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Ebola cordon sanitaire- Liberia Guinea Sierra Leone Triangle
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Author:  niman [ Sat Aug 16, 2014 5:55 pm ]
Post subject:  Ebola cordon sanitaire- Liberia Guinea Sierra Leone Triangle

A cordon sanitaire has been established in a triangle encompassing regions of Guinea, Sierra Leone, and Liberia, but cases are spilling into adjacent regions as well as Monrovia.

Author:  niman [ Sat Aug 16, 2014 6:02 pm ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas
By DONALD G. McNEIL Jr.AUG. 12, 2014

The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the “cordon sanitaire,” in which a line is drawn around the infected area and no one is allowed out.

Cordons, common in the medieval era of the Black Death, have not been seen since the border between Poland and Russia was closed in 1918 to stop typhus from spreading west. They have the potential to become brutal and inhumane. Centuries ago, in their most extreme form, everyone within the boundaries was left to die or survive, until the outbreak ended.

Plans for the new cordon were announced on Aug. 1 at an emergency meeting in Conakry, Guinea, of the Mano River Union, a regional association of Guinea, Sierra Leone and Liberia, the three countries hardest hit by Ebola, according to Agence France-Presse. The plan was to isolate a triangular area where the three countries meet, separated only by porous borders, and where 70 percent of the cases known at that time had been found.

Troops began closing internal roads in Liberia and Sierra Leone last week. The epidemic began in southern Guinea in December, but new cases there have slowed to a trickle. In the other two countries, the number of new cases is still rapidly rising. As of Monday, the region had seen 1,848 cases and 1,013 deaths, according to the World Health Organization, although many experts think that the real count is much higher because families in remote villages are avoiding hospitals and hiding victims.

Officials at the health organization and the Centers for Disease Control and Prevention, which have experts advising the countries, say the tactic could help contain the outbreak but want to see it used humanely.

“It might work,” said Dr. Martin S. Cetron, the disease center’s chief quarantine expert. “But it has a lot of potential to go poorly if it’s not done with an ethical approach. Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore. And as soon as cases are under control, one should dial back the restrictions.”

Experts said that any cordon must let food, water and medical care reach those inside, and that the trust of inhabitants must be won through communication with their leaders.

The phrase cordon sanitaire, or sanitary barrier, appears to date from 1821, when France sent 30,000 troops into the Pyrenees to stop a lethal fever raging in Spain from crossing the border.

In Sierra Leone, large sections of the Kailahun and Kenema districts, an area the size of Jamaica, have been cut off by military roadblocks. Soldiers check the credentials and take the temperatures of those trying to go in or out. In Liberia, similar restrictions have been imposed north of the capital, Monrovia.


Nigeria is not involved because its small Ebola outbreak is hundreds of miles away. All 10 confirmed cases there are in Lagos, the financial capital, and all are apparently linked to a Liberian-American who arrived there on a flight and later died.

Inside the cordoned area of Sierra Leone and Liberia, alarmed residents have told reporters that they fear starving because food prices are rising. Many farmers have died, and traders who cannot travel cannot earn money.

It is not clear whether plans to deliver food, water and care are underway.

When cordons are imposed, “human rights have to be respected,” said Gregory Hartl, a spokesman for the World Health Organization, which last week declared the outbreak an international public health emergency.

The agency will work with the World Food Program and other agencies to make sure food and supplies get in, he said.

W.H.O. officials attended the Conakry meeting but did not join the Aug. 1 announcement of the planned cordon. They have not opposed it, either.

“It seems like a reflexive movement by the governments to show that they’re doing something, and since they have armies more elaborate than their health care systems, they use the army,” said Dr. William Schaffner, the head of preventive medicine at Vanderbilt University’s medical school.

There have been nearly 20 Ebola outbreaks in Africa since the disease was discovered in 1976, and all previous ones were beaten by the same tactics: Teams of outside health experts, usually from Europe and the United States, flew in, recruited local health workers and set up field hospitals where all known victims were quarantined and treated. The teams also took over burials, disinfecting and bagging bodies. They traced all contacts of known victims and hospitalized any people who fell ill. Health workers protected themselves with gloves, coveralls, masks, bleach spray and the burning of used gear.

