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====Benin====
====Benin====
On August 7, [[Benin]] reported two possible Ebola cases at two different hospitals within the country. Both patients were Nigerians who had traveled to Benin on business. Samples were sent to Senegal for confirmation.<ref>{{cite web |url=http://news.yahoo.com/benin-waiting-test-results-two-possible-ebola-cases-220918393.html |title=Benin waiting for test results on two possible Ebola cases |publisher=Agence France-Presse |date=7 August 2014 |accessdate=8 August 2014}}</ref> Initial tests were negative for Ebola.
On August 7, [[Benin]] reported two possible Ebola cases at two different hospitals within the country. Both patients were Nigerians who had traveled to Benin on business. Samples were sent to Senegal for confirmation.<ref>{{cite web |url=http://news.yahoo.com/benin-waiting-test-results-two-possible-ebola-cases-220918393.html |title=Benin waiting for test results on two possible Ebola cases |publisher=Agence France-Presse |date=7 August 2014 |accessdate=8 August 2014}}</ref> Initial tests were negative for Ebola.

====Democratic Republic of Congo====
On August 20 The [[Democratic Republic of Congo]] sent its health minister and a team of experts to a remote northern province after several people were discovered dead there from a disease with Ebola-like symptoms.<ref>{{cite web |url=http://www.express.co.uk/news/world/501668/Ebola-Crisis-Virus-Disease-Death-West-Africa-ZMapp |title=Ebola crisis: Trail of death suggests killer virus has spread to FIFTH Africa nation |publisher=Express.co.uk |date=20 August 2014 |accessdate=21 August 2014}}</ref>

[[Democratic Republic of Congo]] has sent its health minister and a team of experts to the remote northern [[Équateur]] province after several people died there from a disease with Ebola-like symptoms, a local official and a professor said on Wednesday. An [[Équateur]] resident who asked not to be named said that around ten people had died, including four health care workers, after suffering from fever, diarrhea and bleeding from the ears and nostrils - all symptoms of the deadly Ebola virus.<ref>{{cite web |url=http://www.huffingtonpost.com/2014/08/20/congo-ebola_n_5694368.html |title=Ebola crisis: Illness With Ebola-Like Symptoms Kills Several In Congo |publisher=The Huffington Post |date=20 August 2014 |accessdate=21 August 2014}}</ref>


====Ghana====
====Ghana====

Revision as of 17:35, 21 August 2014

Western African Ebola epidemic
Situation map of the outbreak as of 14 August 2014[1]
DateDecember 2013 – present[2]
LocationGuinea, Liberia, Nigeria, Sierra Leone
Casualties

An epidemic of Ebola virus disease (EVD) is ongoing in West Africa. The outbreak began in Guinea in December 2013, but was not publicly revealed until March 2014,[4] after which it spread to Liberia, Sierra Leone, and Nigeria. The outbreak is caused by the Zaire ebolavirus, known simply as the Ebola virus (EBOV). It is the most severe outbreak of Ebola in terms of the number of human cases and fatalities since the discovery of the virus in 1976,[5] with the number of cases from the current outbreak now outnumbering all cases from previous outbreaks combined.[6]

As of 18 August 2014, the World Health Organization (WHO) reported a total of 2,473 suspected cases and 1,350 deaths[7] (1,460 cases and 805 deaths being laboratory confirmed).[3] On 8 August, it formally designated the outbreak as a public health emergency of international concern.[8] This is a legal designation used only twice before (for the 2009 H1N1 (swine flu) pandemic and the 2014 resurgence of polio) and invokes legal measures on disease prevention, surveillance, control, and response, by 194 signatory countries.[9]

Various aid organisations and international bodies, including the Economic Community of West African States (ECOWAS), US Centers for Disease Control and Prevention (CDC), and the European Commission have donated funds and mobilised personnel to help counter the outbreak; charities including Médecins Sans Frontières, the Red Cross,[10] and Samaritan's Purse are also working in the area.

Development of the outbreak

Initial outbreak in Guinea

Researchers believe that the first human case of the Ebola virus disease leading to the 2014 outbreak was a 2-year-old boy who died 6 December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea. His mother, 3-year-old sister and grandmother then became ill with symptoms consistent with Ebola infection and died. People infected by those victims spread the disease to other villages.[2][11]

On 19 March, the Ministry of Health acknowledged a local outbreak of an undetermined viral hemorrhagic fever; the outbreak, ongoing since February, had sickened at least 35 people and killed 23. Ebola was suspected, and samples had been sent to Senegal and France for disease identification.[12] On 25 March 2014, the World Health Organization (WHO) reported that the Ministry of Health of Guinea had reported an outbreak of Ebola virus disease in four southeastern districts: Guekedou, Macenta, Nzerekore and Kissidougou with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths (case fatality ratio: 68.5%), had been reported as of 24 March.[13]

