Ebola cases 'down significantly' in Liberia
Dr. Siegel reports on progress made by coordinated global response effort
By late December, Dr. Kombu Songu-M’briwa had recovered enough from his personal battle with Ebola to participate in a transatlantic radio interview with me, though I could barely hear him because of the profound fatigue reflected in his voice.
M’briwa, one of just three doctors working at the 120-bed Hastings Ebola treatment center in Freetown, Sierra Leone, told me that early identification of his infection in late November, replacing fluids and treating accompanying infections with antibiotics had been the key to his recovery. This is in keeping with the latest statistics from the region, where survival rates have now reached 70 percent.
Shielded by his new immunity and returning courage, M’briwa says he will go back into the community to help educate the people there, as well as to identify and isolate new cases. He is one of the great heroes in the fight against Ebola.
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The population’s response in Sierra Leone is not yet at the level of Liberia, where infection rates have dropped by 80 percent.
“Community mobilization occurred in Liberia due to local volunteers, women's groups, youth groups and the participation of faith communities, [and] has been highly effective,” explained Dr. Timothy Flanigan, professor of infectious diseases at the Warren Alpert Medical School of Brown University as well as a permanent deacon and volunteer with the Catholic Church’s Ebola Response Team.
Flanigan provided guidance and safety at Liberian health facilities. “Ebola causes such intense fear because it is such a dreadful virus,” he said. “I developed great admiration for the nurses and staff in the clinics that stayed open despite the fear.”
The chain of transmission was broken in Liberia by basic public health measures: isolating the sick, burying the dead safely and quarantining those who were exposed. The presence of the U.S. military brought needed resources: more treatment centers and helicopters to transport patients and supplies.
Ebola has had a major impact on the health care infrastructure in the affected countries of West Africa. Dr. Estrella Lasry, who has been in the field for months as the tropical medicine adviser for Doctors Without Borders, told me she is concerned about the disease’s burgeoning impact on malaria and other tropical illnesses. At the same time, care for non-communicable diseases like heart disease and cancer have been drastically diminished, and essentials such as prenatal care and childhood vaccinations are difficult to come by.
By some estimates, over 10,000 children have been orphaned by Ebola. At the same time, care for children with Ebola is especially difficult.
“You see kids suffering Ebola, they just don’t feel well, they want to be touched, they want to be hugged,” said Marina Novack, a nurse with Doctors Without Borders who recently returned from Sierra Leone.
“When you’re wearing a PPE (Personal Protective Equipment), you are scary-looking to them, they still want you to hold them and they reach for you. But because there is the risk that one of them may knock off your goggles or rip your gloves, you’re unable to carry them.”
Since the outbreak began in March, Doctors Without Borders has played a prominent role, admitting more than 7,000 patients to its facilities, with more than 4,000 confirmed as having Ebola. More than 1,300 tons of supplies have been shipped to the affected countries, but Director Sophie Delaunay told me the needs are constantly changing, because Ebola is a moving target.
Unfortunately, there are still too many instances of helicopters dedicated to transporting single vials of blood or ferrying specimensinstead of infected patients.
Delaunay echoed Flanigan’s sentiment that coordination of services remains crucial to controlling the outbreak. Furthermore, she said, “It’s essential, in addition to the isolation units, to be able to provide the full package of education, awareness raising, safe burial, contact training and surveillance” — actions that allowed relative success to be achieved in Liberia.
Virus hunter Joseph Fair, special adviser to Sierra Leone’s health ministry, has been on the front lines for months, and he predicts many more months will pass before they can turn the corner on the epidemic.
But at the same time, he says, there have been significant improvements in awareness in Sierra Leone. “We went from half the population believing that this wasn’t a real disease and was a possible hoax to everyone more or less believing that this is a real disease and learning how it is transmitted,” he told me. “It’s really helping stabilize the spread, along with open beds.”
Fair added that the unprecedented number of cases has allowed for a more detailed study of the disease and treatments. It no more transmissible than originally thought but is more of a gastrointestinal virus, he said.
Here in the U.S., where hysteria has been the operative term and only four cases have been diagnosed and 10 cases treated, Dr. Michael Phillips, infectious disease specialist and director of the infection prevention and control unit at NYU Langone Medical Center, told me that the keys to restoring public confidence are protocol and preparation.
This was evidenced in October by his expert management of the treatment given Dr. Craig Spencer at Bellevue Hospital Center, where a highly coordinated team approach led to a positive outcome without spread. The Spencer case ultimately helped to calm public fears, though the recent CDC bungling of an Ebola specimen, putting a lab worker at risk, again threatens to weaken public confidence.
Phillips believes it is “normal for emerging diseases to scare us because they are unknown,” but at the same time we have to learn to overcome these fears and focus our attention on the real problem in West Africa.
With this in mind, Ebola fighters have been designated Time Magazine’s Person of the Year for 2014, an honor they richly deserve.
Dr. M’Briwa is simultaneously one of the fighters and one of the victims. And now, as fighter once again, he continues to push forward to bring an end to this crisis in his native Sierra Leone.
May his courage serve as an inspiration to us all.
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