Ebola vigilance must continue outbreak evidence of how treatment is urgent

A New York Times article documents how the world can't afford to take a break from the West Africa Ebola epidemic.

Nearly Halted in Sierra Leone, Ebola Makes Comeback by Sea

"...downward trajectory of new cases late last year and into January did not lead to the end of the epidemic."

"...Outreach teams in recent days made their way over twisting dirt paths filled with garbage, fish bones and shells along seaside settlements in Aberdeen, where narrow passages made it impossible to avoid physical contact with others. The volunteers stopped at dozens of residences. 'Nobody sick?', they asked in the Krio language. 'You aren’t hiding anybody?'"

By SHERI FINK FEB. 28, 2015

FREETOWN, Sierra Leone — It seemed as if the Ebola crisis was abating.  New cases were plummeting. The president lifted travel restrictions, and schools were to reopen. A local politician announced on the radio that two 21-day incubation cycles had passed with no new infections in his Freetown neighborhood. The country, many health officials said, was “on the road to zero.”

Then Ebola washed in from the sea.

Sick fishermen came ashore in early February to the packed wharf-side slums that surround the country’s fanciest hotels, which were filled with public health workers. Volunteers fanned out to contain the outbreak, but the virus jumped quarantine lines and cascaded into the countryside, bringing dozens of new infections and deaths.

“We worked so hard,” said Emmanuel Conteh, an Ebola response coordinator in a rural district. “It is a shame to all of us.”

ontinue reading the main storyPublic health experts preparing for an international conference on Ebola on Tuesday seem to have no doubt that the disease can be vanquished in the West African countries ravaged by it in the last year.

But the steep downward trajectory of new cases late last year and into January did not lead to the end of the epidemic.

In Sierra Leone, the hardest hit of the countries, the decline leveled off in late January, and the country has reported 60 to 80 new cases weekly since then. 

Guinea has experienced months of lower-level spread. Even in Liberia, where only a handful of treatment beds remain occupied, responders lament that a health care worker who recently became ill might have exposed dozens of colleagues and patients, and that a knife fight had exposed gang members to the blood of a man who tested positive for Ebola.

“I doubt it will stop just suddenly,” said Dr. Pierre Rollin, an infectious disease expert with the United States Centers for Disease Control and Prevention. “It’s always bumpy, and the bigger the outbreak, the more chance you have a bumpy thing.”

As large epidemics taper off, it is common to find new complications in the effort to reach zero cases. “Oftentimes we find surprises when we get to a low level that were hidden by the epidemic itself early on,” said Dr. William Foege, a former director of the C.D.C. and a leading figure in the eradication of smallpox.

For example, health officials managed to reduce measles drastically in the United States in the 1970s, but it took some time before experts realized that a few travelers per week arriving from other countries were developing the illness, continuing its spread. Importation of measles is again a problem today, and it is suspected as a factor in the current outbreak linked to Disneyland.

Then there is polio, which experts had resolved to eliminate globally by 2000, before wars and unexpected resistance disrupted the plan.

“I don’t think we ever foresaw a time when people would shoot and kill polio vaccinators,” Dr. Foege said, referring to incidents in Pakistan and Nigeria that interrupted inoculation campaigns.

Eliminating smallpox about 35 years ago required a deep understanding of the communities in which it hid. During its last stand, in Somalia, people obscured cases, partly out of embarrassment.

“I think Ebola will turn out to be the same thing,” Dr. Foege said. “The surprises will not be so much scientific as cultural: the ability to hide cases; the desire not to be identified as having Ebola or being in contact with Ebola. Those are the things we have to find out how to overcome.”

That challenge is apparent now in Sierra Leone, where the arrival of infected mariners — combined with a recent easing of anti-Ebola measures, persistent community resistance to containment measures and misunderstanding — has contributed to the surge in the capital. Vice President Samuel Sam-Sumana said Saturday that he had placed himself under quarantine after one of his security officers died of Ebola on Tuesday.

Two wooden boats carrying three sick fishermen arrived at a small wharf in Freetown in early February, cutting short a two-week trip. “The captain was vomiting,” said Mohamed Bangura, 23, a crew member of one boat.

The wharf, Tamba Kula, is an informal settlement where hundreds of people live in shanties made of reclaimed wood and corrugated metal roofs. At the slum’s entrance, a towering sign displays an image of the Statue of Liberty, an advertisement for daily British Airways flights with connections to the United States that were canceled when the Ebola outbreak was declared.

Now, commerce in Tamba Kula is also restricted. Those who contracted Ebola there and nearby — two dozen people since early February — include fishermen, boat cleaners and two women who sold fish.

