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Published On: Thu, Sep 25th, 2014

Ebola: Worry, as U.S agency warns cases could hit 1.4m by January 2015

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nigeria minister of healthBy Ese Awhotu

Even with success recorded in Nigeria in the containment of the dreaded Ebola virus, researchers at the U.S. Centers for Disease Control and Prevention (CDC) have warned that Ebola cases could reach 550,000 to 1.4 mln by late January 2015.

“Between 550,000 and 1.4 million people in West Africa could be infected with the Ebola virus by January 20, 2015”, said a study published on Tuesday by the CDC.

The top range of the estimate, 1.4 million, assumes that the number of cases, 5,864 according to the count kept by the World Health Organization, is significantly underreported, and that it is likely that 2.5 times as many cases, or about 15,000, have in fact occurred.

CDC emphasized that the projections, based on an epidemiological model that takes into account how many people each Ebola patient eventually infects as well as other factors, are based on data from late August. They, therefore, do not account for the recently announced U.S. government Ebola relief effort, which includes sending 3,000 members of the armed forces to the stricken region and training 500 healthcare workers per week.

Reuters quoted a statement by CDC as saying that “Extensive, immediate actions – such as those already started – can bring the epidemic to a tipping point to start a rapid decline in cases,” CDC said in a statement.

“A surge now can break the back of the epidemic,” CDC director Dr. Thomas Frieden told reporters. “If you get enough people effectively isolated, the epidemic can be stopped,” he said, adding, “I am confident the most dire projections will not come to pass” now that the international community has begun to respond.

Also on Tuesday, experts from the World Health Organization projected that Ebola outbreak could infect 20,000 people as soon as early November unless rigorous infection control measures are implemented, and might become a constant, endemic disease in the region rather than being completely eradicated.

In contrast, the WHO in late August predicted that the virus could strike 20,000 people by the middle of 2015. The current death toll is at least 2,811 out of the reported 5,864 cases, the U.N. agency said.

According to the CDC analysis, published in the journal Morbidity and Mortality Weekly Report, reported cases in Liberia are doubling every 15 to 20 days, while those in Sierra Leone are doubling every 30 to 40 days

According to Reuters the essence of the CDC analysis is a mathematical model, called Ebola Response, that allows researchers to see how different actions affect the course of the epidemic.

For instance, it shows that if by late December 70 percent of Ebola patients have received treatment – or safe burial, if medical efforts fail – thereby slashing transmission rates, the epidemic begins to decrease and eventually end by late January 2015.

The model also projects that every 30-day delay in reaching that 70 percent tipping point would triple the number of daily cases at the peak of the epidemic.

In a separate development the World Health Organization (WHO) has warned that Ebola infections will treble to 20,000 by November if efforts to tackle the outbreak are not stepped up.

A new analysis suggests about 70% of those infected have died, higher than the 50% previously reported.

There have been 2,800 deaths so far and the disease remains “a public health emergency of international concern”, the UN agency said.

Trials of experimental drugs are being fast tracked in West Africa.

And more than 160 NHS staff have volunteered for UK efforts to help in the outbreak.

The risk of continued epidemic expansion and the prospect of endemic EVD in West Africa call for the most forceful implementation of present control measures and for the rapid development and deployment of new drugs and vaccines”

Dr Christopher Dye WHO UK staff will be based at a 62 bed treatment centre in Sierra Leone, said chief medical officer for England, Prof Dame Sally Davies.

And she confirmed at a meeting of UK experts in London that the British nurse who survived Ebola, William Pooley, has volunteered to give blood that could help treat patients.

Meanwhile, more information on the spread and likely scale of the epidemic has emerged.

Projections published in The New England Journal of Medcine suggest by early November there will have been nearly 20,000 cases.

A new analysis of confirmed cases suggests death rates are higher than previously reported at about 70% of all cases.

And WHO scientists said numbers were predicted to rise exponentially, raising the possibility that the disease could become endemic [regularly found] in West Africa.

Nearly all of the deaths in the world’s worst Ebola outbreak have been recorded in Guinea, Liberia and Sierra Leone.

Dr Christopher Dye, Director of Strategy for WHO, said projections suggest”unless control measures – including improvements in contract tracing, adequate case isolation, increased quality of care and capacity for clinical management, greater community engagement, and support from international partners – improve quickly, these three countries will soon be reporting thousands of cases and deaths each week”.

Dr. Dye, co-author of the study, called for “the most forceful implementation of present control measures and for the rapid development and deployment of new drugs and vaccines”.

It came as The Wellcome Trust charity announced that experimental drugs would be tested in West Africa for the first time.

Several drugs are under development, but they have not been fully tested and most are in very short supply.

They include the drug ZMapp, which has been given to a handful of infected health workers.

Ethical issues

BBC reported that Dr Peter Horby, of the Centre for Tropical Medicine and Global Health at the University of Oxford, said the first trials could begin in West Africa as early as November.

“We want to evaluate these carefully, properly, in affected countries in West Africa,” he told the BBC.

“For the next one or two weeks we’ll be doing site assessments and we’ll be working with the WHO on identifying which drugs to prioritise, and then there’ll be a number of steps in setting up the systems – getting ethical approval through the countries and getting community participation and agreement to run the trials.

“Currently our wish is that we would hope to be able to enrol some patients sometime in November – that would be extremely quick by most clinical trial standards.”

Dr Jeremy Farrar, director of the Wellcome Trust, said therapeutics alone were not an answer.

“The answer really is public health interventions,” he said. “But I do think vaccines and drugs are going to play a role.”

At the center of the Ebola scourge is West African countries, especially Liberia and Sierra Leone that have suffered severe wars. The worry is that these nation’s economies are fragile and the human and financial resources needed are not there.

However, the BBC’s Jonathan Paye-Layleh in the Liberian capital, Monrovia, says that while statistics are not available, suspicion exists that some of the deaths attributed to Ebola have been caused by cholera, malaria, typhoid and other illnesses, as people either did not go to hospitals or were turned away by medical workers who feared that they carried the deadly virus.

He says with the rainy season under way, the government has in recent weeks taken steps to prevent a cholera outbreak by chlorinating wells in Monrovia.

UNICEF estimates that 8.5 million children and young people under the age of 20 live in areas affected by Ebola in Sierra Leone, Liberia and Guinea. Of these, 2.5 million are under the age of five.


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