Ebola: Latest MSF Updates
- Liberia: The Psychological Scars of Ebola
- Ebola Survivors: Healing Through Sharing
- New Ebola Case Confirmed in Sierra Leone
- End of Ebola Outbreak in West Africa: World Must Learn Lesson for Future Outbreaks, Says MSF
- Op-Ed: The Long Shadow of Ebola
- "Science Should Be at the Service of Survivors"
- PBS Frontline: Outbreak
If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus with a mortality rate between 25 and 80 percent of people who catch it, causing terror among infected communities.
Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.
MSF Ebola activities in West Africa, January 14, 2016
WHO Figures (Updated January 14, 2016)
|Date of Info||Cases||Deaths|
|Liberia||Outbreak 1 over||10,666||4,806|
|Outbreak 2 over||9||3|
|Sierra Leone||Outbreak over||14,122||3,955|
MSF Staff on the Ground (as of January 14, 2016)
At its peak, MSF employed nearly 4,000 national staff and over 325 expat staff to combat the epidemic across the three countries.
MSF’s Ebola response started in March 2014 and included activities in the three most-affected countries (Guinea, Liberia, and Sierra Leone) as well as Nigeria, Mali, and DRC. Since the beginning of the epidemic, 10,288 patients were been admitted to MSF Ebola management centers, 5,226 of whom were confirmed to have the disease. Of those, 2,478 patients recovered.
With the declaration of the end of the Ebola epidemic in West Africa, January 14, 2016, should be a day of celebration and relief. But lessons must be learned from the outbreak and the response.
Lessons learned must be used to improve responses to future epidemics and to neglected diseases. This Ebola response was not limited by a lack of international resources, but by a lack of political will to rapidly deploy assistance to help communities. The needs of patients and affected communities must remain at the heart of any response and outweigh political interests.
This devastating epidemic hit nearly 40 years after the first discovery of Ebola in 1976, yet the lack of research and development on Ebola meant that even today, after the medical trials and at the end of the epidemic, there is no effective treatment.
This has been an unprecedented epidemic with an unprecedented response.
From the very beginning of the epidemic, MSF responded in the worst-affected countries—Guinea, Liberia and Sierra Leone—by setting up Ebola treatment centers and providing services such as psychological support, health promotion, surveillance, and contact tracing. At its peak, MSF employed nearly 4,000 national staff and over 325 international staff to combat the epidemic across these three countries. MSF admitted a total of 10,376 patients to its Ebola treatment centers, of which 5,226 turned out to be confirmed Ebola cases. In total, the organization has spent over 96 million euros on tackling the epidemic.
But there is still a lot of room for progress. Most importantly, there still is no treatment for this deadly disease, and much about the virus remains unknown.
Steps must be taken to better prepare the world for a future outbreak.
A lot of data has been gathered during this outbreak, and a lot of it remains to be analyzed. This analysis will be of vital importance to learn as much as possible about the disease before another outbreak occurs.
We now have a promising vaccine for Ebola, but it is yet to be approved for regular administration. In order for it to be useful during a new outbreak, we must ensure that it will be accessible to those in need.
There’s no treatment for Ebola yet, but there are a few promising developments in the pipeline. In order to test these products, preparations of clinical studies of the most promising treatment products should be prepared before the next outbreak, in order to lose as little time as possible.
A sustained and well-functioning surveillance and rapid response system is essential in order to maintain zero cases of Ebola across West Africa and also to respond to cases of other diseases with epidemic potential, including measles and cholera, which have previously broken out in the region.
Finally, already weak public health systems were seriously damaged by the epidemic and their recovery must be sufficiently funded and resourced.
MSF will continue its work on Ebola.
Even though the epidemic is over, MSF’s work on Ebola is not. Ebola survivors are a particularly vulnerable group, facing continuing health challenges such as joint pain, chronic fatigue, and hearing and vision problems. They also suffer from stigmatization in their communities and need specific and tailored care. MSF has invested in setting up five Ebola survivor clinics in Liberia, Sierra Leone, and Guinea, providing a comprehensive care package, including medical and psychosocial care and protection against stigma.
Re-emergence of cases is very rare.
Evidence gathered during the epidemic shows that the virus can stay in some parts of survivors’ bodies for as long as nine months (or longer). In Sierra Leone and Liberia, there have been some cases of transmission of the disease by survivors, as well as what seems to be relapse of the disease. But these episodes are extremely rare. Only ten cases of re-emergence have been identified out of a total of 15,000 survivors. However, it is important to maintain adequate surveillance systems in order to identify and treat such cases and avoid further transmission.
Update: March 23, 2016
The country was declared free of EVD transmission on November 7 but a new death was confirmed on January 14, followed by an additional case on January 20. Sierra Leone was once again declared free of EVD transmission on March 17.
MSF played a key leading role in treating people who suffered from Ebola and continue to provide medical and psychosocial services to some of the country’s 4,000 Ebola survivors in Freetown and Tonkolili district. New projects on maternal and child health opened in different towns of the country, as the already fragile health system has been further weakened by the burden of the Ebola epidemic. MSF is also maintaining an emergency response capacity through a small team.
The survivor clinic in Freetown has been running since February 2015, providing primary health care and mental health support, with currently around 140 consultations per month. MSF also runs community sensitization and stigma reduction activities.
