Tag Archives: Liberia

Ebola Cases Continue To Rise; Nigeria and Senegal Could Be Declared Ebola-Free in Days

New figures released by the World Health Organisation on Tuesday 14 October revealed that over 8,900 confirmed, probable and suspected cases of the Ebola Virus Disease (EVD) have been reported in seven affected countries: Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain and the United States of America. As of 14 October there have been 4,447 deaths. Health workers have been hit hard by the outbreak, with Doctors Without Borders reporting that sixteen of its employees have been infected with Ebola, in which nine of them have died. A top United Nations official warned this week that Ebola was winning the race as the WHO warned that within the next two months, West Africa could face up to 10,000 new Ebola cases per week if the outbreak is not contained.

Speaking at a news conference in Geneva, WHO assistant director-general Dr Bruce Aylward, disclosed that the death rate in the current outbreak had risen to 70 percent, from the previously estimated mortality rate of 50 percent. Acknowledging that Ebola was “a high mortality disease,” Dr Aylward noted that the UN health agency was still focused on getting six people into isolation and providing treatment to them as early as possible, adding that if the global response to the current Ebola outbreak is not stepped up in the coming sixty days, “a lot more people will die” and health workers will be stretched even further.

Experts in the field have indicated that the epidemic is doubling in size about every three weeks, with Dr Aylward indicating that over the last month, there have been about 1,000 new Ebola cases per week. This included confirmed, suspected and probable cases. Guinea, Liberia and Sierra Leone continue to the be the hardest-hit countries in the current epidemic, with WHO officials particularly concerned about the spread of Ebola in their capital cities – Conakry, Monrovia and Freetown – where people move freely across borders. While some regions in these countries have seen the number of Ebola cases either stabilize or fall, this does not mean that the regions are Ebola-free. Neighbouring countries, including Guinea-Bissau, the Ivory Coast and Mali are currently at a high risk of importing the disease.

The WHO also announced Tuesday that Nigeria and Senegal could be declared Ebola-free in the coming days after completing a 42-day period with no new cases. A statement released on Tuesday revealed “if the active surveillance for new cases that is currently in place continues, and no new cases are detected, WHO will declare the end of the outbreak of Ebola virus disease in Senegal on Friday 17 October.” If no new cases are reported in Nigeria, then the WHO will declare it Ebola-free on 20 October.

Senegal had one patient who was confirmed to have EVD. He has since recovered and it does not appear that anyone else was infected with the deadly disease. In Nigeria, one traveller from Liberia triggered an outbreak in which eight people died, most of them health workers.   The virus spread from the initial case in Lagos to Port Harcourt however it has since been contained with no new reported cases. The situation in Guinea, Liberia and Sierra Leone however is far different as, according to the WHO, “new cases continue to explode in areas that looked like they were coming under control.” Adding “an unusual characteristic of this epidemic is a persistent cyclical pattern of gradual dips in the number of new cases, followed by sudden flare-ups.”

Officials at the WHO indicate that waiting for forty-two days from the time when the last person with high risk exposure has tested negative for the disease effectively provides sufficient confidence to declare that the outbreak is over. The 42-day period is twice the generally accepted maximum incubation period of the virus however some incubation periods are longer, with the WHO is indicating that in 95 percent of Ebola cases, the incubation period was between one and 21 days while in 98 percent, it was no longer than 42 days.

2014 Ebola Outbreak – October Review

Executive Summary

Total Cases and Deaths: As of 23 September 2014 (WHO)

 3,083 people have died from Ebola in Guinea, Liberia, Nigeria and Sierra Leone.  6,553 (probable, confirmed and suspected) cases.

The current Ebola Virus Disease (EVD) outbreak in West Africa has not been contained, with transmission continuing to occur in both community and healthcare settings. Resistance to efforts to control the disease, including outright denials that EVD exists and fears that healthcare workers deployed to combat the virus are spreading it, have further hindered efforts to prevent the disease from spreading and have effectively resulted in the region developing into a fertile ground for speculation and mistaken beliefs. This has sparked a rise in attacks on healthcare workers, including the recent death of an eight-member team in Guinea.

Over the past several weeks, the spread of EVD in West Africa has continued to accelerate. As of 23 September 2014, a total of 3,083 people have died of EVD, with another 6,553 reported cases. While the disease remains concentrated in three countries – Guinea, Liberia and Sierra Leone – it has continued to spread to new regions within these affected countries. On 30 September 2014, officials in the United States confirmed the first Ebola case. The current West Africa Ebola outbreak is likely to continue for another six – nine months before it is completely contained, with World Health Organization (WHO) officials predicting upwards of 20,000 cases.