This time, however, the outbreak quickly spread among the three contiguous countries, all battered by political dysfunction and civil wars. None had seen the virus before, and the global response was initially slow and inadequate. Protective equipment quickly ran out; leading local doctors fell ill and even died, stirring panic.

Now, experts say, the epidemic is too big to control with the old tactics. Tracing contacts requires many health care workers, because any victim — especially a nurse or a market trader — could have had physical contact with dozens of people.

And health care workers are often fearful of helping people who may have Ebola. It may become necessary, Dr. Cetron suggested, to pay people within the cordon to report cases and victims’ contacts.

Before the modern era of vaccines, antibiotics and infection control, cordons sanitaires were far more common.

As louse-borne typhus swept through post-revolutionary Russia, the victors in World War I closed Poland’s eastern border. Travelers wanting to cross had to be interned, bathed, shaved and deloused, and their clothes had to be treated with steam and chemicals.

The most famous voluntary cordon, according to Joseph P. Byrne, a historian at Belmont University in Nashville, was of the English village of Eyam. In 1665, the plague reached it from London, probably in fleas on cloth shipped to a local tailor, the first to die. The village, which had about 350 people, voluntarily cordoned itself off from the spring until November to prevent the plague from spreading to the rest of Derbyshire. Grateful people from other villages left food outside a circle of stones around Eyam. Only a quarter of the village survived, but the plague did not spread.

The United States has its own history of cordons, some with racial overtones. In 1899, a 35-acre area of Honolulu housing its Chinese and Japanese residents was sealed off by the Hawaii National Guard and white vigilantes because of the plague. Workers with outside jobs had to pass through showers. Ultimately, a blaze started by the Fire Department to burn flea-infested buildings got out of control and destroyed much of the district, leaving 8,000 people homeless.

http://www.nytimes.com/interactive/2014 ... pe=nyt_now

Author:  niman [ Sat Aug 16, 2014 6:09 pm ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

Quarantined Ebola regions set to receive emergency food drops
World Bank, UN and WHO assessing how to make deliveries as threat of health crisis from malnutrition deepens

Stella Dawson for Thomson Reuters Foundation, part of the Guardian development network
theguardian.com, Friday 15 August 2014 09.18 EDT
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Neighbours watch from their window as a Liberian health department burial team prepares to enter the home of a woman suspected of dying of Ebola in Monrovia. Photograph: John Moore/Getty Images

International agencies are considering emergency food drops and truck convoys to reach extremely hungry people in Liberia and Sierra Leone, who are cordoned off from the outside world to halt the spread of the Ebola virus, a World Bank official said on Thursday.

Hunger is spreading fast as farmers die leaving crops rotting in fields. Truckers scared of the highly infectious disease are halting deliveries and shops are closing. Major airlines have shut down routes, isolating large swaths of the countries.

The Mano river region, home to about 1 million people and an epicentre for the disease, is a major concern and the issue was raised on Wednesday with the UN secretary general, Ban Ki-moon, said Tim Evans, senior director for health at the World Bank.

“There has been a lot of inflation in food prices and a lot of difficulty in getting food to the quarantined population,” he added.

The World Bank, with the UN and the World Health Organisation (WHO), is urgently assessing how to make emergency food deliveries, or the organisations face the danger of a deepening health crisis from malnutrition and the spread of other diseases, he said.

“This is emerging as an important part of the immediate response,” Evans said. “We are looking at exactly what the needs are and where, and then looking at how we contribute to making sure that food gets to the right places.”

The UN’s World Food Programme (WFP) said it has declared Guinea, Liberia and Sierra Leone – the three countries with more than 1,000 deaths in total from Ebola – a level three food emergency, its highest threat. It is mobilising teams to get food into the area to prevent widespread hunger and deaths.

“We are pulling out all the stops,” said Steve Taravella, WFP spokesman in Washington.

His agency is extraordinarily stretched. Never before has it faced six top-level emergencies at once – in Syria, Iraq, South Sudan, Cameroon, Central African Republic and now the Ebola-hit countries. “It is a dramatic, profound situation,” he said.

For west Africa, the stability of the whole region is at stake if hunger and disease spread uncontrolled, Evans said. “It certainly is a threat to national security,” he added, stressing that a comprehensive response is needed.

But for Nigeria, the World Bank director expressed optimism that it has acted promptly to contain Ebola by reaching those who came into contact with its first victim there. “It suggests at this point that it is relatively contained,” he said.

