The
World Health Organization (WHO) has released a statement saying
problems related to the Ebola outbreak in Liberia are increasingly dire.
Situation in Liberia: non-conventional interventions needed
8 September 2014
During the past weeks, a WHO team of emergency experts worked
together with President Ellen Johnson Sirleaf and members of her
government to assess the Ebola situation in Liberia.
Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially.
The investigative team worked alongside staff from the Ministry of
Health, local health officials, and other key partners working in the
country.
All agreed that the demands of the Ebola outbreak have completely
outstripped the government’s and partners’ capacity to respond. Fourteen
of Liberia’s 15 counties have now reported confirmed cases.
Some 152 health care workers have been infected and 79 have died.
When the outbreak began, Liberia had only one 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.
Liberia, together with the other hard-hit countries, namely Guinea
and Sierra Leone, is experiencing a phenomenon never before seen in any
previous Ebola outbreak. As soon as a new Ebola treatment facility is
opened, it immediately fills to overflowing with patients, pointing to a
large but previously invisible caseload.
Of all Ebola-affected countries, Liberia has the highest cumulative
number of reported cases and deaths, amounting, on 8 September, to
nearly two thousand cases and more than one thousand deaths. The
case-fatality rate, at 58%, is also among the highest.
Situation in Montserrado county
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.
The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centres.
For example, an Ebola treatment facility, hastily improvised by WHO
for the Ministry of Health, was recently set up to manage 30 patients
but had more than 70 patients as soon as it opened.
WHO estimates that 200 to 250 medical staff are needed to safely manage an Ebola treatment facility with 70 beds.
The investigation team viewed conditions in general-purpose health
facilities as well as Ebola-specific transit and treatment facilities.
The John F Kennedy Medical Center in Monrovia, which was largely
destroyed during Liberia’s civil war, remains the country’s only
academic referral hospital. The hospital is plagued by electrical fires
and floods, and several medical staff were infected there and died,
depleting the hospital’s limited workforce further.
The fact that early symptoms of Ebola virus disease mimic those of
many other common infectious diseases increases the likelihood that
Ebola patients will be treated in the same ward as patients suffering
from other infections, putting cases and medical staff alike at very
high risk of exposure.
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 are turned away at Ebola treatment centres, they have
no choice but to return to their communities and homes, where they
inevitably infect others, perpetuating constantly higher flare-ups in
the number of cases.
Other urgent needs include finding shelters for orphans and helping
recovered patients who have been rejected by their families or
neighbours.
Last week, WHO sent one of its most experienced emergency managers to
head the WHO office in Monrovia. Coordination among key partners is
rapidly improving, aiming for a better match between resources and
rapidly escalating needs.
Implications of the investigation
The investigation in Liberia yields three important conclusions that
need to shape the Ebola response in high-transmission countries.
First, conventional Ebola control interventions are not having an
adequate impact in Liberia, though they appear to be working elsewhere
in areas of limited transmission, most notably in Nigeria, Senegal, and
the Democratic Republic of Congo.
Second, far greater community engagement is the cornerstone of a more
effective response. Where communities take charge, especially in rural
areas, and put in place their own solutions and protective measures,
Ebola transmission has slowed considerably.
Third, key development partners who are supporting the response in
Liberia and elsewhere need to prepare to scale up their current efforts
by three- to four-fold.
As WHO Director-General Dr Margaret Chan told agencies and officials
last week in New York City and Washington, DC, development partners need
to prepare for an “exponential increase” in Ebola cases in countries
currently experiencing intense virus transmission.
Many thousands of new cases are expected in Liberia over the coming three weeks.
WHO and its Director-General will continue to advocate for more Ebola
treatment beds in Liberia and elsewhere, and will hold the world
accountable for responding to this dire emergency with its unprecedented
dimensions of human suffering.
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