Affected countries currently fall into two categories: Those with widespread and intense transmission – Guinea, Liberia and Sierra Leone – and those with either an initial case or cases, or with localized transmission – Lagos and Port Harcourt in Nigeria; Dakar in Senegal; Dallas, Texas in the United States. The capital cities of Guinea (Conakry), Liberia (Monrovia) and Sierra Leone (Freetown) have all been affected by the current outbreak.

The World Health Organization (WHO) has identified three patterns of transmission:

1. In rural communities, which is facilitated by strong cultural practices and traditional beliefs;
2. In densely populated urban communities;
3. Cross-border transmission

1. Countries with Widespread and Intense Transmission

Guinea

Total Cases: As of 23 September 2014

1074 clinical cases (876 confirmed; 162 probable; 36 suspected);  648 deaths (481 confirmed; 162 probable; 5 suspected)

Current Affected Areas:  Conakry, Coyah, Forecariah, Gueckedou, Kouroussa, Macenta, Siguiri, Pita, Nzerekore, Dubreka, Youmou, Kerouane.

No Longer Active:  Boffa, Dabola, Dinguiraya, Kissidougou, Telimele

In September, the district of Kindia reported its first confirmed case of EVD. While there have been a number of other areas across the country that have not reported any new cases of EVD, currently there is no indication of a sustained reduction in case incidence in Guinea.

In mid-September, eight people, involved in Ebola awareness-raising activities, were killed near Womey, near the town of Nzerekore in the Forest region of Guinea.   Police officials in the region have confirmed that the team was targeted on suspicion that they were attempting to spread the virus. In a separate incident on 24 September, a Red Cross team was attacked while collecting bodies believed to be infected with Ebola in south-eastern Guinea. Further such incidents in the coming weeks are likely to occur.

Land borders with Liberia, Senegal and Sierra Leone have been closed. Health screenings at all border crossings have been set up and all travellers displaying a fever, or EVD-like symptoms, will be subject to quarantine and/or denied entry/exit, from the country. Expect to experience delays at land border crossings. Enhanced screening measures have been introduced for outbound passengers at Conakry airport.

Liberia

Total Cases: As of 23 September 2014

3458 clinical cases (914 confirmed, 1539 probable, 1005 suspected);  1830 deaths (792 confirmed; 623 probably; 415 suspected)

 Current Affected Areas:  Lofa, Montserrado, Margibi, Bomi, Bong, Grand Cape Mount, Nimba, Grand Bassa, Grand Gedeh, River Cess, River Gee, Sinoe, Gbarpolu, Grand Kru

Liberia remains the most-affected country in the current Ebola outbreak. The number of newly reported cases continues to rise on a week-to-week basis. This is primarily driven by a continuation of a recent surge in cases in the capital city, Monrovia, coupled with a lack of capacity in Ebola treatment centres.

In September, six confirmed cases of EVD and four deaths were reported in the district of Grand Kru, a rural area located near the border with the Ivory Coast. This is the first time the EVD cases have been reported in this area of the country.

Since 20 August, a state of emergency has been in place, with security forces enforcing a nationwide curfew. Between 11PM and 6AM every night no movement is allowed anywhere in the entire country. Liberian authorities have set up road blocks in a bid to restrict movement around the country while security forces have been deployed in order to enforce quarantine for certain areas, including Lofa county. In Monrovia, the army and police have sealed off the neighbourhood of West Point with the area being placed under quarantine. There have been a number of outbreaks of violence, with civilians rioting at hospitals and attacking health workers.

All borders of Liberia have been closed, with the exception of major entry points, including the Roberts International Airport and James Spriggs Payne Airport. The Bo Waterside Crossing to Sierra Leone remains closed along with the Foya Crossing to Guinea. Any remaining border crossings may be closed with minimal notice. The Liberia Airport Authority has introduced enhanced screening measures for both inbound and outbound travellers at airport facilities.

The Ministry of Health and Social Welfare has established hotlines for the public to get basic information on Ebola: Call 0770198517 or 0777549805 or 0886530260 or 0886549805.

General medical facilities throughout the country are currently under severe strain as a result of the Ebola outbreak. Dedicated healthcare facilities for Ebola are overwhelmed and may not accept further cases.