Longer term, the Ebola outbreak has exposed the danger from chronic underfunding of national healthcare systems and the need to invest in regional laboratories to test and manage infectious diseases, he said.

Most African countries have fallen far short of a 2000 pledge, known as the Abuja declaration, to devote 15% of their budgets to healthcare. The World Bank “absolutely” expects more lending for health in the years ahead, Evans said.

http://www.theguardian.com/global-devel ... erra-leone

Author:  niman [ Mon Aug 18, 2014 1:14 am ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

Struggling Liberia creates 'plague villages' in Ebola epicentre

Reuters | Boya (Liberia) | Published: Aug 18 2014, 10:32 IST

Summary
Liberia evokes 'plague villages' of medieval Europe that were shut off from the outside world.

To try to control the Ebola epidemic spreading through West Africa, Liberia has quarantined remote villages at the epicentre of the virus, evoking the "plague villages" of medieval Europe that were shut off from the outside world.

With few food and medical supplies getting in, many abandoned villagers face a stark choice: stay where they are and risk death or skip quarantine, spreading the infection further in a country ill-equipped to cope.

In Boya, in northern Liberia's Lofa County, Joseph Gbembo, who caught Ebola and survived, says he is struggling to raise 10 children under five years old and support five widows after nine members of his family were killed by the virus.

Fearful of catching Ebola themselves, the 30-year-old's neighbours refuse to speak with him and blame him for bringing the virus to the village.

"I am lonely," he said. "Nobody will talk to me and people run away from me." He says he has received no food or health care for the children and no help from government officials.

Aid workers say that if support does not arrive soon, locals in villages like Boya, where the undergrowth is already spreading among the houses, will simply disappear down jungle footpaths.

"If sufficient medication, food and water are not in place, the community will force their way out to fetch food and this could lead to further spread of the virus," said Tarnue Karbbar, a worker for charity Plan International based in Lofa County.

Ebola has killed at least 1,145 people in four African nations, but in the week through to August 13, Lofa county recorded more new cases than anywhere else - 124 new cases of Ebola and 60 deaths.

The World Health Organization and Liberian officials have warned that, with little access by healthcare workers to the remote areas hidden deep in rugged jungle zones, the actual toll may be far higher.

WHITE SHIELD

In the ramshackle coastal capital Monrovia, which still bears the scars of the brutal 14-year civil war that ended in 2003, officials say controlling the situation in Lofa is crucial to overcoming the country's biggest crisis since the conflict.

With her country under threat, President Ellen Johnson Sirleaf has imposed emergency measures including the community quarantine and a "cordon sanitaire" -- a system of medical roadblocks to prevent the infection reaching cities, widely used against the Black Death in Medieval times.

Troops have been deployed under operation "White Shield" to stop people from abandoning homes and infecting others in a country where the majority of cases remain at large, either because clinics are full or because they are scared of hospitals regarded as 'death traps'.

A crowd attacked a makeshift Ebola quarantine centre in Monrovia on Saturday, throwing stones and looting equipment and food, and, according to one health worker, removing patients from the building.

"There has to be concern that people in quarantined areas are left to fend for themselves," said Mike Noyes, head of humanitarian response at ActionAid UK. "Who is going to be the police officer who goes to these places? There's a risk that these places become plague villages."

Aid workers say the virus reminds them of the forces roaming Liberia during the civil war, making it a byword for brutality.

"It was like the war. It was so desolate," said Adolphus Scott, a worker for U.N. child agency UNICEF describing Zango Town in the jungles of northern Liberia, where most of the 2,000 residents had either died of Ebola or fled.

Elderly people sat in the doorways of their homes, gazing at a dirt street empty but for a few roaming goats and skinny chickens, he said. "Ebola is like a guerrilla army marauding the country."

HEALTHY AT RISK

The Ebola virus, never previously detected in poverty-racked West Africa, is carried by jungle mammals like fruit bats. It is thought to have been transmitted to the human population via bush meat as early as December in remote southeastern Guinea.

Initial symptoms like fever and muscular pains are difficult to distinguish from other tropical illnesses such as malaria, meaning the outbreak was not detected til March. By the late stages of the disease, victims are at their most contagious, bleeding from eyes and ears, with the virus pouring out of them.

