Ebola is not the only haemorrhagic fever that stalks West Africa. The Lassa season is about to begin. This year, like every year, around 20,000 people will succumb to the disease in the region.
The symptoms are identical to those of Ebola. Fever, vomiting and bleeding all occur. Lassa, unlike Ebola is spread by infected rats, but once it has infected people human to human transmission begins. Like Ebola patients, those suffering from Lassa need to be treated in strict isolation.
Lassa fever is spread by contact with bodily secretions of infected people as well as by inhalation of the dust from dried rat faeces. There is some evidence that supports the sporadic spread of the disease via infected rat bites.
Like Ebola, not everyone dies from Lassa. Usually, the death rate is much lower than it is with Ebola, but there have been sporadic outbreaks where the death rate has reached 70%, albeit rarely.
Every year medics and scientists struggle to contain Lassa; it’s a major focus for what health services there are in the region. This year however that focus has been taken by Ebola. Wards and medical facilities usually set aside for Lassa patients have been overwhelmed by those suffering from Ebola. Dr. Sheik Umar Khan head of the Lassa programme at Kenema Government Hospital, Sierra Leone died of Ebola in September. Six nurses and a lab technician have also been lost to the disease leaving the specialist unit direly understaffed.
This situation causes two major problems. Firstly, cases of Lassa will go untreated causing a surge in deaths from the disease. Secondly, people may assume they are suffering from Lassa because of its prevalence at this time of year, when in fact they are suffering from and spreading, Ebola.
At this point in the Ebola epidemic there is little point waiting for laboratory confirmation of the disease. The fact is that with both Lassa and Ebola showing the same symptoms, and with both diseases requiring treatment in isolation, the tipping point has arrived.
There is no way the already overwhelmed medical facilities are going to be able to cope with the extra case load. The countries worst hit by Ebola are the same countries that suffer the worst outbreaks of Lassa Fever.
Ribavirin is used to treat Lassa, but is useless against Ebola. Giving every patient Ribavirin and waiting to see what happens is not an option. On average there are 300,000-500,000 cases of Lassa Fever every year in West Africa, all of them presenting with the same symptoms as Ebola. (source)
There is no possibility whatever that all of these people, or even half of them can be treated, let alone isolated. The toll that Lassa takes on West Africa this year remains to be seen, but it wouldn’t be a surprise if it’s worse than usual given the lack of facilities for patients. Every coin, though, has two sides, and if Lassa patients aren’t being treated, then neither are Ebola patients. It’s inevitable that there will be confusion amongst medical staff about who has what condition.
One has to wonder if it was the pending Lassa season that made the World Health Organization suggest that the death rate ‘from Ebola’ would massively increase in the latter part of this year. They predicted up to 10,000 cases a week by December. If you add Lassa Fever cases to the current rate of Ebola cases being reported that would be about right.
With the projected number of isolation beds available in Sierra Leone, Liberia and Guinea coming in at 4,500 by December 1st, which disease patients are suffering from is a moot point…They can’t be isolated regardless of what it is.
Nigeria, declared Ebola free just last week, is reporting an outbreak of Lassa in Oyo State. Medeciens Sans Frontieres (MSF) has already lost one doctor to Lassa according to Dr Geraldine O’Hara, an infectious diseases specialist from Huddersfield, UK.
It would be insane to think that these diseases are just Africa’s problem – it isn’t. As we saw with Thomas Duncan, it only takes one infected person to slip through the net and the chain of infection starts all over again in a new place. Luckily, this time it was contained; next time who knows?
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Contributed by Lizzie Bennett of Underground Medic.
Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.