Liberia Quarantines Slum of 50,000 After Residents Raided Ebola Treatment Center

[James Madison]

This has the potential to turn a dangerous outbreak into a plague of global significance. They're taking all of these (likely) sick and infected people and locking them in a tightly-packed shithole. No way Liberia can keep this quarantine up for more than a few weeks; imagine hundreds or thousands of terminal, highly-contagious patients running around western Africa.


http://www.nytimes.com/2014/08/21/world/africa/ebola-outbreak-liberia-quarantine.html?_r=0


MONROVIA, Liberia — Liberia’s halting efforts to contain the Ebola outbreak spreading across parts of West Africa quickly turned violent on Wednesday when angry young men hurled rocks and stormed barbed-wire barricades, trying to break out of a neighborhood here that had been cordoned off by the government.

Soldiers repelled the surging crowd with live rounds, driving hundreds of young men back into the neighborhood, a slum of tens of thousands in Monrovia known as West Point.

One teenager in the crowd, Shakie Kamara, 15, lay on the ground near the barricade, his right leg apparently wounded by a bullet from the melee. “Help me,” pleaded Mr. Kamara, who was barefoot and wore a green Philadelphia Eagles T-shirt.

Lieut. Col. Abraham Kromah, the national police’s head of operations, arrived a few minutes later.

The clashes marked a dangerous new chapter in West Africa’s five-month fight against the Ebola epidemic, already the deadliest on record. Outbreaks in neighboring Sierra Leone and Guinea have mostly been concentrated in rural areas, but the disease has also spread to this major city, Monrovia, the Liberian capital.

Fighting Ebola in an urban area -– particularly in a place like West Point, an extremely poor and often violent place that still bears deep scars from Liberia’s 14-year-long civil war –- presents challenges that the government and international aid organizations have only started grappling with.

The risks that Ebola will spread quickly, and the difficulties in containing it, are multiplied in a dense urban environment, especially one where the health system has largely collapsed and residents appear increasingly distrustful of the government’s approach to addressing the crisis, experts say.

Many people in West Point were already seething at the government’s attempt to open an Ebola center at a school in their neighborhood, complaining that suspected Ebola patients from other parts of the city were being brought there as well. Their neighborhood, they feared, was effectively being turned into a dumping ground for the disease.

On Saturday, hundreds of people stormed the school, carrying off supplies and provoking suspected Ebola patients to flee the facility, heightening concerns that the disease would spread through the city.

On Wednesday morning, the residents of West Point awoke to learn that their entire area was under government quarantine. Soldiers and police in riot gear blocked roads in and out of the seaside neighborhood. Coast guard officers stopped residents from setting out aboard canoes from West Point, the neighborhood with the highest number of confirmed and suspected cases of Ebola in the capital.

As residents realized that the entire area had been sealed off from the rest of the capital, frustrations began to mount. In one midmorning attempt to break through the cordon, at an entrance to the neighborhood next to an electrical station, soldiers fired in the air to dispel the protesters. But some of the bullets appear to have hit the crowd as well, intensifying the sense of a neighborhood under siege.

Continued at Link...

[Acala]

No, contrary to the declarations of the joyful fear mongers, ebola is not going to be a "plague of global significance". Deadly as it is, it simply is not that contagious.

Chikun gunya, on the other hand . . .

[James Madison]

Disagree.
Ebola is very contagious; it isn't very transmissible. Consinder Patrick Sawyer -- one man infected nearly a dozen people. That's an R0 twice that of smallpox; you just have to get really close to see numbers like that.
This thing would go to town in Bangladesh or the Philippines. Imagine it getting into a huge megaopolis like Rio or Mexico City.

But the biggest danger is that as the virus lingers within humans, it will continue to adapt to become more transmissible, less lethal, less incapacitating. That's the real issue here.

[tangent4ronpaul]

http://www.mysinchew.com/node/101120?tid=37

Liberia, which has seen the biggest toll in this epidemic with 576 deaths, has witnessed chaotic scenes in recent days following a surge in cases.