On 31 March 2014, the Centers for Disease Control and Prevention sent a five-person team to assist Guinea Ministry of Health and World Health Organization to lead an international response to the Ebola outbreak. On that date the WHO reported 112 suspected and confirmed cases including 70 deaths. Two cases were reported from Liberia of people who had recently travelled to Guinea, and suspected cases in Liberia and Sierra Leone were being investigated.[13] On 30 April, Guinea's Ministry of Health reported 221 suspected and confirmed cases including 146 deaths. The cases included 25 health care workers with 16 deaths. Liberia reported 13 suspected cases. On 26 May, the WHO reported the first death in Sierra Leone. On 28 May the total cases had reached 281 with 186 deaths.[13]

By late May, the outbreak had spread to Guinea's capital, Conakry,[13] a city of about two million inhabitants. According to Ibrahima Touré, Country Director of Plan Guinea, an NGO: "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."[14]

Subsequent spread

In Liberia, the disease was reported in Lofa and Nimba counties in late March,[15] and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties.[16]

Sierra Leone, Mali, and Ghana identified suspected cases of the disease by mid-April, but all clinical samples of suspected cases at the time tested negative for the Ebola virus.[17] From 23 to 27 May, three previously affected districts (Guéckédou, Macenta and Conakry), four new districts (Boffa, Télimélé, Boke and Dubréka) and one new country (Sierra Leone) reported several new EVD clinical cases.[18] In mid-June the first cases in Liberia's capital Monrovia were reported.[19]

The outbreak progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea.[20] By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country.[21] By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia.[22] By 20 July, cases of the pestilence had additionally been reported in the Bo District;[23] the first case in Freetown, Sierra Leone's capital, was reported in late July.[24][25]

Médecins Sans Frontières described the situation as being "totally out of control" in late June. Urging the world to offer aid to the affected regions, the Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."[26]

The first case in Nigeria was reported by the WHO on 25 July:[27] Patrick Sawyer, a Liberian Ministry of Finance official, flew from Liberia to Nigeria after exposure to the virus, and died at Lagos soon after arrival.[28] In response, the hospital where he was being treated was shut down and quarantined, and the health officials who were treating him were isolated in an attempt to stop the spread of the virus.[29][30][31] However, on 4 August, it was confirmed that the doctor who treated Sawyer tested positive for Ebola,[32] and on 6 August, authorities confirmed the Ebola death of a nurse who had treated Sawyer.[33]

A total of 2,473 suspected cases with 1,350 deaths have been reported by the World Health Organization as of 18 August 2014, of which 1,460 cases and 805 deaths have been laboratory confirmed to be Ebola.[3] Many experts believe that the official numbers substantially understate the size of the outbreak, because of families' widespread reluctance to report cases.[34]

Response by country and organisation

Countries with active local transmission

Countries with active transmissions, as of 9 August 2014.

The national authorities of Guinea, Sierra Leone, and Liberia have activated their national emergency committees, prepared Ebola virus disease response plans, and carried out needs assessments.[35]

WHO's Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs, and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[27]

Cordon sanitaire, a disease fighting practise, by isolating affected regions, was established in August, covering the area where 70% of the cases were reported.[34]

Guinea

The border between Guinea and Liberia remained open in April; Guinea's ambassador in Monrovia noted his government's belief that efforts to fight the disease directly would be more effective than closing the border.[36] In early August 2014, Guinea closed its borders with both Sierra Leone and Liberia to help contain the spreading of the disease, as more new cases were being reported in those countries than in Guinea.[37]

Liberia

By 23 July, the Liberian health ministry began to implement a strategic plan in line with the Accra meeting's conclusions to improve the country's response to the outbreak.[38]

On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points, such as the country's principal airport, where screening centres would be established, and the worst-affected areas in the country would be placed under quarantine.[39] Football events were banned, because large gatherings and the nature of the sport increase transmission risks.[40] Three days after the borders were closed, Sirleaf announced the closure of all schools nationwide, including the University of Liberia,[41] and a few communities were to be quarantined.[42] Sirleaf declared a state of emergency on 6 August, partly because the disease's weakening of the health care system had the potential to reduce the system's ability to treat routine diseases such as malaria; she noted that the state of emergency might require the "suspensions of certain rights and privileges."[43] On the same day, the National Elections Commission announced that it would be unable to conduct the scheduled October 2014 senatorial election and requested postponement,[44] one week after the leaders of various opposition parties had publicly taken different sides on the question.[45]

