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PostPosted: Sat Sep 13, 2014 4:57 pm 
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The recent warning by WHO that Ebola was expanding exponentially has led to series of media reports citing outcomes of unchecked exponential growth.

These reports have also cited a need for the US to take charge, and President Obama has a scheduled meeting with the CDC in Atlanta on Tuesday

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PostPosted: Sat Sep 13, 2014 5:03 pm 
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Ebola situation in Liberia: non-conventional interventions needed

Situation assessment - 8 September 2014

During the past weeks, a WHO team of emergency experts worked together with President Ellen Johnson Sirleaf and members of her government to assess the Ebola situation in Liberia.

Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially.

The investigative team worked alongside staff from the Ministry of Health, local health officials, and other key partners working in the country.

All agreed that the demands of the Ebola outbreak have completely outstripped the government’s and partners’ capacity to respond. Fourteen of Liberia’s 15 counties have now reported confirmed cases.

Some 152 health care workers have been infected and 79 have died. When the outbreak began, Liberia had only 1 doctor to treat nearly 100,000 people in a total population of 4.4 million people. Every infection or death of a doctor or nurse depletes response capacity significantly.

Liberia, together with the other hard-hit countries, namely Guinea and Sierra Leone, is experiencing a phenomenon never before seen in any previous Ebola outbreak. As soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload.

Of all Ebola-affected countries, Liberia has the highest cumulative number of reported cases and deaths, amounting, on 8 September, to nearly two thousand cases and more than one thousand deaths. The case-fatality rate, at 58%, is also among the highest.

Situation in Montserrado county

The WHO investigation concentrated on Montserrado county, which includes Liberia’s capital, Monrovia. The county is home to more than one million people. The teeming West Point slum, which has no sanitation, little running water, and virtually no electrical supplies, is also located in Monrovia, and is adjacent to the city’s major market district.

In Montserrado county, the team estimated that 1000 beds are urgently needed for the treatment of currently infected Ebola patients. At present only 240 beds are available, with an additional 260 beds either planned or in the process of being put in place. These estimates mean that only half of the urgent and immediate capacity needs could be met within the next few weeks and months.

The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centres.

For example, an Ebola treatment facility, hastily improvised by WHO for the Ministry of Health, was recently set up to manage 30 patients but had more than 70 patients as soon as it opened.

WHO estimates that 200 to 250 medical staff are needed to safely manage an Ebola treatment facility with 70 beds.

The investigation team viewed conditions in general-purpose health facilities as well as Ebola-specific transit and treatment facilities.

The John F Kennedy Medical Center in Monrovia, which was largely destroyed during Liberia’s civil war, remains the country’s only academic referral hospital. The hospital is plagued by electrical fires and floods, and several medical staff were infected there and died, depleting the hospital’s limited workforce further.

The fact that early symptoms of Ebola virus disease mimic those of many other common infectious diseases increases the likelihood that Ebola patients will be treated in the same ward as patients suffering from other infections, putting cases and medical staff alike at very high risk of exposure.

In Monrovia, taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none. As WHO staff in Liberia confirm, no free beds for Ebola treatment exist anywhere in the country.

According to a WHO staff member who has been in Liberia for the past several weeks, motorbike-taxis and regular taxis are a hot source of potential Ebola virus transmission, as these vehicles are not disinfected at all, much less before new passengers are taken on board.

When patients are turned away at Ebola treatment centres, they have no choice but to return to their communities and homes, where they inevitably infect others, perpetuating constantly higher flare-ups in the number of cases.

Other urgent needs include finding shelters for orphans and helping recovered patients who have been rejected by their families or neighbours.

Last week, WHO sent 1 of its most experienced emergency managers to head the WHO office in Monrovia. Coordination among key partners is rapidly improving, aiming for a better match between resources and rapidly escalating needs.

Implications of the investigation

The investigation in Liberia yields 3 important conclusions that need to shape the Ebola response in high-transmission countries.

First, conventional Ebola control interventions are not having an adequate impact in Liberia, though they appear to be working elsewhere in areas of limited transmission, most notably in Nigeria, Senegal, and the Democratic Republic of Congo.

Second, far greater community engagement is the cornerstone of a more effective response. Where communities take charge, especially in rural areas, and put in place their own solutions and protective measures, Ebola transmission has slowed considerably.

Third, key development partners who are supporting the response in Liberia and elsewhere need to prepare to scale up their current efforts by three- to four-fold.

As WHO Director-General Dr Margaret Chan told agencies and officials last week in New York City and Washington, DC, development partners need to prepare for an “exponential increase” in Ebola cases in countries currently experiencing intense virus transmission.

Many thousands of new cases are expected in Liberia over the coming 3 weeks.

WHO and its Director-General will continue to advocate for more Ebola treatment beds in Liberia and elsewhere, and will hold the world accountable for responding to this dire emergency with its unprecedented dimensions of human suffering.

WHO media contacts:
Fadéla Chaib
Telephone: + 41 22 791 3228
Mobile:+ 41 79 475 55 56
Email: chaibf@who.int

Tarik Jasarevic
Mobile: +41 793 676 214
Tel: +41 22 791 5099
E-mail: jasarevict@who.int

http://www.who.int/mediacentre/news/ebo ... r-2014/en/

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PostPosted: Sat Sep 13, 2014 5:18 pm 
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Ebola threatens to destroy Sierra Leone and Liberia

The virus is spreading like wildfire. A German Ebola expert tells Deutsche Welle, that it will not be possible to contain the virus with the measures that have been taken so far.
Image
Ebola in Liberia Photo: EPA/AHMED JALLANZO
A security official in Liberia's capital, Monrovia

His statement might alarm many people.

But Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.

"The right time to get this epidemic under control in these countries has been missed," he said. That time was May and June. "Now it will be much more difficult."

Schmidt-Chanasit expects the virus will "become endemic" in this part of the world, if no massive assistence arrives.

With other words: It could more or less infect everybody and many people could die.

Stop the virus from spilling over to other countries

Schmidt-Chanasit knows that it is a hard thing to say.

He stresses that he doesn't want international help to stop. Quite the contrary: He demands "massive help".

For Sierra Leone and Liberia, though, he thinks "it is very difficult to bring enough help there to get a grip on the epidemic."

According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, "and to help where it is still possible, in Nigeria and Senegal for example."

Moreover, much more money has to be put into evaluating suitable vaccines, he added.
Image
Ebola in Liberia Photo: EPA/AHMED JALLANZO
In Liberia, the death toll has risen to over 1000.

Angry reactions

In the headquarters of Welthungerhilfe, a German non-governmental aid organization that is engaged in helping with the Ebola epidemic, Schmidt-Chanasit's statement causes much contempt.

Such declarations "are not very constructive," a spokeswoman said.

Jochen Moninger, Sierra Leone based coordinator of Welthungerhilfe, told DW, Schmidt-Chanasit's statement is "dangerous and moreover, not correct."

Moninger has been living in Sierra Leone for four years and has experienced the Ebola outbreak there from the beginning.

"The measures are beginning to show progress," he says. "The problem is solvable - the disease can be stemmed."

"If I had lost hope completely, I would pack my things and take my family out of here", Moninger adds. Instead, he and his family will stay.

In Sierra Leone, the government has ordered a quarantine of 21 days for every household in which an Ebola case occurred. Soldiers and police are guarding these houses preventing anyone who has come into contact with an Ebola patient from leaving.

According to Moninger, that is exactly the right thing to do: isolating sick people - should it be necessary, even with military force.
Image
Ebola in Liberia Photo: EPA/AHMED JALLANZO
When Liberia's government quarantined the slum area of West Point, frustration led to protest.

Creating hopelessness doesn't help

Moninger says he doesn't know much about the situation in Liberia. But indeed, he got the impression that "there seems to be happening something that is not good at all."

He grants that Schmidt-Chanasit's statement "might point a little bit into the right direction" regarding Liberia.

Liberia has not taken on the same quarantine measures as Sierra Leone. According to a WOrld HEalth Organization (WHO) report, Ebola-infected people are crisscrossing the capital in shared taxis, looking for a treatment place and returning home after finding none. This way the virus spreads.

"Distributing hopelessness", though, Moninger said, "is dangerous", adding that there are many human lives at risk, and "statements like these make the situation even worse".

Disastrous, but not without hope

The WHO in Geneva refuses to comment on Schmidt-Chanasit's statement.

WHO spokeswoman Fadéla Chaib, though, says that there is "of course" still hope for both countries.

"We can bring the situation under control in 6 to 9 months," she told DW.
Image
Ebola in Liberia Photo: EPA/AHMED JALLANZO
When protesting against government's decision to quarantine West Point, residents have been injured.

She admits, though, that the situation especially in Liberia is "very intense".

The government is completely outstripped and as soon as a new Ebola treatment center has opened, it is overflowed by patients, she says, adding that Liberia has the highest number of cases and deaths in West Africa with a 60 percent case-fatality rate.

The situation is getting worse after 80 health workers, doctors and nurses, have died after contracting the disease.

The WHO even expects thousands of new cases of Ebola in Liberia over the next few weeks.

Winning together

Not only neighboring countries but also Europe and the US will have to support the fight against the epidemic, WHO's Chaib demands.

Then it might be possible to win this fight.

The key to getting a grip on the epidemic is to stop the transmission of Ebola, especially in healthcare workers, she says.

Creating Ebola centers in the communities themselves will stop Ebola patients and their family members moving around and infecting other people.

"We will do everything we can to stop this Ebola outbreak. We will not let down West Africa."

http://www.dw.de/ebola-threatens-to-des ... a-17915090

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PostPosted: Sat Sep 13, 2014 5:30 pm 
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Eurosurveillance, Volume 19, Issue 36, 11 September 2014
Rapid communications
EARLY TRANSMISSION DYNAMICS OF EBOLA VIRUS DISEASE (EVD), WEST AFRICA, MARCH TO AUGUST 2014
H Nishiura ()1, G Chowell2,3
Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States
Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States

We have derived global and country-specific estimates of the Rt of EVD for the ongoing outbreak in West Africa. Our global estimates of the Rt appear to be continuously above one since early June, indicating that the epidemic has been steadily growing and has not been brought under control as of 26 August 2014. The country-specific estimates for Sierra Leone and Liberia were also above one, perhaps reflecting the increasing trend in cases in these countries since June. Our estimated reproduction numbers, broadly ranging from one to two, are consistent with published estimates from prior outbreaks in Central Africa [9,17]. Our estimates of Rt<2 indicate that the outbreak could be brought under control if more than half of secondary transmissions per primary case are prevented.