Countries like Uganda in east Africa have tackled previous rural outbreaks through online reporting systems and rigorous surveillance, said Uganda's Director of Community and Clinical Services Dr. Anthony Mbonye. But in the West of the continent, weak healthcare systems were unprepared.

Liberia, one of the world's least developed nations, has poor Internet and telecommunications, and only around 50 doctors for a population of over 4 million. Traditional funerals, where family members bathe and dress highly contagious corpses, have expedited Ebola's spread to 9 of the country's 15 counties.

In recognition of the region's inability to cope, the World Health Organization this week declared Ebola an international health emergency - only the third time in its 66-year history it has taken this step.

Neighbours Guinea and Sierra Leone have placed checkpoints in Gueckedou and Kenema, creating a cross-border quarantine zone of roughly 20,000 square km, about the size of Wales, called the "unified sector".

Within this massive area, Information Minister Lewis Brown described more intense quarantine measures in Lofa county, ring fencing areas where up to 70 percent of people are infected.

"Access to these hot spots is now cut off except for medical workers," he said in an interview this week.

Reaching the sick in isolated villages there is critical because the county's main Foya health centre is full. The site was run by U.S. charity Samaritan's Purse until it pulled out after two of its health workers contracted the virus in Monrovia.

Medical charity MSF, which has now stepped in, says 137 patients are packed into the 40-bed site.

Health workers hope to train locals to create isolation units in schools and churches within their own communities.

"Quarantines expose healthy people to risk - which is why the effectiveness of states is so important in supporting preventive measures that will minimise this," said Robert Dingwall, specialist in health policy responses to infectious diseases at Nottingham Trent University.

Such measures include prevention education, crematorium facilities and protective equipment, he said.

ISOLATED

But Liberia's response team is struggling to keep up.

The main health care centre in Lofa is "overwhelmed" by new patients, a health ministry report said. A total of 13 health care workers have already died from Ebola in the county while its surveillance office lacks computers to manage cases.

Liberia's Brown also acknowledged the risk: "We can establish as many checkpoints as we want but if we cannot get the food and the medical supplies in to affected communities, they will leave."

Even if the resources arrive, help might be chased away.

Unlike in other areas of the country, where Ebola awareness campaigns are helping to draw people out of hiding, in this isolated border region, far from the otherwise ubiquitous 'Ebola is Real' government billboards, denial is still strong.

According to a local rumour, merchants dressed as health workers are taking people away in order to sell human organs, provoking violent reactions from locals, Karbarr said.

In late July, an ambulance was stoned in the Kolahun district as it tried to take a body for burial. In the same area, a group of hand pump technicians were told to leave or have their vehicle torched. The police arrested a man this week for Ebola denial.

SUPPLY DISRUPTIONS

Brown said that people in unaffected counties in Liberia's east have so far welcomed the quarantine, but sentiment could swing if supplies start to run short.

The Italian roots of the word quarantine - meaning 40 days - refers to the isolation period for ships arriving into Venice from plague regions. But Liberia's operation could go on for three months or more, creating the need for a long-term plan.

As well as increasing the feelings of isolation and criminalisation felt by those in quarantine, the duration of the quarantine risks creating national supply disruptions. Already the price of oil and rice has doubled, residents say.

While those in Lofa are located within the country's sweet potatoes and palm fruit-growing food belt, the unaffected eastern counties cannot feed themselves.

The World Food Programme intends to distribute food to more than 1 million people living in the cross-border quarantine zone, but there are not yet plans for the unaffected counties.

"My worry is how the southeast will get food. You could have trade with Ivory coast but they might not want to for fear of the virus," said UNICEF'S Scott, referring to the landlocked River Gee and Maryland counties.

The early signs suggest this is happening already.

Aboubacar Barry, who sells rice and sugar in the Ivorian town of Danane, says his business is a fifth of what it was before the de facto closure of the Liberian border.

Yacouba Sylla, the driver of a motorbike taxi in the border area, also complained of a slump in his business.

