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PostPosted: Fri Aug 22, 2014 10:39 am 
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WHO stated last week that the number of Ebola cases was vastly under-reported. This morning they tweeted that as soon as a new treatment center is opened in parts of Liberia, new cases immediately appear (and the cases had not been identified previously by the current surveillance system.

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PostPosted: Fri Aug 22, 2014 10:39 am 
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WHO ‏@WHO 4m
In parts of #Liberia, as soon as a new #Ebola treatment facility is opened, patients immediately come, many not previously identified 1/2

WHO ‏@WHO 4m
This phenomenon suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system #Ebola 2/2

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PostPosted: Fri Aug 22, 2014 10:41 am 
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WHO ‏@WHO 6m
“Shadow-zones” - these are villages w/ rumours of #Ebola cases, deaths, that can't be investigated bcause of community resistance

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PostPosted: Fri Aug 22, 2014 12:09 pm 
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Why the Ebola outbreak has been underestimated


Situation assessment - 22 August 2014

The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons.

Many families hide infected loved ones in their homes. As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home.

Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.

These are fast-moving outbreaks, creating challenges for the many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need. Hospital and diagnostic capacities have been overwhelmed.

Many treatment centres and general clinics have closed. Fear keeps patients out and causes medical staff to flee.

In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have travelled to villages and counted the number of fresh graves as a crude indicator of suspected cases.

In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified. This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system.

For example in Monrovia, Liberia’s capital, an Ebola treatment centre with 20 beds, which opened last week, was immediately overwhelmed with more than 70 patients.

An additional problem is the existence of numerous “shadow-zones”. These are villages with rumours of cases and deaths, with a strong suspicion of Ebola as the cause, that cannot be investigated because of community resistance or lack of adequate staff and vehicles.

In some areas, most notably Monrovia, virtually all health services have shut down. This lack of access to any form of health care contributed to the mobbing incident on Saturday at an Ebola holding facility in the West Point township, Liberia’s most disease-prone slum.

Rumours spread that the holding facility, hastily set up by local authorities in an abandoned schoolhouse, was actually a clinic for general health care. People from other communities brought their ailing family members there, where they were housed together with suspected Ebola patients.

The presence of patients from these other communities was resented by the West Point community, and this resentment contributed to the riot and subsequent looting, in which potentially contaminated materials were carried into these communities.

WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Médecins Sans Frontières (Doctors without Borders) and the US Centers for Disease Control and Prevention, to produce more realistic estimates and thus communicate the true magnitude of needs.

WHO media contacts:

Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Email: hartlg@who.int

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 ... t-2014/en/

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PostPosted: Fri Aug 22, 2014 12:15 pm 
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WHO warns of 'shadow zones', hidden cases in Ebola outbreak
GENEVA Fri Aug 22, 2014 11:41am EDT

(Reuters) - The scale of the world's worst Ebola outbreak has been concealed by families hiding infected loved ones in their homes and the existence of "shadow zones" that medics cannot enter, the World Health Organization (WHO) said on Friday.

The U.N. agency issued a statement detailing why the outbreak in West Africa had been underestimated, following criticism that it had moved too slowly to contain the killer virus, now spreading out of control.

Independent experts raised similar concerns a month ago that the contagion could be worse than reported because suspicious local inhabitants are chasing away health workers and shunning treatment.

More than 1,300 people have died from the disease and many experts do not expect the epidemic to be brought under control this year.

Under-reporting of cases is a problem especially in Liberia and Sierra Leone. The WHO said it was now working with Medecins Sans Frontières (MSF) and the U.S. Centers for Disease Control and Prevention to produce "more realistic estimates".

The head of MSF, which has urged the WHO to do more, told Reuters in an interview on Thursday that the fight against Ebola was being undermined by a lack of international leadership and emergency management skills.

The stigma surrounding Ebola poses a serious obstacle to efforts to calibrate the outbreak in Liberia, Sierra Leone, Guinea and Nigeria, which has claimed far more victims than any other episode of the disease that was first discovered nearly 40 years ago in the forests of central Africa.

"As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home," the WHO statement said.

"Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed."

Corpses are often buried without official notification, the WHO said, while an additional problem is the existence of numerous "shadow zones", or rural villages where there are rumours of cases and deaths that cannot be investigated because of community resistance or lack of staff and transport.

In other cases, where treatment is available, health centres are being immediately overwhelmed with patients, suggesting there is an invisible caseload of patients that is not on the radar of the official surveillance systems.


STRATEGY PLAN

The WHO said it had drawn up a draft strategy plan to combat Ebola in West Africa over the next six to nine months, implying that it does not expect to halt the epidemic before the end of the year.

"WHO is working on an Ebola road map document; it's really an operational document how to fight Ebola," WHO spokeswoman Fadela Chaib said at a news briefing. "It details the strategy for WHO and health partners for six to nine months to come."