Nigeria

There are twelve confirmed cases of Ebola in Nigeria as of 18 August 2014.[3] The first was an imported case of a Liberian-American, Patrick Sawyer, who travelled by air from Liberia and became violently ill upon arriving in the city of Lagos. On 20 July, Sawyer flew into Nigeria via Lomé and Accra from Liberia, and he died five days later in Lagos. In response, the Nigerian government increased surveillance at all entry points to the country; health officials were placed at entry points to conduct tests on people arriving in the country. Initial reports noted that sixty-nine people previously in contact with Sawyer (including airport staff, fellow flight passengers and health workers at the hospital where Sawyer was hospitalised) were placed under close surveillance without symptoms.[46] On 4 August, it was confirmed that the doctor who treated the patient tested positive for the virus strain and was being treated.[32] On 6 August, Nigerian authorities confirmed the Ebola death of a nurse who had treated Sawyer.[33] The doctor who treated Sawyer, Ameyo Adadevoh,[47] died in the afternoon of 19 August 2014. The Commissioner of health in Lagos announced that 4 people of the 12 confirmed cases, including the index case, had recovered.[48]

On 9 August 2014, the Nigerian National Health Research Ethics Committee, the organization regulating research ethics in the country, issued a statement waiving the regular administrative requirements that limit the international shipment of any biological samples out of Nigeria.[49] The statement also supports the use of non-validated treatments without prior review and approval by a health research ethics committee.[49]

On 14 August the Nigerian government said Aliko Dangote had donated $150 million to halt the spread of the 2014 West Africa Ebola virus outbreak.[50]

Sierra Leone

Sierra Leone has instituted a temporary measure which includes reactivation of its "Active Surveillance Protocol" that will see all travellers into the country from either Guinea or Liberia subjected to strict screening to ascertain their state of health.[51] The government of Sierra Leone declared a state of emergency on 30 July and deployed troops to quarantine the hot spots of the epidemic.[52]

Awareness campaigns in Freetown, Sierra Leone's capital, were delivered in August 2014 on the radio or through car loudspeakers.[53]

Countries with suspected or non-transmissive cases

Benin

On August 7, Benin reported two possible Ebola cases at two different hospitals within the country. Both patients were Nigerians who had traveled to Benin on business. Samples were sent to Senegal for confirmation.[54] Initial tests were negative for Ebola.

Democratic Republic of Congo

On August 20 The Democratic Republic of Congo sent its health minister and a team of experts to a remote northern province after several people were discovered dead there from a disease with Ebola-like symptoms.[55]

Democratic Republic of Congo has sent its health minister and a team of experts to the remote northern Équateur province after several people died there from a disease with Ebola-like symptoms, a local official and a professor said on Wednesday. An Équateur resident who asked not to be named said that around ten people had died, including four health care workers, after suffering from fever, diarrhea and bleeding from the ears and nostrils - all symptoms of the deadly Ebola virus.[56]

Ghana

Multiple suspected Ebola cases were reported in Ghana by early August. All blood tests returned negative results, but Ghana has built three isolation centres.[57][58]

Saudi Arabia

On 1 April, Saudi Arabia stopped issuing visas for the Muslim pilgrimage to Mecca to people from Guinea, Liberia, and Sierra Leone.[59] Despite this, on 3 August, a man suspected of being infected with Ebola returned home to Saudi Arabia from Sierra Leone, and died within three days of arrival.[60] On 10 August, it was confirmed that he tested negative for Ebola.[61]

On 5 August Saudi Arabia announced that it would block issuance of Hajj and Umrah visas to the citizens of Sierra Leone, Guinea and Liberia.[62]

On 6 August, the Saudi Ministry of Health advised citizens and residents of Saudi Arabia to avoid travelling to Liberia, Sierra Leone, and Guinea until further notice.[63]

Spain

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that the Spanish Brother Miguel Pajares was infected with the Ebola virus while volunteering in Liberia. His repatriation, coordinated by the Spanish Ministry of Defence, occurred on 6 August 2014.[64] Spanish authorities confirmed that the patient would be treated in the 'Carlos III' hospital in Madrid. The decision attracted some controversy, amid questions as to the authorities' ability to guarantee no risk of transmission.[65] Brother Pajares died from the virus on 12 August.[66]

United States

On 31 July 2014, US health officials from the Centers for Disease Control and Prevention issued a travel advisory for Guinea, Liberia, and Sierra Leone, warning against non-essential travel.[67]

American aid worker Kent Brantly became infected with Ebola, while working in a Monrovia treatment centre as medical director for the aid group Samaritan’s Purse; Nancy Writebol, one of Brantly's missionary co-workers, became infected at the same time.[68][69][70] Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital, near the headquarters of the Centers for Disease Control.[71] On 21 August, both Dr. Brantly and Ms. Writebol were discharged from Emory University Hospital, having recovered from the virus. Neither patient is considered contagious. [72]


