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April 23, 2015

Ebola dies down, total eradication still far

by Brian Le, Online News Editor
The unprecedented outbreak of the Ebola virus disease that began in late 2013 has been limited to only a few cases in Sierra Leone and Liberia, but has seen a recent spike in Guinea. The three West African countries were the most affected by the outbreak and are working to eliminate the last Ebola cases.

The index case, or the first patient affected, was one-year-old Emile Ouamouno of Meliandou, Guinea, who later died of the disease in December of 2013. Since then, the virus has proliferated rapidly throughout West Africa and spread to Western Europe and the United States, although cases there have been limited with no further cases expected. "The risk for Americans is essentially zero," Dr. William Shaffner of Vanderbilt University School of Medicine said.

Specifically, the disease has affected Liberia, Sierra Leone, Guinea, Nigeria, Mali, the United States, the United Kingdom, Senegal and Spain. Currently, it is only active in Liberia, Sierra Leone and Guinea.

As of April 8, there have been at least 25,556 cases of Ebola and at least 10,602 people have died from the disease, although these numbers are most likely underestimated because not all cases, especially in remote villages, are reported. The World Health Organization (WHO)'s Ebola Response Team has estimated that 70 percent of people who contracted Ebola have died, but the mortality rate for only hospitalized patients is slightly lower, between 57 and 59 percent.

Both the virus and fear of the virus spread rapidly, and in the latter half of 2014, it became the center of the media's attention for months. When Thomas Eric Duncan became the first person to be diagnosed with Ebola in America during September of 2014, a global epidemic seemed plausible. On September 26, 2014, the Center for Disease Control (CDC) released a worst case scenario prediction that up to 1.4 million people in Sierra Leone and Liberia alone would be infected by January 20, 2015.

With the potential disastrous outcomes of the outbreak, many criticized global leaders for not taking enough precautionary measures. "Leaders are failing to come to grips with this transnational threat," Doctors Without Borders president Dr. Joanne Liu said in a September briefing on Ebola.

Media attention towards the disease died down at the end of 2014, but Ebola was still spreading in West Africa. In April of 2015, the disease was contained to the three African countries that were most hard hit, but complete eradication of the Ebola virus has been a difficult process.

West Africa
In Senegal and Nigeria, the outbreak was deemed over in October of 2014, while in Mali, the outbreak was considered to be over in January of 2015. In those countries, there were a total of 29 reported cases of Ebola and fourteen deaths.

Liberia
Liberia has suffered at least 4408 deaths from the Ebola virus as of April 8, 2015.

Prior to the outbreak, the country only had 50 doctors and 1000 nurses, and there was a severe shortage of personnel. "The three things we need the most are people, supplies and money. The most critical right now are people, health workers in particular, trained health care workers," said Anthony Banbury, the head of the United Nations (UN) Mission for Ebola Emergency Response, during the initial months of the outbreak in Liberia.

As the disease spread across the country, Liberia closed all of its schools and denied all border crossings. Quarantines were set in place, most notably in the West Point slum of Monrovia for nearly two weeks in August. Clinics were subject to mob violence as many believed that Ebola was a hoax, according to the Liberian government.

Advancement of the disease began declining in Liberia in December, and schools were reopened in February of 2015. In early March, the Liberian government declared that the last patient was released. "This is the last reported Ebola case throughout the country," deputy health minister Tolbert Nyenswah said.

On March 20, however, Liberia reported its first case of Ebola since March 5, ending hopes that the virus had been eradicated in the country. The patient, Ruth Tugbah, died on March 27. There have been no reported cases since.

Because Tugbah had no risk factors for Ebola other than having a boyfriend who survived the disease, the Liberian government recommended that Ebola survivors practice safe sex until there is more information about the length of time the virus can survive in bodily fluids.

Sierra Leone
The Ebola virus continues in parts of Sierra Leone. As of April 8, 2015, there have been 3842 reported deaths.

The disease began in May of 2014, and, like in Liberia, spread rapidly as citizens knew little about the virus. The government responded fast, quarantining "hot spots," or villages hard-hit with Ebola. The government also called for regional lockdowns, closed down schools and imposed punishments on those who were hiding people with Ebola. Still, Ebola patients quickly exceeded the number of beds by September of 2014.

By October of 2014, it was estimated that five people were infected every hour with Ebola.

In January, the government of Sierra Leone reported that the disease was slowing down after banning all Christmas and New Year's celebrations. By March 18, 2015, there were 30 reported cases of Ebola across the country.

Eliminating Ebola completely is an extremely difficult process and the government imposed another nationwide lockdown from March 27 to March 29. "The lockdown…will be like the one conducted in September last year. The government and partners are hopeful that latent cases that are now not being reported or recorded will come out,” head of Sierra Leone's National Ebola Response Center Palo Conteh said.

Cases continued after the lockdown but became more sporadic, and the Sierra Leone government reopened schools on April 14. The WHO reported nine new cases the week of April 12.

Guinea
There have been 2337 reported deaths from Ebola in Guinea as of April 8, 2015.

After originating in the country in December of 2013, the virus reached the capital by May of 2014. Some villagers in Guinea evaded health care workers, contributing to the proliferation of the disease, and the government had little interaction with the people. According to the World Health Organization, "infrastructure, logistics, health information, surveillance, governance and drug supply systems were weak."

While cases in other countries waned, cases in Guinea saw an increase in March of 2015. An average of twenty-one people were infected with Ebola per day in Guinea the week of March 15, from the average of eight people per day in the weeks before.

Officials blamed the rise in cases on the lack of implementing safe procedures. "People are simply not practicing the safety rules that [the United Nations] has been talking about for a year," Fatoumata Lejeune-Kaba, the spokeswoman for the United Nations' Ebola emergency response mission, said.

New Ebola cases in Guinea continue, with 28 cases reported the week of April 12. The outbreak is concentrated in west Guinea and authorities there are implementing campaigns to improve community reporting of suspected Ebola cases.

Americas
After arriving at the Texas Health Presbyterian Hospital on Sept. 24, 2014 with symptoms of Ebola, 45-year-old Thomas Eric Duncan, who had traveled to Liberia, was diagnosed with the disease on September 30, 2014, becoming the first person to be diagnosed with Ebola in the United States. He later died on October 8.

Two nurses who had been infected with Ebola while taking care of Duncan, 26-year-old Nina Pham and 29-year-old Amber Vinson, were both treated and cured of the disease.

In late October, Doctors Without Borders physician Craig Spencer flew from Guinea to the United States and was diagnosed with Ebola in New York City's Bellevue Hospital Center after treating Ebola patients in Guinea. In November, he was cured of the disease.

Seven patients with Ebola have been medically evacuated to centers in Texas, Nebraska, and Maryland. So far only one of the seven patients, Sierra Leone doctor Martin Salia, died.

The most recent of the seven Ebola patients to be evacuated to the United States is an American health care worker who was working in Sierra Leone. After being diagnosed with Ebola on March 10, 2015, he was transported to the National Institutes of Health in Bethesda, Maryland, where he was downgraded to critical condition. He was declared Ebola-free and released on April 9.



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