Ebola obviously is not under control there must be more resources applied to care and cure

Fighting Ebola in Western Africa will take a long time.

Liberia now has an upper hand against Ebola, but Sierra Leone is experiencing a rapid spread of the virus, as is Conakry, the capital of Guinea. The World Health Organization today announced that the number of cases and deaths in Liberia, Sierra Leone, and Guinea — the epicenter of the outbreak — has risen to 19,340 and 7518, respectively.  

Although some infection control education and implementation will curb the spread of the Ebola virus, the processes aren't curing new outbreaks.

Ebola Remains a 'Long, Hard Fight,' CDC Chief Says

The head of the Centers for Disease Control and Prevention (CDC) recently came back from a tour of Ebola-ravaged West Africa with stories that made him feel both optimistic about defeating the virus and somber about the long-term nature of the struggle.

In a news conference yesterday, CDC Director Thomas Frieden, MD, MPH, recalled visiting a cemetery in Liberia where gravediggers once struggled to keep up with burying the bodies of Ebola victims. Now the number of deaths is quickly tapering off, so much so that gravediggers are using some of their time to make furniture for survivors, said Dr Frieden. He returned from his trip on December 20.

However, Dr Frieden said he also witnessed scenes suggesting that healthcare workers might let victory slip through their hands. He described how a nurse in Guinea acquired the Ebola virus from a patient — and survived — after she started an intravenous line on him without wearing any gloves. "Getting good infection control practices up and running is not easy," said Dr Frieden.

"The bottom line is, there's been real momentum and real progress," Dr Frieden said. "I'm hopeful about stopping the epidemic, but I remain realistic that this will be a long, hard fight."

Dr Frieden surveyed a public health battleground in which Liberia now has an upper hand against Ebola, but Sierra Leone is experiencing a rapid spread of the virus, as is Conakry, the capital of Guinea. The World Health Organization today announced that the number of cases and deaths in Liberia, Sierra Leone, and Guinea — the epicenter of the outbreak — has risen to 19,340 and 7518, respectively.

Healthcare workers from the CDC, the 54-nation African Union, Great Britain, France, Switzerland, and other countries, along with their West Africa colleagues, represent a "world working together to make a difference" in stopping the virus, Dr Frieden said. He thanked Congress for recently budgeting roughly $5 billion to battle Ebola, money that "allows us to move faster, allows us to do more, allows us to see the possibility of an end to this epidemic more clearly."

The ultimate challenge, he said, is reducing the number of Ebola cases to zero. Doing that will require the continued painstaking work of tracing contacts of every infected person, monitoring them for signs of illness, and isolating and treating them if they turn out to have the virus. That job of sleuthing is harder, said Dr Frieden, in urban areas such as Freetown, Sierra Leone, and Monrovia, Liberia, which have more mobile populations than rural areas.

The CDC director said he is looking forward to the arrival of several public health tools to help Ebola fighters in their work. A point-of-care diagnostic test for the virus would eliminate having to transport blood samples by jeep, helicopter, and canoe back to a laboratory. Such a test might become available in a matter of months, he said. Likewise, Dr Frieden said testing an experimental vaccine on healthcare workers could begin as early as January in Sierra Leone. Meanwhile, researchers are assessing experimental Ebola treatments such as plasma therapy.

"Scientific studies don't know if [experimental Ebola treatments] work or save lives," said Dr Frieden. "That's got to happen very quickly."

Ebola is an infectious disease: American health care workers are front line experts

Although the etiology of the Ebola virus and longitudinal studies about the disease are ongoing, one aspect of treatment for the disease includes isolation of victims and strict infection control procedures to prevent the spread. America's health care workers are well trained to respond to an individual who presents with an infectious disease. Indeed, infection control procedures are included in all hospital personnel orientations, even among clerical staffs. Nevertheless, America's health care systems are not totally prepared to handle an epidemic of Ebola. One of the biggest problems isn't related to the causation of the disease, at all. Rather, the problem is ethical. Who will receive the most effective treatments?  Even worse, who will receive transport to a hospital for treatment?

America's health care workers are as much at risk for contracting Ebola as those who work with victims in developing countries in Africa. Most at risk are the emergency responders, who are likely the first ones called when a person becomes incapacitated by critical illness, like Ebola. Emergency providers are likely most at risk for being exposed to an Ebola outbreak, should one occur. 

Yet, there are a very limited number of ambulances available for transporting patients to a hospital or emergency treatment facility during an infectious disease outbreak, like Ebola.  

Transporting an Ebola patient puts the ambulance out of service until it's completely bathed in a chlorine disinfecting solution - twice. There are only a few transports any emergency medical transport will be able to accommodate, given the risk of Ebola exposure to the EMS responders. An additional risk of exposure includes the people cleaning the ambulance and equipment, following the transports.  

Therefore, when US public health officials are speaking confidently on national media about how Ebola will be managed, they're speaking about the disease process. They're not addressing the systems crises that will erupt as a result of the disease spreading. 

There's justifiable confidence in America's ability to respond to an isolated Ebola outbreak. Of course, the treatment of the victims will be expensive because of the intensity of the treatment of the isolated patient and the follow up "contact tracing" of those who are exposed.

It was just a matter of time before Ebola showed up in the USA. Indeed, it seems like our US health care system may have been victims of the "someplace else" delusion, like it would never happen to them. Now, it's here.  

The "someplace else" syndrome will be debunked. Health care systems will certainly pull out those pandemic policies from the years when H1N1 "bird flu" was supposed to cause a worldwide pandemic.

