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Offline Riney

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Ebola crisis - the Guardian briefing
« on: October 02, 2014, 18:26:43 PM »
Ebola Crisis- The current Ebola outbreak has killed at least 3,000 people in west Africa and has for the first time been diagnosed outside the region, with a man admitted to hospital in Dallas, Texas. We examine the background to the disease, its spread and its impact.

The Guardian
World News
October 1st 2014

What’s the story?

West Africa is experiencing the biggest outbreak of Ebola virus disease ever known, causing thousands of deaths, devastating fragile healthcare systems and damaging the economies of states, some of which are still recovering from civil war. Infections are now doubling every few weeks. The WHO predicts 20,000 cases by early November, while the US Centres for Disease Control (CDC) says that if nothing changes there could be 1.4 million cases by late January. For the first time in this outbreak Ebola has also been diagnosed outside of Africa, with a man who flew from Liberia to the US five days before exhibiting symptoms now hospitalized in Dallas, Texas.

How this happened

Since its beginnings in southern Guinea in December 2013, Ebola has spread with lethal effect across Guinea, Liberia and Sierra Leone. There have also been cases in Nigeria and Senegal. As of 26 September, the World Health Organisation (WHO) put the number of cases as 6,574 and deaths at 3,091 but the fatality rate is probably more like 70% because deaths outside hospitals are not recorded.

Ebola outbreaks in the past have generally been in remote rural areas with swift action to isolate the victims able to contain them. The WHO has been criticised for not reacting fast enough to the current outbreak: it took three months to diagnose the first cases, and five months more before a public health emergency was declared.

An editorial for the New England Journal of Medicine by Jeremy Farrar, the director of the Wellcome Trust, and Peter Piot, the head of the London School of Hygiene and Tropical Medicine, said the exceptional spread of the disease in the current outbreak was probably down to a number of factors including dysfunctional health systems, high population mobility across state borders, densely populated capitalsand a lack of trust in authorities after years of armed conflict so health advice is not heeded. Fear is also a factor. People are afraid to go to hospital because they think it may be the source of infection.

How the disease spreads

Ebola is not an air-borne disease and can only be spread from human to human through close contact with the bodily fluids of someone who has the disease – in blood, vomit, semen, urine, tears or saliva. The incubation period - the gap between an individual being infected and showing symptoms - is up to 21 days, meaning it is possible for an infected person to travel widely before they know they have the disease. Humans are not infectious until they develop symptoms, which at first are fever, muscle pain, headache and sore throat. These are followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function and in some cases internal and external bleeding.

Death of health workers

The spread of Ebola through bodily fluids puts health workers dealing with such symptoms as vomiting, diarrhoea and bleeding at a high risk. By 26 September, 375 health workers had developed the disease across Guinea, Liberia, Sierra Leone and Nigeria with 211 dead. One in 10 is becoming infected and while pictures of doctors in full body suits and visors treating Ebola patients have been published all over the world, there is in reality not enough protective clothing. The suits are also very uncomfortable to wear in hot climates and risk of contamination when they are taken off. Most health workers are infected in clinics treating patients they do not know or suspect have Ebola. The first symptoms can resemble malaria, which is common. Some healthcare workers have been staying away from work for fear of the disease, and in Liberia there have been strikes over pay and conditions.

No drugs or vaccine

Until now, pharmaceutical firms have given Ebola very low priority. The few potential drugs and vaccines under development are now being sped into trials. Healthy volunteers in the UK and US have been injected with a candidate vaccine to test safety. Drug trials will soon be set up in west Africa, but they are several months away and there is no certainty that they will work. Stocks of ZMapp, the experimental drug used to treat several international aid workers and medical staff, have now run out.

Healthcare system collapse

Healthcare in the region was fragile at best before Ebola. Now there is disintegration as staff become ill or stay away for fear of the disease. Infection control and hygiene are major issues. Soap and water are unavailable in some areas. Alcohol hand rubs are needed on a large scale. Isolation facilities are vital to contain Ebola, as are labs for testing because rapid diagnosis is very important. 

Both are in very short supply. In some places, isolation is nothing more than an area behind a curtain. People with other diseases and women in childbirth are now at risk because hospitals are no longer functioning properly.

Cultural issues
The virus can still be present after death and health officials are concerned the disease can spread during traditional funeral practices that involve close contact with the dead person. The WHO advises that people who have died of Ebola must be handled using strong protective clothing and buried immediately. Traditional healing practices also involve touching and families normally nurse their sick at home.
Furthermore, there is little respect for government authority in a region still emerging from civil war and where corruption is rife. Advice that runs counter to cultural practices is resented and in the absence of authority, myth and superstition take over.

