Ebola - A Race Against Time | MSF

Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Ebola is so infectious that patients need to be treated in isolation by staff wearing protective clothing.

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Crisis Info: September 2014

Since the Ebola outbreak in West Africa was officially declared on 22nd March in Guinea, it has claimed at least 2,461 lives. The outbreak is the largest ever, and is now raging unabated. Five countries are currently affected: Guinea, Liberia, Nigeria, Sierra Leone and Senegal.

MSF has welcomed the ambition of a new US Ebola response plan, in which President Obama pledged on 16th September to send 3,000 troops to West Africa and set up 17 new Ebola management centres, while urging the plan to be put into action immediately.

Meanwhile, in recent days the World Bank has approved a $105-million grant, Australia has pledged $7 million, and Cuba and China have offered to send doctors to the region. “We need more countries to stand up, we need greater concrete action on the ground, and we need it now,” said Brice de le Vingne.

“If implemented swiftly, setting up new Ebola management centres, deploying qualified staff and training health personnel could begin reversing the trend of the fight we have collectively been losing against Ebola.”

Despite the UN calling the epidemic a “crisis unparalleled in modern times”, so far the international response has so far been lethally inadequate. MSF teams in West Africa are seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation.

"We are honestly at a loss as to how a single, private [non-governmental organisation] is providing the bulk of isolation units and beds," MSF president Joanne Liu said in a speech to the UN in Geneva on 16th September. Two weeks earlier at the UN, she called for states with biological-disaster response capacity, including civilian and military medical capability, to dispatch specialist medical units to West Africa as a matter of urgency to prevent the virus from spreading further.

MSF has been responding to the outbreak since March, and currently has a total of 2,239 staff working in Guinea, Liberia, Nigeria, Sierra Leone and Senegal, treating a rapidly increasing number of patients. 

MSF case numbers since the outbreak began (as of 16th September) 

Guinea: Admissions* - 1,184 | Confirmed - 538 | Recovered - 208

Sierra Leone: Admissions - 539 | Confirmed - 340 | Recovered - 111

Liberia: Admissions - 1,108 | Confirmed - 869 | Recovered - 201

Total: Admissions- 2,932 | Confirmed - 1,747 | Recovered - 520

* Admissions include all suspected, probable and confirmed cases. 

Ebola treatment: interactive guides

Hover over the image below for an interactive guide to an MSF Ebola treatment centre

Hover over the image below for an interactive guide to the high risk zone inside an MSF Ebola treatment centre

Ebola Guide

It is estimated there had been over 1,800 cases of Ebola, with nearly 1,300 deaths, before this latest outbreak in 2014. 

Ebola history

The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died — and died quickly.

That same year, 284 people in Sudan also became infected with the virus, killing 156.

Facts

Ebola first appeared in 1976 in simultaneous outbreaks in Nzara, Sudan, and in Yambuku, DRC
The latter was in a village situated near the Ebola River, from which the disease takes its name
Fruit bats are considered to be the natural host of the Ebola virus
The case-fatality rate varies from 25 to 90 percent, depending on the strain

There are five different strains of the Ebola virus: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire, named after their places of origin.

Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

Risk of Ebola spreading

The risk of Ebola spreading to the UK is minimal, but to minimise it even further we need more resources to bring the outbreak under control in West Africa. 

Before this outbreak, MSF has treated hundreds of people affected by Ebola in UgandaRepublic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Healthcare workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

No specific treatment or vaccine is yet available for Ebola

Symptoms of Ebola

Early on, symptoms are non-specific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches and a sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing and swallowing.

MSF nurse Lucie Perardel checks her goggles, an essential part of the protective gear that must be worn when treating patients during an Ebola outbreak. Guinea, 2014

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.Henry is also working on the current outbreak. 

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus – through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified.

Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

Once a patient recovers from Ebola, they are immune to the strain of the virus they contracted. 

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment centre.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

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This New York Times video gives a shocking insight into the current situation in Monrovia, Liberia.