Sierra Leone

Total Cases: As of 23 September 2014

2021 clinical cases (1816 confirmed, 37 probable, 168 suspected);  605 deaths (557 confirmed; 37 probable; 11 suspected)

Current Affected Areas:  Kailahun, Kenema, Kono, Kambia, Bombali, Tonkolili, Port Loko, Pujehun, Bo, Moyamba, Bonthe, Western Area

EVD cases in Sierra Leone continue to increase. Transmission remains high in the capital city, Freetown, and in the surrounding urban areas. Although over the past several weeks the number of newly reported cases in the districts of Kailahun and Kenema appear to have stabilized, a number of other districts have reported an increase. These include Port Loko, a district adjacent to Freetown, Bo, Bombali and Tonkolili.

Between 19 – 21 September, the Sierra Leonean government imposed a three-day nationwide shutdown. During this period, civilians were required to remain in their homes while Ebola awareness teams were deployed across the country to search for possible EVD patients. The government has since deemed the programme a success, adding that further such shutdowns may be implemented in the near future.

2. Countries with Initial Case/Cases or Localized Transmission

Three countries, Nigeria and Senegal and most recently the United States, have reported a case or cases imported from a country with widespread and intense transmission.

Nigeria

Total Cases: As of 23 September 2014

 20 clinical cases (19 confirmed; 1 probable; 0 suspected); 8 deaths (7 confirmed; 1 probable)

Current Affected Areas:  Lagos and Port Harcourt

While Nigeria has not reported any new EVD cases since the first week of September, the country has not been deemed Ebola-free however the spread of EVD has been contained. All EVD cases in Nigeria occurred in Lagos and Port Harcourt.

Nigeria’s first Ebola case was an imported one and all cases in the transmission chain have been linked to a single person. Contact tracing and follow-up is on-going. In Nigeria, 847 contacts (out of a total of 872) have now completed the 21-day follow-up (349 contacts in Lagos; 498 in Port Harcourt). The last confirmed case in Lagos was reported on 5 September while the last confirmed case in Port Harcourt was reported on 1 September. In Lagos, all contacts have completed the 21-day follow-up.

Senegal

In Senegal, all contacts have now completed the 21-day follow-up and there have been no further reported cases of EVD. The last confirmed case of EVD was reported on 28 August. While the country has not been confirmed to be Ebola-free, the spread of EVD has been contained.

United States

Total Cases: As of 23 September 2014

1 Confirmed Case; 0 deaths

Current Affected Areas:  Dakar

On 30 September, officials confirmed the first Ebola case in Dallas, Texas. Officials have confirmed that the unidentified male patient is being kept in isolation at Texas Health Presbyterian Hospital. It is believed that the man contracted the virus in Liberia prior to travelling to the US nearly two weeks ago. He arrived in the US on September 20. Symptoms of the virus became apparent on September 24 and the patient was admitted and placed in isolation on 28 September. While previously US aid workers have come back to the US, after catching Ebola in West Africa, this is the first case of a patient developing the virus on US soil. Health officials are currently identifying all people who came into contact with the unnamed patient while he was infectious. Those people will then be monitored for a period of 21 days.

Ebola Outbreak in Democratic Republic of Congo (DRC)

Total Cases: As of 24 September 2014

70 clinical cases (30 confirmed; 26 probable; 14 suspected); 40 deaths

Current Affected Areas:  Equateur province

An epidemic has since been declared in the region of Djera, in the territory of Boende in the province of Equateur. Officials however believe that the infections are of a different strain to those in the outbreak in West Africa.   One of the two cases tested positive for the Sudanese strain of the disease, while the other tested positive for a mixture between the Sudanese and the Zaire strain. The outbreak in West Africa is due to the Zaire strain.

First Ebola Case Confirmed Outside of Africa

The first case of the deadly Ebola Virus Disease (EVD) diagnosed on US soil has been confirmed in Dallas, Texas. Officials confirmed Tuesday that the unidentified male patient is being kept in isolation at Texas Health Presbyterian Hospital and have pledged to contain the virus that has already killed more than 3,000 people in West Africa.

It is believed that the man contracted the virus in Liberia prior to traveling to the US to visit family members nearly two weeks ago. He arrived in the US on September 20. Symptoms of the virus became apparent on September 24, with the patient being admitted to hospital on the 26^th and placed in isolation on September 28. While previously US aid workers have come back to the US, after catching Ebola in West Africa, this is the first case of a patient developing the virus on US soil. It is believed that the patient was not in Liberia as part of on-going efforts to combat the spread of the virus there.