On 6 August 2014, the Centers for Disease Control moved its Ebola response to Level 1 (the highest on a scale from 1 to 6) to increase the agency's ability to respond to the outbreak.[73]

Other countries and economic regions

Economic Community of West African States

On 30 March 2014, during the 44th Summit of the heads of state and government of West Africa, Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak.[74] At the event in July of that year, the Nigerian government donated US$500,000 to the Liberian government to aid the fight against the virus.[75]

In July, the WHO convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana.[76] On 3 July 2014, the West African states announced collaboration on a new strategy, and the creation of a World Health Organization sub-regional centre in Guinea "to co-ordinate technical support";[77] the centre was inaugurated in Conakry on 24 July.[78]

On 31 July, the WHO and West Africa nations announced $100 million in aid to help contain the disease.[79]

European Union

In March, the European Commission (EC) gave €500,000 to help contain the spread of the virus in Guinea and its neighbouring countries. The EC has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities. EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response Kristalina Georgieva said: "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it. It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries."[80]

In April, a mobile laboratory, capable of performing the molecular diagnosis of viral pathogens of risk groups 3 and 4, was deployed in Guinea by the European Mobile Laboratory project (EMLab) as part of the WHO/GOARN outbreak response. Prior samples were analyzed at the Jean Mérieux BSL-4 Laboratory in Lyon.[81]

Germany's Foreign Office issued travel warnings for all affected countries at the end of July.[82] Spain did so on August 2.[83]

Canada

On 12 August 2014, the Canadian Public Health Agency announced that the country would donate between 800 and 1,000 doses of an untested vaccine (VSV-EBOV) to the World Health Organization.[84] The offer was made by the Minister of Health directly to the Director General of the WHO as part of the country's commitment to containment efforts. The Government of Canada holds the intellectual property associated with the vaccine, but has licensed BioProtection Systems of Ames, Iowa to develop the product for use in humans.[85]

As of 12 August 2014, Canada's contribution to address the spread of the Ebola virus in West Africa is estimated at $5,195,000. This includes resources dedicated to humanitarian, security, and public health interventions.[86]

China

On 30 July Hong Kong's health authorities increased surveillance against the virus after a Hong Kong woman became ill after visiting Kenya. She tested negative for the disease. She will be discharged after 21 days' isolation in hospital.[87]

A Chinese plane carrying supplies worth 30 million yuan (4.9 million US dollars) arrived in Guinea, Sierra Leone and Liberia on August 11.[88][89] This is their second Ebola relief after the first batch delivered in May to Guinea, Liberia, Sierra Leone and Guinea-Bissau. The supplies include medical protective clothes, disinfectants, thermo-detectors and medicines. China also sent three expert teams composed of epidemiologists and specialists in disinfection and protection as well as medical supplies to Guinea, Liberia and Sierra Leone despite high risk of infection.[90][91] Before their arrival, eight members of a Chinese medical team sent to assist patients in Sierra Leone's hospitals were quarantined after treating Ebola patients.

Some Chinese companies in West Africa also joined the relief efforts. China Kingho Group, a leading exploration and mining company in Sierra Leone, donated 400 million Leones (about $90,000) to the Government and People of Sierra Leone on August 15.[92]

On 16 August, Chinese President Xi Jinping and UN Secretary-General Ban Ki-moon on Saturday discussed several hot issues, including Ebola, in their fourth meeting this year. The meeting in Nanjing, capital of east China's Jiangsu Province, was held before they attended the opening ceremony of the 2nd Summer Youth Olympic Games.

Xi said China will continue to make joint efforts with the international community to prevent and control the Ebola virus outbreak that has hit west Africa. China has provided emergency medical assistance to Ebola-hit countries and sent expert groups. China's medical teams in the countries are working with local staff, according to Xi.

Xi also spoke highly of the measures taken by the United Nations and World Health Organization its professional institutions, and called for more assistance and input for medical and health services in African countries.[93]

Colombia

On 8 August, the Vice Minister of Health and Social Protection of Colombia, Fernando Ruiz, assured the public that the Government is preparing itself to face the virus even though Colombia's given conditions don't give Ebola the chance to natively spread since "the bat species in charge of transmitting the disease nor the practice of eating it aren't present in Colombia."[94] Ruiz also stated that Colombians travelling to the affected parts of West Africa are being warned to take appropriate precautions.[95] Previously, on 5 August, the Ministry of Health and Social Protection issued a press release stating that "since the month of April the National Government has been closely following and monitoring the outbreak of the Ebola virus in West Africa and the State has decided to adopt word by word the contingency plan prepared by the World Health Organization (WHO)."[96]