Meanwhile, in my opinion, the Ebola patient who traveled from Liberia to Texas before he exhibited symptoms of the illness, simply can't be an isolated incident. Not knowing who else may present as a result of the 21 day incubation time of the virus is, frankly, more dangerous than the disease itself.  

Health care workers can isolate, and treat the Ebola patient, and clean the transport and treatment equipment. 

What we can't do is predict who might be carrying the virus and where they might be located.  Therefore, the health care community isn't prepared to respond to an Ebola outbreak of more than a few people, unless a great deal of money is made available to pay for the training for a response to the disease. 

As with all infectious diseases, the most important response is prevention.  

Hand washing is the first line of defense for all infectious  diseases and more important than ever to help prevent Ebola.

America's health care providers are experts at handling infectious diseases and practicing infection control procedures. Nevertheless, the care givers and first responders are not systems analysts. 

In my opinion, our our US health care and emergency responder "systems" are not prepared to respond to an infectious Ebola outbreak.

Ebola causing panic and under reporting cases appears dangerously preventing isolation and infection control

The World Health Organization (WHO) describes Ebola. It first appeared in 1976, in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Unfortunately, the only known way to prevent the rapid spread of the deadly Ebola virus is to identify those who have the infection and to isolate them while they are treated with fluids.  

Instead, what's happening in African nations where Ebola is spreading is that governments are in panic mode, while access to infection control and isolation treatments are hard to identify. 

In the absence of preventive interactions, like universal precautions and isolation, the disease will continue to spread and kill people who have no access to curative treatment. In fact, there is no definitive curative treatment for Ebola; but at least fluid monitoring and isolation can prevent secondary infections and reduce the risk or the virus from infecting others.

Now, more health care workers are at risk for contracting Ebola because the universal precautions required to reduce their exposure are not available. There are reports of universal precautions, like rubber gloves and masks being unable to reach those who need them, probably the result of corrupt customs officials looking for bribes. For whatever reason, the supplies are not getting where they are desperately needed.

CNN reports: CNN) -- "It's even worse than I'd feared," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said Wednesday of the Ebola outbreak rampaging through West Africa. "Every day this outbreak goes on, it increases the risk for another export to another country.

"The sooner the world comes together to help Liberia and West Africans, the safer we will all be."

Frieden spoke to CNN's Nima Elbagir in Monrovia, Liberia, where fear and anger over the largest Ebola outbreak on record has grown as health officials put up quarantines around some of the capital city's poorest areas.

More than 2,600 people have been infected by Ebola in Liberia, Guinea, Sierra Leone and Nigeria since the outbreak began in December, according to the World Health Organization. Nearly 1,500 have died.

A CDC staff member was recently flown home to the United States on a private charter after spending time in close proximity with another health care worker who tested positive for Ebola in Sierra Leone.

The CDC worker is reportedly healthy and has shown no symptoms of the deadly virus. He or she is simply rotating back to the United States as previously scheduled, according to the CDC. It is CDC policy that people who have been exposed to Ebola and are traveling long distances do so on a private plane in the three weeks after exposure to lower the risk of spreading the infection.

"We think it's the right thing to do, to bring them home," CDC spokesman Tom Skinner said. "They want to come home. Their tour of duty was up, and we've made it crystal clear that if they go over there and have something like this happen and want to go home, we're going to bring them home."

The staff member will be monitored for 21 days -- the longest known incubation period -- for Ebola symptoms, but he or she currently "poses no Ebola-related risk to friends, family, co-workers, or the public," the CDC said in a statement.

Inside the Ebola outbreak with the CDC

The other health care worker, who tested positive for Ebola, has been flown to Germany to recover, Skinner said.

The World Health Organization said Monday that 120 health care workers have died in the Ebola outbreak, and twice that number have been infected.

Public health experts say several factors are to blame, including a shortage of protective gear and improper use of the gear they do have.

The fact that the disease has killed so many people working to care for infected patients is making it increasingly hard to combat the virus in West Africa, WHO said.

"It depletes one of the most vital assets during the control of any outbreak. WHO estimates that in the three hardest-hit countries, only one to two doctors are available to treat 100,000 people, and these doctors are heavily concentrated in urban areas."

Another outbreak

On Tuesday, the Ministry of Health for the Democratic Republic of Congo notified WHO of another possible Ebola outbreak.

Health officials say a woman in the Central African country became ill with symptoms of Ebola after butchering a bush animal that had been given to her by her husband. She died on August 11. Since then health care workers, relatives and other individuals who came in contact with her body have developed symptoms and died.

Between July 28 and August 18, a total of 24 suspected cases of an unidentified hemorrhagic fever, including 13 deaths, have been identified, WHO said.

Samples have been sent to laboratories to confirm that these illnesses are being caused by the Ebola virus and to identify the strain. As none of the people involved has been to the four countries affected by the other Ebola epidemic, health officials believe this to be a separate outbreak.

The Democratic Republic of Congo has seen six smaller Ebola outbreaks since the 1970s, according to the CDC.

Unfortunately, the African governments are incapable of coordinating a response to this deadly Ebola. It's impossible to say if the virus is infecting people outside of the identified cases in Western Africa, because of reports that people are actually hiding the victims.

Consequently, while universal precautions are not finding their way to those in desperate need, and governments are incapable of coordinating a response, while under reporting includes hidden victims....the outcome of this deadly trivecta are clear. Ebola will eventually spread to become a pandemic, maybe it has already reached this threshold, fueled by panic and governments unable to coordinate a pandemic response.  Ebola infections are growing while the world response is one of recoil from effective prevention.

In a world already totally consumed with war in the Middle East and millions of refugees, the Ebola virus has not received much attention.....but it's going to keep killing people until something is done to stop the spread.