Chaib, asked whether the timeline meant that the United Nations health agency expected the epidemic now raging in Guinea, Liberia and Sierra Leone to continue into 2015, said: "Frankly, no one knows when this outbreak of Ebola will end."

Ebola will be declared over in a country if two incubation periods, or 42 days in total, have passed without any confirmed case, she said. Nigeria is the fourth country with known cases.

"So with the evolving situation, with more cases reported, including in the three hot places - Guinea, Sierra Leone, and Liberia - the situation is not yet over," Chaib said.

"So this is a planning document for six to nine months that we will certainly revisit when we have new developments."

The WHO expects to issue details of the plan early next week, she said.

In a sign of spreading international alarm, Senegal, West Africa's humanitarian hub, said it had blocked a regional U.N. aid plane from landing and was banning all further flights to and from countries affected by Ebola, potentially hampering the emergency response to the epidemic.


(Reporting by Stephanie Nebehay in Geneva, Ben Hirschler in London and Emma Farge in Dakar; Editing by Mark)

http://www.reuters.com/article/2014/08/ ... RW20140822

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PostPosted: Fri Aug 22, 2014 12:18 pm 
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The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons, according to the World Health Organization.

Many families hide infected loved ones in their homes and as Ebola has no cure, some believe loved ones with the virus will be more comfortable dying at home.

Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.

"It's a brand new disease in the area and you can understand why people have pre-existing ideas and fears about it, as not enough is known about Ebola," Sandra Smiley, from the charity Doctors Without Borders, told IBTimes UK.

"People are dying at home and buried by their families – which is how the disease spreads," she added. "We need to provide information about hygiene and safe funeral practices."

Outbreaks like this are fast-moving, creating challenges for the many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need.

Many treatment centres and general clinics have closed, and fear keeps patients out and causes medical staff to flee.

"Health care workers dying has caused people to be fearful, though many of those workers died in situations where the appropriate precautions weren't taken," Smiley added.


Health care posts had to shut because people are scared to go to work. That's really troubling, because of a lack of skilled health care workers in the first place."

In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have counted the number of fresh graves as a crude indicator of suspected cases.

In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified - suggesting the existence of an invisible caseload of patients.

For example in Monrovia, Liberia's capital, an Ebola treatment centre with 20 beds, which opened last week, was immediately overwhelmed with more than 70 patients.

An additional problem is the existence of numerous "shadow-zones" - villages with rumours of cases and deaths that cannot be investigated because of community resistance or lack of adequate staff and vehicles.

In some areas, most notably Monrovia, virtually all health services have shut down. This lack of access to any form of health care contributed to the mobbing incident on Saturday at an Ebola holding facility in the West Point township, Liberia's most disease-prone slum.

Rumours spread that the holding facility, hastily set up by local authorities in an abandoned schoolhouse, was actually a clinic for general health care. People from other communities brought their ailing family members there, where they were housed together with suspected Ebola patients.

WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Doctors without Borders and the US Centers for Disease Control and Prevention, to produce more realistic estimates and communicate the true magnitude of needs.

http://www.ibtimes.co.uk/world-health-o ... ed-1462280

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PostPosted: Fri Aug 22, 2014 12:29 pm 
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VIDEO
Ebola Epidemic Out of Control
August 20, 2014
Sierra Leone has been hit the hardest with over 450 confirmed cases of Ebola at the beginning of August. In Kailahun, Doctors Without Borders/Médecins Sans Frontières (MSF) is running a 64 bed treatment center. Despite the lack of a cure for the virus, doctors are able to treat the symptoms of the disease: diarrhea, vomiting, and high fever. A psychologist is also working with patients and their families. Some 200 community health workers are educating the local population about the disease and the necessary measures to take.

http://www.doctorswithoutborders.org/ne ... ign=social

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PostPosted: Fri Aug 22, 2014 10:54 pm 
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As Ebola outbreak grows, WHO notes case-count difficulties
Filed Under: Ebola; VHF
Robert Roos | News Editor | CIDRAP News | Aug 22, 2014

Image
Ebola treatment center
CDC
As West Africa's Ebola toll climbed by another 142 cases and 77 deaths today, the World Health Organization (WHO) conceded that the size of the epidemic has been underestimated and cited a list of reasons for that, from concealment and denial of cases to the closing of treatment centers and clinics.

Also today, the WHO's Keiji Fukuda, MD, MPH, speaking at a press conference in Monrovia, Liberia, estimated it will take 6 to 9 months to bring the outbreak under control. He and a United Nations (UN) official promised to scale up WHO support for the Ebola-stricken countries.

Death toll tops 1,400
With the latest cases, reported on Aug 19 and 20, the WHO's Ebola virus disease (EVD) count reached 2,615, including 1,427 deaths. The numbers include confirmed, probable, and suspected cases.

Liberia accounted for most of the increase, with 110 new cases and 48 deaths, for a total of 1,082 cases and 624 fatalities, the WHO reported. Guinea cited 28 cases and 10 deaths, raising its totals to 607 and 406, while 3 new cases and 18 deaths in Sierra Leone raised the country's count to 910 cases and 392 deaths.