Health officials have disclosed that they are currently identifying all people who came into contact with the unnamed patient while he was infectious however officials at the Centres for Disease Control and Prevention have cautioned that since he was not sick on the plane, he was unlikely to have infected other travellers as Ebola is not contagious until the patient begins to display symptoms, which can include fatigue, fever, muscle aches, vomiting, diarrhoea and bleeding. According to CDC chief Tom Frieden, “at this point there is zero risk of transmission on the flight. The illness of Ebola would not have gone on for 10 days before diagnosis…he was checked for fever before getting on the flight and there is no reason to think that anyone on the flight that he was on would be at risk.” Anyone to have had contact with the patient will be monitored for a period of 21 days. According to Mr Frieden, currently there are only a “handful” of people, mainly family members, believed to have come in contact with the patient while he was sick.   While measures, such as checking temperatures, have been implemented at airports and border crossings across the affected countries in West Africa, this case has demonstrated that patients deemed Ebola-free when leaving an infected region may not necessarily be free of the virus, but may only be not displaying any symptoms at the time.

Latest figures released by the World Health Organization (WHO) indicate that the world’s largest outbreak of Ebola has infected more than 6,500 people across five West African countries, killing 3,091 since the start of this year.

The beginning of the West Africa outbreak has been identified as a two-year-old boy in Guinea who became sick with EVD in December 2013. While experts do not know how the child came down with the virus, some believe that he may have come in contact with an infected fruit bat, which are the natural hosts for the virus. Since then, the disease has spread rapidly, primarily affecting Guinea, Liberia and Sierra Leone. In July, Ebola was confirmed in Nigeria when a dual US-Liberian citizen, who flew on a pane from Liberia to Lagos, died days later. The outbreak there killed eight and infected 20 people, however WHO officials have indicated that while Nigeria is not yet Ebola-free, the spread of the deadly virus has been contained, with no new confirmed cases reported since the beginning of September. One patient was also confirmed to have Ebola in Senegal, however like in Nigeria, the spread of the disease has been contained. The last confirmed case of Ebola reported in Senegal occurred on 28 August.

Ebola Death Toll Nears 2,000 Mark

According to new figures released Thursday by the World Health Organisation (WHO), more than 1,900 people have died in West Africa’s Ebola outbreak. There have also been 3,500 confirmed or probable cases reported in Guinea, Liberia and Sierra Leone. WHO chief Margaret Chan warned Thursday “the outbreaks are racing ahead of the control efforts in these countries,” adding that at least US $600 million (£360 million) is needed in order to fight the virus. Ms Chan has described the current outbreak as “the largest and most severe and most complex we have ever seen.”

The latest statistics represent a significant increase from the 1,552 deaths and 3,069 cases that were reported by the Geneva-based organisation last week. According to the WHO, more than 40% of the deaths have occurred in the three weeks leading up to 3 September. This indicates that the epidemic is fast outpacing efforts to control it. According to Ms Chan, the WHO “…would like to reverse the trend in three months” in those countries where there is a “very tense transmission.” This includes Guinea, Liberia and Sierra Leone. In countries with “localized transmission,” such as Senegal, where so far only one case has been reported, and the Democratic Republic of Congo, which now has reported 31 deaths, the WHO “would like to stop all transmission within eight weeks.”

The speed of the deadly virus has prompted WHO officials to meet on Thursday in order to examine the most promising treatments and to discuss how to fast-track testing and production. According to sources, disease control experts, medical researchers, officials from affected countries and specialists in medical ethics will be represented at the meeting, which will take place in Geneva.

The Ebola virus has continued to spread in Nigeria, despite WHO officials stating that they were hopeful it would remain under control. On Wednesday, Nigerian authorities reported two additional cases in the city of Port Harcourt. Until the Port Harcourt case was announced, Nigeria’s government had indicated that the virus was contained in Lagos. On Thursday, the WHO warned “the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos.” The UN health body has disclosed that the virus’ arrival in Port Harcourt, located 435 kilometres (270 miles) east of Lagos and home to oil and gas majors including Chevron, Shell and Total, showed “multiple high-risk opportunities for transmission of the virus to others.” Out of 255 people currently under surveillance for signs of the disease, 60 are considered to have had “high-risk or very high-risk exposure.

Tagged as: Democratic Republic of Congo, Ebola, Guinea, Lagos, Liberia, Nigeria, Port Harcourt, Senegal, Sierra Leone, West Africa, WHO, World Health Organisation

2014 Ebola Outbreak – Security Review for Travellers and Companies in West Africa

Summary

The current Ebola virus outbreak in West Africa is the most severe in terms of the number of human cases and fatalities since the virus was discovered in 1976. Cases of the virus have been confirmed in Guinea, Liberia, Nigeria and Sierra Leone. On 25 August, the Democratic Republic of Congo confirmed two Ebola deaths however officials believe the cases are unrelated to the outbreak in West Africa.

