Ebola: Have we turned the corner?

The signs are promising, but doctors warn there is no room for complacency. Elizabeth Finkel reports. 

A transmission electron micrograph reveals the structure of the Ebola virus. – Centers for Disease Control/Science Faction/Getty Images

As the year draws to a close the raging Ebola epidemic has turned the corner in West Africa. But there’s no room for complacency, as the WHO’s assistant director-general Bruce Aylward told a Geneva press briefing on 1 December. “We’re in a very different place than we were 60 days ago with that yawning and increasing gap between response capacity and disease… But the risk is still very, very high.”

Aylward walked a fine line – acknowledging the success of what has been achieved and congratulating the heroic efforts of those on the front line and the leadership of West African governments, but without offering any excuse for complacency. “Using the word optimism and Ebola in the same sentence is completely inappropriate,” he said.

On the positive side, the WHO largely achieved the goals it set two months ago. In September the infection rate across the bordering West African countries of Guinea, Liberia and Sierra Leone was doubling every three weeks. Africa is no stranger to Ebola outbreaks – there have been 25 since 1976 – but past ones were nothing like this. In most the death toll was lower than 100. But as of 3 December the death toll in West Africa had climbed to 6,070.

Back in September the number of cases was predicted to reach more than half a million by January, with a 72% fatality rate. That’s when the WHO set its 70:70:60 target – to get 70% of sick people isolated in beds, 70% of the dead safely disinfected and buried, and to achieve those goals in 60 days.

Despite some confusion arising from the initial field reports (and doubts over the reliability of data given the number of affected villages with unpassable roads) Aylward is confident the goals have been met in Guinea and Liberia and that they are responsible for lowering Ebola infection rates. The west of Sierra Leone is still a moving target but he expressed confidence the roll-out of beds and burial teams will catch up there too.

Human behaviour has also been credited for the initial
wildfire spread of Ebola in the recent outbreak.

Besides beds and burial teams, Aylward said one more factor was responsible for the Ebola strategy’s success. “It’s the behaviour changes in places like Liberia that have been important. A lot of this is driven by very, very strong national government leadership.”

But human behaviour has also been credited for the initial wildfire spread of Ebola in the recent outbreak. As with past outbreaks this one began in a rural area – most likely caught from bats, considered the natural hosts of the disease. A person can be infected by handling or eating a bat or handling or eating infected bush meat such as chimpanzee, monkey or antelope – animals are infected by grazing near bat droppings.

In this case, it’s known that a two-year-old boy died of the disease on December 6, 2013 in the village of Meliandou, in southeastern Guinea bordering Sierra Leone and Liberia. Family members also died. A deeply held West African burial custom requires relatives to wash and touch the body. With no running water or electricity it’s not possible to protect yourself from a virus that concentrates in the sweat and tears of the dead – let alone in the vomit, blood and other body fluids of the living.

A Doctors Without Borders healthworker in protective clothing carries a child suspected of having Ebola in a treatent centre in Paynesville, Liberia. – John Moore/Getty Images

Ebola might well have stayed in a remote Guinea village had people not sought help from a popular faith healer across the border in Sierra Leone, who later died of the disease. Soon Ebola was on the loose – its spread assisted by traditional burials, extreme poverty and a 60% illiteracy level. And made worse by a war-scarred population deeply suspicious of health authorities.

As of 1 December there have been 17,145 cases. But while there is no cause for complacency, Aylward says Liberians have moved away from their initial sense of helplessness. The situation has moved from “that sense of being hunted by this virus to actually hunting the virus.” And he reported that patients treated in the pop-up hospitals being rolled out by the WHO, foreign governments and non-government organisations such as Medecins Sans Frontieres, were more likely to survive. When Ebola remained untreated death rates were higher than 80% – but inside the hospitals a combination of hydration and antibiotics was halving that rate to 40%.

The US Centres for Disease Control also tacitly acknowledges the turning tide. From its September estimate of half a million cases by January “it’s now likely to be closer to tens of thousands,” says epidemiologist Manoj Gambhir who, seconded from Monash University, Australia, is working in a rapid response team for the organisation.

Another positive note is that the panic that gripped the world in early October, when two nurses in Dallas and one in Spain became infected after treating patients from West Africa, appears to have receded. By the end of October the nurses had survived and Ebola had not spread – validating the scientific view that the virus is not highly infectious and is controllable with established public health measures.

That lesson was validated in Nigeria. On 20 October the WHO officially declared Nigeria “free of Ebola transmission”. It was just three months after their first case appeared on 20 July in Lagos, Africa’s most populous city. The world feared the worst but only 20 people officially contracted the disease and eight died.

Finally another positive note is that two vaccines (one from New Link Genetics and the other from GlaxoSmithKline) are in early human safety trials. The hope is that both vaccines will be ready for testing in West Africa in January. If they work, a full scale-up is planned by April. And they’ll be needed.

There are still some 1,100 new cases every week. Western Sierra Leone remains a hot spot and there are signs of complacency in Liberia as people start acting more freely, by, for example, taking taxis again. As Aylward reminded the gathered press, “At this point the biggest risk is that this drops out of the media. We have got to stay really really vigilant… and drive this right down to zero.”

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