Our statistical analysis of the reproduction number of EVD in West Africa has demonstrated that the continuous growth of cases from June to August 2014 signalled a major epidemic, which is in line with estimates of the Rt above 1.0. Moreover, the timing of Rt reaching levels above one is in line with a concomitant surge in cases in Sierra Leone and Liberia. In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014. Although such numbers must be interpreted with caution (as they rest on an assumption of continued exponential growth within 2014, which is unlikely), our study supports the notion that the ongoing EVD epidemic must be regarded as a Public Health Emergency of International Concern [3]. This finding also implies that transnational spread of EVD might have hindered control efforts, suggesting that preparedness plans for potential case introductions is critical particularly for countries at high risk of EVD case importations [18] with suboptimal public health systems. The transnational spread per person appears to have been reduced over time, but our most recent model estimates still suggest a non-negligible number of secondary cases arising from transnational spread. Uncontrolled cross-border transmission could fuel a major epidemic to take off in new geographical areas (e.g. as seen in Liberia). Unaffected countries at risk of transnational spread should be on high alert for potential EVD introductions and be ready to launch comprehensive and timely containment responses to avert outbreaks.

http://eurosurveillance.org/ViewArticle ... leId=20894

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PostPosted: Sat Sep 13, 2014 5:46 pm 
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The world yawns as Ebola takes hold in West Africa

By Richard E. Besser September 11
Richard E. Besser is chief health editor at ABC News.

In Monrovia, the blue steel gates guarding JFK Medical Center’s Ebola ward separate two worlds, each hopeless. On one side, three Liberians lie huddled on the ground under a UNICEF shelter, waiting to get in. On the other side, a flatbed truck loaded with 10 bodies in white plastic bags waits to drive out.

The truck belongs to one of four burial teams who pluck the dead from treatment wards — or worse, from homes where terrified families huddle around loved ones, desperate for one last touch. For many Liberians, giving a body to the burial team for cremation is unthinkable. Yet those last touches — part of Liberian funeral practices — are the very things that spread Ebola.

I follow the burial team to a home said to hold five bodies, all Ebola victims. As rain falls and a crowd gathers, the team members from the truck put on white suits and masks and set out down a narrow alley to the home. In 10 minutes, they are back. There were only two dead in the home, and the family told them to leave. “It isn’t Ebola,” they said. No time to find out if they were right — there are many more bodies to collect.

The truck heads next to ELWA 2 hospital, a major treatment center. Until just weeks ago, the hospital was run by the mission groups Samaritan’s Purse and SIM; others oversee it now. Then two of their American volunteers became ill. As the burial team pulls up to the walled compound, more people are waiting for treatment, including two suspected Ebola patients in an ambulance. But there are not enough beds for the patients — and not enough health-care workers to provide treatment even if they could fit them in.


This is a big part of the problem. There’s no cure for Ebola, but supportive treatment as simple as supplementary fluids can save lives and slow the spread of the disease. But many treatment centers are unable to provide even rudimentary care. Last week, the World Health Organization and the U.S. Centers for Disease Control and Prevention called for more support for the region. CDC Director Tom Frieden talked about the window of opportunity for the world to respond — a window that is quickly closing.

I don’t think the world is getting the message. The magnitude of the response needed for a deadly outbreak like this in a staggeringly poor country demands both dollars and people.

For four years I led the CDC’s emergency-response activities, including the early response to the H1N1 flu pandemic in 2009. I speak from sad experience: The level of response to the Ebola outbreak is totally inadequate. At the CDC, we learned that a military-style response during a major health crisis saves lives. In a global setting, the CDC usually provides technical support to local ministries of health. This crisis calls for much more.

The United States has the expertise and the personnel to get this outbreak under control. This week there were encouraging signs that the U.S. government was starting to take it more seriously and scale up the response.

The president has started talking more about the outbreak. USAID and the State Department announced that they will transport 100 African medical workers from across the continent to provide support in the Ebola-affected region. They are also providing equipment and resources to outfit an additional 1,000 beds. The administration is asking Congress for funds to provide more CDC technical experts and supplies. However, while supplies and experts will help, they are not enough. It will take much more.


We need to establish large field hospitals staffed by Americans to treat the sick. We need to implement infection-control practices to save the lives of health-care providers. We need to staff burial teams to curb disease transmission at funerals. We need to implement systems to detect new flare-ups that can be quickly extinguished. A few thousand U.S. troops could provide the support that is so desperately needed. There could be casualties, but what military operation is ruled out solely because it is dangerous?

Some may ask why the United States should play this role. Well, no one country is doing enough. We have the expertise and the personnel to tackle this challenge. From a humanitarian and medical perspective, we have a moral obligation to provide care to those who need it, wherever they may live. Nancy Writebol, an American missionary who survived Ebola, said she hoped a silver lining in her brush with death would be increased attention to the plight of her “brothers and sisters in Africa.” She recognizes a sad truth about her own story: Without American victims, Americans might not care.

But go beyond humanitarianism: Epidemics destabilize governments, and many governments in West Africa have a very short history of stability. U.S. aid would improve global security. And consider the issue of “health security.” Microbes don’t respect borders. Now that Ebola is spreading in Nigeria, a global travel hub, cases are sure to appear outside the continent. While one Ebola case in the United States is unlikely to spark an outbreak, things could change if the virus becomes more easily transmittable. We already know it’s mutating.

In my 13 years at the CDC, I never witnessed an outbreak as disturbing as this one. We have the tools to save thousands of lives, but our response has been inadequate. We underestimated this epidemic, and the people of West Africa are paying for it. We know how to control Ebola. It’s time to step up and get the job done.

http://www.washingtonpost.com/opinions/ ... story.html

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PostPosted: Sat Sep 13, 2014 5:59 pm 
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The Opinion Pages | Op-Ed Contributor

What We’re Afraid to Say About Ebola

By MICHAEL T. OSTERHOLM
SEPT. 11, 2014

MINNEAPOLIS — THE Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.

