Ebola Update: The Crisis Worsens While the Global Community Responds

 

Explanation of the image above:  New heat map of Ebola’s impact on African nations over past week. Since July 27, 2014 the situation is new and bad in Nigeria, has gotten worse in Liberia, worse in Guinea, and is stable at bad in Sierra Leone. The more red there is the worse the crisis is. The more blue the lower the level of disease-caused crisis on the ground. Yellow is bad enough, indicating a need for an organized response. Remember MERS? Compare those bad feelings against the level of reds for Ebola. Typically a cold and flu season in the US is just a 30% yellow, perhaps some orange and no red.”

There will be a Twitter Chat at 2 pm ET today with the CDC.

Just search Twitter for the #CDCchat and join us!

The Sermo community received an update from Jim Wilson, MD, faculty member with the University of Nevada Reno, pediatrician and infectious disease expert for Ascel Bio, as well as a Sermo physician correspondent.  Unfortunately the situation has worsened in Africa.  Below is the Ebola update from the National Infectious Disease Forecast Center.

Wilson wrote, “we have long been more concerned with the fate of Liberia than any other country for the following reasons:

1. Report of as many as 75% of unidentified cases out in the community cryptically transmitting.
2. Report of medical response capacity compromise, where we don’t have enough “hands on deck” to perform clinical care.  MSF has indicated otherwise per Sierre Leone, but have said little about Liberia.
3. Persistent high signature patterns for public-official tension, evident in reports of attacks of MOH facilities (rumor or otherwise, it’s concerning)
4. Reports of corpse abandonment in private homes. A good news / bad news indicator- we don’t want them handling the dead if they do not have the proper training / equipment, however the next step in the social process is abandonment of the LIVING, of which we have seen one report.  If this is ground truth, then we are looking at Liberia slipping into sporadic CAT 7 conditions, which is a strong driver for population migration.  This, obviously, is not good.”

Wilson also expects hear about a lot of suspect cases in the media. 

“What’s common is still what’s most common when dealing with returning travelers from these African nations.  Most likely people have commonly acquired illnesses like malaria, but we need to make sure they’re separated from the population until we can get a negative Ebola confirmation given the context of the threat.  You will see a lot of false cases that will be tested to be not-Ebola and that’s ok, it’s part of the process to keep people safe.  And it is part of what the world must do right now.”

Key issues noted during the review by Ascel Bio of the raw articles and Exigence output are as follows:

 

Case counts and death surging; international response gathering steam. The Ebola outbreak in West Africa has worsened since last reporting on July 27th, 2014.  This outbreak, unprecedented in size with a current tally (as of 8/6/2014) of 1,711 cases and 932 deaths (C.F.R = 54%), has overwhelmed the local and international capacity to contain it.  This disease has spread to a 4th African country in Nigeria, where two deaths have occurred and a handful of new suspected cases have popped up.  Other countries such as Saudi Arabia have reported fatalities in travelers returning from West Africa suspected to have been due to Ebola infection.  The WHO Emergency Committee is beginning today a two-day discussion of forward plans to combat the growing threat of Ebola, with a focus on bringing further medical personnel and equipment in affected areas.

Local response dramatic.  Sierra Leone, Liberia and Guinea remain embattled by the outbreak.  In Freetown, Sierra Leone a military battalion has been deployed to oversee medical facilities and keep patients isolated.  Additionally, a “stay-home” day was called on August 5th restricting Freetown residents to remain indoors and out of public spaces.  In Monrovia, Liberia, protests have boiled over into the streets as residents cry out against the government’s treatment of dead bodies, which have been abandoned in streets and houses for days without collection.  Additionally, Liberian schools were closed nationwide at the end of July.  In all affected areas, healthcare workers have gone on strike citing the need for better protective equipment.  In Nigeria, which has been affected for a little over a week, airport screenings, quarantine of suspected cases, and contact tracing have begun.  Doctors have been on strike prior to the introduction of Ebola into the country, but this has not yet affected the capacity of hospitals to deal with Ebola, as the disease remains contained to the index patient and his contacts.

Outbreak indicators reminiscent of past Ebola outbreaks, abandonment of family members noted in Kikwit 1995.  With abandonment of family members at hospitals being reported in Liberia, Ascel Bio notes a similarity to the outbreak of Ebola in Kikwit, Zaire in 1995.  During this outbreak, Ebola victims were abandoned at hospitals a few months into the outbreak and, eventually, thousands of residents attempted to flee the affected areas, only to be contained by quarantine.  Ascel Bio is watching closely for any indication that residents of currently affected areas are fleeing en masse to new locations.  Should this indicator be observed, the situation would be assessed as an IDIS Catagory 7 event, with implications for further spread of the epidemic into previously uninvolved countries.  Additional indicators including the use of military force to detain and isolate victims, border closures, and the social stigmatization of the infected have been seen in previous outbreaks.

Liberia: Ebola Now Approaching Disruption Levels Seen in Kikwit in 1995
While the 2014 Ebola outbreaks in West Africa are generating the highest ever recorded number of fatalities, Ascel Bio’s analysis has determined that the Ebola outbreak in Kikwit in 1995 was the most disruptive of all Ebola outbreaks since 1994. This was directly due to unfamiliarity both by local and international responders to Ebola at that time. We note that the proper way of expressing relative case counts across different sites in Africa over the last twenty years is cases per 100,000 individuals. We emphasize that absolute case counts do not provide an adequate perspective when attempting to claim a “worst ever” situation from an epidemiological perspective. The issue has been lack of accurate population statistics for the involved countries.

Other Ebola Updates are available here.

Key Indicators
Based on a review of prior patterns, it is Ascel Bio’s assessment that key indicators do not neatly fit the indicators from prior outbreaks. Instead, Ascel Bio is focused on:

• Evidence that case counts are dropping in each country, which would signal that containment is working.
• Measurements of tension between the public and officials, which will impact the success of containment strategies.
• Levels of medical infrastructure strain, which will impact fatalities and containment.
• Airport closures into and out of affected countries.
• Increases in migration caused by the disease.

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Sermo physicians are collaborating actively inside the community to help stay on top of the epidemic and discuss the latest treatment options.  If you’re an MD or DO we strongly recommend you come into our free, private, physician-exclusive social network to discuss Ebola further.