West Africa Ebola Outbreak Is Unprecedented, U.S. CDC Says

Aug 07, 2014 5:13 pm ET

(Updates with CDC chief’s comments in second paragraph.)

Aug. 7 (Bloomberg) -- Western Africa’s raging Ebola outbreak may produce more victims than the combined tally of all previous epidemics of the deadly virus, the head of the U.S.’s disease tracking agency said.

Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, called the outbreak a crisis, though one that can be stopped by “core public health interventions” -- quickly diagnosing patients and isolating them before they can infect others.

“If you leave behind even a single burning ember, like a forest fire, it flares back up,” Frieden told Congress at a hearing today in Washington. “The challenge really isn’t the strategy. The challenge is the implementation.”

A top official at a nonprofit treating patients in Liberia later said the U.S. and Europe essentially ignored the outbreak until two Americans became infected in July.

The officials spoke today at a Foreign Affairs subcommittee hearing on Ebola, which has killed at least 932 people in Sierra Leone, Guinea, Liberia and Nigeria since it was first reported in March, according to the World Health Organization. Local customs, fear and ignorance about the disease have hampered efforts to control the virus, and developed nations were late to help, aid workers told Congress.

Overwhelmed Agencies

“That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries testifies to the lack of serious attention the epidemic was given,” Ken Isaacs, vice president of international programs and government relations for Samaritan’s Purse, said in written testimony to a House subcommittee. His organization helps run a hospital in Liberia.

The U.S. should increase its budget to prepare for disease threats such as Ebola, said Representative Chris Smith, a New Jersey Republican who chairs the subcommittee on Africa, Global Health, Global Human Rights and International Organizations.

“We mustn’t short-change vital efforts to save lives in these developing countries,” he said.

Not until two Americans working in Liberia, Kent Brantly and Nancy Writebol, were revealed to be infected with the virus on July 26 did developed nations begin to pay attention, Isaacs said. Until then, Samaritan’s Purse and Medecins Sans Frontieres, or Doctors Without Borders, were left to combat the epidemic alone, he said.

Liberian Diaster

The American ambassador to Liberia declared a disaster in that country on Aug. 4, and since March the U.S. Agency for International Development has dedicated $14.6 million to try to help control the virus, Ariel Pablos-Mendez, the assistant administrator for global health at the agency, said in testimony prepared for the hearing.

Witnesses from Samaritan’s Purse and SIM USA, another charity in the region, described a hell-scape in Liberia, where doctors and nurses have fled the country or refuse to work, hospitals aren’t functioning and bodies of Ebola victims lie in the streets of the capital, Monrovia, or in shallow, unsanitary mass graves.

The only place in Liberia to receive care is the Monrovia hospital operated by SIM and Samaritan’s Purse, said Frank Eugene Glover, a doctor representing SIM who testified at the hearing. The hospital has five doctors, 77 nurses and aides and space for 25 patients, he said.

Deadly Funerals

“Attempts to expand the capacity to treat Ebola patients were resisted by the local community,” he said. “Protests began and health workers were assaulted.”

Local customs conflict with the effort to control the infection, Isaacs said, especially the funeral process for dead family members, which includes washing and kissing the bodies.

“The corpse of an Ebola victim is at its maximum point of contamination in the hours immediately following death,” he said. “Every contact with it will result in another infection.”

Augustine Ngafuan, Liberia’s foreign minister, said the aid workers’ description captures the dire situation.

“We are losing our best,” he said in an interview after the hearing. “We need protective equipment as early as possible so those in the front line can be protected.”

Local doctors have sometimes hampered the effort, he said. Many local health professionals aren’t familiar with Ebola and even deny that it’s real, he said. Two prominent doctors in Liberia, including a Liberian-American, examined Ebola patients at the isolation ward at a Monrovia hospital without using protective equipment, Isaacs said.

Doctors at Risk

“These men were highly educated, credentialed and respected professionals, yet they did not believe in the existence or seriousness of the disease,” Isaacs said.

He didn’t name the Liberian-American doctor, who he said traveled to Lagos, Nigeria, before falling ill and dying. A Liberian-American doctor named Patrick Sawyer died in Lagos on July 25 after traveling from Liberia; a nurse who treated him has also died, and there have been five other cases in Lagos, a city of 20 million people, the Nigerian Health Minister, Onyebuchi Chukwu, said yesterday.

Pablos-Mendez said in his testimony that his agency is “currently assessing what additional assistance may be needed” in West Africa. USAID announced this week it would provide another $12.5 million to support work by government agencies and groups like Samaritan’s Purse.

Work to develop treatments for the disease should be accelerated, Isaacs said, and a regional group should be created to coordinate efforts by local health ministries in Africa to combat the virus.

Health Systems

U.S. President Barack Obama, in remarks yesterday, said the focus in Western Africa should be on shoring up the public health infrastructure there and containing the outbreak. “We’re focusing on the public health approach right now because we know how to do that,” Obama said.

The two Americans who worked with Samaritan’s Purse were evacuated to Emory University Hospital in Atlanta. Both are in stable condition, after receiving doses of an experimental drug by Mapp Biopharmaceutical Inc.

Frieden said at the hearing that he believes the number of doses of the Mapp drug available are “fewer than the fingers on one hand,” and that it would take months or years to produce significant quantities of any treatment or vaccine. Scientists won’t be able to tell whether the drug is effective from Brantly and Writebol’s experience, he said.

Rigorous Study

“We won’t know until it’s rigorously studied scientifically,” he said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that the Department of Health and Human Services is developing policy on how experimental medicines such as Mapp’s drug should be distributed in future outbreaks.

“The critical question is: when companies do start to scale up production and a reasonable amount of doses become available to distribute, how should the decisions be made to address the requests that will inevitably be more than the available supply?” he said in an e-mail. “These decisions must be weighed in light of sound ethical principles.”

The Ebola virus is spread through direct contact with an infected person’s bodily fluids. There is no approved cure, and about 55 percent of those infected in the current outbreak have died, Pablos-Mendez said.

The disease causes fever, followed by vomiting, diarrhea and hemorrhaging. Standard treatment is to keep patients hydrated, replace lost blood and use antibiotics to fight off opportunistic infections.