Ebola virus (shown spewing from an infected cell) does not recognize ethnic or political borders.
October 11, 2014
All Poro ethnic groups in Liberia, Sierra Leone, and Guinea have now had cases of Ebola.
• In Liberia, the rural district of Gbarpolu, has reported its first two confirmed cases. This is home to some Gola, Kpelle, Belle, Gbandi and Mende people (Map 3).
• As of 7 October, all ethnic groups in Liberia have become involved, although SE Grand Bassa County (Bassa) and Maryland County (Grebo) have not had any active cases reported in the 3 weeks prior (according to WHO). The case in Grand Gedeh (Kran) that was reported on 19 September was not included on the map below.
• NE Sierra Leone and much of northern Guinea have also not reported any new cases during the 3-week incubation period prior to 19 September.
• There is still no significant headway being made in the fight against Ebola. A total of 8399 confirmed, probable, and suspected cases of Ebola virus disease have been reported in seven affected countries (Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the United States of America) up to the end of 8 October. There have been 4033 deaths (WHO UPDATE).
• Medical infrastructure strain and social unrest continues, particularly in Liberia and Sierra Leone. These factors inhibit containment efforts.
• When American healthcare workers (HCW) Dr. Kent Brantley and Nancy Writebol became ill, there were difficulties in securing medivac from Liberia. This highlighted the dual problems of inadequate training of HCW and inadequate infrastructure to support aid workers. These problems continue, and have many negative side-effects on recruitment capacity, medical infrastructure resilience, and translocation risk. Local containment efforts will continue to be inhibited until these problems are addressed.
• For some unknown reason, Côte d”Ivoire has yet to report a case. Many people wonder if this is not due to a failure to report. Although there have been no new cases of Ebola reported in Grand Gedeh County (Kran territory) since an infected man from Ganta (Mano land) became ill in Zwedru, active and new cases have occurred along the Ivorian border with N’Zerekoré, Guinea, and Nimba, River Gee and Grand Kru Counties, Liberia.The risk of movement of infected individuals to Cote d’Ivoire is increasing.
• These problems contribute to the growing global scale of the problem. It is almost certain that there will be new global infections involving HCW treating aid workers (such as those reported in Spain) and in the United States, for as long as foreign HCW working in West Africa are unable to obtain local treatment, and West African borders remain porous (which they will).
• The potential remains for re-emergence in countries making progress towards containment. This ‘twin peaks’ nature of distribution has historically been observed around Ebola outbreaks, and has already occurred in Guinea and as we’ve noted in Foya, Liberia.
• There seems to be a general mistrust of the data, and there remains concerns about information suppression and incomplete public health data.
Figure 1 shows the location of cases throughout the countries with widespread and intense transmission. In Liberia, the rural district of Gbarpolu, has reported its first two confirmed cases (WHO).
Although we’ve briefly discussed the issue of decontamination of objects and the wisdom of avoiding possible exposure to newly arrived travelers from West Africa, the following advice meant for physicians is useful:
• When asking a travel history, TRUST BUT VERIFY and err on the side of caution.
• Significant lack of data and active information suppression in West Africa is inhibiting accurate assessments. This is a poor indicator. Epidemic curves now falsely show a “peaking out” of cases. This is not the reality. Things remain very much completely out of control.
• Several African nations have resumed flights to Liberia. This is an exceedingly poor decision according to infectious disease experts.
• As noted above, there are new cases popping up along the NW border of Côte d’Ivoire. We are waiting for a declaration of Ebola involvement in this country, coming by water from across the Cavally River or from newly re-established flight connections.
• There are reports of West Africans who have successfully fled by airplane to Colombia, and reported intercepts at the southern border of the US. Some of this information requires verification, but if true, it is obviously a point of concern for the involved states, and this is no longer just an East Coast problem.