WHO Declares Ebola a “Public Health Emergency of International Concern”

The Ebola outbreak in West Africa is unprecedented. The death toll is rapidly approaching 1,000 reported cases, with no end to the epidemic in sight.

Yesterday, the World Health Organization (WHO) declared the outbreak an international public health emergency after a committee meeting.

From the WHO’s official statement:

After discussion and deliberation on the information provided, the Committee advised that:

• the Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
• the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.
• a coordinated international response is deemed essential to stop and reverse the international spread of Ebola.

It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.

The current Ebola outbreak began in Guinea in December 2013, and has spread to Liberia, Nigeria, and Sierra Leone. As of August 4, 1,711 cases have been reported (1 070 confirmed, 436 probable, 205 suspect), including 932 deaths. This is currently the largest outbreak ever recorded.

Updated information was provided by the WHO on August 8, and the number of deaths jumped from 932 to 961. The number of reported cases increased from 1,711 to 1,779.

The death rate for this outbreak is currently around 50%.

An estimated 150 healthcare workers have been infected with the virus, and 80 of them lost their lives to the disease.

WHO director general Dr. Margaret Chan said “We do believe there are more cases than what’s being reported.”

That’s because case numbers only count those that are documented. The actual numbers are higher, but how much cannot be determined – some victims don’t report their illness (or that of family members) to authorities out of fear or avoidance of the chaotic state of hospitals.

At a news conference from Geneva yesterday, Dr. Chan asked for global support for the outbreak:

“The outbreak is moving faster than we can control it. Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.”

A surge in cases over the last two days has overwhelmed aid organizations.

From the Wall Street Journal:

Several doctors and aid workers on the ground said they had witnessed a surge in cases over the past 48 hours that has broken the predictable rhythm of the epidemic. Ebola usually takes eight to 12 days from the moment of infection to flare up and become symptomatic. Previous spikes in Ebola cases rose and fell to the pace of that incubation period.

Now, doctors say, they see back-to-back surges in patient volumes. At a field clinic in Sierra Leone, 10 people died on Friday morning, Sierra Leone Red Cross spokesman Abubakar Tarawelly said. And 40 more arrived. “The number keeps rising,” he said. “It’s getting too much for our volunteers.”

Hospitals are running out of supplies, and staff are leaving their posts after watching colleagues succumb to Ebola.

The WHO listed the challenges affected countries are facing:

• their health systems are fragile with significant deficits in human, financial and material resources, resulting in compromised ability to mount an adequate Ebola outbreak control response;
• inexperience in dealing with Ebola outbreaks; misperceptions of the disease, including how the disease is transmitted, are common and continue to be a major challenge in some communities;
• high mobility of populations and several instances of cross-border movement of travellers with infection;
• several generations of transmission have occurred in the three capital cities of Conakry (Guinea); Monrovia (Liberia); and Freetown (Sierra Leone); and
• a high number of infections have been identified among health-care workers, highlighting inadequate infection control practices in many facilities.

Some are skeptical about the impact (if any) the WHO’s declaration will make:

“Statements won’t save lives,” said Dr. Bart Janssens, director of operations for the Doctors Without Borders charity group. “For weeks, (we) have been repeating that a massive medical, epidemiological and public health response is desperately needed. … Lives are being lost because the response is too slow.”

“I don’t know what the advantage is of declaring an international emergency,” added Dr. David Heymann, who directed WHO’s response to the SARS outbreak and is now a professor at the London School of Hygiene and Tropical Medicine. “This could bring in more foreign aid but we don’t know that yet.” (source)

The World Bank has pledged up to $200 million in emergency funding to help the countries affected by Ebola, and to strengthen West African health systems. Yesterday, the European Union said it would provide $10.7 million, and will send a second mobile diagnostics lab. And, USAID announced it would invest an extra $12.45 million to fight Ebola.

Meanwhile, Dr. Kent Brantly and Nancy Writebol, the American aid workers who were transported from West Africa to the US for treatment, are improving after receiving experimental treatment.

The WHO said that people who have had contact with those infected with Ebola should avoid travel, but the organization did not recommend any travel or trade bans. They did recommend screenings and surveillance at airports and borders to spot potential cases, and said suspected cases should be treated as medical emergencies.

Dr. Chan said while extraordinary measures might be necessary to contain the Ebola outbreak, it was important to recognize civil rights:

“We need to respect the dignity of people and inform them why these measures are being taken,” she said.