A report from Liberia's Ministry of Health and Social Welfare said today that EVD has hit 117 healthcare workers in the country, killing 63 of them.

The WHO report showed just one new case and one death in Nigeria, for a total there of 16 illnesses and 5 deaths.

Nigerian cases spark concern
Meanwhile, the media today reported two newly confirmed cases in Nigeria. A Reuters story said cases were confirmed in the spouses of a man and a woman who died of the disease after helping to care for the country's first Ebola case-patient, Patrick Sawyer, who died of EVD after flying to Nigeria from Liberia in July.

The story called the two new cases "an alarming development," because the patients are outside the group of caregivers who had direct contact with Sawyer. On Aug 19 the WHO said the 12 confirmed cases in Nigeria at that point all involved individuals who had contact with Sawyer.

The Reuters story said the new illnesses raise Nigeria's tally of confirmed cases to 14. Today's WHO update says that 12 of the 16 cases in Nigeria have been confirmed. Of the 14 confirmed cases, 5 patients have died, 5 have recovered, and 4 are still being treated, according to Reuters.

The WHO noted that it continues to hear of rumored and suspected Ebola cases around the world and that "systematic verification" of them is ongoing. No new EVD cases have been confirmed outside Guinea, Liberia, Sierra Leone, and Nigeria.

In that vein, California officials announced late yesterday that a hospital patient in Sacramento tested negative for the disease. The patient had an illness that raised suspicion of EVD, but he or she was regarded as low risk on the basis of history and symptoms, officials said 2 days ago.

The US Centers for Disease Control and Prevention (CDC) tested a sample from the patient, with negative results, the California Department of Public Health said in a statement. The agency gave no details about the patient or his or her illness.

Why the epidemic has been underestimated
In a separate statement today, the WHO acknowledged that the scale of the Ebola epidemic has been underestimated and listed a number of factors that have made it hard to get an accurate assessment. The agency, which declared the epidemic an international public health emergency on Aug 8, has been accused of responding too slowly to the epidemic.

Some of the items the agency listed are not new. For example, it said many families hide sick loved ones at home, believing they can't be helped and will be more comfortable dying at home. Other families deny that a person has Ebola and fear that care in an isolation ward will lead to infection and death.

Other factors cited by the WHO:

Many treatment centers and general clinics have closed, as fear keeps patients away and causes staff members to flee
"In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death."
There are many villages with rumors of Ebola cases and deaths, but they can't be investigated because of community resistance or a lack of personnel vehicles. The WHO referred to these as "shadow zones."
The WHO also said that in parts of Liberia, newly opened treatment facilities have been immediately flooded with patients, many of whom were not previously identified. "This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system."

For example, a 20-bed Ebola treatment center in Monrovia opened last week and was immediately overwhelmed with more than 70 patients, the agency said.

WHO, UN promise more help
At the Monrovia press conference today, Fukuda of the WHO and David Nabarro, MD, of the UN sought to provide reassurance and promised more aid to West Africa. The two were wrapping up the first leg of a visit to all the affected West African countries, according to a UN statement.

Nabarro, senior UN System Coordinator for Ebola, told reporters at the end of his 2-day visit that more health workers will be brought to the country to deal with the outbreak, saying, "The United Nations is looking at ways to radically scale up support to fight Ebola," according to the UN statement.

The two officials promised that the WHO will provide 500 more treatment beds for Ebola patients in Monrovia within the next 6 weeks, according to a USA Today story today.

Fukuda, the WHO's assistant director-general for health security and environment, told reporters, "This is not a hopeless situation," the UN statement said. But he estimated it will take 6 to 9 months to tame the epidemic, according to USA Today. "We expect several months of very hard work," he said.

The two officials also said they would be increasing efforts to provide other medical care to Liberians and to support the nation's economy, the newspaper reported.

At the same press conference, Karin Landgren, special representative of the UN secretary-general and coordinator of UN operations in Liberia, said that UN peacekeepers were not involved in quarantining people because of Ebola, according to the UN statement.

CDC chief to visit West Africa
In other developments, the Associated Press (AP) reported that CDC Director Tom Frieden, MD, MPH, plans to visit West Africa to get a firsthand look at the Ebola situation. He will visit Liberia, Sierra Leone, and Guinea next week.

Frieden wants to meet African and international health leaders fighting the epidemic and to hear what help they need, the story said. He also plans to visit hospitals treating Ebola patients.

See also:

Aug 22 WHO update

Aug 22 Liberian health ministry report

Aug 22 Reuters story on Nigerian cases

Aug 21 CDPH statement

Aug 22 WHO statement on factors in underestimation of epidemic

Aug 22 UN statement on press conference

Aug 22USA Today story

Aug 22 AP story on Frieden visit

http://www.cidrap.umn.edu/news-perspect ... fficulties

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