Equatorial Guinea

Equatorial Guinea temporarily stopped issuing visas from neighbouring countries and cancelled regional flights by Ceiba Intercontinental Airlines.[97]

India

On 21 July, three Dwarka, Delhi residents on an inbound flight from Accra to New Delhi via Addis Ababa were placed under surveillance after WHO confirmation that one of the passengers on the flight had tested positive for Ebola; however, as of 8 August, none of the three had shown any symptoms of the disease.[98] On 8 August, India placed all of its airports on high alert and stepped up surveillance of all travellers entering the country from Ebola-affected regions. The Union Health Minister, Harsh Vardhan, issued a statement, "There is no cause for panic. We have put in operation the most advanced surveillance and tracking systems." From 9 August, passengers coming from Ebola-affected countries will have to complete a form before landing; the form has a check-list for symptoms and asks travellers from West Africa for information about places visited, length of stay and other important information.

"The form is ready and will be officially released by Saturday. We will request all airlines to direct their staff to distribute the form in-flight, like immigration forms are given before arrival," said Jagdish Prasad, director general of health services, Union Ministry of Health. In New Delhi, Ram Manohar Lohia Hospital in New Delhi has been designated as a treatment centre for Ebola Virus Disease (EVD) cases. A 24-hour emergency helpline will also be functional from Saturday. Its numbers are (011)-23061469, 3205 and 1302. The estimated 47,000 Indians in the affected countries are being contacted by area diplomatic missions and supplied with educational material about the disease.[99]

Japan

In April, the Government of Japan gave $520,000 through the United Nations Children’s Fund (UNICEF) to support the Ebola outbreak response in Guinea.[100] And in August, $1.5 million provide additional support to efforts to aid is to be disbursed via the WHO, UNICEF and Red Cross, and will be used for measures to prevent Ebola infections and to provide medical supplies.[101]

Kenya

Kenyan government banned people travelling from or through Sierra Leone, Guinea and Liberia for all ports of entry.[102]

Morocco

Beginning in April, Morocco reinforced medical surveillance at the Casablanca airport, a regional hub for flights from and to West Africa.[103][104] In early August, Liberian interior minister Morris Dukuly announced the Ebola death of a Liberian man in the country,[105] but the Moroccan Ministry of Health announced that the person died of a heart attack, rather than Ebola.[106]

Philippines

The Philippine Department of Foreign Affairs has raised Alert Level 2 in Guinea, Liberia and Sierra Leone and has temporarily halted the sending of Filipino workers to the affected countries since June 30. Filipino seafarers are also cautioned about potentially contracting Ebola when their ship docks in affected countries.[107] The Department of Health expressed its willingness to send medical workers to Ebola-affected countries to help contain the outbreak.[108]

Senegal

Senegal's Ministry of Interior has ordered all movements of people through the southern border with Guinea to be suspended indefinitely to prevent the spread of the disease, according to a statement published on 29 March by state agency APS.[109]

Seychelles

Seychelles introduced a visa requirement for the citizens of Sierra Leone, Liberia, Guinea-Bissau, Guinea Conakry, Nigeria, Cameroon, Chad, Niger, Burkina Faso, Mali, Benin, Ivory Coast, Ghana, Togo, Congo, D.R. Congo, Gambia, Mauritania, and Senegal. Citizens of these countries will require a visa until the Ebola outbreak is declared over.[110] Members of the Sierra Leone national football team were refused visas over the outbreak.[111]

United Kingdom

Public Health Wales reported on 5 August 2014 that a British woman might have been exposed to the Ebola virus while travelling in West Africa.[112] She agreed to voluntary isolation in her home in Cardiff, Wales, even though she was showing no symptoms of the virus.[112] She is being closely monitored by public health agencies.

Response by organisations

Airlines

Arik Air, Nigeria's main airline, has stopped flying to Liberia and Sierra Leone.[39]

On 5 August, British Airways suspended all flights to and from Liberia and Sierra Leone, until the end of the month.[113]

Korean Air announced on 14 August that they will be suspending flights to and from Kenya.[114]

US Centers for Disease Control

By the beginning of August, the US Centers for Disease Control (CDC) had placed staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak.[115] On 6 August, the CDC moved its Ebola response to Level 1 (the highest on a scale from 1 to 6) to increase the agency's ability to respond to the outbreak.[73]

Tom Frieden, director of the CDC, stated: "The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away."[116]

Médecins Sans Frontières

The humanitarian aid organisation Médecins Sans Frontières (Doctors Without Borders) has a team of 676 staff working in Guinea, Sierra Leone and Liberia, and has set up several specialist centres to give medical care to affected people.[117] On 8 August MSF declared that it had reached the limit of its capacity.[118]