On 8 August 2014, the World Health Organization (WHO) formally designated the outbreak as a Public Health Emergency of International Concern. This designation invokes legal measures pertaining to disease prevention, surveillance, control and response.

The WHO has announced that the current Ebola outbreak is likely to continue for another six months before it is completely contained.

Ebola Virus Disease (EVD)

Genus Ebolavirus is a virological taxon that is included in the Filoviridae family (filovirus), order Mononegavirales. Genus Ebola virus comprises of five distinct species in which four of these cause the EVD in humans: Bundibugyo ebolavirus (BDBV); Ebola virus, formerly known as Zaire virus (EBOV); Reston ebolavirus (RESTV); Sudan ebolavirus (SUDV); Taï Forest ebolavirus (TAFV).

The five known virus species are named for the region where they were originally identified. Although Bundibugyo, Reston, Zaire, and Sudan ebolavirus have been associated with the large Ebola virus outbreaks in Africa, Zaire ebolavirus is the virus with the highest mortality rate of the ebolaviruses and is responsible for the largest number of outbreaks of the five known members of the genus, including both the first documented outbreak in 1976 and the outbreak with the most deaths (2014).

Symptoms

EVD is a severe acute viral illness that is often characterized by the sudden onset of fever (greater than 38.6°C/101.5°F), intense weakness, muscle pain, severe headache, abdominal pain, lack of appetite and sore throat. This is then followed by vomiting, diarrhoea, rash, impaired liver and kidney function, and in some severe cases, both internal and external bleeding. The incubation period, which is the time interval between infection with the virus to the onset of symptoms, is 2 to 21 days however symptoms commonly appear between 8 – 10 days.

The virus is believed to originate in fruit bats, which carry and spread the virus without being affected. EVD is believed to occur after the ebolavirus is transmitted to an initial human by contact with an infected animal’s body fluids. Human-to-human transmission occurs via direct contact with bodily fluids, including blood, faeces and sweat. Transmission can also occur by touching an infected deceased person during embalming, or by contact with contaminated medical equipment, particularly needles and syringes. Spreading of the virus through air has not been documented. People are infectious as long as their blood and secretions contain the virus.

Laboratory tests must be carried out in order to confirm an Ebola virus diagnosis as the virus displays similar symptoms to malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers. Samples taken from possibly infected patients pose an extreme biohazard risk; therefore testing should be conducted under maximum biological containment conditions.

Treatment

No specific treatment for EVD is available and the disease has a high risk of death, killing between 50% and 90% of those infected with the virus. Severely ill patients require intensive supportive care. ZMapp is an experimental biopharmaceutical drug that is currently under development as a treatment for EVD. It has been given to several patients infected with the virus however it is not widely available. 

2014 West Africa Ebola Virus Outbreak

Unlike previous Ebola outbreaks, which have occurred in isolated areas, the current West Africa epidemic erupted in places where there is more traffic, trade and freedom of movement, effectively making it easier for the disease to spread. Myths about the Ebola outbreak have also made combatting the disease more difficult.

Guinea

Guinea was the first nation to report cases of Ebola in the current outbreak. Researchers believe that the first Ebola case emerged in late 2013 however it was not reported, nor confirmed, to international authorities until March 2014. This lag period effectively enabled measures to not be enacted and resulted in the outbreak spreading throughout the country and then into Liberia and Sierra Leone.

Land borders with Liberia, Senegal and Sierra Leone have been closed. Health screenings at all border crossings have been set up and all travellers displaying a fever, or EVD-like symptoms, will be subject to quarantine and/or denied entry, or exit, from the country. Expect to experience delays at land border crossings. Enhanced screening measures have been introduced for outbound passengers at Conakry airport.

Hospital response and isolation/treatment centres:

• Conakry: MSF is running the ETU in Donka Hospital
• Gueckedou: MSF treatment centre in Guinee forestiere
• Macenta: The WHO and MOH have set up a transit centre. Confirmed EVD patients are transferred to Conakry or Gueckedou for treatment.
• Telimele: The MSF treatment centre in Basse-Guinee was closed in July after no new cases were reported for twenty-one days.