There have been more than 4,300 cases and 2,300 deaths over the past six months. Last week, the World Health Organization warned that, by early October, there may be thousands of new cases per week in Liberia, Sierra Leone, Guinea and Nigeria. What is not getting said publicly, despite briefings and discussions in the inner circles of the world’s public health agencies, is that we are in totally uncharted waters and that Mother Nature is the only force in charge of the crisis at this time.

There are two possible future chapters to this story that should keep us up at night.

The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums. What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even Karachi, Jakarta, Mexico City or Dhaka?

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico.

Why are public officials afraid to discuss this? They don’t want to be accused of screaming “Fire!” in a crowded theater — as I’m sure some will accuse me of doing. But the risk is real, and until we consider it, the world will not be prepared to do what is necessary to end the epidemic.

In 2012, a team of Canadian researchers proved that Ebola Zaire, the same virus that is causing the West Africa outbreak, could be transmitted by the respiratory route from pigs to monkeys, both of whose lungs are very similar to those of humans. Richard Preston’s 1994 best seller “The Hot Zone” chronicled a 1989 outbreak of a different strain, Ebola Reston virus, among monkeys at a quarantine station near Washington. The virus was transmitted through breathing, and the outbreak ended only when all the monkeys were euthanized. We must consider that such transmissions could happen between humans, if the virus mutates.

Long before Ebola infects or kills any significant number of people, it will destroy the world's economies.

First, we need someone to take over the position of “command and control.” The United Nations is the only international organization that can direct the immense amount of medical, public health and humanitarian aid that must come from many different countries and nongovernmental groups to smother this epidemic. Thus far it has played at best a collaborating role, and with everyone in charge, no one is in charge.

A Security Council resolution could give the United Nations total responsibility for controlling the outbreak, while respecting West African nations’ sovereignty as much as possible. The United Nations could, for instance, secure aircraft and landing rights. Many private airlines are refusing to fly into the affected countries, making it very difficult to deploy critical supplies and personnel. The Group of 7 countries’ military air and ground support must be brought in to ensure supply chains for medical and infection-control products, as well as food and water for quarantined areas.

The United Nations should provide whatever number of beds are needed; the World Health Organization has recommended 1,500, but we may need thousands more. It should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. Many countries are pledging medical resources, but donations will not result in an effective treatment system if no single group is responsible for coordinating them.

Finally, we have to remember that Ebola isn’t West Africa’s only problem. Tens of thousands die there each year from diseases like AIDS, malaria and tuberculosis. Liberia, Sierra Leone and Guinea have among the highest maternal mortality rates in the world. Because people are now too afraid of contracting Ebola to go to the hospital, very few are getting basic medical care. In addition, many health care workers have been infected with Ebola, and more than 120 have died. Liberia has only 250 doctors left, for a population of four million.

This is about humanitarianism and self-interest. If we wait for vaccines and new drugs to arrive to end the Ebola epidemic, instead of taking major action now, we risk the disease’s reaching from West Africa to our own backyards.



Michael T. Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

A version of this op-ed appears in print on September 12, 2014, on page A31 of the New York edition with the headline: What We’re Afraid To Say About Ebola. Order Reprints|Today's Paper|Subscribe

http://www.nytimes.com/2014/09/12/opini ... .html?_r=0

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PostPosted: Sat Sep 13, 2014 6:04 pm 
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Liberian President Pleads With Obama for Assistance in Combating Ebola
By HELENE COOPER
SEPT. 12, 2014

WASHINGTON — The president of Liberia, Ellen Johnson Sirleaf, has implored President Obama for help in managing her country’s rapidly expanding Ebola crisis and has warned that without American assistance the disease could send Liberia into the civil chaos that enveloped the country for two decades.

In a letter on Tuesday to Mr. Obama, Ms. Johnson Sirleaf wrote that “I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us.” She urgently requested 1,500 additional beds in new hospitals across the country and urged that the United States military set up and run a 100-bed Ebola hospital in the besieged capital, Monrovia.

Infectious disease experts have sharply criticized as inadequate the Obama administration’s response to the Ebola crisis, particularly in Liberia, a country founded by freed American slaves. Global agencies like the World Health Organization and the United Nations have also come under criticism for responding too slowly to the Ebola outbreak.

The epidemic has taken an estimated 2,218 lives out of 4,366 cases in West Africa. So far more than 1,000 people have died of the virus in Liberia.

Ms. Johnson Sirleaf’s request was made several days after Mr. Obama, in an interview on NBC’s Meet the Press, called the disease a national security priority and said the United States must lead the international effort in containing the spread of Ebola in Africa.

Shortly afterward, his administration announced that it would use the American military to set up a 25-bed health facility in Liberia to treat health care workers, a gesture that many infectious disease specialists working in West Africa derided as paltry, particularly in comparison with the Pentagon’s large-scale response to the earthquake in Haiti in 2010.

“When President Obama announced that the U.S. government was going to greatly increase its help, I was ecstatic,” said Dr. Timothy Flanigan, an infectious disease specialist with Brown University, in an interview from Monrovia, where he has been working for the past month. “The 25-bed hospital that’s being provided is hardly a drop in the bucket for the people of Liberia.”

Obama administration officials said Friday that the president would go to the Centers for Disease Control and Prevention in Atlanta next Tuesday, when he would announce a more aggressive American response to the disease. The military’s 25-bed hospital, a senior administration official said, “is the floor in terms of D.O.D.’s response, not the ceiling,” referring to the Department of Defense. “You’ll see more of that on Tuesday.”