Samaritan's Purse

Samaritan's Purse is also providing direct patient care in multiple locations in Liberia.[119] At a congressional committee hearing on 7 August 2014, the head of Samaritan's Purse stated that "The disease is uncontained and out of control in West Africa."[120]

World Health Organization

WHO's Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs, and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[27] On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak.[27]

WHO declared the outbreak an international public health emergency on 8 August 2014, after a two-day teleconference of experts.[8] 11 August they emphasised lack of supplies and capacity as one of the problems while local awareness of the diseased had increased. Several cases could not be treated for this reason at some centres.[121] Revised guidelines on how to spread the disease from patients were released for downloading updating guidelines from 2008. E.g., they warn about dust when sweeping or shaking brooms and mist if spraying liquid disinfectants and recommend other methods like washing floors with detergents and / or a suitable disinfectant; and that many disinfectants only work well after rinsing most dirt off. Soap and other substances that dissolve fat can also kill the virus on surfaces.[122] Ash dissolves fat because it is alkaline (pH about 9.5 to 11, and 8.5 after reaction with air and water for some days) and is widely available and has been tested effective for hand-washing to stop the spread of other diseases in low-income countries.[123] It was not mentioned in the WHO guidelines.

World Food Program

On 18 August, World Food Program announced plans to mobilise food assistance for an estimated 1 million people living in restricted access areas.[124]

World Bank Group

The World Bank Group has pledged up to US $200 million in emergency funding to help Guinea, Liberia, and Sierra Leone contain the spread of Ebola infections, help their communities cope with the economic impact of the crisis, and improve public health systems throughout West Africa. [125]

Complications in containment efforts

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders,[26] inadequate equipment given to medical personnel,[126] lack of soap and water in communities for hand-washing and disinfection.[127] Furthermore, funeral practices such as washing and cleaning bodies increase risks the way it is done,[128] and there is reluctance among country people to follow preventive practices,[129] including "freeing" suspected Ebola patients from isolation.[24][130]

Rumours and denial

Denial in some affected countries, such as Sierra Leone, have made containment efforts often more difficult.[131] Language barriers and the appearance of medical teams in protective suits sometimes exaggerated fears of the virus.[132] There are reports that some people believe that the disease is caused by sorcery and that doctors are killing patients.[133] In late July, the former Liberian health minister Peter Coleman stated that "people don't seem to believe anything the government now says."[39] In August, a mob attacked a Liberian Ebola isolation centre, stealing equipment and "freeing" patients. Some shouted that, "There's no Ebola".[134]

Healthcare workers

As of 11 August, healthcare workers have represented nearly 10 percent of the cases and fatalities, significantly impairing the ability to respond to the outbreak.[135] Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare whom British newspaper The Guardian described as "one of Liberia's most high-profile doctors."[136] Two American aid workers at a treatment centre in Monrovia run by Serving In Mission /Samaritan's Purse have also been infected.[136][137] On 2 August, Kent Brantly, one of the two workers, was flown into Atlanta's Emory University Hospital for treatment, making him the first patient infected with Ebola Virus Disease in the United States.[138] On 29 July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak,[139][140] and another senior physician in that country was infected the following week.[141]

There was also an attack on aid workers who were hurrying to retrieve "freed" patients, and did not explain to villagers who they were,[142] and the Red Cross was forced to suspend operations in Guinea after staff were threatened by a group of men armed with knives.[143] Demonstrations outside the main hospital treating Ebola patients in Kenema, Sierra Leone, on 25 July were broken up by police.[144]

Fatality rate

See also: Ebola virus disease § Prognosis

The infection and mortality data from Guinea, where new infections had slowed considerably by 18 June, indicated a fatality rate of about 64%, which includes also cases of probable and suspected Ebola infections, as reported by the World Health Organization.[3] Guinea and WHO disagree on patient data, including mortality data.[citation needed]

The case fatality rate has been described as unreliable, given differences in testing policies, the inclusion of probable and suspected cases, and the rate of new cases.[145]

Virology

A researcher working with the Ebola virus while wearing a BSL-4 positive pressure suit to avoid infection
Main article: Ebola virus

The strain of virus affecting people in the current outbreak is a member of the Zaire lineage.[146]

An article published in the New England Journal of Medicine on-line in April 2014 asserted that while the Zaire ebolavirus (EBOV) in Guinea shared 97% of its genetic code with the Zaïre lineage, it was of a different clade than the strains from outbreaks in the Democratic Republic of Congo and Gabon, and constituted a new strain indigenous to Guinea, and was not imported from Central Africa to West Africa.[11] This result, however was contradicted by two subsequent reports.

