At ebolaudbruddet i Vestafrika har fået lov at sprede sig så voldsomt skyldes et mix af faktorer, der tilsammen skabte ”den perfekte storm”, siger en af sygdommens opdagere. Væsentligt er det, at det tog tre måneder at opdage udbruddet, mener han.
LONDON, 24 September 2014 (IRIN): The new figures from the World Health Organization’s (WHO) Ebola Response Team are sobering. If cases in the three worst affected countries continue to rise at the present rate, by the beginning of November more than 20,000 people in West Africa will have been infected.
Mere dødelig end først antaget
And despite earlier suggestions that this might be a less deadly strain of the Ebola virus, allowing half its victims to recover, the new figures show a much higher fatality rate, in the region of 70 percent.
The authors attribute this to better data, and the fact that this time they have only included cases they are absolutely sure of – cases they know had Ebola and where they are certain of the final outcome, whether the patient lived or whether they died.
And unlike the previous estimates, these figures are consistent across all the three countries with major outbreaks – Guinea, Liberia and Sierra Leone.
For patients who had been treated in hospital, the mortality rates were a little lower, ranging from 67 percent in Liberia down to just over 61 percent in Sierra Leone, so hospital treatment made some difference, but perhaps not as much as might have been hoped.
Where there was a marked difference between the three countries was in the rates of transmission.
In the early days of the epidemic the disease was spreading fastest in Sierra Leone, with each case infecting 2.02 other people. This has now been reduced considerably, to 1.38. Liberia has managed to reduce its rate a little, while the rate of transmission in Guinea has actually increased.
This means the numbers infected are doubling in Guinea every 16 days, compared with every 24 days in Liberia and every 30 days in Sierra Leone.
The two men who originally identified the Ebola virus, in 1976 in what is now DR Congo (DRC), Peter Piot and David Heymann, were among a group of experts who held a briefing on the current outbreak at the Wellcome Trust in London this week.
Piot, who is now director of the London School of Hygiene and Tropical Medicine, said this was on a totally different scale from previous outbreaks.
WHO var langsom
“The reason for that,” he said, “is what I call a perfect storm, of decades of civil war, corrupt dictatorship as a background, leading to a loss of trust in the authorities, dysfunctional health systems, strong traditional beliefs about disease causation, and also what I think frankly was the most important factor, that the response was so slow. It took three months between the first case and the cause being identified as Ebola. And it took another five months and 1,000 deaths before WHO declared this a public health emergency.”
His colleague, David Heymann, now professor of infectious disease epidemiology at the London School, added that 25 previous outbreaks had been stopped while they were still in rural areas.
“There’s a better organization in communities, there’s a common language, there are village elders, village chiefs who help keep things in order, and it’s much easier and more effective to stop an outbreak in rural areas. Kikwit, the major outbreak in DRC in 1995, was only five hours journey by road from the capital, yet by stopping the outbreak in a rural area it doesn’t spread into the complex issues involved in the city, where there’s a breakdown in traditional governance and where there are all kinds of challenges due to different languages and different cultures.”
Behov for nytænkning
Speakers at the briefing all stressed the need for classic public health measures – contact tracing, isolation, health education – to check the spread.
Heymann said it was up to African governments to find innovative ways to trace contacts. They were the ones who had to reach their own people in the way they knew best.
Referring to the recent three-day lock-down in Sierra Leone, he told IRIN:
“They were able to reach more than 70 percent of households with messages about how the community can protect itself. In addition, it seemed to pass without any violence. I think it went against much of the international advice that they were receiving but maybe in the end it was what the government felt it had to do, and maybe that’s the innovation which will make a difference.”
Chris Whitty, the chief medical adviser to the UK Department for International Development, said up till now contact tracing had relied on actively going out to look for cases.
“What we need to do now is move over to some variant of passive case-finding where we incentivize people who have symptoms to come forward much earlier. But clearly to do that they are going to have to have a genuine possibility that they are going to be better treated than if they stayed at home. They’ve got to have other incentives too, but we have to take care not to over-incentivize it so we don’t get a huge crowd at the centres which will actually increase transmission. You need to get everyone with symptoms to come forward, test them quickly and send home those who don’t have Ebola. That sounds very easy, but getting the details right is very difficult.”
Healthcare workers still getting infected
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