On Monday, the W.H.O. issued a dire Ebola warning for Liberia, saying that the number of new Ebola cases was increasing exponentially and that all new treatment facilities were overwhelmed, “pointing to a large but previously invisible caseload.”

The organization’s data indicated a 68 percent spike in Ebola cases in Liberia over the past three weeks. The description of the crisis in Liberia, which along with Sierra Leone and Guinea is at the center of the worst Ebola outbreak ever recorded, suggested an even more chaotic situation than had been thought.

The global consulting firm Oxford Analytica said this week that of the three West African countries at the epicenter of the Ebola outbreak, Liberia is in the most dire straits because of the high concentration of infected people in Monrovia.

In an echo of the colonialism that characterized West Africa in the 19th century, Britain has focused its assistance efforts on its former colony Sierra Leone, as British troops head there to build and staff a 63-bed facility near the capital, Freetown. France has sent medical experts to its former colony Guinea.

That leaves Liberia, with its historic ties to America’s antebellum era, in the United States’ hands. In an interview on Thursday, Ms. Johnson Sirleaf said a perception by other countries that the United States would take care of Liberia had hurt the country so far in the Ebola fight. She said a health expert with the French group Doctors Without Borders told her recently: “We’re French. You’ve got America behind you; why should we have to do this for you?”

But the government of Ms. Johnson Sirleaf, a Nobel Peace laureate, had also come under criticism for its response to the Ebola crisis, in particular a quarantine that she placed on a densely populated Monrovia neighborhood that caused deadly riots. That quarantine was lifted after 10 days.

In her letter to Mr. Obama, Ms. Johnson Sirleaf asked that the Pentagon set up and operate “at least one” Ebola treatment center in Monrovia, an echo of several infectious disease specialists who say that only the American military has the capacity and experience working with viral hemorrhagic fevers like Ebola that demand a quick response.

Many health experts say that the military brings much-needed organization and discipline to the work at Ebola treatment centers, including ensuring that health workers adhere to strict safety protocols. Because the disease, transmitted by bodily fluids, is contagious when patients are sick, or after they have died, health care workers must wear gloves, masks and full-body protective gear before touching patients and must go through several steps of chlorination after treating patients.

“It has been three months since I felt the warmth of bare skin that was not mine,” Dr. Kanagasabi Udhayashankara, pediatric resident at John F. Kennedy Medical Center in Monrovia, wrote in an email. “Two months since I have been less than two feet of another human without P.P.E,” or personal protective equipment. Health workers in Liberia, Dr. Knight said, “move with an invisible force field of three feet between us and the nearest human.”

Rear Adm. John Kirby, the Pentagon press secretary, said Friday that “since the outbreak began in March, the whole government has been engaged in fighting this.” He added that the Defense Department is “actively working to look at capabilities that we might be able to provide that would be of use.”

Correction: September 13, 2014
An earlier version of this article erroneously attributed an email about what it feels like to work with Ebola patients to Dr. David Knight, an American doctor working in Liberia. The email was written by Dr. Kanagasabi Udhayashankara, pediatric resident at John F. Kennedy Medical Center in Liberia’s capital, Monrovia.

A version of this article appears in print on September 13, 2014, on page A6 of the New York edition with the headline: Liberian President Pleads With Obama for Assistance in Combating Ebola. Order Reprints|Today's Paper|Subscribe


http://www.nytimes.com/2014/09/13/world ... .html?_r=0

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PostPosted: Sat Sep 13, 2014 7:03 pm 
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West Africa: Obama to Announce Ebola Czar As Businesses, Senators Press for More

By Tami Hultman and Reed Kramer
Washington, DC — President Obama will announce the appointment of a high-level coordinator to manage the U.S. response to the Ebola outbreak when he visits Atlanta on Tuesday, administration sources have told AllAfrica.

White House Press Secretary Josh Earnest said Friday that the president is visiting the Atlanta, Georgia-based U.S. Centers for Disease Control and Prevention (CDC) to receive a briefing from officials at the organization, whose director, Dr. Thomas Frieden, visited the region last month.

Obama will also discuss U.S. assistance to fight the Ebola virus and will thank the doctors, scientists and health care workers who have been engaged in the effort to stop its escalating spread. A stepped-up administration plan, which has been discussed by officials from across the executive branch for more than a month, received higher level attention this past week as the scope of the outbreak became more widely acknowledged – at least partly in response to pressure from private sector companies engaged in the most-affected countries and from members of Congress [See Ebola 'Racing Ahead' of Response]

ArcelorMittal, a multinational steel manufacturing corporation headquartered in Luxembourg - which has profitable iron ore mining operations in Liberia - has been hosting telephone conferences for a number of weeks among dozens of global companies, mostly in mining, on an Ebola response. After internal discussions, the companies widened the dialogue to include health officials, such as World Health Organization Director Margaret Chan.

Last Monday, chief executives from 11 of the companies operating in the three most-affected countries of Liberia, Sierra Leone and Guinea, made an urgent appeal for the international community "to pool its resources and lend support" to fight Ebola.

"Our companies have made long term commitments to these countries and their people and we intend to honour these commitments," the executives said. "Despite the challenging environment, we are continuing where possible with normal operations, with the health and safety of our employees being the absolute priority at all times."

Riva Levinson, whose boutique Washington DC-based firm KRL International serves both government and corporate clients in west Africa, applauded the private sector efforts as "a valuable tool for mobilization of resources". She noted that the corporate consultations started before global health organizations and governments, with few exceptions, recognized the urgency of a large-scale response.