"Ebola hasn't arrived here, but it is going to kill us anyway before it gets here, as we will die of hunger," he said.

http://www.financialexpress.com/news/st ... /1280285/0

Author:  niman [ Mon Aug 18, 2014 7:12 am ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

AUGUST 18 2014 12:09h
Liberia «to shoot» people crossing border closed to halt Ebola

Liberia's armed forces were given orders to shoot people trying to illegally cross the border from neighbouring Sierra Leone, which was closed to stem the spread of Ebola, local newspaper Daily Observer reported Monday.
Image

Soldiers stationed in Bomi and Grand Cape Mount counties, which border Sierra Leone, were to "shoot on sight" any person trying to cross the border, said deputy chief of staff, Colonel Eric Dennis. The order comes after border officials reported people continued to cross the porous border illegally. Grand Cape Mount county had 35 known "illegal entry points," according to immigration commander Colonel Samuel Mulbah. Illegal crossings were a major health threat, said Mulbah, "because we don't know the health status of those who cross at night." Liberia closed its borders with Sierra Leone weeks ago in an attempt to contain the Ebola outbreak, which killed more than 1,100 people in West Africa.

The announcement came after residents of a slum near the capital broke into an isolation centre and freed up to 30 Ebola patients, local newspaper Front Page Africa reported. "As I speak the police station is deserted. There is no security now in West Point," resident Moses Teah was quoted as saying. The break-in to protest poor conditions at Ebola quarantine centres has raised fears that the deadly virus will spread in the slum. "I saw sick people being taken out of the Ebola Centre. Some took them home to care for them," said Teah. Other residents, who reportedly continue to deny the existence of Ebola, looted the quarantine centre, stealing patients' mattresses, blood-stained bedding, cooking utensils and medication, according to media reports.

Some Liberians believe the Ebola outbreak was a ploy by government to secure foreign aid, the Daily Observer reported. Liberians also criticize government for not providing sufficient services to Ebola patients, including health care, food and safe burials.

The World Health Organization (WHO) has said that a "massive scaling up of the international response" is necessary to get the outbreak under control. By August 15, 2,127 cases and 1,145 deaths were reported from Guinea, Liberia, Nigeria and Sierra Leone. In Liberia, there were 786 suspected and confirmed cases, according to the WHO, of which 413 people died.

The current outbreak is caused by the most lethal strain in the family of Ebola viruses. Ebola causes massive haemorrhages and has a fatality rate of up to 90 per cent. It is transmitted through contact with blood and other body fluids.

http://dalje.com/en-world/liberia-to-sh ... ola/518767

Author:  niman [ Mon Aug 18, 2014 8:02 am ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

Ebola: How 2-yr-old boy infected mother, sister, spread virus

17.Aug.2014

PATIENT Zero in the Ebola outbreak, researchers suspect, was a 2-year-old boy who died on December 6, just a few days after falling ill in a village in Guéckédou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Guéckédou is at the intersection of three nations, where the disease found an easy entry point to the region.

A week later, it killed the boy’s mother, then his 3-year-old sister, then his grandmother. All had fever, vomiting and diarrhea, but no one knew what had sickened them.

Two mourners at the grandmother’s funeral took the virus home to their village. A health worker carried it to another, where he died, as did his doctor. They both infected relatives from other towns. By the time Ebola was recognised, in March, dozens of people had died in eight Guinean communities, and suspected cases were popping up in Liberia and Sierra Leone — three of the world’s poorest countries, recovering from years of political dysfunction and civil war.

In Guéckédou, where it all began, “the feeling was fright,” said Dr Kalissa N’fansoumane, the hospital director. He had to persuade his employees to come to work.

On March 31, Doctors Without Borders, which has intervened in many Ebola outbreaks, called this one “unprecedented,” and warned that the disease had erupted in so many locations that fighting it would be enormously difficult.

Now, with 1,779 cases, including 961 deaths and a small cluster in Nigeria, the outbreak is out of control and still getting worse. Not only is it the largest ever, but it also seems likely to surpass all two dozen previous known Ebola outbreaks combined. Epidemiologists predict it will take months to control, perhaps many months, and a spokesman for the World Health Organisation (WHO) said thousands more health workers were needed to fight it.

Some experts warn that the outbreak could destabilise governments in the region. It is already causing widespread panic and disruption. Recently, Guinea announced that it had closed its borders with Sierra Leone and Liberia in a bid to halt the virus’s spread. Doctors worry that deaths from malaria, dysentery and other diseases could shoot up as Ebola drains resources from weak health systems. Health care workers, already in short supply, have been hit hard by the outbreak: 145 have been infected, and 80 of them have died.

