Ebola Trend Uneven as UN Worries ‘Like Mad’ About Rebound

It’s too early to say the Ebola outbreak in West Africa is waning even as reports of empty beds in treatment centers and a decline in the rate of new cases in some areas buoy optimism, a United Nations envoy said.

Transmission has slowed in parts of Liberia and Sierra Leone, though the virus is “advancing rapidly” in other areas, said David Nabarro, the senior UN system coordinator for Ebola. Infections have flared in communities where there had been improvement.

“It’s hard to tell exactly where we are at the moment -- whether we have started to turn the corner or not,” Nabarro said in a telephone interview today from Geneva. “Once the curve starts to come down, we worry like mad that people will take their eye off the ball and it starts to go up again.”

Nabarro joins other health officials in urging continued vigilance. The three worst-hit countries in West Africa -- Liberia, Sierra Leone and Guinea -- are lacking about 75 percent of the treatment beds needed for Ebola patients, the World Health Organization said today.

The virus has infected more than 13,500 people, with almost 5,000 deaths, according to the WHO’s Oct. 31 report. The Geneva-based organization maintains a worst-case scenario of as many as 10,000 new cases a week by early December if nothing is done to improve containment efforts.

Sustaining Control

Stringent control measures, including safe burial practices and rigorous “contact tracing” of people who may have been exposed to the virus, have helped lower transmission rates in areas such as Lofa county in the north of Liberia, on the border with Sierra Leone and Guinea, Nabarro said.

“Maintaining the effort until the very last case is identified and brought under treatment” is critical, he said. “There is always a tendency for people to get excited for a period of time and then move onto something else.”

Koinadugu district in northeastern Sierra Leone recently had its first cases of Ebola, showing the outbreak is still spreading, the WHO said last week. More than 100 people are being monitored in Mali after a two-year-old died from the virus.

Doctors Without Borders, which has more than 250 international staff in the three worst-hit countries and is operating six treatment centers, said last week it is seeing “critical gaps in all aspects of the response.” The aid organization expects to spend $64 million on its Ebola response in West Africa this year, according to its website.

Most major donor nations have considered increasing their financial commitment to the Ebola response multiple times, Nabarro said.

“That’s not a bad sign,” he said. “It’s just a sign of adjusting our response to the need. At the moment, I am utterly pleased with the way in which we are in tune with each other.”

No Cure

There’s no cure for Ebola, which jumps to humans from animals such as fruit bats and chimpanzees. The virus spreads from contact with bodily fluids such as blood, vomit and feces. While drugmakers including Tekmira Pharmaceuticals Corp., GlaxoSmithKline Plc and Johnson & Johnson are racing to bring vaccines and drugs to market, the therapies may not arrive in time for this outbreak.

Nabarro says it’s too early to judge the world’s response to the epidemic, which has killed more people than all previous Ebola outbreaks combined.

“Have we all made a hash of it? Let’s wait until the history books are written,” he said. “The global system for identifying and dealing with rogue diseases is quite strong, and so perhaps the fact that one got through the defenses is a reminder of how important these defenses really are. I am not just prepared to present this as a failure.”

There are already some lessons from the current outbreak, he said.

“What we are seeing is that when a health crisis gets big, it quickly becomes much more than a health crisis,” said Nabarro, who previously worked with the WHO responding to the 2004 Indian Ocean tsunami and diseases such as malaria. “That’s why we are needing a whole of society response, and that’s exactly what we should have.”

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