There are various theories about how the seamen might have been infected and how they spread Ebola to others. Some fishermen delayed reporting their illnesses, stopping instead at an island for treatment with native herbs before coming home to the capital. A few wharf residents who later fell ill thought they had come into contact with contaminated bodily fluids at a shared toilet block that was recently built in Tamba Kula by the aid group Oxfam.

When the cluster erupted at the wharf area — part of a large neighborhood known as Aberdeen, with about 9,000 residents — some Ebola prevention workers were taken by surprise because they had been continuing surveillance efforts. Officials imposed a quarantine, prompting many fishermen to take to the sea to avoid it. The authorities sent out word for them to return.

On a recent afternoon, James Bangura, an official leading the Ebola response in the capital, chastised the deputy harbor master of Tamba Kula for failing to keep arriving fisherman on their boats to be evaluated.

“Once they’re lost and nobody accounts for them, we can’t get to zero,” Mr. Bangura told the man.

“They scatter,” the deputy harbor master responded, but he checked the men from the next boat that arrived.

Outreach teams in recent days made their way over twisting dirt paths filled with garbage, fish bones and shells along seaside settlements in Aberdeen, where narrow passages made it impossible to avoid physical contact with others. The volunteers stopped at dozens of residences. “Nobody sick?” they asked in the Krio language. “You aren’t hiding anybody?”

One night at 11:30, Foday Kamara, a community monitor, walked breathlessly up the road from Tamba Kula. He said he had spent two hours with soldiers chasing down a dozen or so residents who had tried to escape quarantine in the dark. They said that they felt cooped up and that food did not always arrive.

“Ebola work is not easy,” Mr. Kamara said. “I feel like these people, they aren’t ready to end Ebola yet.”

The hard work — by teams of student volunteers, with national and international public health experts — was rewarded, as new cases in Tamba Kula declined.

“I feel like our response was rapid, it was strong, and it appears to have helped,” Dr. John T. Redd, an epidemiologist with the C.D.C., said at the district’s command center in Freetown 10 days ago. On a white board, he had drawn two smiley faces next to the number zero for the previous day’s positive cases.

But the problem was not over. It had moved.

In early February, Abass Koroma, who ran a food grinding shop in Tamba Kula, left there with the help of his wife. His sister had recently died, and he was sick.

Mr. Koroma’s mother, Fatmata Kalokoh, a rice farmer who had traveled to Freetown after her daughter’s death, said her son’s wife had paid a taxi driver about $40 for the three-hour journey back to the family’s village, Rosanda, east of the capital. Her son had refused to go to the hospital in Freetown out of fear, she said. When he arrived in Rosanda, she took him to a traditional healer, who prepared an herbal medicine to help him sleep. Mr. Koroma drank it and began vomiting blood.  The next day, he died en route to another village to see another traditional healer.

His death was reported to teams in charge of safe burials, but some villagers said they had touched him while he was sick, thinking that something like a curse had killed him and not Ebola. Mr. Koroma has been linked to the subsequent infections of 42 people in the community, some of whom have died, according to Ebola response officials in the district.

“His wife caused all this,” Ms. Kalokoh said. Now a patient at an International Medical Corps treatment center, she gestured to a treatment tent where her daughter-in-law lay. A survivor working at the center shushed Ms. Kalokoh, saying that it was in God’s hands and that she should not blame anyone.

Every day last week, ambulances bumped over dusty roads, going to Rosanda to carry villagers 45 minutes to the medical center. Two mothers walked weakly to the open doors of an ambulance as their young sons watched, shoulders heaving with sobs. A young girl was taken last Sunday as her mother stood helpless behind candy-striped quarantine tape. The girl, Marie Kamara, died on Friday.

As cases mounted, Dr. Conteh, the district’s Ebola response coordinator, summoned about 125 traditional healers, tribal chiefs and other local leaders. He called for a suspension of traditional practices and warned that criminal summonses were being issued to anyone accused of hiding the sick. Experts fear that such threats will lead more people to go underground.

“The war is still on,” Dr. Conteh told colleagues the next day. “We’re at a critical stage. We can either make or break.”


A version of this article appears in print on March 1, 2015, on page A1 of the New York edition with the headline: Nearly Halted in Sierra Leone, Ebola Makes Comeback by Sea. Order Reprints| Today's Paper|Subscribe

Ebola fighters - thank you Time pesons of the year: recognition helps fight the virus

Ebola is a deadly virus without a definitive cure. 

The infectious disease has now claimed more than 6,000 lives (mostly in West Africa), more than 17,000 people have been diagnosed as infected, and the disease has tested the world's health-care infrastructure. Essentially, Time is paying homage to the brave caregivers, nurses, ambulance drivers, doctors, and health-care workers who rose to care for victims of this challenge.

Tireless and dangerous  acts of courage and mercy by caregivers are buying the world time to strengthen its infectious disease defenses.  