Past Ebola outbreaks have been snuffed out, often within a few months. How, then, did this one spin so far out of control? It is partly a consequence of modernisation in Africa, and perhaps a warning that future outbreaks, which are inevitable, will pose tougher challenges. Unlike most previous outbreaks, which occurred in remote, localised spots, this one began in a border region where roads have been improved and people travel a lot. In this case, the disease was on the move before health officials even knew it had struck.

Also, this part of Africa had never seen Ebola before. Health workers did not recognise it and had neither the training nor the equipment to avoid infecting themselves or other patients. Hospitals in the region often lack running water and gloves, and can be fertile ground for epidemics.

Public health experts acknowledge that the initial response, both locally and internationally, was inadequate.

“That’s obviously the case,” said Dr Thomas R. Frieden, director of the Centers for Disease Control and Prevention. “Look at what’s happening now.”

He added, “A couple of months ago, there was a false sense of confidence that it was controlled, a stepping back, and then it flared up worse than before.”

Health experts have grown increasingly confident in recent years that they can control Ebola, Dr Frieden said, based on success in places like Uganda.

But those successes hinged on huge education campaigns to teach people about the disease and persuade them to go to treatment centers. Much work also went into getting people to change funeral practices that involve touching corpses, which are highly infectious.

But in West Africa, Ebola was unknown.

How Ebola spread

A report in The New England Journal of Medicine traces the spread of the recent Ebola outbreak from Guéckédou, Guinea, to towns nearby.

In some areas, frightened and angry people have attacked health workers and even accused them of bringing in disease.

“Early on in the outbreak, we had at least 26 villages or little towns that would not cooperate with responders in terms of letting people into the village,” said Gregory Hartl, a spokesman for the World Health Organisation (WHO).

The outbreak has occurred in three waves: the first two were relatively small, and the third, starting about a month ago, was much larger, Mr. Hartl said. “That third wave was a clarion call,” he said.

At a House subcommittee hearing on Thursday, Ken Isaacs, a vice president of Samaritan’s Purse, said his aid group and Doctors Without Borders were doing much of the work on the outbreak.

“That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries testifies to the lack of serious attention the epidemic was given,” he said.

Guinea’s monumental task

In mid-March, Guinea’s Ministry of Health asked Doctors Without Borders for help in Guéckédou.

At first, the group’s experts suspected Lassa fever, a viral disease endemic in West Africa. But this illness was worse. Isolation units were set up, and tests confirmed Ebola.

Like many African cities and towns, this region hums with motorcycle taxis and minivans crammed with passengers.

The mobility, and now the sheer numbers, make the basic work of containing the disease a monumental task. The only way to stop an outbreak is to isolate infected patients, trace all their contacts, isolate the ones who get sick and repeat the process until, finally, there are no more cases.

But how do you do that when there can easily be 500 names on the list of contacts who are supposed to be tracked down and checked for fever every day for 21 days?

“They go to the field to work their crops,” said Monia Sayah, a nurse sent in by Doctors Without Borders. “Some have phones, but the networks don’t always work. Some will say, ‘I’m fine; you don’t have to come,’ but we really have to see them and take their temperature. But if someone wants to lie and take Tylenol, they won’t have a temperature.”

At Donka Hospital in Guinea’s capital, Dr Simon Mardel, a British emergency physician, who has worked in seven previous hemorrhagic fever outbreaks and was sent to Guinea by the World Health Organisation, realised this outbreak was the worst he had seen. A man had arrived late one night, panting and with abdominal pain. During the previous few days, he had been treated at two private clinics, given intravenous fluids and sent home. The staff did not suspect Ebola because he had no fever. But fever can diminish at the end stage of the disease.

The treatment room at Donka was poorly lit and had no sink. There were few buckets of chlorine solution, and the staff found it impossible to clean their hands between patients.

The man died two hours after arriving. Tests later showed he had been positive to Ebola. Untold numbers of health care workers and their subsequent patients had been exposed to the disease.

Gloves, in short supply at the hospitals, were selling for 50 cents a pair on the open market, a huge sum for people who often live on less than a dollar a day. At homes where families cared for patients, even plastic buckets to hold water and bleach for washing hands and disinfecting linens were lacking.

