The World Health Organization's
September 8 Situation Assessment of Western Africa's Ebola epidemic predicts several thousand more cases in Liberia alone in the next three few weeks, in the most dire report I've seen from them so far. The WHO also reports that the number of cases and deaths may be 3 to 4 times higher than current reports, and that 14 of Liberia's 15 counties now report cases.
As of September 8, Liberia alone has nearly 2,000 cases and more than 1,000 known deaths. With a mortality rate of 58%. The epidemic continues in Guinea, Sierra Leone, Nigeria, and with a different strain in the Democratic Republic of the Congo, but the WHO "seems" to be implying is better contained by traditional intervention methods that have totally failed in Liberia.
Liberia's inadequate health system, already ravaged by civil war seems to be buckling under this new challenge. All existing treatment centers seem to be full and turning away new patients. It would take approximately 250 qualified medical personal to open each new 70 bed facility.
Some 152 health care workers have been infected and 79 have died. When the outbreak began, Liberia had only 1 doctor to treat nearly 100,000 people in a total population of 4.4 million people. Every infection or death of a doctor or nurse depletes response capacity significantly.
The report states "(a)s soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload."
The WHO investigation concentrated on Montserrado county, which includes Liberia’s capital, Monrovia. The county is home to more than one million people. The teeming West Point slum, which has no sanitation, little running water, and virtually no electrical supplies, is also located in Monrovia, and is adjacent to the city’s major market district.
In Montserrado county, the team estimated that 1000 beds are urgently needed for the treatment of currently infected Ebola patients. At present only 240 beds are available, with an additional 260 beds either planned or in the process of being put in place. These estimates mean that only half of the urgent and immediate capacity needs could be met within the next few weeks and months. ...
In Monrovia, taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none. As WHO staff in Liberia confirm, no free beds for Ebola treatment exist anywhere in the country.
According to a WHO staff member who has been in Liberia for the past several weeks, motorbike-taxis and regular taxis are a hot source of potential Ebola virus transmission, as these vehicles are not disinfected at all, much less before new passengers are taken on board.
When patients discover that all to the treatment centers are turning away patients do to overcrowding of up to 400% of designed capacity they must return to their communities where they continue to spread the deadly virus.
The WHO also reports an urgent need for shelters for orphans and recovering patients ostracized by families and neighbors.
The WHO urges an immediate 3 to 4 fold scaling up of the response and suggests alternative community based approaches may improve the response but doesn't suggest what this would actually mean.
What a sad tragedy. Yesterday, I reported that President Obama was interviewed by Chuck Todd and said he is asking for $30 million of extra funds to pay for additional contact tracers and intelligence officers to be sent to Western Africa to help.
I've proposed that we send a division of U.S. troops trained in biological warfare to help set up treatment centers as fast as possible.
We should also note that millions die every year in tropical areas from Lassa Fever malaria and a host of other tropical diseases diseases, some as "trivial" as diarrhea and cholera due to inadequate health care systems and lack of clean water. I hope our fascination with Ebola is not just due to the possibility that it could arrive here, something experts assure us is not a major threat as we could contain it with our superior health system.
Let's hope instead that we are undergoing an educational and consciousness raising experience that will lead to greater concern for the inadequate levels of health care throughout this region of the world.
Our prayers and best wishes go out to all of those afflicted, their families, and all the people of Western Africa and the Republic of the Congo struggling with this terrible epidemic and other tropical diseases.