What if Ebola became endemic in West Africa?

Last fall as the Ebola epidemic continued unabated, experts started discussing something that had never before been bandied about: the idea of Ebola becoming endemic in parts of West Africa. Endemic diseases, like malaria andLassa fever in that region of Africa, are constant presences. Instead of surfacing periodically, as it always has before now, Ebola in an endemic form would persist in the human population, at low levels of transmission, indefinitely.

What would it mean exactly for Ebola to become endemic, and how would it change things?

The implications of an endemic Ebola are equally muddled. Epidemic risk management consultants Jody Lanard and Peter Sandman wrote on their website about one worst-case scenario: that visitors to the region will always be at risk of Ebola, which could result in “sparks” unpredictably landing in other countries and causing catastrophic economic and public health effects.

Ebola’s high mortality rates of 60 to 90 percent could actually prevent it from becoming endemic. (Mortality in the current epidemic has been pegged at about 70 percent.) If, on the other hand, the Ebola virus mutates so that it is less lethal, that could make it more likely to become endemic.

Dealing with endemic Ebola would necessitate the development and distribution of affordable and accurate Ebola diagnostic tests. Another important tool will be genomic sequencing, to track the virus on a long-term basis and determine whether and how it is spreading.

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Ebola: Mapping the outbreak

The Ebola outbreak in West Africa was first reported in March 2014, and has rapidly become the deadliest occurrence of the disease since its discovery in 1976.

In fact, the current epidemic sweeping across the region has now killed more than all other known Ebola outbreaks combined.

Up to 15 December, 6,856 people had been reported as having died from the disease in six countries; Liberia, Guinea, Sierra Leone, Nigeria, the US and Mali.

The total number of reported cases is more than 18,000.

The World Health Organization (WHO) admits the figures are underestimates, given the difficulty collecting the data. WHO officials this week discovered scores of bodies in a remote diamond-mining area of Sierra Leone , raising fears that the scale of the Ebola outbreak may have been underreported.

Ebola deaths

Up to 13 December

6,856

Deaths – probable, confirmed and suspected

(Includes one in the US and six in Mali)

  • 3,290 Liberia
  • 2,033 Sierra Leone
  • 1,518 Guinea
  • 8 Nigeria

The WHO has declared the outbreaks in Nigeria and Senegal officially over, as there have been no new cases reported since 5 September.

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How the virus spread: Ebola death toll

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Researchers from the New England Journal of Medicine have traced the outbreak to a two-year-old toddler, who died in December 2013 in Meliandou, a small village in south-eastern Guinea.

In March, hospital staff alerted Guinea’s Ministry of Health and then MSF. They reported a mysterious disease in the south-eastern regions of Gueckedou, Macenta, Nzerekore, and Kissidougou.

It caused fever, diarrhoea and vomiting. It also had a high death rate. Of the first 86 cases, 59 people died.

The WHO later confirmed the disease as Ebola.

Disease spreadsThe Gueckedou prefecture in Guinea, where the outbreak started, is a major regional trading centre and, by the end of March, Ebola had crossed the border into Liberia. It was confirmed in Sierra Leone in May.

In June, MSF described the Ebola outbreak as out of control.

Nigeria had its first case of the disease in July and, in the same month, two leading doctors died from Ebola in Liberia and Sierra Leone.

In August, the United Nations health agency declared an “international public health emergency”, saying that a co-ordinated response was essential to halt the spread of the virus.

Senegal reported its first case of Ebola on 29 August. A young man from Guinea had travelled to Senegal despite having been infected with the virus, officials said.

By September, WHO director general Margaret Chan said the number of patients was “moving far faster than the capacity to manage them”.

Director of the Centers for Disease Control and Prevention (CDC) in the US, Thomas Frieden, said in October that the Ebola outbreak in West Africa was unlike anything since the emergence of HIV/Aids.

Authorities in Mali confirmed the death of the country’s first Ebola patient, a two-year-old girl, on 25 October. The girl had travelled hundreds of kilometres by bus from Guinea through Mali showing symptoms of the disease, the WHO said.