Workers were failing to trace all patients’ contacts. The resulting unsuspected cases, appearing at hospitals without standard infection control measures, worsened the spread in a “vicious circle,” Dr Mardel said.

Tracing the epidemic’s origins

As is often the case in Ebola outbreaks, no one knows how the first person got the disease or how the virus found its way to the region. The virus infects monkeys and apes, and some previous epidemics are thought to have begun when someone was exposed to blood while killing or butchering an infected animal. Cooking will destroy the virus, so the risk is not in eating the meat, but in handling it raw. Ebola is also thought to infect fruit bats without harming them, so the same risks apply to butchering bats. Some researchers also think that people might become infected by eating fruit or other uncooked foods contaminated by droppings from infected bats.

Once people become ill, their bodily fluids can infect others, and they become more infectious as the illness progresses. The disease does not spread through the air like the flu; contact with fluids is necessary, usually through the eyes, nose, mouth or cuts in the skin. One drop of blood can harbour millions of viruses, and corpses become like virus bombs.

A research team that studied the Guinea outbreak traced the disease back to the 2-year-old who died in Guéckédou and published a report in The New England Journal of Medicine. He and his relatives were never tested to confirm Ebola, but their symptoms matched it and they fit into a pattern of transmission that included other cases confirmed by blood tests.

Roaring back in Liberia

Dr Fazlul Haque, deputy representative of Unicef in Liberia, said that after a few cases there in March and April, health workers thought the disease had gone away. But it came roaring back about a month later.

“It reappeared, and this time, it came in a very big way,” he said. “The rate of increase is very high now.”

From July 30 to August 6, Liberia’s government reported more than 170 new cases and over 90 deaths.

“Currently, our efforts are not enough to stop the virus,” Dr Haque said.

He added that most health agencies believed the true case numbers to be far higher, in part because locals were not coming forward when relatives fell ill, and because detection by the health authorities has been weak. Rukshan Ratnam, a spokesman for Unicef in Liberia, said some families had hidden their sick to avoid sending them to isolation wards, or out of shame stemming from traditional beliefs that illness is a punishment for doing something wrong.

Dr Haque said that the tracing of cases, crucial for the containment of the disease, was moving too slowly to keep up with new infections. Seven counties have confirmed cases, and the government has deployed security forces in Lofa County, where Liberia’s first case was detected, he said. But the government has given leave to non-essential employees in those areas, so it is not clear how they will have the staffing to isolate the sick. Some hospitals have closed because so many health workers have fallen ill.

Liberia has closed markets and many border crossings. It has said testing and screening will be done at immigration checkpoints.

But on Thursday, at a checkpoint staffed by at least 30 soldiers in Klay, Bomi County, there was no screening — just a blockade and a line of trucks loaded with bags of charcoal, plantains and potato greens.

Hilary Wesseh, a truck driver who was sucking the last drops of juice out of a small lime, said he had been stuck there for two days.

“They are holding us hostage,” he said.

A desperate call for help

By June and July, Sierra Leone was becoming the center of the outbreak. At the government hospital in Kenema, Dr Sheik Umar Khan was leading the efforts to treat patients and control the epidemic.

But he was desperate for supplies: chlorine for disinfection, gloves, goggles, protective suits, rudimentary sugar and salt solutions to fight dehydration and give patients a chance to survive. Early in July, he emailed friends and former medical school classmates in the United States, asking for their help and sending a spreadsheet listing what he needed, and what he had. Many of the lines in the “available” column were empty. One of his requests was for body bags: 3,000 adult, 2,000 child.

Before his friends could send the supplies, Dr Khan contracted Ebola himself. He died on July 29.

Source: New York Times
http://tribune.com.ng/special-report/it ... read-virus

Author:  niman [ Mon Aug 18, 2014 8:20 am ]
Post subject:  Re: Ebola cordon sanitaire- Liberia Guinea Sierra Leone Tria

Survivors enlisted in Sierra Leone's Ebola battle
AFP By Frankie Taggart
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An ambulance is parked in front of the Kenema government hospital in Sierra Leone, on August 16, 2014
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KAILAHUN (Sierra Leone) (AFP) - Hawa Idrisa was visiting her father-in-law on an Ebola ward in eastern Sierra Leone when his drip snapped out and his atrophying veins spurted thin, uncoagulated blood into her eyes and mouth.