Due to the Ebola outbreak, general medical facilities throughout the country are currently under strain and are unable to provide the same standard of healthcare as in Western countries. Dedicated healthcare facilities for Ebola are also under pressure.

Liberia

Liberia has experienced two Ebola outbreaks in 2014. The first was reported in late March in Foya district, Lofa county. The virus later spread to Monrovia and Margibi and by early April, cases were reported in Nimba and Bong counties. Although in mid-April, suspected or confirmed cases were reported in six counties: Bong, Grand Cape, Moount, Lofa, Margibi, Montserrado and Nimba, by mid-May there were no reports of new suspected or confirmed cases. The country at this time was on track to declare the outbreak over. Although 42 days passed with no new cases reported, at the beginning of June, suspected cases were again reported in Lofa county. This effectively launched a second outbreak of the deadly virus, with cases being reported in Foya and Monrovia.

The Liberian government has declared a state of emergency and since 20 August, security forces are enforcing a nationwide curfew. Between 9PM and 6AM every night no movement is allowed anywhere in the entire country. Liberian authorities have set up road blocks in a bid to restrict movement around the country while security forces have been deployed in order to enforce quarantine for certain areas, including Lofa county. In Monrovia, the army and police have sealed off the neighbourhood of West Point with the area being placed under quarantine. There have been a number of outbreaks of violence, with civilians rioting at hospitals and attacking health workers.

All borders of Liberia have been closed, with the exception of major entry points, including the Roberts International Airport and James Spriggs Payne Airport. The Bo Waterside Crossing to Sierra Leone remains closed along with the Foya Crossing to Guinea. Any remaining border crossings may be closed with minimal notice. The Liberia Airport Authority has introduced enhanced screening measures for both inbound and outbound travellers at airport facilities.

Hospital response and isolation/treatment centres:

• Foya, Lofa County: Borma Hospital Ebola Treatment unit is being run by MSF.   It has a capacity of 40 beds, with expansion to 80 beds currently underway. A mid-level isolation unit has been established in Telewowan Hospital, Voinjama. It is also managed by MSF. The centre will expand to 40 beds however no estimated date for completion has been set.
• Monrovia: ELWA Hospital Ebola Treatment Unit (ETU) is run by MSF. The new 120-bed facility was opened on 17 August. There are plans to expend it to 300 beds by 2 September. The facility in JFK hospital is functioning as a full ETU.
• Montserrado: West Point holding unit has been established.
• Nimba: Renovation of the holding facilities at G.W. Harley and Ganta Hospitals is underway as of 20 August.
• Bong: As of 22 August, a new ETU is being constructed however it has not been determined how the clinic services will be run.
• Bomi: Bomi county Health Team (CHT) opened three, two-room, quarantine units with a 12-bed capacity.

The Ministry of Health and Social Welfare has established hotlines for the public to get basic information on Ebola: Call 0770198517 or 0777549805 or 0886530260 or 0886549805.

General medical facilities throughout the country are currently under severe strain as a result of the Ebola outbreak. Dedicated healthcare facilities for Ebola are overwhelmed and may not accept further cases.

Nigeria

Nigeria’s first Ebola case was an imported one. In July a Liberian man, Patrick Sawyer, flew from Monrovia, Liberia to Lagos, Nigeria, via Lome, Togo, despite displaying Ebola-like symptoms. He arrived in Nigeria on 20 July and died five days later while in quarantine. In response to his death, which was later confirmed to have been the result of Ebola, the Nigerian government placed all of those who had contact with the man under observation.  All confirmed Ebola cases have been linked to Mr Sawyer. On 28 August, Nigerian authorities confirmed that a doctor has died from Ebola in the south-eastern city of Port Harcourt. This is the first case of the deadly virus to be reported outside of Lagos.

On 8 August 2014 Nigerian President Goodluck Jonathan declared a national state of emergency. Since then, the Nigerian government has introduced measures for passengers departing from and arriving at all airports.

Hospital response and isolation/treatment centres:

• Lagos:   Infectious Disease Hospital, Yaba, has an isolation facility for Ebola cases.
• Delta State: Seven hospitals have been identified to be isolation centres for Ebola Cases. These include Warri Central Hospital; Ughelli Central Hospital; Sapele Central hospital; Agbor Central Hospital; Oleh Central Hospital; Eku Baptist Government Hospital and Delta State University Teach Hospital Oghara.
• Niger State: A quarantine centre is being established in Minna, with containment centres being established in the three Senatorial districts.