The Red Cross said the crematorium in the capital Monrovia was struggling to deal with the dozens of bodies being brought in each day.

Crematorium workers were having to return corpses to a hospital in the city because they "did not have the capacity to cremate all the bodies", Fayah Tamba, the head of the charity's Liberian office, told a local radio station.

Her comments came a day after troops used tear gas to disperse protesting crowds after President Ellen Johnson Sirleaf ordered a nightime curfew and quarantine zone in Monrovia's West Point slum and Dolo Town, to the east of the capital.

The death toll from the epidemic now stands at 1,350 after a surge of 106 victims in just two days, most of them in Liberia, according to the World Health Organization (WHO).

Given the extent of the crisis, the WHO has authorised largely untested treatments -- including ZMapp and the Canadian-made VSV-EBOV vaccine, whose possible side effects on humans are not known.

Ireland's health service meanwhile said authorities were testing a "suspected case" after a person who travelled to an affected area in Africa was found dead.

The case is in Donegal in northwest Ireland. Test results are expected late on Friday.

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AJAM: patients are also being treated by giving them blood transfusions from people that have survived the disease in the hopes that antibodies in the blood will help.

AJAM: it's spread to Germany, Ireland and California.

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http://www.doctorswithoutborders.org/our-work/medical-issues/ebola

Liberia

Update: August 18, 2014

Doctors Without Borders/Médecins Sans Frontières (MSF) admitted nine patients today into its newly constructed ELWA 3 Ebola Management Center in Monrovia, Liberia, beginning a process of scaling up operations at the 120-bed facility.

An Ebola outbreak continues to rage virtually unchecked in this city of approximately one million people, far exceeding the capacity of the few medical facilities accepting Ebola patients. Much of the city’s health system has shut down over fears of Ebola among staff members and patients, leaving many people without treatment for other conditions.

The first nine patients at ELWA 3 were among those seeking treatment at another Ebola center, ELWA 2, which is currently run by the Ministry of Health. MSF will increase the number of patients at ELWA 3 in the coming days, as newly trained staff members gain experience with the safety procedures. MSF currently has 19 international and 250 national staff members in Monrovia.

Update: August 8, 2014

The situation in the Liberian capital, Monrovia, is “catastrophic,” according to Lindis Hurum, MSF emergency coordinator in Liberia. There are reports of at least 40 health workers being infected with Ebola over recent weeks. Most of the city’s hospitals are closed, and there are reports of dead bodies lying in streets and houses.

MSF teams are providing technical support for an Ebola case management center in Monrovia in conjunction with the Ministry of Health, and has started construction of a new case management center.

An MSF team based in Guékédou, Guinea, has recently launched a response in Liberia’s Lofa region, alongside the Guinean border, which has been badly affected by Ebola.

MSF is reinforcing its current team of nine international staff and 10 Liberian staff, but the organization is reaching the limits of its capacity, and there is a dire need for the WHO, Ministry of Health, and other organizations to rapidly and massively scale up the response in Liberia.

In Liberia, the situation is deteriorating rapidly, with cases now confirmed in seven counties, including in the capital Monrovia.

There are critical gaps in all aspects of the response, and urgent efforts are needed to scale up.

Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health (MoH).

The MSF team has set up an Ebola treatment center in northern Liberia, where cases have been increasing since the end of May.

After the initial set up, the center was handed over to Samaritan’s Purse on July 8. There are currently six patients and MSF experts continue to provide technical support and training.

The team will now shift its efforts to Voinjama, in Lofa county, where there are reports of people dying of Ebola in their villages.

The team will set up a referral unit so suspected Ebola patients can be isolated and transferred to the treatment center.

In Monrovia, an MSF emergency team is building a new tented treatment center with capacity for 40–60 beds. It is scheduled to open on July 27 and will also be run by Samaritan’s Purse.

A 15 bed MSF treatment unit set up at Monrovia’s JFK hospital was handed over to the MoH in April. However, the unit has since been closed and all patients are currently cared for at ELWA hospital in Paynesville until the new center is open at the same site.