Hawa had been carrying her infant daughter Helen but luckily she had laid the child down, otherwise the baby would almost certainly be dead by now.

A single droplet of blood smaller than a full stop can carry up to 100 million particles of the deadly Ebola virus, yet one is enough to end a human life.

"The blood got all over me, and people were running away. So I took a bucket of chlorine and poured it over myself," Hawa said.

She returned home to forget her ordeal, but a week later she began experiencing fever and headaches, the early symptoms of the Ebola.

Her 12-month-old mercifully tested negative, but her husband Nallo was infected and he and Hawa checked into the Doctors Without Borders' (MSF) treatment facility in the eastern district of Kailahun.

Hawa spent four weeks drifting between life and death at the centre, in the district capital Kailahan city, a trading post of 30,000 in the Kissi triangle linking to Liberia and Sierra Leone.

"I didn't know what was happening to me. I didn't even know where I was. I don't remember anything from that time," she told AFP of the ordeal she survived.

Ebola kills more than half of the people it infects, putrifying their insides in the worst cases until their vital organs seep from their bodies.

View galleryA girl suspected of being infected with the Ebola virus …
A girl suspected of being infected with the Ebola virus has her temperature checked at the governmen …
It is highly infectious but not particularly contagious, meaning that once you are exposed, your chances of escaping the fever are extremely low, although it can only be passed on through bodily fluids.

- Survival and suspicion -

The good news is that when patients are caught early enough, given paracetamol for their fevers, kept rehydrated and nourished, their chances of survival increase dramatically.

Hawa proudly shows off a certificate saying she has recovered fully, and she is preparing to return home.

"I know there is nothing wrong with my daughter, but my mind and heart will be at the centre with my husband," she says.

Already more than 2,100 people have been infected across four west African countries, and 1,145 people have died, dwarfing previous Ebola outbreaks.

The epidemic is perhaps worst of all in Sierra Leone, which has registered 810 cases, more than any other country.

The hardest-hit districts, Kailahun and the diamond trading hub of Kenema next door, have been sealed off to ordinary members of the public.

View galleryLocals stand at a market in Kenema, Sierra Leone, on …
Locals stand at a market in Kenema, Sierra Leone, on August 16, 2014 (AFP Photo/Carl De Souza)
Around a million people in the two districts are in effective lockdown, and locals say soaring food prices are pushing the region towards a crisis.

Local doctors and nurses are fighting not just the disease, but also the distrust of locals who fear modern medical practices.

Relatives have been known to snatch infected loved-ones from clinics to die in their own villages, exacerbating the spread of the virus.

They have even attacked treatment centres -- as armed men did in neighbouring Liberia at the weekend --- convinced that Ebola is a Western conspiracy against traditional African communities and that foreign healthworkers are in on the secret.

Some 1,500 police and soldiers have been deployed to prevent raids, but they are powerless faced with the suspicion and fear of poorly educated traditional communities.

Many tribespeople at the epicentre of the outbreak either don't know how to prevent and treat Ebola or do not believe it exists at all.

This, says MSF, is where the survivors come in.

- Building trust -

Ella Watson-Stryker, 34, a health promoter with the aid agency, is part of a team taking Hawa and other survivors home to their villages.

She will gather their neighbours and family members around, answer their questions about the virus and try to reassure them that Hawa poses no danger.

"This is very exciting for us. It's also really beneficial to the overall response to the outbreak because when survivors go home, they can explain about their stay at the centre.

"They give people hope that it is possible to survive and it really builds trust between the community and MSF," she says.

Watson-Stryker also says that when survivors go back to their communities, people begin to understand that treatment centres are not just "a place where people go to die".

They are surprised to learn that patients are fed, given unlimited soft drinks, access to toilets, showers and medicine, and that their families are encouraged to visit.

"We try to assuage the fears of the community, because there are a lot of rumours out there, that as soon as you come to the treatment centre you will just be left to die."

Back at the MSF centre, Nallo enthuses about his future with Hawa and their baby girl, despite remaining in grave danger in the high risk area.

"At first people thought that when they got here, they were going to have all their blood removed and they would die," he says.

"They have been giving me drugs and I am much better, so when I get back to my community I will tell people that if it ever happens that they get Ebola we advise them to come here."

http://news.yahoo.com/survivors-enliste ... 54552.html

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