currently gripping Guinea, Sierra Leone, and Liberia.
While public health officials in the US focus their efforts on easing public panic and boosting hospital preparedness, the Ministry of Health and Social Welfare (MOHSW) in Liberia alone said it is currently tracking more than 7,000 potential contacts, and requires an additional 79,940 body bags, 98,271 kilograms of chlorine powder, and 3,232 mattresses to meet its needs over the next six months.
Just a day after the World Health Organization (WHO) called the Ebola outbreak in West Africa "unquestionably the most severe acute public health emergency in modern times," new figures from the United Nations public health arm suggest the situation is getting worse.
"It is clear, however, that the situation in Guinea, Liberia, and Sierra Leone is deteriorating, with widespread and persistent transmission of [Ebola]," WHO said in its situation report for October 15, noting that transmission is continuing in all three capital cities of the most affected countries. Compounding this statement, a day earlier the agency had said that "epidemiologists see no signs that the outbreaks in any of these three countries are coming under control."
According to WHO, two areas in Sierra Leone where cases of Ebola transmission at one point seemed to be slowing down have now seen an uptick in new infection reports. Sierra Leone's capital Freetown has been the hardest hit, with 172 new cases between October 5 and October 12.
After the corpse of a woman who died of Ebola was left in the street for two days, residents of a populous neighborhood in Freetown took their anger to the streets on Wednesday — only to be tear gassed by police wielding AK-47s. A military medic from Sierra Leone was diagnosed with Ebola on Tuesday, initially creating a buzz when it was reported that he was with 870 members of an African Union battalion set to ship off to Somalia. Officials corrected this news, however, and said he was not a member of that unit.
"I have never seen a health event threaten the very survival of societies and governments in already very poor countries," a statement delivered on behalf of WHO Director-General Margaret Chan said. "I have never seen an infectious disease contribute so strongly to potential state failure."
Evidence points to an increase in transmissions in Guinea as well. Despite a slight drop in the number of cases in the capital of Conakry since October 5, a neighboring town saw a "sharp rise," according to WHO. There was only one new case in the village of Guékédou, where the outbreak is believed to have originated. Districts bordering Ivory Coast and Guinea-Bissau have also reported active transmissions in recent days.
Out of all the data reported Wednesday by WHO, the most alarming revelation may not be the numbers themselves, but continued reports that properly collecting data on transmission in Liberia is proving difficult. There have been few new cases reported in Monrovia for the last month, where WHO said there "is almost certainly significant under-reporting of cases." In a situation report from October 8, WHO said the fall in number of new cases in the country where 2,458 people have died from the virus, "reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data."
This isn't the first time an endemic has overwhelmed data collection. Alan Card, a global communicative disease expert and risk assessment consultant, told VICE news that a similar issue arose during the 1918 Spanish influenza outbreak that left an estimated 20-40 million people dead. Card explained that cases then were widely underreported because workers were too overwhelmed to keep accurate counts.
"They couldn't look for new ones, they were up to their eyeballs with what was in front of them," Card said.
While the numbers are largely unreliable in places like Monrovia, WHO does believe that Lofa County in Liberia continues to see a decline in transmissions in recent weeks. International Rescue Committee's healthcare unit director Dr. Emmanuel D'Harcourt told VICE News that this trend in Lofa was the first thing he noticed when arriving there in September.
'Success stories are small in scale, but they are happening all over Liberia and Sierra Leone.'
"People are actually winning the battle, but no one is focusing on it," he explained. "Success stories are small in scale, but they are happening all over Liberia and Sierra Leone."
According to D'Harcourt, successes like Lofa County, Liberia's breadbasket, where 170 farmers and their families had died as of mid-September, can largely be explained by community-based solutions. Unfortunately, he explained that international efforts, which were slow to begin with, have been focused on Western solutions.
"The big problem is the assumption is made that we have answers and these ignorant people need to listen to what we say and just do it," he said, explaining that in many cases decision makers come from outside Liberia and do not know the country.
One example where international efforts haven't necessarily matched up with local needs is the distribution of Ebola care kits to people's homes. As D'Harcourt explained, providing home kits would seem standard for an emergency in the US, but if you dump a kit onto a household without training, it becomes useless. Furthermore, he said the kits being distributed in West Africa often have only one Personal Protective Equipment (PPE) suit, which can only be used once before it is contaminated.
According to D'Harcourt, it's more effective to focus on instructing individuals in proper cleaning techniques, and teaching them how to properly use what they have. In many cases, he said, residents have utilized chlorine and plastic bags to wash things and protect themselves.
The LA Times reported a case last week in which Liberian nursing student Fatu Kekula managed to treat her family members for Ebola by utilizing items like plastic bags, a raincoat, and a surgical mask. Kekula reportedly treated four family members and only one died. The overall mortality rate in the current outbreak is estimated at 70 percent. She has since given lessons at public workshops about how to utilize plastic bags for protection against Ebola.
"We're told they need to be rescued, but what it's about is us listening to Liberians who are figuring it out, and making sure their message goes to the rest of the country," D'Harcourt said.
One situation D'Harcourt witnessed in Liberia was an instance where a Western-educated physician's assistant returned to his home village to teach residents there about Ebola and explain the necessary precautions for preventing the spread of the virus. While there have been widespread cases of mistrust and myths surrounding Ebola in all three countries, in this case villagers took the man for his word and despite being at the heart of the outbreak, not a single person was infected. When D'Harcourt asked the man for an explanation, he replied "I'm a native son."
"The good news is we're seeing more and more Liberians empowered and realizing the solution is not coming from outside, it's coming from them," he said, emphasizing that discussions about involving the community needs to move beyond superficial talk. "No amount of treatment is going to be able to stop transmission, only Liberian people can stop it."
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