Ebola: latest updates from the frontline

Update 23rd September 2014

Investigational Ebola treatments are to be tested in West Africa for the first time as part of an international initiative to fast-track trials of the most promising drugs, for the disease that has already led to over 2,600 deaths.

A £3.2 million grant from the Wellcome Trust will enable multiple partners around the world, including the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC), the University of Oxford, Médecins Sans Frontières/Doctors Without Borders (MSF), the World Health Organisation (WHO), Institut Pasteur, Institut Pasteur de Dakar, Fondation Mérieux and the Global Health Network, to quickly establish clinical trials at existing Ebola treatment centres.

Read the full story

Update 17th September 2014

We can confirm that one of our international staff members in Liberia has been diagnosed with Ebola haemorrhagic fever.
 
The French MSF staff member currently on assignment in Monrovia was placed in isolation on Tuesday, 16th September, after she developed ​​a fever. Laboratory tests performed on the same day confirmed an Ebola infection.
 
Following MSF medical evacuation procedures, she will be soon transferred to a specialised treatment centre in France.
 

Update 12th September 2014

Pierre Trbovic, MSF anthropologist in Monrovia, Liberia.
"Soon after arriving in Monrovia, I realised that my colleagues were overwhelmed by the scale of the Ebola outbreak. Our treatment centre – the biggest Médecins Sans Frontières has ever run – was full, and Stefan, our field coordinator, was standing at the gate turning people away.

This wasn’t a job that we had planned for anyone to do, but somebody had to do it – and so I put myself forward.For the first three days I stood there, it rained hard. People were drenched, but they carried on waiting because they had nowhere else to go.The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car.

He was an educated man, and he pleaded with me to take his teenage daughter, saying that while he knew we couldn’t save her life, at least we could save the rest of his family from her. At that point I had to go behind one of the tents to cry. I wasn’t ashamed of my tears but I knew I had to stay strong for my colleagues – if we all started crying, we’d be in trouble..."

Read the rest of Pierre Trbovic's startling account of what is happening on the ground in Monrovia today on The Guardian.

Update 2nd September 2014

Today, MSF has called for states with biological-disaster response capacity, including civilian and military medical capability, to immediately dispatch assets and personnel to West Africa to respond to the Ebola outbreak.

In a speech to the United Nations, MSF International President Dr Joanne Liu warned that the further spread of the virus will not be prevented without a massive deployment of such specialised medical units to bolster epidemic control efforts in affected countries.

"We cannot cut off the affected countries and hope this epidemic will simply burn out. To put out this fire, we must run into the burning building," said Joanne in her speech.

Despite repeated calls by MSF for a massive mobilisation on the ground, the international response has been lethally inadequate.

Update 28th August 2014

Today, the World Health Organisation (WHO) has issued a roadmap to scale up the international response to the Ebola outbreak in West Africa. 

“This WHO roadmap is welcome, but it should not give a false sense of hope. A plan needs to be acted upon." said Brice de le Vingne, MSF Director of Operations.

Brice de le Vingne, MSF Director of Operations

“Huge questions remain about who will implement the elements in the plan: who has the correct training for the variety of tasks that are detailed, how long will it take to train organisations to set up and run an Ebola management centre, how long before any new centres become operational, who will undertake the vitally important health education, contact tracing and safe burials work in the affected communities?”

“We have learned an uncomfortable lesson over the past six months; none of the organisations in the most-affected countries – UN, WHO, local governments, NGOs (including MSF) – currently have the right set-up to respond at the scale necessary to make a serious impact on the spread of the outbreak. For some the limits are due to capacity constraints - simply not able to do more - and others may need to be encouraged to show more willingness to push the boundaries and scale up effective activities at a meaningful scale.”

“We cannot escape the need to rapidly and effectively contain this epidemic and provide the necessary care to patients, their families and affected communities. As an international public health emergency, states with the capacity to help have the responsibility to mobilise resources to the affected countries, rather than watching from the sidelines with a naive hope that the situation will improve.”

Update 26th August 2014

It is with great sorrow that Médecins Sans Frontières/Doctors Without Borders (MSF) confirms that three of our colleagues, a Guinean outreach worker, a Liberian nurse and a Sierra Leonean nurse, have passed away.  

