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Ebola is a 'global emergency' as bodies litter streets

15:08 08 August 2014 by Debora MacKenzie

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The World Health Organization has today declared the Ebola outbreak in West Africa an international public health emergency. In separate meetings, witnesses describe bodies lying in the street in Liberia, and US health authorities say cases will continue to rise.

The Ebola outbreak, the largest known, began in December in Guinea and has now spread to neighbouring Liberia and Sierra Leone, with a few infected travellers detected elsewhere. The official toll so far is 1779 cases and 961 deaths.

The WHO declares a Public Health Emergency of International Concern when an outbreak crosses borders and poses an unusual threat. It has made such a declaration only twice before: for the swine flu pandemic in 2009 and the polio resurgence in Pakistan .

Today's declaration. triggered by an expert panel that met via teleconference with WHO officials over the last two days, asserts that "a coordinated international response" is required to stop further spread of Ebola, because of "weak health systems in the most at-risk countries".

This highlights the fact that it is the three most-affected countries and their neighbours who are most at risk, rather than countries like the US and Spain, who have both quarantined health care workers who contracted Ebola in the affected region.

Because the disease can incubate for up to three weeks, infected people may initially be well enough to travel, only to develop symptoms and spread the virus on arrival at their destination. In their statement, the WHO warns countries to watch for unexplained clusters of death or fever.

Worldwide concern

While the WHO experts were meeting, a foreign affairs subcommittee of the US Congress met in Washington to discuss the outbreak. "The situation in Lagos in particularly concerning," Tom Frieden, head of the US Centers for Disease Control and Prevention, told the hearing yesterday.

Lagos, the capital of Nigeria, is a chaotic megacity of 21 million people where Ebola could cause havoc. Five health care workers there who treated Patrick Sawyer, a Liberian who developed Ebola symptoms after a flight to Lagos, are being kept under quarantine. Another has died.

But there could be further cases: Ebola might be flying under the radar. Ken Isaacs of the relief group Samaritan's Purse. one of whose doctors is battling Ebola, told the hearing that the WHO's case count may be only a half or a quarter of the true number.

Citing bodies lying in the street and gangs threatening to burn down hospitals in Liberia, Isaacs said the crisis "threatens the stability of the society."

This was echoed by Liberian president Ellen Johnson Sirleaf yesterday when she declared a state of emergency in the country. saying the outbreak required "extraordinary measures for the very survival of our state".

Prevention measures

There is no generally-available treatment or vaccine for Ebola. The only way to stop it spreading is by preventing people from coming into contact with body fluids of victims, tracing contacts of patients and quarantining them if they develop fever.

This isn't happening. The WHO panel cites several cases of infection being passed from one person to another, then to another, in the capitals of the three most-affected countries. Isaacs said in Washington that no contacts are being traced in Liberia.

He also reported that there are only fifty doctors left in the country, and all government hospitals have shut. As a result, Liberians are dying of ordinary rainy-season diseases such as malaria and typhoid, said Sirleaf in her address. Internal roadblocks meant to stop people leaving affected regions in Liberia and Sierra Leone are also reportedly stopping food getting in.

The WHO declaration says there should be no general ban on international travel or trade. But affected countries should inform the public about how to handle Ebola, make protective supplies such as rubber gloves available to health care workers and stop people with unexplained fever, and their contacts, from leaving the country. They should also provide "appropriate medical care" to airline staff, and help them trace passengers who have been flights that have carried symptomatic patients.

Even if all that happens, case numbers will continue to rise. "In a few weeks," Frieden said in Washington, "there will be more cases (of Ebola) than in all previous outbreaks put together."