Sierra Leone

Sierra Leone’s first Ebola case occurred in late May, in Kailahun district near the border of Guinea. The deadly virus later spread to Port Loko district and then to Kenema, Kono and the Western Area. Kenema and Kailahun have been the most affected areas. Ebola affects twelve out of thirteen districts in Sierra Leone however the epicentres of the deadly disease are in the Eastern Province, near the borders with Guinea and Liberia.

On 30 July, President Koroma declared a state of public emergency, which is expected to last between 60 – 90 days. This measure effectively enables the military to enforce quarantine zones, restrict public movements and limit public gatherings. There is currently a nationwide ban on public gatherings. Increased restrictions on movement of people and vehicles have been placedin the districts of Kailahun and Kenema. All land borders with Guinea and Liberia have been closed. Health screenings have been introduced at all border crossings and all travellers displaying a fever or EVD-like symptoms will be subject to quarantine and/or denied entry, or exit, from the country. Over the weekend of 25 – 27 July, reports emerged that demonstrations and local disturbances had occurred in Kenema and Freetown and were related to the Ebola outbreak. Further such demonstrations cannot be ruled out at this time.

Hospital response and isolation/treatment centres:

• Kenema: The isolation facility in Kenema Government Hospital is to be relocated outside the township of Kenema, a few miles from Hanga. All new cases will be treated at the centre in Kailahun until the new facility is open. The Red Cross is establishing a new facility, with officials reporting on 22 August that it is expected to be functional soon.
• Kailahun: There is an 80-bed facility that is operated by MSF. The villages of Koindu and Buedu have referral units, where patients displaying symptoms of Ebola are isolated and evaluated for the disease. If it is determined that they have Ebola, they are then transferred to the isolation facility.
• Freetown: An isolation unit has been established at Connaught Hospital.
• Bo: MSF is constructing a 35-bed isolation centre that is expected to be functional by 28 August. A transit centre in Gondama is run by MSF.
• Western Area: A holding facility is being established in Lakka and a facility is being constructed in Kerry Town. Monrovia: ELWA Hospital ETU is run by MSF. The new 120-bed facility was opened on 17 August. There are plans to expand it to 300 beds by 2 September

Democratic Republic of Congo

Authorities in the DRC have confirmed two deaths related to the Ebola virus. Officials have disclosed that two of eight samples from the northwest Equateur province have come back positive for the deadly disease, with officials believing that Ebola has killed 13 people in the region, including five health workers. An epidemic has been declared in the region of Djera, in the territory of Boende in the province of Equateur. Officials however believe that the infections are of a different strain to those in the outbreak in West Africa.   One of the two cases tested positive for the Sudanese strain of the disease, while the other tested positive for a mixture between the Sudanese and the Zaire strain. The outbreak in West Africa is due to the Zaire strain.

 Ebola Myths and Impact on Outbreak

A number of myths that have materialized over the past few months have greatly impacted the spread of the current outbreak. In turn, a lack of understanding about what causes Ebola and how it is passed on has effectively resulted in the region developing into a fertile ground for speculation and mistaken beliefs.

Officials at the WHO have confirmed that the already difficult conditions are made more difficult by public misunderstanding caused by “rumours on social media claiming that certain products or practices can prevent or cure Ebola Virus Disease.” In Nigeria, at least two people died as a result of drinking salt water after stories circulated that doing so would protect against the deadly disease. Other supposed cures for the virus include raw onions, coffee, condensed milk and holy water. Some civilians have opted to hide infected family members at home, or prefer to take them to local doctors instead of to an Ebola treatment centre. Health officials in Sierra Leone disclosed in August that the Ebola outbreak spread from Guinea after an herbalist in the remote eastern border village of Sokoma claimed to have powers to heal the deadly virus. Officials have confirmed that the virus spread in Sierra Leone after cases from Guinea crossed over the border, seeking treatment.

Fears over the deadly virus have also sparked riots and attacks on health workers. As the Ebola outbreak continues, such attacks may spark similar reactions to those carried out against polio workers.

At the start of the outbreak, a team from MSF had to stop working at an isolation ward in Guinea after local residents mistakenly believed that they had brought the virus with them. Groups of health workers from MSF, the Red Cross and from the ministry of health have been pelted with rocks as they attempted to reach Ebola-hit areas. In Liberia, a number of Ebola patients escaped a healthcare facility after it was attacked by rioters.

Due to the region’s recent history of bloody civil war, some believe that the army’s deployment to control the affected areas is a sign that the government is deliberately infecting people in a bid to have an excuse to enforce martial law.