By the end of February 2016, the MSF survivor care in Tonkolili has been integrated into the MoH primary health care system. We are still following a small number of survivors with mental health support, medical care, and referral, but the majority of patients have been discharged from our program. While supporting survivors, we saw a reduction in medical complaints and improvement of the mental health status.
The project continues to support pediatrics and maternity in Magburaka hospital. Ten days after MSF started supporting the hospital in January, a new Ebola case was identified in Magburaka. The team managed to continue medical care in the hospital throughout this new outbreak, which was rapidly contained. MSF is also supporting the screening and isolation facility at the hospital. In February, we admitted 152 children to the pediatric ward and 83 women to maternity.
In Kabala hospital, in Koinadugu district, MSF will open a new project with the aim to increase access to free maternal, ne-onatal, and pediatric care while ensuring health care to Ebola survivors in the district and effective response to outbreaks and emergencies in the area.
Update: March 23, 2015
The last patient was tested negative and discharged on December 4. Liberia was then declared Ebola free on January 14. According to WHO, the last cluster of cases is now understood to have been a result of the re-emergence of Ebola virus that had persisted in a previously infected individual.
The Liberian national health system, which was already among the weakest in the world, has been decimated by the outbreak—close to 200 Liberian health care workers having died from Ebola according to official statistics, which represents eight percent of all health workers in the country. MSF is now focusing activities on helping to restore offer of health care, notably through a MSF-managed pediatric hospital in Monrovia. Before the epidemic, there were 220 inpatient pediatric beds in Monrovia, but in April 2015, when MSF opened its pediatric hospital, all pediatric wards had closed. At the end of 2015, 122 inpatient beds were available. But this is clearly not enough for a city of 1.4 million inhabitants, with an estimated 17 percent of them being children under 5-years-old.
In Monrovia, MSF is running a 91-bed pediatric hospital, the Barnesville Junction Hospital (BJH), including a 22-beds neonatal intensive care unit, aiming to contribute to restoring the provision of emergency and secondary health care for children in the aftermath of the Ebola outbreak. In 2015, more than 3,400 consultations took place in the emergency room of the hospital, and over 3,000 children were admitted in the inpatient ward. MSF also runs a clinic for Ebola survivors in the premises of the hospital. Former patients have to face stigma and discrimination while accessing care, as well as social and economic problems (loss of work, loss of housing, etc.). MSF provides general outpatient consultations, and addresses mental health needs to a group of more than 500 identified former Ebola patients, which are estimated to be a third of all survivors in Montserrado county. Teams have been providing consultations also to patients who are not identified as survivors, because of the lack of certificates of cure/discharge from ETCs. Compared to identified survivors, their access to medical and social assistance has therefore been even poorer. Common complaints are joint pains and ophthalmic issues. For the latter, MSF provides care in collaboration with a Liberian eye clinic. About 400 survivors have been seen since April 2015, 168 are actively followed. Thirty-two patients are under psychiatric treatment and 35 patients are currently followed for eye problems. MSF also offers supportive mental health services to front-line workers during the outbreak (ETU staff, burial teams, etc.), as well as members of the families of survivors.
Update: March 23, 2016
Guinea was declared free of Ebola on December 28, 2015. MSF is now running an Ebola clinic for survivors in Conakry. In February, there were 126 psychological consultations and 181 medical consultations at the clinic. In addition to this, the MSF team also carries out sensitization activities at the clinic and in the community.
On March 17, the Guinean government announced two new confirmed deaths and three suspected cases, in the first re-emergence of the virus in the country since the outbreak was declared over in December 2015. MSF is not involved in case management but is ready to provide support if needed.
Update: October 23, 2014
WHO declared October 20 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.
Update: October 23, 2014
WHO declared October 17 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West African Unit (Dakar) will keep in contact with the government for follow-up as part of their routine activities.
Democratic Republic of Congo (DRC)
Update: November 20, 2014
The outbreak in DRC’s Equateur province, which was unrelated to the one in West Africa, was declared over this week. Around 60 MSF staff worked on this outbreak and two case management centers were established. The MSF teams have activated an exit plan.
Update: November 20, 2014
On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared since.
Update: November 20, 2014
Mali confirmed its first case of Ebola on October 23. So far there have been seven reported deaths in the country (including the first case): five confirmed with Ebola and two suspected cases. To date, 360 contacts have been identified and nearly all have been placed under surveillance.
In Bamako, MSF is running a CMC in collaboration with CNAM, Mali’s national disease center. The only confirmed Ebola patient admitted to this facility recently died. The case was detected on November 11 and the patient was immediately admitted to the facility. There is one more suspected case currently at the CMC.
MSF has reinforced its team and expanded its activities to help stop the disease spreading further. MSF is training Malian staff from CNAM to manage Ebola cases, and is overseeing the organization of an ambulance system and safe burials.
No specific treatment or vaccine is yet available for Ebola.
Symptoms of Ebola
Early on, symptoms are nonspecific, making it difficult to diagnose.
The disease is often characterized by the sudden onset of fever, feeling weak, muscle pain, headaches, and a sore throat. This is followed by vomiting, diarrhea, 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, and difficulty breathing and swallowing.
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 while caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.
“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.”
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 him or her 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.
MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.
Risk of Ebola Spreading
The risk of Ebola spreading to the US is minimal, but to minimize 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 Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.
"I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms,” says Kiiza Isaac, a nurse from Uganda.
On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.
"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."
It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.
The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic 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.
The Ebola virus is made up of five species: 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.
MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2014, MSF admitted 7,400 people into Ebola management centers.