How can I find out more?

The New England Journal of Medicine has published a detailed report written by the WHO’s Ebola team to mark nine months since the start of the outbreak. TheWHO itself also produced a compilation of articles in August to mark six months since the first case was formally identified. They examine Ebola’s impact on west Africa and warn that without measures to control it, the number of cases will rise fast. Médecins sans Frontières provides information on its treatment centres and regular reports from the frontline. The US Centres for Disease Control hasinformation on diagnosis and treatment, and the World Bank has put together a report on Ebola’s potential economic impact.
« Last Edit: October 02, 2014, 18:34:57 PM by Riney »
"Life shrinks or expands in proportion to one's courage" Anais Nin .. and yet we must arm ourselves with fear

Offline Riney

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Re: Ebola crisis - the Guardian briefing
« Reply #1 on: October 02, 2014, 18:38:37 PM »
This outbreak will get worse. It has been estimated that each exposure will double enough that by the end of the year the amount of people with it could almost reach half a million. We will hear more about this in the coming months. It will spread to places all over the world. I will keep this thread updated as best I can.
"Life shrinks or expands in proportion to one's courage" Anais Nin .. and yet we must arm ourselves with fear

Offline Riney

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Re: Ebola crisis - the Guardian briefing
« Reply #2 on: October 03, 2014, 18:12:35 PM »
Understanding the Risks of Ebola, and What ‘Direct Contact’ Means

Denise Grady
Oct 2 2014
New York Times

A Liberian street artist worked on a mural in Monrovia to inform people about the symptoms of Ebola.CreditDominique Faget/Agence France-Presse — Getty Images

Can you catch Ebola on a crowded bus or train if you are standing next to someone who is infected? What if that person sneezes or coughs on you? If the person has symptoms, the answer could be yes.
Questions that may have seemed theoretical a few days ago have taken on a troubling reality since a traveler from Liberia, Thomas E. Duncan, carried the virus to Texas and potentially exposed dozens of people before he was placed in isolation. And the hospital where he first sought help failed to make the diagnosis, leaving him in the community for several days when he was becoming more and more contagious.

It could happen again, said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, in a telephone news briefing on Thursday. He said there was no way to detect the disease during the incubation period — the interval before symptoms set in — so other infected people could pass fever checks at airports in West Africa, just as Mr. Duncan did, and board planes to the United States.

 But Dr. Frieden emphasized that the odds of contracting Ebola in the United States
 were still extremely low. The disease is not contagious during the incubation period,
 and patients do not transmit it until they develop symptoms, he said. And those with
 symptoms will probably feel sick enough to stay home. People are highly unlikely to
 catch the disease on the bus or subway, Dr. Frieden said.

The incubation period can run from two to 21 days, but is usually eight to 10. The first symptoms are typically fever, aches and pains, nausea, vomiting and diarrhea. Even after they set in, it takes direct contact with bodily fluids to transmit Ebola. Blood, vomit, urine and diarrhea from very sick patients are highly infectious, but other body fluids like sweat, saliva, tears, semen and breast milk are also risky.
Direct contact means that the fluids splash or spray into someone else’s mouth, eyes or nose, or enter the bloodstream through cuts or breaks in the skin.
ontinue reading the main storyPeople can also contract the disease by touching infected fluids and then touching their eyes or mouth. The virus does not spread through the air, unlike
People can also contract the disease by touching infected fluids and then touching their eyes or mouth. The virus does not spread through the air, unlike measles orchickenpox. And Ebola does not invade healthy skin, so merely touching secretions does not mean an infection will follow. But washing hands or using an alcohol-based hand sanitizer is essential after any potential contact, to avoid spreading the virus to other people or to one’s own eyes or mouth.

Ebola does not cause respiratory problems, but a cough from a sick patient could infect someone close enough to be sprayed with droplets of mucus or saliva. Droplets can generally fly about three feet, so people dealing with anyone who may be ill are told to stand at least three feet away, preferably six. Being within three feet of a patient for a prolonged time, without wearing protective gear, is considered direct contact, Dr. Frieden said.
According to the C.D.C., the virus can survive for a few hours on dry surfaces like doorknobs and countertops. But it can survive for several days in puddles or other collections of body fluid at room temperature. It is not clear how long it may survive in soiled linens and clothing. Bleach solutions can kill it.
« Last Edit: October 03, 2014, 18:15:50 PM by Riney »
"Life shrinks or expands in proportion to one's courage" Anais Nin .. and yet we must arm ourselves with fear