Economic Impact

While the Ebola epidemic has been an urgent health crisis, it has also had a devastating impact on the economies of Guinea, Liberia and Sierra Leone.

Due to travel restrictions, and a growing fear of human contact, markets and shops throughout Guinea, Liberia and Sierra Leone have been forced to close, leading to the loss of income for producers and traders. The Ebola crisis has also resulted in many people moving away from the affected areas, which in turn has disturbed agricultural activities.  Road blocks and quarantines manned by police and military have prevented the movement of farmers and labourers as well as the supply of goods, resulting in the cost of farm produce doubling in a matter of weeks. Officials at the UN are now warning of a looming food crisis in eastern Sierra Leone because of the acute shortage in farm labour.

Tourism within the affected countries and regionally has also been directly impacted. Despite WHO officials advising against suspending flights to the affected region, several airlines have temporarily suspended flights to Guinea, Liberia and Sierra Leone while a number of airlines have opted to suspend flights to regional countries where no Ebola cases have been reported. In early August, Korean Airlines chose to suspend flights to and from Kenya in a measure aimed at preventing the spread of the Ebola virus. The closure of borders and the suspension of flights have had a detrimental effect on trade as the move has severely limited the ability of countries to export and import goods. A number of foreign companies have chosen to withdraw non-essential personnel.  Some mining companies in the region have imposed travel restrictions on their workers, deferred new investments and cut back their operations.

The Ebola epidemic has had a severe impact on the three West African nations, especially Liberia and Sierra Leone, which are still in the process of emerging from civil wars and are attempting to rebuild their economies.

Forecasts of economic growth in the region have been reduced as the outbreak has strained the finances of a number of governments. An initial World Bank-IMF assessment for Guinea projected a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent. While Liberia’s economy had initially been expected to grow by 5.9% this year, the country’s Finance Minister has disclosed that this was no longer realistic as the Ebola crisis has slowed down the transport and service sectors and has resulted in the departure of a number of foreign workers. Sierra Leone’s Agriculture Minister has also disclosed that the country’s economy has deflated by 30% because of the Ebola outbreak, noting that the agricultural sector was the most impacted as 66% of the country’s population are farmers.  On 26 August, the African Development Bank disclosed that the worst-ever Ebola epidemic could cut the economic output of Guinea, Liberia, Sierra Leone and the Ivory Coast by between 1 percent and 1.5 percent of gross economic product.

 Advice for Companies/Employees in Affected Regions

MS Risk currently advises all to reconsider their need to travel to Guinea, Liberia and Sierra Leone. This is due to the current Ebola outbreak, the challenges in containing it, the limited emergency care options that are available and the increasing travel restrictions, which have significantly reduced the freedom of movement throughout the region. MS Risk advises all those in the affected countries to consider leaving while limited commercial flights continue to operate.

MS Risk advises all travellers and those working in the affected countries to closely monitor the advice provided by local health officials and the WHO. MS Risk advises all to maintain strict standards of hygiene, including following strict hand washing routines; avoiding contact with symptomatic patients and their bodily fluids; avoiding contact with corpses and/or bodily fluids from deceased patients; avoiding contact with any objects that may have been contaminated with bodily fluids. Travellers should also avoid close contact with live or dead animals and should not eat or handle raw or undercooked animal products, such as blood and meat. Travellers should avoid consumption of bush meat. All companies should be aware of the symptoms of Ebola and should brief all workers. Whenever possible, companies should implement screenings for workers, especially in highly affected areas. These include enforcement of regular hand washing routines and the measuring of temperature. If an employee develops symptoms, he/she must be quarantined immediately and a healthcare provider must be contacted.

A number of airlines have changed or suspended flights to West Africa as a result of the Ebola outbreak. These include:

• Arik Air and Gambia Bird – Suspended services to Liberia and Sierra Leone
• Asky Airlines – Suspended flights to and from Guinea, Liberia and Sierra Leone.
• Air France – Suspension of flights to Freetown, Sierra Leone beginning 28 August.
• British Airways – Suspended flights to Liberia and Sierra Leone until the end of this year.
• Ceiba Intercontinental – Suspended flights to West African countries
• Emirates Airlines – Suspended flights to Guinea
• Kenyan Airways – Temporarily suspended flights from Liberia and Sierra Leone into Nairobi
• Korean Airlines – Suspended flights to and from Kenya
• Royal Air Maroc and Brussels Airlines are still operating however on modified routes and schedules
• Delta continues to operate as normal however the airline is due to cease flying to Monrovia, Liberia at the end of August.