Since our last update on The PediaBlog, one Spanish health care worker and two American health workers have been diagnosed with and are now recovering from Ebola. Both Americans were nurses who took care of a man who contracted Ebola in Liberia, became sick (and contagious) once he was here in the U.S., and subsequently died in a Texas hospital. Due to well-established epidemiological protocols and procedures recommended and supervised by the Centers for Disease Control (CDC), there have been no other cases of Ebola diagnosed in the United States. With the 21-day incubation period from the last time the Liberian man could have transmitted the infection having expired, it’s improbable that there will be any more cases of Ebola from this index case.
Clearly, there is no Ebola “outbreak” in the United States. The problem is almost wholly in West Africa. According to WHO, on October 14 there were 9,216 cases of Ebola (4,218 laboratory-confirmed) and 4,555 deaths. The WHO warns that these numbers underestimate the magnitude of the epidemic.
But not all the news from West Africa is bad:
The lines on the tabular situation reports, sent to WHO each day by its country office in Nigeria, have now been full of zeros for 42 days.
WHO officially declares that Nigeria is now free of Ebola virus transmission.
Still, the bulk of the epidemic is in three other West African nations: Guinea, Liberia, and Sierra Leone. Controlling Ebola there is more difficult due to, among other things, cultural obstacles. Joe DeCapua was briefed by WHO’s Dr. Bruce Aylward:
“Any sense that the great effort that’s been kicked off over the last couple of months is already starting to see an impact – that would be really, really premature.”
Aylward said every district in the three worst affected countries must have full control over burials, casement management and behavior change. That’s not the case yet. He also said there is still a lack – of what he calls – real crisis management.
Maggie Fox tells about the toll Ebola is taking on everyone in Sierra Leone:
Almost as soon as they got to Sierra Leone, epidemiologists Michelle Dynes and Anne Purfield saw Ebola do its worst: killing 20 nurses and a beloved doctor, wiping out entire families and making one orphan after another.
They struggled to hold themselves back from hugging people who’d lost as many as 10 family members, and cried for the five children buried in unmarked graves because they died before anyone could find out their names.
But the worst part was seeing how mercilessly Ebola punished anyone who cared. It’s turned Sierra Leone, Liberia and Guinea into countries where the enemy is the person next to you, where hospitals are feared as the most dangerous places you could go.
Fox describes how an act of love was actually a breech in protocol which turned tragic:
“There was a woman who had come into the treatment center with her infant,” said Dynes, who with Purfield first told the story on NPR’s Story Corps. The young mother died, but her baby, still young enough to be breast-feeding, tested negative for the virus.
“But we know that baby’s risk of becoming Ebola positive was very high, from contact with the mother and breast-feeding. The nurses decided they would keep the baby in the nurses’ area so they could watch over the baby instead of putting the baby in the Ebola ward.”
Dynes, who has three children of her own, understands the impulse.
“It’s this tough choice between picking up the baby and caring for the baby and putting yourself at risk in contrast to just letting that baby sit in a box,” she said. “This speaks to the mother in all of us. How can anyone see the baby in a box and not love and comfort her?”
But the baby did develop Ebola infection, and so did all but one of the dozen or so nurses. The baby and most of the nurses all died.
Tomorrow, our Travel-Ready M.D. Sarah Kohl will have an Ebola advisory for those who are traveling abroad.