On 19th August, our Guinean colleague was admitted to one of MSF’s Ebola management centres in Guinea. He received medical care there, but sadly passed away the following day. His funeral took place on 21th August in the presence of his family and the MSF team. Our colleague was working in MSF’s outreach team.

Our Liberian colleague, who was a Ministry of Health nurse working alongside MSF, was admitted to one of MSF’s Ebola management centres in Liberia on 19th August. MSF’s doctors did their utmost to provide the best possible medical care, but tragically he passed away on 23th August. Arrangements are currently being made for his funeral.

Our Sierra Leonean colleague was a nurse working with one of the MSF teams in Sierra Leone. He was admitted to an MSF Ebola management centre on 24th August where the MSF medical team did all they could to provide the best medical care possible. He passed away on 25th  August, to the great sadness of the team. Arrangements are currently being made for his funeral.

A thorough investigation is underway to determine how the staff members became ill. At this point, there is no indication that the illness was acquired in the context of their professional activities.

We offer our sincere condolences to the families and friends of our colleagues, who we will support through this difficult time.

During an Ebola outbreak, funeral rituals are the most dangerous means of spreading the virus. Here, body bags disinfected with chlorine to prevent further contamination are incinerated in a crematorium by MSF staff.

Update 25th August 2014

MSF has launched a response to the confirmed Ebola viral hemorrhagic fever outbreak in Equateur Province, Democratic Republic of Congo (DRC). Present in DRC for more than 30 years, MSF is sending doctors, nurses, logistics experts and hygiene specialists to the epicenter of this outbreak.

“We received confirmation on Sunday that four of the samples our team took last week have tested positive for Ebola virus,” says Jeroen Beijnberger, MSF Medical Coordinator in DRC.

“We are responding fast to try to isolate the suspect and confirmed patients and to start the work of contact tracing.” 

Working with the Congolese Ministry of Health, MSF is setting up an Ebola management centre in Lokolia, the area most affected by the outbreak in the Boende health zone.“Our key objective for now is to do all we can to stop the outbreak spreading and to protect other people from catching the virus,” says Beijnberger.

No link with the Ebola outbreak in West Africa has been established, although that cannot be categorically discounted.

“For now, we consider this outbreak as an unfortunate coincidence,” says Beijnberger.

“We are trying to confirm the origin of the outbreak, but at this time nothing points to a direct link with the epidemic in Guinea, Liberia and Sierra Leone.”

Update 18th August 2014

MSF has today started admitting patients into its newly constructed Ebola treatment centre in Monrovia, Liberia, beginning the process of scaling up its operations in the country. 

Ebola continues to rage relatively unchecked in the Liberian capital that is home to nearly one million people, stretching the existing medical facilities beyond their capacity. The situation is compounded because much of the city’s health system has shut down due to fears of Ebola amongst staff and patients, leaving many people without access treatment for everyday health conditions.

The first nine patients were today admitted into the 100 bed treatment centre, and more will follow over the coming days. 

MSF currently has 19 international and 250 Liberian staff working in Monrovia.

Update 15th August 2014

Despite the World Health Organisation (WHO) declaring the largest-recorded Ebola epidemic a “health emergency,” the international effort to stem the outbreak is dangerously inadequate. Read the full MSF report.

Update 13th August 2014

Our Deputy General Director, Stephan Goetghebuer, responds to the World Health Organisation's (WHO) statment on experimental Ebola drugs:

"MSF welcomes the steps the WHO is taking to adopt exceptional regulatory procedures in the face of an exceptionally grave Ebola epidemic.

"Our priority right now is to save the lives of people affected today and it is unclear how quickly a trial of a new treatment could feasibly be organised. The use of unregistered interventions for Ebola viral disease will not alone be the answer to combating the outbreak - that requires a massive scaling up of all the known measures such as community mobilisation, education, effective contact tracing, early presentation of suspected Ebola patients at appropriately equipped treatment centres, training and equipping health workers, and effective coordination of the response.