The first of these reports reached the conclusion that the outbreak "is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus."[147]

A second report published in June 2014 also supports the latter view, determining that it was "extremely unlikely that this virus falls outside the genetic diversity of the Zaïre lineage" and that their analysis "unambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage."[146]

Another study in July 2014 indicated that there had been some genetic drift between the March 2014 Guinea samples and the June 2014 Sierra Leone samples.[148]

Treatment

Researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them.
See also: Ebola virus disease § Research, and Ebola virus disease § Treatment

No proven Ebola virus-specific treatment exists.[149] Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control bleeding, maintaining oxygen levels, pain management, and the use of medications to treat bacterial or fungal secondary infections.[150][151][152] Early treatment may increase the chance of survival.[153] A number of experimental treatments are being studied,[154] including ZMapp and an RNA interference drug called "TKM-Ebola".[155]

The unavailability of treatments in the most-affected regions has spurred controversy, with some calling for experimental drugs to be made more widely available in Africa on a humanitarian basis, and others warning that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies.[156][157] As a result of the controversy, an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects both for treatment and for prevention of Ebola, and also said that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion.[158]

The two Americans being treated have been receiving an experimental treatment from Mapp Biopharmaceutical.[159] Three Liberian health workers received the same treatment more recently.[159] The Canadian government has promised to supply up to a thousand doses of a vaccine, once safety concerns have been addressed.[159]

Economic effects

In addition to the loss of life, the outbreak is having a negative economic effect. In early April, Conakry's Palm Camayenne Hotel, which is popular among businessmen and politicians, reported that it had less than a third of its occupancy rate. At the same time, Brussels Airlines flights from Brussels to Conakry experienced reduced passenger traffic, while flights in the reverse direction experienced heavier traffic, and regional airline Gambia Bird delayed the start of a route to Conakry after Senegal closed its border with Guinea, because of the outbreak.[160] Other countries in Africa which are not directly affected by the virus have also reported adverse effects on tourism[161]

Non-essential employees of British firm London Mining in Sierra Leone were transported out of the country in June, following an outbreak of the virus.[162] Subsequently, a number of other mining companies have withdrawn personnel from Sierra Leone, Guinea and Liberia[163]

The ongoing outbreak in Sierra Leone caused the closure of schools, markets, Kailahun's lone bank, and stores.[164]

An initial World Bank-IMF assessment for Guinea projects a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent[125]

Tekmira Pharmaceuticals, a Canadian company developing an experimental Ebola treatment, had their stock price rise due to the outbreak.[165]

"Ebola in Town," a dance tune by a group of West African rappers warning people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia during the first quarter of 2014.[166][167]

In August 2013, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola.[168]

Timeline of the outbreak

A timeline of the outbreak follows, using data reported by the Centers for Disease Control and Prevention[13] and the World Health Organization (WHO).[3] The table also includes suspected cases that have yet to be confirmed for the virus. The reports are sourced from official information from the affected countries' health ministries. WHO has stated the reported numbers "vastly underestimate the magnitude of the outbreak".[169]

