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Ebola Spreading in a “Perfect Storm”

NEW YORK – The current outbreak of Ebola in West Africa is a “perfect storm” that requires a massive and immediate international response to prevent it from developing into a global pandemic, warns Dr. Peter Piot, the co-discoverer of the Ebola virus.

“There are now five affected West African countries: Guinea, Liberia, Nigeria, Sierra Leone, and most recently, Senegal,” Piot warns in an editorial published in Science magazine.

Piot is director and professor of Global Health at the London School of Hygiene and Tropical Medicine.

He argues the outbreak is the result of dysfunctional health services hampered by decades of war, low public trust in government and Western medicine, traditional beliefs, denials of the existence of the virus and burial practices that include contact with Ebola-infected corpses.

He expresses alarm at the rapid rate at which the Ebola virus is advancing within the affected West African countries, with the threat the virus could expand globally.

“Ebola has killed around 2,000 and infected more than 3,500 with over 40 percent of cases occurring within the past few weeks. The World Health Organization predicts that 20,000 may become infected. This fast pace of Ebola’s spread is a grim reminder that epidemics are on a global level and the only way to get this virus under control is through a rapid response at a massive global scale – much stronger than current efforts.”

Piot is critical of the current international response, and he charges that West African governments and the international community “have been slow to act in a way commensurate to a major threat to health, economies, and societal stability.”

He points out it took nearly four months after the first patient died in December 2013 before the outbreak was confirmed as being caused by the Ebola virus. WHO and concerned governments waited until August before declaring the epidemic a public health emergency, despite multiple calls by Médecins Sans Frontières, or Doctors Without Borders.

“Finally, national organizations, including WHO, the United Nations, the U.S. Centers for Disease Control and Prevention, and MSF are intensifying their efforts, hopefully in a coordinated manner, with WHO releasing a roadmap to contain Ebola within 9 months,” he writes.

The immediate needs are enormous, Piot stresses.

“International assistance to the growing local efforts must include support for disease-control activities such as the provision of protective equipment, patient care, and addressing the health nutritional, and other needs of populations in quarantine,” he says.

“This must be done while dealing with other epidemic health challenges: Uninfected people are dying from treatable diseases because of closed or abandoned health facilities, the cancellation of international flights to the infected countries is creating an obstacle to international support, and there are growing concerns about sending medical help without a plan of treatment for these workers (around 150 doctors and nurses have died of Ebola, and 240 medical staff are infected).”

Piot pleads that the time remains opportune to accelerate clinical evaluation of experimental therapies, vaccines and diagnostics. He urges using all available means, even those not fully proven by clinically controlled human trials, to combat a disease that is about to grow out of control.

“An exceptional crisis requires an exceptional response,” he writes. “One of the lessons from the AIDS response is that prevention has little credibility if treatment for those infected is not available.”

He expresses hope that one or more of the experimental therapies, vaccines and diagnostics the WHO has now authorized for use combating the Ebola virus will be effective.

“Let us hope this is the last Ebola outbreak where all we have to offer is isolation and quarantine, instead of a vaccine and treatment.”

He warns the impact of the epidemic will last long after the West African outbreak ends.

“Health systems will need to be rebuilt, disease surveillance systems established, trust in health services and authorities rebuilt, orphans educated and protected, and economic losses restored,” he writes.

After all, he notes, there will be more obstacles.

“More Ebola outbreaks will follow, because the populations at risk in Africa are growing, as is their mobility. There is an urgent need to clarify the ecology and reservoir of the Ebola virus, as well as the human behaviors that trigger epidemics,” he says.

“The tragedy in West Africa demonstrates that where there is a fertile ground of poverty, dysfunctional health systems, and slow response, local outbreaks can turn into major epidemics with major casualties.”

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Ebola Spreading in a “Perfect Storm”

 

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