"Nevertheless, we fully support the acceleration of actions to select a promising treatment, to scale up production, and to organise a fast-track trial on the ground - all within a medical ethical framework that has been debated by WHO ethical specialists.

"MSF is keen for its patients to benefit from any treatment that shows promise, and will continue to work with the WHO and other organisations to support an appropriate acceleration of procedure for any treatment that is considered a good candidate for a medical trial .

"The responsibility for selection of a treatment and the definition of the ethical framework for this will be in the hands of the WHO and the Ministries of Health of the countries where the epidemic has spread."

Staff take photos of Lansana, 18, as she leaves the MSF Ebola treatment centre in Kailahun, Sierra Leone. She and her mother, who live more than an hour away by road, were both admitted to the centre. Last week Lansana was discharged from the facility, having been cured of the illness. 5th August 2014.

Update 8th August 2014

Since the Ebola outbreak began in March this year the disease has claimed 932 lives, according to the World Health Organization (WHO).

Over recent weeks, our teams have seen a worrying surge in the epidemic, with the number of cases increasing dramatically in Sierra Leone and Liberia, and the disease spreading to many more villages and towns.

We currently have 676 staff working in Guinea, Sierra Leone and Liberia, but we have reached our limit in terms of staff. We urge the WHO, health authorities and other organisations to scale up their response. 

Guinea

  • We currently have 31 international staff and 300 Guinean staff working in the country.
  • In Conakry, we have admitted 232 patients, of whom 124 were confirmed to have Ebola. Sixty-four patients have recovered and returned home.
  • In Gueckedou, we have admitted 366 patients, of whom 169 were confirmed to have Ebola. Forty-six patients have recovered and returned home.

After a lull in new cases in Guinea, recent weeks have seen an increase in new infections and deaths from Ebola. Currently there are 17 patients in Conakry and nine in Guéckédou.

In Macenta transit centre in southwest Guinea, near the Liberian border, MSF is supporting the Ministry of Health by transferring Ebola patients by ambulance for case management in either Conakry or Guékédou. Patients are arriving from a wide area, including the region around Nzerekore.

Sierra Leone

  • We currently have 26 international staff and 300 Sierra Leonean staff working in the country.
  • In total, we have admitted 260 patients, of whom 174 were confirmed to have Ebola. Thirty-six patients have recovered and returned home.

In Sierra Leone, our treatment centre in Kailahun, near the border with Guinea, has been expanded to 80 beds, to cope with spiralling patient numbers.

Between five and 10 new patients are being admitted each day. Currently there are 60 patients in the centre. Nine patients were discharged on 4th August after recovering from the disease.

Meanwhile, 200 community health workers are running health promotion acitivities in the region to increase people’s knowledge about Ebola and how to protect themselves from infection.

Liberia

  • We currently have nine international staff and 10 Liberian staff responding to the Ebola outbreak.

The situation in the Liberian capital, Monrovia, is “catastrophic”, according to Lindis Hurum, MSF Emergency Coordinator in Liberia.

There are reports of at least 40 health workers being infected with Ebola over recent weeks. Most of the city’s hospitals are closed, and there are reports of dead bodies lying in streets and houses.

Our teams are providing technical support to an Ebola treatment centre in Monrovia with the Ministry of Health, and we have started construction of a new treatment centre.

An MSF team based in Guékédou, Guinea, has recently launched a response in Liberia’s Lofa region, alongside the Guinean border, which has been badly affected by Ebola.

MSF is reinforcing its current team, but we are reaching the limits of our capacity. There is a dire need for the WHO, Ministry of Health and other organisations to rapidly and massively scale up the response in Liberia.

Update 6th August 2014

The Sunday Times' Rod Liddle spoke to MSF UK's executive director Vickie Hawkins and press officer Sandra Smiley about Ebola and whether people outside of the UK should be scared of the disease.

Update 4th August 2014

Cokie van der Velde, a sanitation specialist with MSF, has been helping to combat Ebola in Liberia and Guinea. On Friday she returned to her home in Yorkshire. Here, she describes her last day of work in the isolation zone.