  • Cumulative totals of cases and deaths over time
    Cumulative totals of cases and deaths over time
  • Average new cases and deaths per day (between WHO reporting dates)
    Average new cases and deaths per day (between WHO reporting dates)
Ebola cases and deaths by country and by date
Date Total Guinea Liberia Sierra Leone Nigeria References
Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths
18 Aug 2014 2,473 1,350 579 396 972 576 907 374 15 4 ao 08-18[170]
16 Aug 2014 2,240 1,229 543 394 834 466 848 365 15 4 ✓[171]
13 Aug 2014 2,127 1,145 519 380 786 413 810 348 12 4 ✓[172]
11 Aug 2014 1,975 1,069 510 377 670 355 783 334 12 3 ✓[173]
9 Aug 2014 1,848 1,013 506 373 599 323 730 315 13 2 ✓[174]
6 Aug 2014 1,779 961 495 367 554 294 717 298 13 2 ✓[175]
4 Aug 2014 1,711 932 495 363 516 282 691 286 9 1 ✓[176]
1 Aug 2014 1,603 887 485 358 468 255 646 273 4 1 ✓[177]
30 Jul 2014 1,440 826 472 346 391 227 574 252 3 1 ✓[178]
27 Jul 2014 1,323 729 460 339 329 156 533 233 1 1 ✓[179]
23 Jul 2014 1,201 672 427 319 249 129 525 224 ✓[180]
20 Jul 2014 1,093 660 415 314 224 127 454 219 ✓[181]
17 Jul 2014 1,048 632 410 310 196 116 442 206 ✓[182]
14 Jul 2014 982 613 411 310 174 106 397 197 ✓[183]
12 Jul 2014 964 603 406 304 172 105 386 194 ✓[184]
8 Jul 2014 888 539 409 309 142 88 337 142 ✓[185]
7 Jul 2014 844 518 408 307 131 84 305 127 ✓[186]
2 Jul 2014 779 481 412 305 115 75 252 101 ✓[187]
1 Jul 2014 759 467 413 303 107 65 239 99 ✓[188]
22 Jun 2014 599 338 — — 51 34 — — ✓[189]
20 Jun 2014 390 270 — — 158 34 ✓[189]
17 Jun 2014 528 337 — — — — 97 49 ✓[190]
16 Jun 2014 398 264 33 24 — — ✓[190]
15 Jun 2014 524 336 394 263 33 24 95 46 ✓[191]
10 Jun 2014 474 252 372 236 13 9 89 7 No WHO source?
6 Jun 2014 — — — — 89 7 ✓[192]
5 Jun 2014 351 226 — — — — ✓[192]
5 Jun 2014 438 230 344 215 13 9 81 6 GU ao 06-03
SL ao 06-05
LI ao ? unchanged; case from SL died returned[193]
2 Jun 2014 328 208 79 6 ao 06-01 GU
SL
LI ao ? case from SL died returned[194]
30 May 2014 354 208 291 193 13 9 50 6 GU ao 05-28
SL ao 05-29
LI ao 05-29 no cumulative case from SL died returned[195]
27 May 2014 309 200 281 186 12 9 16 5 GU ao 05-27
SL ao ?
LI ao ? no new cases[196]
LI: no new cases reported since 9 April[197]
23 May 2014 270 183 258 174 — — — — ✓[198]
18 May 2014 253 176 — — — — ✓[199]
12 May 2014 248 171 — — — — ✓[200]
10 May 2014 245 166 233 157 12 11 — — ✓[201]
7 May 2014 236 158 — — — — ✓[202]
3 May 2014 243 164 231 155 — — SL no cases of EVD confirmed[203]
2 May 2014 226 140 13 11 GU ao 05-01
LI ao 05-02 is 13/11[204]
30 Apr 2014 233 155 221 146 12 9 No WHO source?
23 Apr 2014 220 145 208 136 12 9 GU ao 04-23 fail 218/141
LI ao 04-24 fail 35/?
LI reclassify
may toss up to 27
35-25=12[205]
22 Apr 2014 208 136 34 11 GU ao 04-20
LI ao 04-21
deaths reduced by 2
1 death no EVD
1 death in GU total[206]
21 Apr 2014 215 138 203 129 12 9 GU ao 04-17
LI ao ? no new cases[207]
GU ao 04-17 fail 202/125
LI ao 04-17 fail 27/13[208]
16 Apr 2014 209 131 197 122 12 9 GU ao 04-16
LI ao 04-16 fail 27/13
1 case was Lassa
Mali cases negative
SL 12/?
2 prev deaths were in GU[209]
14 Apr 2014 168 108 GU ao 04-14
LI ao 04-11 fail 26/13[210]
10 Apr 2014 169 110 157 101 12 9 ao 04-09 GU fail 158/101
ao 04-10 LI fail 25/12
SL unchanged[211]
7 Apr 2014 163 102 151 95 12 7 ao 04-07
LI fail 21/10
SL 2 EHF were Lassa Fever
Mali 4; 2 from GU[212][213]
2 Apr 2014 135 88 127 83 8 5 ao 04-01
LI +1 death from 03-31[214]
31 Mar 2014 130 82 122 80 8 2 ✓[215]
28 Mar 2014 114 70 112 70 2 0 GU ao 03-28
LI 3/3 from GU
SL 2/2 from GU[216]
LI ao 03-29 fail 2/1?
of 7 tests only 2 were Ebola
of 2 deaths only 1 was Ebola[217]
27 Mar 2014 103 66 103 66 GU ao 03-27
LI suspect 8/6
SL suspect 6/5[218]
26 Mar 2014 86 62 86 62 ✓[219]
25 Mar 2014 86 60 86 60 ✓[220]
24 Mar 2014 86 59 86 59 ✓[221]
22 Mar 2014 49 29 49 29 ✓[222]
Notes:
Date of report is inconsistent. Sometimes it is the date of the WHO report, and sometimes it is the information "as of" date.
Date of report may not be current for all countries. Some reports quote different "as of" dates for different countries.
Total cases and deaths before 1 July 2014 are calculated.

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  173. ^ Ebola virus disease, West Africa – update 13 August 2014, WHO
  174. ^ Ebola virus disease, West Africa – update 11 August 2014, WHO
  175. ^ Ebola virus disease, West Africa – update 8 August 2014, WHO
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  178. ^ Ebola virus disease, West Africa – update 31 July 2014, WHO
  179. ^ Ebola virus disease, West Africa – update 29 July 2014, WHO
  180. ^ Ebola virus disease, West Africa – update 25 July 2014, WHO
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