Currently there are 14 patients admitted to this center.

MSF is also supporting the MoH in the overall coordination of the Ebola response and providing technical and medical advice.

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http://www.doctorswithoutborders.org/news-stories/statement-new-strategies-more-resources-needed-curb-ebola-epidemic

August 15, 2014
Statement by MSF International President





In a briefing organized today by the journalist association “Association des Correspondents Auprès des Nations Unies” (ACUNU) in Geneva, Dr. Joanne Liu, international president of Doctors Without Borders/Médecins Sans Frontières (MSF), gave an account of her recent visit to Guinea, Sierra Leone, and Liberia, sharing what MSF teams are seeing and what more needs to be done to bring the outbreak under control.

“The epidemic is at different stages in the three countries, with the situation in Guinea having somewhat stabilized, while in Sierra Leone and Liberia the epidemic is still spiralling out of control.

Overall we are seeing a totally different scenario than what we have seen in past. It is an open epidemic, reaching urban areas and not isolated to a few villages, as in past outbreaks. This goes further than Ebola. It is destroying the health care system in entire zones in Liberia and Sierra Leone. We desperately need new strategies adapted to this reality.

Health workers have been infected, and many others have fled in fear. In some areas, people are knocking on our doors in desperate need of health care. Without basic healthcare, we are likely to see deaths from common illnesses such as malaria and diarrhea. In Monrovia, we have seen women coming to our teams searching for assistance to give birth because most health-care structures in Monrovia are closed. Six of them in need of obstetric care lost their babies.

Meanwhile, our teams in our Ebola medical centers in Sierra Leone and Liberia are stretched to the breaking point.

In Kailahun, in Sierra Leone, today there is an urgent need to follow up 2,000 people who came into contact with patients who have Ebola. They all need to be followed up. But we have only been able to follow up with around 200 of them. We hear of deaths in the community, but we have no capacity to verify them.

In Foya, Liberia, we had 137 patients yesterday with suspected Ebola who are at the 40-bed center. Not only is the medical team overwhelmed, but the laboratory also has a backlog of tests for suspected cases. In the Liberian capital of Monrovia, we are in the process of opening a 120-bed Ebola care center.

We are breaking new ground in the history of Ebola. We have never managed or set up care centers of this size.

We are also implementing new strategies adapted to the situation. For example, we are finding ways for patients with Ebola who are in isolation wards to remain in touch with their families so that they are not completely cut off from their loved ones. We have also worked closely with families, to support them when bodies need to be buried, so that they can do it safely, but with dignity.

This is very important ,as there is a very human side to this crisis that needs to be taken into account to help patients, to help families, and to build trust and support of communities.

But MSF is limited in what it can do. More help is needed in these countries to improve outreach with communities, epidemiological surveillance, and care of patients. More workers with hands-on capacity are essential, to help implement and develop new approaches and strategies.

It’s not only about having more epidemiologists, physicians, and Ebola specialists. There is also a need for people who have disaster and emergency response experience even if they have little or no experience with Ebola. These people are desperately needed to cover the huge gaps in areas such as providing general hospital support, infection control support, community outreach, and providing communities with tools such as home disinfection kits.

The World Health Organization, the international community in general, and nongovernmental organizations must rapidly scale-up their response and send in more teams. It is urgent that management and coordination are improved, but also that strategies are implemented to reach all affected areas and to help improve general access to healthcare in areas where the system has collapsed.

Any measures taken, ranging from safe burials to encouraging people not to hide when they are sick, to contact tracing, will need the understanding and acceptance of the population to be fully successful.

Unlike past Ebola outbreaks that lasted around eight weeks, the response this time needs at least a medium term commitment of many months to help curb the epidemic.”

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Not finding it right now, but there is also a issue that vehicles and gas are in short supply to pick up bodies on the streets.