Businesses have been sharing information and pooling assets for the Ebola fight in a creative and coordinated way that other sectors should emulate, she said in an interview.

"Companies are inventorying their assets to deploy on the front line to support humanitarian and healthcare workers on a real-time emergency basis," she said. Their activities include grading roads, providing equipment, including generators, and contributing materials such as chlorine solutions.

"It's not going to turn the tide," Levinson said of the corporate effort, "but it's going to have an impact."



United States envoys in the three most-affected countries are now points of contact for the broader donor and in-country efforts. There are working groups led by company teams at the operational level in each of the countries, and in Liberia that coordination is managed by a Disaster Assistance Response Team (DART) from USAID.

Senators Call on Administration and Congress to Act

Speaking on the Senate floor on Thursday, Delaware Democrat Chris Coons, who heads the Foreign Relations Africa Subcommittee, called for the appointment of a coordinator, saying it is "critical" for the U.S. government to have "one leadership point". Coons appealed to the administration and members of Congress "to dramatically increase our support as communities across West Africa struggle to confront and combat Ebola."

Vermont Democrat Patrick Leahy also addressed the Senate, decrying "the lack of urgency exhibited by much of the international community" and governments, "including our own." He paid tribute to "courageous public health workers who have risked their lives" and to the Liberian government for its efforts "in the face of woefully inadequate resources."

Leahy, who chairs the subcommittee that oversees appropriations for the State Department and other international activities and is the Senate's most senior member, said large budget cuts at the World Health Organization contributed to the slow response, with "ample blame to go around."

He said Ebola is "a public health issue, a moral issue, and one that should unite us all to do what is necessary to defeat this epidemic."

On the House side of the U.S. Congress a hearing has been scheduled for Wednesday by the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations to hear from the National Institutes of Health and other experts.

Looking for More Government Engagement

The Obama administration raised hopes a week ago for the more robust response that the private sector and front-line treatment organizations – most prominently Médecins Sans Frontières (MSF / Doctors Without Borders) have been advocating. In an NBC Meet the Press interview last Sunday, Obama called Ebola "a national security priority" and pledged that "military assets" would be deployed to assist with efforts to end the epidemic.

http://allafrica.com/stories/201409130282.html

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PostPosted: Sat Sep 13, 2014 7:38 pm 
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Back to the Slums of His Youth, to Defuse the Ebola Time Bomb

By NORIMITSU ONISHISEPT. 13, 2014

Slide Show|11 Photos

Image

In Liberia, Fighting Ebola With Information

CreditDaniel Berehulak for The New York Times

MONROVIA, Liberia — The girl in the pink shirt lay motionless on a sidewalk, flat on her stomach, an orange drink next to her, unfinished. People gathered on the other side of the street, careful to keep their distance.

Dr. Mosoka Fallah waded in. Details about the girl spilled out of the crowd in a dizzying torrent, gaining urgency with the siren of an approaching ambulance. The girl’s mother had died, almost certainly of Ebola. So had three other relatives. The girl herself was sick. The girl’s aunt, unable to get help, had left her on the sidewalk in despair. Other family members may have been infected. Still others had fled across this city.

Dr. Fallah, 44, calmly instructed leaders of the neighborhood — known as Capitol Hill, previously untouched by Ebola — how to deal with the family and protect their community. He promised to return later that day, and send more help in the morning. His words quelled the crowd, for the moment.

A woman in Monrovia, Liberia, passed a man believed to be infected with Ebola. Researchers say it could take 12 to 18 months to bring the epidemic under control.

“This is a horrific case,” he said as he walked away. “It could be the start of a big one right here. It’s a ticking time bomb.”
Continue reading the main story

Play Video|3:47

Image

Dying of Ebola at the Hospital Door


Monrovia, the Liberian capital, is facing a widespread Ebola epidemic, and as the number of infected grows faster than hospital capacity, some patients wait outside near death.
Video Credit By Ben C. Solomon on Publish Date September 11, 2014.
Months into the Ebola outbreak, Liberia remains desperately short on everything needed to halt the rise in deaths and infections — burial teams for the dead, ambulances for the sick, treatment centers for patients, gloves for doctors and nurses. But it is perhaps shortest on something intangible: the trust needed to stop the disease from spreading.

Dr. Fallah, an epidemiologist and immunologist who grew up in Monrovia’s poorest neighborhoods before studying at Harvard, has been crisscrossing the capital in a race to repair that rift. Neighborhood by neighborhood, block by block, shack by shack, he is battling the disease across this crowded capital, seeking the cooperation of residents who are deeply distrustful of the government and its faltering response to the deadliest Ebola epidemic ever recorded.

“If people don’t trust you, they can hide a body, and you’ll never know,” Dr. Fallah said. “And Ebola will keep spreading. They’ve got to trust you, but we don’t have the luxury of time.”

With his experience straddling vastly different worlds, Dr. Fallah acts as a rare bridge: between community leaders and the Health Ministry, where he is an unpaid adviser; between the government and international organizations, which have the money to back his efforts.

But the scale of the task is daunting. He is trying to beat Ebola in a city of 1.5 million people where the disease is expanding exponentially, where entire families search in vain for medical care, and where the main hospital is dangerously overwhelmed, plagued by electrical fires, floods and the deaths of health workers infected with the disease.