Mali is currently battling a second wave of the deadly virus.

An infected Islamic preacher from Guinea, who was initially diagnosed with a kidney problem, was treated at a clinic in Bamako. The preacher died a few days after entering the country.

Two health workers who cared for the preacher also died after contracting the virus. In total, Mali has recorded six deaths from Ebola.

Ebola outside West Africa

Ebola outside West Africa

*In all but three cases the patient was infected with Ebola while in West Africa. Infection outside Africa has been restricted to health workers in Madrid and in Dallas. DR Congo has also reported a separate outbreak of an unrelated strain of Ebola.

The first case of the deadly virus diagnosed on US soil was announced on 1 October. Thomas Eric Duncan, 42, who contracted the virus in Liberia before travelling to the US, died on 8 October.

He had not displayed symptoms of the disease until 24 September, five days after his arrival. Other people with whom he came into contact are being monitored for symptoms.

Two medical workers in Dallas, Texas, who treated Duncan tested positive for Ebola since his death but have both recovered.

Spanish nurse Teresa Romero was the first person to contract the virus outside West Africa. She was part of a team of about 30 staff at the Carlos II hospital in Madrid looking after two missionaries who returned from Liberia and Sierra Leone after becoming infected.

Germany, Norway, France, Italy, Switzerland and the UK have all treated patients who contracted the virus in West Africa.

Ebola weekly cases chart for Guinea, Liberia and Sierra Leone

Are cases levelling off?Efforts to tackle Ebola have been hindered by fierce resistance from local communities with a history of suspicion towards outside intervention.

This has enabled new chains of transmission to pop up.

Over the last few weeks, health officials admit that the disease is now entering a new phase, with a marked slowing down in the some of the affected areas in the three countries, especially Guinea and Liberia.

According to the WHO, transmission remains intense in Sierra Leone, especially in the country’s west and north

2014 outbreak in contextEbola was first identified in 1976 and occurs in regions of sub-Saharan Africa. There are normally fewer than 500 cases reported each year, and no cases were reported at all between 1979 and 1994.

In August 2014 the WHO confirmed a separate outbreak of Ebola in the Democratic Republic of Congo. By the beginning of October there had been 70 cases reported and 43 deaths.

However, the outbreak in DR Congo is a different strain of the virus and unrelated to the epidemic in West Africa, which now dwarfs all previous outbreaks.

Past epidemics

Ebola past outbreaks

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Study Will Test Survivors’ Blood to Treat Ebola

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A coalition of companies and aid groups announced plans Tuesday to test experimental drugs and collect blood plasma from Ebola survivors to treat new victims of the disease in West Africa.

Plasma from survivors contains antibodies, substances the immune system makes to fight the virus. Several Ebola patients have received survivor plasma and recovered, but doctors say there is no way to know whether it really helps without a study like the one they are about to start within a month.

The Bill & Melinda Gates Foundation is giving $5.7 million to scale up production of the treatments for the project in Guinea and other Ebola-affected countries in Africa. More than a dozen companies, universities and others are contributing supplies, staff and cash, and are working with the countries and the World Health Organization on specific procedures and locations.

Besides helping Ebola patients now, plasma “could be a tool for a future epidemic as well” from different viruses, Microsoft co-founder Bill Gates said in an interview with The Associated Press.

“You might not have drugs and vaccines for some new thing” and it would be good to have capabilities in place to collect and give plasma to fill the gap until those other tools can be developed, he said.

There are no drugs or vaccines approved now for Ebola, which has killed about 5,000 people this year in West Africa, most of them in Guinea, Liberia and Sierra Leone. Doctors Without Borders last week also said it would host studies of experimental treatments and plasma at three of its West Africa treatment centers.

The drugs to be tested by both groups include brincidofovir, an antiviral medicine that has been tried in a few Ebola cases so far. Its maker, North Carolina-based Chimerix Inc., developed it to treat other types of viruses and lab tests suggest it might fight Ebola.

