We screwed up on Ebola, and now the crisis is getting much worse

By Lauren F Friedman From Business Insider

Back in April, when the Ebola outbreak in West Africa had killed less than 100 people, Doctors Without Borders urged the world to mobilize a significant response, warning that failure to act could result in an “unprecedented epidemic.”

Instead, the world responded with what Nicholas Kristof of The New York Times called “a global shrug.” Over the summer, as residents of the developed world comforted themselves with the knowledge that an outbreak on our home turf was highly unlikely, the death toll in one of the poorest corners of the world climbed sharply.

The “unprecedented epidemic” went from dire prediction to on-the-ground reality, and now the Centers for Disease Control and Prevention has said that — worst-case scenario — there could be 1.4 million cases of Ebola in West Africa by January.

It didn’t have to be this way.

Early Warnings

For anyone paying attention, the long-brewing crisis hardly came out of nowhere.

At the beginning of August, in a House subcommittee meeting, Ken Isaacs of Christian relief organization Samaritan’s Purse said that elevated international aid was already overdue. “The Ebola crisis was not a surprise to us — we saw it coming back in April,” he testified, sounding outraged as he castigated the United States for mostly not paying attention until two American Samaritan’s Purse workers fell sick in late July.

“The international response to the disease has been a failure,” he said. “The international community allowed two relief organizations [Samaritan’s Purse and Doctors Without Borders] to provide all of the clinical care for Ebola victims in three countries.”

On their own, Liberia, Sierra Leone, and Guinea “simply do not have the capacity to handle the crisis in their countries,” Isaacs said. “The world will effectively be relegating the containment of this disease to three of the poorest countries in the world.”

That assessment was echoed by Daniel Bausch, an American doctor who talked to Business Insider in August about his experience on the ground in Guinea and Sierra Leone. “You have a very dangerous virus in three of the countries in the world that are least equipped to deal with it,” Bausch told us. “The scale of this outbreak has just outstripped the resources. That’s why it’s become so big.”

He also emphasized that an international response had to be swift and significant. “Every moment we wait, we risk more transmission,” Bausch said. “It’s a race against time.”

What Now?

By late August, The Wall Street Journal reported, “the nations with the funds and medical resources to help deal with this scourge [had] offered only a trickle of aid.” (The CDC has been on the ground helping with the Ebola outbreak for a while, but only in small numbers.)

In mid-September, around the same time the World Health Organization doubled its August estimate of the funding needed to bring the crisis under control, saying approximately $1 billion was needed, President Obama announced that he would lead the United States in “a major increase in our response” to Ebola.

That effort will include hundreds of millions of dollars in aid as well as 3,000 American troops in Liberia, who will be helping with logistics, building Ebola facilities containing 1,700 much-needed beds, and training hundreds of local healthcare workers.

France, China, the UK, Cuba, Canada, and other countries are also providing funding and assistance on the ground, though none currently at the scale of the United States.

“As tragic and difficult as the situation in West Africa is today, this is a fight we know how to win. We have the tools and the capacity to contain this epidemic and to prevent future ones,” Susan Rice, Obama’s national security adviser, wrote Friday in USA Today. “What’s needed now is the political will to dedicate the necessary resources and to transform our vision into reality.”

The Cost Of Waiting

The nations able to help fight what is now a raging epidemic waited far too long to unleash the tools and resources needed to contain a crisis that has already ravaged a trio of countries ill-equipped to manage it on their own. “We have to act fast. We can’t dawdle on this one,” Obama said two weeks ago, after the international community had already dawdled for months.

“We would never tolerate such shortsightedness in private behavior,” Kristof observed, in The New York Times. “If a roof leaks, we fix it before a home is ruined. If we buy a car, we add oil to keep the engine going. Yet in public policy — from education to global health — we routinely refuse to invest at the front end and have to pay far more at the back end.”

And while containing the Ebola epidemic will cost far more now than it would have in April, “the worst consequence of our myopia isn’t financial waste,” wrote Krisof. “It’s that people are unnecessarily dying.”

Ebola cases and case deaths in western Africa, according to data from the WHO. (Current as of September 21.)

A new paper in the New England Journal of Medicine by a team of World Health Organization researchers estimates that if current trends continue, the number of confirmed and probable cases will rise to 20,000 by Nov. 1, with almost half of those cases in Liberia:

The Centers for Disease Control and Prevention also released projections on Tuesday, using a new modeling tool that ended up with different numbers than the predictions published in the NEJM.

They estimated that reported cases in Sierra Leone and Liberia could rise to 8,000 by the end of September. But the CDC also noted that cases seem to be vastly underreported, perhaps by a factor of 2.5. According to the new projections, the true number of cases by the end of September could — worst-case scenario — rise to 21,000.

By Jan. 20, 2015, the number of Ebola cases in Liberia and Sierra Leone could be as high as 550,000, the CDC report said. Correcting for underreporting, the number would be vastly higher: 1.4 million cases.