-t

[tangent4ronpaul]

WHO: Ebola outbreak in Africa likely underestimated

http://www.usatoday.com/story/news/world/2014/08/22/ebola-who-liberia-sierra-leone/14451855/?utm_source=feedblitz&utm_medium=FeedBlitzRss&utm_campaign=usatoday-newstopstories

As Ebola cases continued to climb, particularly in Liberia and Sierra Leone, the World Health Organization admitted Friday that it probably isn't capturing the full scope of the outbreak.

The WHO and the United Nations promised a redoubled effort to bring the epidemic under control.

Between Aug. 19 and 20, 142 new cases of Ebola and 77 deaths were reported from Liberia, Sierra Leone, Guinea and Nigeria. The current outbreak has lead to 2,615 total cases and 1,427 deaths, but those numbers don't tell the whole story.

In a news release Friday, the WHO conceded that it has likely been undercounting cases of Ebola because families are in denial or afraid to admit their loved ones might have the dreaded disease.

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

Keiji Fukuda, WHO's assistant director-general, said he hopes to reduce the number of new cases in the near future, but he estimated that it will take six to nine months to bring the outbreak under control. "We expect several months of very hard work," he said.

The WHO promised to add 500 treatment beds to Liberia's capital of Monrovia within the next six weeks to address the surge in cases.

Fukuda and a United Nations official also said they would be stepping up efforts to provide other medical care to people in Liberia, where the already-shaky medical systems have collapsed in the face of Ebola, and to support the nation's economy.

"We want to make sure it happens as quickly as possible. That's our mission," said David Nabarro, senior United Nations system coordinator for Ebola, who has been in Liberia for the past week.

Sophie Delaunay, executive director of Doctors Without Borders/Médecins Sans Frontières, which has led the medical fight against Ebola, said the international community has been slow to address the crisis in West Africa, but she welcomed a more robust response.

"Humanitarian action alone is not going to solve this problem," she said by phone.

Delaunay also called on all countries that have expertise in the type of infection control needed to fight Ebola — including the United States, Australia, Japan and European nations — to figure out how they can best support the effort.

The need is particularly acute for people trained to work under strict infection controls. People without such training are a hazard, she said, because they risk spreading the infection.

"We don't expect to have people with Ebola experience, because there are few in the world, but people with long-term experience in dealing with highly infectious environments can be a good resource," she said.

Despite the dangers of the assignment, Delaunay said she has been happily surprised that health care providers from around the world continue to volunteer for the work.

In a Friday news conference, Fukuda emphasized that Ebola is a treatable disease, with more than half of patients surviving if they get proper care early. Many Liberians have been reluctant to go to health care centers or bring their sick loved ones there, because they assume there is no chance of survival.

"This is not a hopeless situation," he said.

In addition to direct medical care, more education is sorely needed to adequately fight Ebola, said Stephen Morse an infectious-disease expert at the Mailman School of Public Health at Columbia University in New York.

"We really need a public education effort at the village level to explain to people not only how to understand Ebola, but what they should do so they can protect themselves while they're caring for their loved ones before they are able to get medical care," Morse said.

In figures released Friday, the WHO said there has been one new Ebola case and death in Nigeria, bringing the total to 16, including five deaths. All of those cases are tied to Liberian-American Patrick Sawyer, who traveled to Nigeria in late July, getting very ill along the way.

In Guinea, the WHO reported 28 new cases and 10 deaths. In Sierra Leone, three new cases have been reported and 18 deaths; and in Liberia, there were 110 new cases and 48 deaths. Although Ebola is reported to kill as many as 90% of its victims, the death rate has varied widely by country, so far, with Guinea reporting that roughly 31% of its patients have died and 58% of Liberians dying.

It is not clear how those figures would change if the reports of the disease were more accurate.

John Brownstein, an associate professor at Harvard Medical School and director of the Computational Epidemiology Group at Boston Children's Hospital, said he is not surprised that the WHO is undercounting cases of Ebola; most infectious diseases are undercounted. With diseases that are well understood, such as the flu, epidemiologists can adjust counts to cover for undercounting. But Ebola is so rare and little-understood that it is very hard to do in this case, he said.

-t