“We said to them, ‘well, if money was no constraint, how much could you make?’ and they gave us a number,” Gates said. “So we said, ‘OK, we’ll take the risk that maybe nobody will ever buy this from you. So we’ll help you scale up the manufacturing.'”

Making plasma available is a complex task. Plasma is the clear part of blood, and the part that contains antibodies. In Africa, donors’ blood will be filtered through a machine to remove small amounts of plasma and return the rest of the blood to the donor — a process that allows someone to donate as often as every two weeks.

One of the first patients successfully treated for Ebola in the U.S. — aid worker Dr. Kent Brantly — received plasma from a 14-year-old boy he treated in Africa, where he was infected. Brantly has donated plasma several times to Ebola patients in the U.S.

A plasma recipient must have a compatible blood type as the donor. Survivors who give plasma also must be tested to make sure they are cured of Ebola and don’t have other diseases such as hepatitis, syphilis or HIV. The Africa study will take an added step — use of an experimental system by Cerus Corp. for inactivating viruses in blood.

Dr. Ada Igonoh, a doctor in Nigeria who got Ebola from a patient and recovered, expects to donate plasma and recruit others for the study.

“Survivors will be willing if they understand the goal,” she said.

She and Brantly met with Gates to discuss the project earlier this month at an American Society of Tropical Medicine & Hygiene conference in New Orleans.

Dr. Luciana Borio, who is leading the Food and Drug Administration’s Ebola response, spoke at the conference about plasma. Even though it seemed to help in some cases, “The bottom line is that we don’t really know if it helps and to what degree it might help,” she said.

“We would love to not be in the same situation in the future,” and a study is the only way to know for sure, she said.

Clinical Research Management Inc., a Northeast Ohio company that contracts with sponsors to run clinical trials, will lead the plasma study in Africa. Plasma will be collected through three bloodmobiles donated by another Microsoft co-founder, Paul G. Allen, and the Greenbaum Foundation. The bloodmobiles have been flown to Africa.

The U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) will provide Ebola testing for the study. Several universities will help, as will the Blood Centers of America and the Safe Blood for Africa Foundation. About a dozen companies donated equipment and supplies.

Why It’s Too Early to Forget About Ebola The Ebola outbreak is far from over in West Africa. Pay attention, America.

BY SOPHIE NOVACK
Protestors demand G-20 action to fight Ebola on Nov. 15, 2014 in Brisbane, Australia.(Daniel Munoz/Getty Images)
November 17, 2014 Americans are googling Taylor Swift more than they’re googling Ebola.

The panic that gripped the country following four diagnoses of the virus in the United States seems to have faded into a collective amnesia following a three-week period with no new Ebola cases.

But the out-of-sight, out-of-mind approach ignores the crisis that continues to plague West Africa. Funding for the international response has lagged, and positive developments in Liberia have resulted in premature optimism about a situation that we still don’t fully have a grasp on. Health experts have said all along that the only way to eliminate the risk of infection in the U.S. is to end the outbreak there—and we’re still far, far away from the finish line.

“The Ebola focus we had over the past month really has been largely on that in the U.S.; many of us kept saying, ‘Don’t take the eye off the ball in West Africa,’ ” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “[But] the interest and concern has focused on a few cases in the U.S. This is not surprising—people think, ‘Am I going to contract Ebola? If it’s over there, it’s not my problem.'”

The risk of contracting Ebola in the U.S. has always been negligible, but that doesn’t mean Americans shouldn’t be concerned. Instead, health experts are imploring the public to direct concern toward the crisis in West Africa, worried that complacency could set back any gains in in controlling the epidemic and thus put West Africa and the U.S. at greater risk.

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“We can’t confuse this as a humanitarian effort only; it’s also in our self-interest,” Osterholm continued. “As long as the infectious disease forest fire is going on there, we’re going to have embers flying around the world.”