“If conditions continue without scale-up of interventions,” the CDC researchers warned, “cases will continue to double approximately every 20 days, and the number of cases in West Africa will rapidly reach extraordinary levels.”

The projection of over 1 million cases by the end of January is not the likeliest scenario, but it is entirely possible. “My gut feeling is, the actions we’re taking now are going to make that worst-case scenario not come to pass,” CDC director Tom Frieden told The New York Times. “But it’s important to understand that it could happen.”

There are reasons to think that the tide may be turning against Ebola. “The findings … indicate that the epidemic can be controlled,” the CDC researchers wrote, and the international community has already begun mobilizing to help avoid the worst-case-scenario predictions. (The CDC’s best-case-scenario projections show that the epidemic could be almost over — rather than infecting more than a million people — by Jan. 20.)

Ebola is spread via bodily fluids, and isolating patients and their contacts is the most effective way to contain it. More beds set up for Ebola treatment are desperately needed.

The CDC projections — based on data from August — “reflect a moment in time before recent significant increases in efforts to improve treatment and isolation,” said Frieden in a statement. “They do not account for actions taken or planned since August by the United States and the international community. We anticipate that these actions will slow the spread of the epidemic.”

IMAGES:

Tony Gentile / Reuters Italian Air Force soldiers attend a military exercise preparing to help people infected with the Ebola virus in the event that it happens, at the Pratica di Mare Air Base, near Rome September 24, 2014.

John Moore / Getty

A Chinese UN soldier prepares a truckload of Ebola relief aid after it was airlifted by the United Nations Children’s Fund, on August 23, 2014 in Harbel, Liberia.

Luc Gnago / Reuters

A student holds a sign after a performance by actors during an awareness campaign against Ebola at Anono school in Abidjan September 25, 2014.

For more on this story go to: http://www.businessinsider.com/what-went-wrong-with-ebola-2014-9#ixzz3Ee9z3SyQ

Related story:

Obama says Ebola effort not enough

By Julie Pace in New York From The New Zealand Herald

Deaths could reach 1.4m by mid-January unless more international aid is forthcoming, says President

President Barack Obama, in a sober assessment of international efforts to stem a deadly Ebola outbreak, warned a high-level United Nations gathering yesterday that there is a “significant gap” between what’s been offered so far and what is actually needed to stem the health crisis in West Africa.

The leaders of the hardest-hit nations also appealed for more help, with the President of Sierra Leone calling the Ebola virus “worse than terrorism”.

The emergency UN session on Ebola reflected the deep concern about an outbreak that has so far killed nearly 3000 people. US health officials have warned that the number of infected people could explode to at least 1.4 million by mid-January, though they have also cautioned that the totals could peak well below that if efforts to control the outbreak are ramped up.

Despite the grim warnings, Obama said international aid simply is not flowing into West Africa fast enough.

“The outbreak is such where at this point, more people will die,” Obama said as he closed out three days of diplomacy at the annual gathering of the UN General Assembly. “So this is not one where there should be a lot of wrangling and people waiting to see who else is doing what. Everybody has got to move fast in order for us to make a difference.”

Yesterday, top lawmakers in the US Congress also approved the use of leftover Afghanistan war money to begin funding Obama’s US$1 billion ($1.27 billion) request to help fight the outbreak.

Obama has come under criticism from some in West Africa for a slow response to the outbreak. He outlined a more robust plan last week, announcing that the US would dispatch 3000 troops to Liberia to set up facilities and form training teams to help with the response. The Pentagon mission will involve airlifting personnel, medical supplies and equipment, such as tents to house Ebola victims and isolate people exposed to the virus.

European Commission chief Jose Manuel Barroso announced yesterday that the European Union was increasing aid to tackle the outbreak by nearly US$40 million.

The Ebola outbreak has hit Sierra Leone, Liberia and Guinea the hardest, leaving aid groups in the region scrambling desperately for resources.

Liberian President Ellen Johnson Sirleaf, addressing the conference via video, cited a “precipitous decline in economic activity” as well as the “loss of income and jobs” for people in her country.

President Ernest Bai Koroma of Sierra Leone, who also spoke on a video feed, said his country was facing “life-and-death challenges” that were worse than the threat of terrorism. His comments appeared to be a veiled reference to the degree to which the threat from Middle East extremists – most notably the Islamic State group in Iraq and Syria – has dominated the discussions at the UN this week.

Koroma took the dramatic step yesterday of sealing off districts where more than one million live in order to try to contain the outbreak.

The fears around the outbreak have spread far beyond West Africa, and one African leader made a plaintive appeal yesterday during his address at the UN for the world not to stigmatise the entire continent.

“Not all countries in Africa have disease,” Tanzanian President Jakaya Kikwete said, to rare applause from the chamber. “In fact, the affected countries are closer to Europe than they are to Kenya, Tanzania or South Africa in eastern and southern Africa … To cancel visits to these parts of Africa is incomprehensible.”

For more on this story go to: http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=11332370&ref=rss

See also today’s iNews Cayman related story “Militarising the Ebola crisis”