"For the risks they took and the lives they saved, the Ebola fighters are Time's 2014 Person of the Year," Time editor Nancy Gibbs said on the magazine's Web site.
 
In 2014, Time picked a group of people, rather than one individual, and its choice also cast the spotlight on one of the most pressing global health issues.

The Ebola virus, which first emerged as a problem in the west African nations of Guinea, Liberia, and Sierra Leone, and was declared an outbreak in March of 2014, has ravaged regional economies, as well as testing local and global health systems. As such, it has dominated the headlines for much of the year.

 

Time magazine lauds the brave caregivers, nurses, ambulance drivers, doctors, and health-care workers who rose to the Ebola challenge. 

By Husna Haq, Correspondent December 10, 2014

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  REUTERS/TIME/Handout

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The Ebola virus has thrown the spotlight on the selfless individuals who have cared for the infected patients. According to the World Health Organization, 622 health-care workers are known to have been infected with Ebola through the end of November; 346 of them have died. According to a report by the Centers for Disease Control and Prevention, the incidence rate of Ebola cases in Sierra Leone is about 100 times higher for health-care workers than it was for other people in the country.

And yet, they continue to fight the virus. Their bravery helps to keep the outbreak of this epedemic in the location where it is endemic, until it hopefully subsides, rather than spreads outside of West Africa.

"Ask what drove them, and some talk about God; some about country; some about the instinct to run into the fire, not away," writes Time Magazine.

Adds Foday Gallah, an ambulance driver who survived infection, says “I am going to fight Ebola with all of my might.”

Sierra Leone doctor Komba Songu-M’briwa, who contracted the disease after treating a fellow Sierra Leone physician (who later died), told the Associated Press that the Ebola field work was "the 'most difficult, most pitiful' work of his life." But he vowed to return to the field to fight the virus. "I don't have regrets because I'm enjoying my job, and I think it's been a blessing to other people."

Time cover Man of the Year Dr. Kent Brantly told Time, “Whenever we go through a devastating experience like what I’ve been through, it is an incredible opportunity for redemption of something. We can say, 'How can I be better, because of what I’ve been through?', (so) to not do that is kind of a shame.”

As such, the Ebola outbreak has been both a source of inspiration and a challenge for the global community, suggests Time Magazine.
 
"So that is the next challenge," writes Time. "What will we do with what we’ve learned? This was a test of the world’s ability to respond to potential pandemics, and it did not go well. It exposed corruption in African governments along with complacency in Western capitals and jealousy among competing bureaucrats. It triggered mistrust from Monrovia to Manhattan. Each week brought new puzzles."

For inspiration on the road that lies ahead in the fight against Ebola, the magazine points readers once again to its "Person of the Year."

"The rest of the world can sleep at night because a group of men and women are willing to stand and fight. For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time’s 2014, Person of the Year."

Thank you Time Magazine for  recognizing the enormous contributions of the Ebola caregivers. They are humanitarian heroes contributing to the health and well-being of the world.

Another physician victim of Ebola - tremendous loss to humanitarian efforts

When a physician or nurse dies of Ebola, as a result of treating people with the virus, thier loss is magnified by the number of desperate people who are impacted by the decline in numbers of medical caregivers, those who are qualified to provide treatment.

Medscape article:

Sierra Leone surgeon Martin Salia, MD, died of Ebola this morning November 16, 2014, after being airlifted to the Nebraska Medical Center in Omaha on November 15 for treatment, the hospital announced.

"Dr Salia was extremely critical when he arrived here and unfortunately, despite our best efforts, we weren't able to save him," said Phil Smith, MD, director of the center's biocontainment unit, in a news release. Dr Salia was already experiencing kidney and respiratory failure on arrival.

The hospital said Dr Salia was placed on dialysis and a ventilator. He received a dose of convalescent plasma andZMapp (Mapp Biopharmaceutical, Inc) therapy.


"We used every possible treatment available to give Dr Salia every possible opportunity for survival," said Dr Smith. "As we have learned, early treatment for these patients is essential. In Dr Salia's case, his disease was already extremely advanced by the time he came here for treatment."

The 44-year-old Dr Salia was the chief medical officer at United Methodist Church Kissy General Hospital in Freetown, Sierra Leone. He also treated patients at other medical facilities in Freetown, according to the church's news agency. United Methodist News said it was not clear where and how Dr. Salia contracted the Ebola virus.

A legal permanent resident of the United States, Dr Salia leaves behind a wife, Isatu Salia, and two children.

Nebraska Medical Center is one of four US hospitals with special biocontainment units designed for deadly infectious diseases such as Ebola. Two other patients with Ebola have been treated there and discharged virus-free.

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Tragically, the world has lost another physician who had the capacity to heal thousands of other people. God Bless his efforts.