The release last week of Dr. Craig Spencer, who contracted Ebola while treating patients in Guinea and was diagnosed in New York City, brought the number of U.S. cases down to zero. Of the ten people treated for Ebola in the U.S. thus far, all eight Americans have survived. The other two individuals tragically lost their lives: Thomas Eric Duncan, who traveled to Dallas from Liberia, died on Oct. 8; while Dr. Martin Salia, a surgeon from Sierra Leone who was brought to the U.S. for treatment, passed away Monday morning.

There have been more than 14,000 reported cases and 5,160 deaths in the Ebola outbreak in Liberia, Sierra Leone, and Guinea, according to new data from the World Health Organization.

White House Ebola ‘Czar’ Ron Klain called Spencer’s recovery a “milestone,” but warned, “We will see other cases of Ebola in the United States.”

“We are not at the beginning of the end or even the end of the beginning, but we are at the throes of this effort in West Africa with interventions that can work,” Klain said Thursday.

The Obama administration’s focus on the outbreak has only deepened, as the public’s attention has waned. The White House has asked Congress for nearly $6.2 billion in both immediate and contingency funding to fight the epidemic in West Africa, ramp up preparedness in the U.S., and prevent future outbreaks.

“What we are seeing is cases moving … to other regions in the country,” said Health and Human Services Secretary Sylvia Mathews Burwell. “We very quickly need to get to those areas and do the process again.”

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Recent WHO and CDC reports show that cases appear to be declining in Liberia, but the rate of transmission of the virus remains high in Sierra Leone and Guinea. A handful of cases have also cropped up in Mali, and travellers from the country will face enhanced screenings upon their arrival at U.S. airports, the CDC said Sunday.

“There’s been some confusion over the past two weeks, with WHO saying cases are leveling off in Liberia,” Osterholm said. “There’s this idea that we’re done. It’s very premature to suggest that. We’ve seen a fireworks transmission—a big burst of cases and then it goes dark. Some NGOs have taken down treatment centers and moved them because those areas were no longer ‘hot.’ Then they turned hot again.”

Relief organizations like Doctors Without Borders are trying to temper optimism, saying it’s too early to scale back response efforts. Yet the public’s engagement remains low.

Doctors Without Borders has received $96.4 million globally in funding for its Ebola response, $18.2 million of which were U.S. donations, according to spokesperson Tim Shenk. The organization raised $138 million globally for its response to the Haiti earthquake.

The American Red Cross has received $3.7 million in donations for Ebola relief, $2.9 million of which came from the Paul G. Allen Foundation, according to Jana Sweeny, the director of international communications. This is compared with $486 million in donations for the 2010 earthquake in Haiti, and $87 million for Typhoon Haiyan in the Philippines last year. Sweeny said the organization saw a small jump in donations around diagnosis of the first U.S. case.

Internet searches for “Ebola” have also spiked at each U.S. diagnosis, then plummeted. The number is currently at its lowest point since before the first U.S. case was diagnosed—a negligible interest level on par with this spring and summer, when most Americans were largely unaware of the Ebola outbreak that has been ravaging West Africa since March.

Google itself has jumped in to boost fundraising. Last week the company included a banner at the top of its homepage for all U.S. users to donate, and pledged to give $2 for every $1 donated until $7.5 million total is raised. Facebook, too, put a “donate” button at the top of user profiles.

The banners served also as a reminder to their millions of users about the crisis continuing in West Africa. But several days after the campaign began, Google has met its total goal of $7.5 million, and the donation banners were promptly removed from the site.

“My frustration is the big picture. People care now because Ebola is in the news and came to the U.S., but Liberia and Sierra Leone were devastated by civil war before and are going to need so much help,” said Emily Bell, marketing and development manager at More Than Me, a nonprofit dedicated to providing education and opportunity for girls in the West Point slum in Liberia, which has worked to combat Ebola since the outbreak began.

“I worry that’s going to die out in a couple weeks and months, and no one will care about Liberia again,” Bell told me. That was a few weeks ago.