Dr. Fallah has slowly begun winning over the city’s toughest neighborhood, West Point, the seaside slum where he spent two years of his childhood. Deadly clashes between angry residents and soldiers erupted recently after Liberia’s government placed the entire neighborhood under quarantine. The 10-day cordon, enforced by the army and the police, merely deepened the mistrust of the government in the city’s slums, the very neighborhoods most affected by Ebola.

Dr. Fallah plunged into West Point, deciding with community leaders to battle Ebola by resurrecting a survival mechanism used during Liberia’s catastrophic 14-year civil war.

They divided West Point into zones, much as was done during the war to ensure that everybody received food and other vital supplies. Surveillance teams of volunteers overseen by Dr. Fallah now scour West Point, searching for information about a dead or sick person, hoping to identify victims and remove the bodies before the disease can be passed on.

His teams visit every morning, tracing the circle of people around Ebola victims to see who else develops fevers or starts vomiting. This painstaking process, repeated until an outbreak is eventually contained, has extinguished past Ebola outbreaks in rural Africa — and may be the only hope of stopping it now.

“Dr. Fallah has taken the situation in West Point as if he were living here,” said Kenneth Martu, a political organizer in West Point. “We can say openly: Had he not been here, things would have gotten far worse.”

Two days after the government lifted the quarantine in West Point, the Health Ministry asked Dr. Fallah to start using the civil war-era zone system in two other Ebola-stricken neighborhoods, perhaps another signal of the government’s turn away from force in its campaign against Ebola.

“We feel that using the communities to provide the leadership for us to do the Ebola work is more effective,” said Dr. Bernice Dahn, a deputy health minister.

Dr. Fallah’s team of contact tracers pushed deep into West Point one morning, into a labyrinth of hovels and alleys that became ever narrower. A group of young men appeared abruptly, blocking the only exit, their intention clear. They went away, with a $10 bill.

“I usually carry small bills,” Dr. Fallah said. “But I forgot to break this bill this morning.”

Monrovia is the first city to face the full onslaught of Ebola. Tracing the contacts of Ebola victims has never been attempted on this scale, yet Dr. Fallah’s team has only five vehicles to monitor hundreds of thousands of people. One vehicle was in the shop for five days, so Dr. Fallah used his own.

In West Point, a slum of up to 120,000 people, Dr. Fallah deployed 15 volunteers to track 150 people who may have been exposed to the virus. The tracers fan out early in the morning to catch the people at home — they are supposed to stay indoors, but many do not — and to minimize contact with an often hostile community.

“On the field, as we are going, they are cursing us, passing around, talking plenty,” said Marie Harding, a tracing supervisor.

At one house — a large one by West Point standards, with eight rooms and, even more unusual, a restroom — about 20 people came to the entrance, emphatically stating that everything was fine. A man named Junior, who rented a room, had died in late August, apparently of Ebola, and a burial team had come to pick up his body three days later.

David Yeah, 75, the home’s owner, said that he had locked the room. Sprayers had come to decontaminate it; they had thrown the dead man’s clothes into the sea. The house’s other occupants had avoided the man before his death, bringing him neither food nor water, he insisted.

But after a few minutes, Mr. Yeah and his tenants acknowledged that a woman — possibly a relative — had been nursing the man and mixing with the other occupants. Then she fled after his death.

Dr. Fallah had seen this many times before. The government’s failure to provide basic services keeps undermining the trust he is trying to build. Burial teams take days to pick up the dead; ambulances — there are only about a half-dozen in the capital — respond to only a fraction of emergency calls. Those lucky enough to be transported to a treatment center are often turned back, taken home because of a shortage of beds, or left pleading at the gate for admission.

“The government has to keep its part of the bargain,” Dr. Fallah said, adding, “The community can do one thing for us. They can limit the spread. But they must see that their labor is leading to some fruit.”
Image


Dr. Mosoka Fallah, center, an epidemiologist and immunologist, with residents of New Kru Town, a district in Monrovia, Liberia. Credit Daniel Berehulak for The New York Times
The government’s lifting of the quarantine after 10 days also gave West Point a conflicting message. Many rejoiced at the move but interpreted it as proof that there was no Ebola in their community.

On the Sunday after the quarantine was lifted, churchgoers celebrated what many saw as West Point’s deliverance from Ebola. Inside the Dominion Life Church, next to an Ebola holding center, the faithful danced and — disregarding awareness campaigns to avoid touching and risk exchanging body fluids — shook hands and grasped one another’s arms with fervor.

“No, no, no, no,” the Rev. William Morlu, the church’s senior pastor, said when asked whether Ebola was present in West Point.

At the Church of Pentecost, Emmanuel Oben, 45, the chairman of a local P.T.A., said that the government was “not sincere.” But Dr. Fallah, whom he had met twice, was “a man that everybody wants to work with,” he said.

“People trust him,” he said. “He was once like us.”

When Dr. Fallah was 10 years old, his father lost his job as a driver for an American mining company, so the family moved to Monrovia. The family lived in West Point for two years and then moved to a squatter’s area called Chicken Soup Factory, where his parents eventually built a house. His mother still lives in it.

During Liberia’s civil war, he spent 11 years completing his college studies at the University of Liberia, and worked for Doctors Without Borders. A friend’s support led to graduate studies in the United States, where he earned a doctorate in microbiology and immunology at the University of Kentucky in 2011 and a master’s degree in public health at Harvard in 2012.

A project to open a maternal care clinic in Chicken Soup Factory brought Dr. Fallah back to Liberia after Harvard. The clinic opened in June but was shut down a month later because of the Ebola outbreak.