Update 30th July 2014

Twenty-nine-year-old doctor Hannah Spencer, from Surrey, recently arrived back in the UK after three weeks fighting the Ebola epidemic in West Africa with MSF. Read her eye witness account of the Ebola outbreak here. 

Update 28th July 2014

Canadian GP Tim Jagatic is on the ground in Kailahun, Sierra Leone, helping MSF fight the worst Ebola outbreak in history. Read his interview on fighting Ebola

Update 24th July 2014

As the Ebola outbreak continues to spread, with 1,093 cases and 660 deaths now reported across West Africa, MSF is stepping up its response in the most affected areas.

While the number of cases in Guinea has declined significantly, in neighbouring Sierra Leone and Liberia, more and more people are being infected with the virus.

Sierra Leone

In Sierra Leone – now the epicentre of the epidemic, with 454 cases recorded so far – our teams are rapidly scaling up its response, with 22 international and 250 Sierra Leonean staff.

In Kailahun, in the east of the country, the team is running a 64-bed Ebola treatment centre.

Since the facility opened on 25th June, 131 suspected, probable and confirmed patients have been admitted for treatment. So far, 12 patients have recovered and returned home to their families.

An MSF psychologist is providing support and counselling to patients and their families, as well as to our staff.

We are also supporting the Ministry of Health and Sanitation at two referral sites in the Kailahun district.

In the past three weeks, MSF has trained more than 200 community health workers to deliver essential health messages to people in their villages about how to protect themselves against Ebola and what action to take if someone shows any signs or symptoms of the disease.

We will now focus on halting the spread of the disease in the border area between Sierra Leone, Guinea and Liberia, where the population is very mobile and people continue to transmit the disease to different villages.

Liberia

In Liberia, the situation is deteriorating rapidly, with cases now confirmed in seven counties, including in the capital Monrovia.

There are critical gaps in all aspects of the response, and urgent efforts are needed to scale up.

Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health (MoH).

Our team has set up an Ebola treatment centre in northern Liberia, where cases have been increasing since the end of May.

After the initial set up, we handed over the centre to Samaritan’s Purse on 8th July. There are currently six patients and MSF experts continue to provide technical support and training.

The team will now shift its efforts to Voinjama, also in Lofa county, where there are reports of people dying of Ebola in their villages.

Our  team will set up a referral unit so suspected Ebola patients can be isolated and transferred to the treatment centre.

In Monrovia, an MSF emergency team is building a new tented treatment centre with capacity for 40-60 beds. It is scheduled to open on 27th July and will also be run by Samaritan’s Purse.

A 15 bed MSF treatment unit set up at Monrovia’s JFK hospital was handed over to the MoH in April.  However, the unit has since been closed and all patients are currently cared for at ELWA hospital in Paynesville until the new centre is open at the same site.

Currently there are 14 patients admitted to this centre.

Our team is also supporting the MoH in the overall coordination of the Ebola response and providing technical and medical advice.

Guinea

In Guinea, the situation has stabilised in some areas and MSF has closed its Ebola treatment centre in Telimélé, in the west of the country, after no new cases were reported for 21 days.

During seven weeks, 21 people with the disease were admitted to the centre, with an astonishing 75 percent of patients making a recovery.

Without medical care, as few as ten percent of patients could be expected to survive.

In the capital Conakry, MSF is reducing its activities as far fewer cases are appearing.

Of the 59 confirmed Ebola patients admitted to the Donka centre since 25 March, 63 percent recovered and were able to return home.

In Guéckédou, in the south east – the original epicentre of the epidemic – the number of patients in MSF’s centre has declined significantly, with currently just two patients admitted.

It is very unlikely however, that this reflects an end to the outbreak; instead it suggests that infected people may be hiding in their communities rather than coming for treatment.

There continues to be significant fear surrounding Ebola amongst local communities and MSF teams have been prevented from visiting four villages due to hostility.

Weare working with local authorities and elders to try to ensure safe access to these areas to obtain a clearer picture of whether people are still being infected and dying of the virus.

Since the beginning of the outbreak, MSF has treated 150 patients in its centre in Guéckédou.

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