Chinese Medics in Liberia to Beef up Ebola Fight

W460

A large team of Chinese health workers arrived in Liberia to boost the Ebola fight as a US-based doctor infected in Sierra Leone was described as being “extremely ill”.

The 160-strong Chinese deployment to the west African country worst hit by the virus came as the world’s most powerful economies vowed to “extinguish” the epidemic, which has claimed more than 5,100 lives.

The Chinese doctors, epidemiologists and nurses will staff a $41 million (33 million euro) Ebola treatment unit which will be up and running in 10 days, ambassador Zhang Yue said in a statement on Sunday.

The health workers have had previous experience in tackling the SARS (Severe Acute Respiratory Syndrome) in Asia, Zhang said, adding that its total aid to Liberia would be $46 million.

At least 2,812 people have so far died of Ebola in Liberia.

So far Beijing has promised Ebola-hit countries the equivalent of $122 million to help fight the epidemic.

Since the beginning of the year, China has given west African countries a total of 234 million yuan ($38.2 million) in emergency assistance, including disease prevention and control materials, grain and cash, according to the Chinese foreign ministry.

China is Africa’s largest trading partner, and its diplomatic footprint across the continent has expanded hugely in recent years as it seeks resources to power its economy.

Still it is a long way behind the European Union, whose leaders have boosted their Ebola aid to one billion euros ($1.26 billion).

On Sunday, a Dutch aid ship, the “Karel Doorman”, docked at Dakar on its way to Freetown, Conakry and Monrovia. On board were vehicles and emergency equipment from nine European countries, the Netherlands’ embassy in Senegal said.

– ‘Hour by hour situation’ –

Meanwhile a doctor said to be “extremely ill” after being infected with Ebola in Sierra Leone was being treated in the United States.

Martin Salia, a US resident who was infected with the deadly haemorrhagic fever while treating patients in his home country, was flown to Nebraska for treatment.

“This is an hour-by-hour situation,” said Phil Smith, medical director of the biocontainment unit at the Nebraska hospital, one of a handful of medical facilities in the United States specially designated to treat Ebola patients.

“He is extremely ill,” Smith said. “We will do everything humanly possible to help him fight this disease.”

World leaders meeting at the Group of 20 summit in the Australian city of Brisbane said they were prepared “to do what is necessary to ensure the international effort can extinguish the outbreak”.

The Ebola outbreak which began earlier this year has been centred around Guinea, Liberia and Sierra Leone.

– Charity single –

In London, musicians including boy band One Direction and Led Zeppelin’s Robert Plant recorded a new “Band Aid” single to help raise funds combat the virus.

Other performers ranging from U2 frontman Bono, Coldplay’s Chris Martin and Sinead O’Connor recorded late into the night for a 30th anniversary version of the charity single “Do They Know It’s Christmas?”

“It’s not just about what’s happening in west Africa, it could happen here tomorrow,” said rocker-turned-activist Bob Geldof, one of the forces behind the original Band Aid.

Set to be officially released Monday, the single will be the fourth incarnation of the song, which became one of the biggest-selling singles ever after its release in 1984 to raise funds for Ethiopian famine relief.

In Brisbane, G20 members welcomed an International Monetary Fund initiative to release $300 million to combat Ebola and promised to share best practices on protecting health workers on the front line.

The G20 pledge came as Togo, whose president is coordinating the west African fight, warned that the world “cannot relax efforts” despite some encouraging signals.

There is no known cure for Ebola, one of the deadliest known pathogens, but trials for several possible treatments were announced last week in west Africa and Canada. The disease spreads through contact with bodily fluids.

The World Health Organization said Friday that 5,177 people are known to have died of Ebola across eight countries, out of a total 14,413 cases of infection since December 2013.

UN chief Ban Ki-moon urged “G20 countries to step up”, warning that Ebola’s disruptive effect on farming could potentially spark a food crisis for a million people.

“Transmission continues to outpace the response from the international community,” Ban told reporters.