On an afternoon of heavy rain, Dr. Fallah drove out to two neighborhoods where local residents had begun organizing Ebola awareness campaigns on their own. In the face of the hysteria gripping the capital, they were joining forces and fighting back.

In one area, volunteers like Obediah Daykeay, 22, who had read up on Ebola in an Internet cafe, were instructing neighbors on the use of bleach and water to wash their hands. They had invited Dr. Fallah after hearing him on the radio.

“We are trying our best with the few resources we have,” Mr. Daykeay said. “Nobody else has come here.”

In another neighborhood, a group of youths had raised money to print an eight-page pamphlet on Ebola. Dr. Fallah spoke to them inside a church, urging them to organize monitoring teams.

The youths listened intently, fear visible on many faces, craning forward in their pews toward Dr. Fallah as rain beat noisily on the church’s corrugated roof.

“I’m not saying I know the answer,” Dr. Fallah said later. “I’m struggling like any other person to find the answer — just have a lot of spirit and God. But one thing I’ve realized is that the people in the community, some of them have the answers.”


A version of this article appears in print on September 14, 2014, on page A1 of the New York edition with the headline: Back to the Slums of His Youth, to Defuse

http://www.nytimes.com/2014/09/14/world ... beria.html

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PostPosted: Sat Sep 13, 2014 8:03 pm 
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A concrete response to the Ebola outbreak cannot wait

By Joanne Liu September 11
Joanne Liu is the international president of Doctors Without Borders.
Six months into the worst Ebola epidemic in history, the world is losing the battle to contain the disease. Leaders are failing to come to grips with this transnational threat.

In West Africa, cases and deaths continue to surge. Riots are breaking out. Isolation centers are overwhelmed. Health workers on the front lines are becoming infected and dying in shocking numbers. Others have fled, leaving people without care for even common illnesses. Entire health systems have crumbled.

It is impossible to keep up with the sheer number of infected people pouring into facilities. Ebola treatment centers have been reduced to little more than palliative-care facilities where people go to die. In Sierra Leone, bodies are rotting in the streets. Rather than building Ebola care centers in Liberia, we are forced to build crematoriums.

Nations neighboring the worst-affected countries are closing their borders. Flights are being stopped, preventing additional relief supplies and health workers from reaching the hot zones.

The World Health Organization (WHO) projected that as many as 20,000 people could be infected over three months in the three worst-affected countries: Liberia, Sierra Leone and Guinea. This number is likely underestimated.

As the president of a medical humanitarian organization that has cared for more than two-thirds of the officially declared infected patients, I can tell you that my colleagues are completely overwhelmed. They are forced to turn away up to 30 infectious people a day.


In the face of this worsening disaster, WHO has delivered a clear road map for Ebola. But huge questions remain about who will implement elements in the plan. Who has the correct training for the tasks that are detailed?

These questions must be answered quickly. We cannot wait.

This Ebola outbreak is akin to a war, claiming lives, destroying communities and perpetuating fear. No country could be expected to manage such a disaster without additional support. We need a large-scale deployment of highly trained personnel who know the protocols for protecting themselves against highly contagious diseases and who have the necessary logistical support to be immediately operational. Private aid groups simply cannot confront this alone.

We appealed for a massive scale-up of isolation and treatment facilities 10 days ago. It is beyond time for countries with biosafety capacity to deploy civilian or military assets. These countries have a political responsibility to use these capabilities in Ebola-affected countries. This deployment must happen within days — not weeks or months.

The mobilization of such threat-containment teams would constitute a surge in trained personnel into hot zones. Their roles would be to immediately scale up the number of isolation centers, deliver protective gear to health workers, deploy mobile laboratories to improve diagnostic capabilities, move personnel and equipment to and within West Africa and build a regional network of field hospitals devoted to treating infected medical personnel.


On Sunday, President Obama said the U.S. government would deploy military assets to establish isolation units and deliver additional supplies. This is an important development, but it must translate into immediate concrete action on the ground. So far, the Pentagon has pledged only one 25-bed unit for Liberia, to be used just for health workers. This is highly insufficient. In Monrovia alone, there is an immediate need for an additional 800 beds of isolation capacity. Other governments must step in in all three of the most affected countries.

One of the biggest obstacles has been restrictions on commercial air traffic. Regional flights in West Africa have virtually stopped, and several carriers have pulled out. Even the U.S. government has been relying on commercial airlines to deliver medical supplies. Civil military air assets should be mobilized to create an air bridge. The flow of aid workers and relief supplies cannot come second to commercial interests of private companies.

This emergency is going to require a sustained mobilization of resources for months to come. To maintain our current staffing levels, we have several hundred staff on standby to rotate into the affected region every six to eight weeks.

Fighting this outbreak goes beyond trying to control the virus. The health system in Liberia has collapsed. Pregnant women experiencing complications have nowhere to turn. Malaria and diarrhea, which are easily preventable and treatable, are killing people. Hospitals need to be reopened, and created.


Lastly, we must change the collective mind-set driving the response to the epidemic. Coercive measures, such as laws criminalizing the failure to report suspected cases, and forced quarantines, are driving people underground, pushing the sick away from health systems. These measures have served only to breed fear and unrest, rather than to contain the virus.

Countries cannot focus solely on measures to protect their own borders. Only by battling the epidemic at its roots can we stem it. This is a transnational crisis, with social, economic and security implications for the African continent.

We cannot cut off the affected countries and hope this epidemic will simply burn out. To put out this fire, we must run into the burning building.

http://www.washingtonpost.com/opinions/ ... story.html

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