Health Alert Update / Ebola outbreak

The Ebola outbreak in West Africa continues to evolve.  Case counts and deaths in Guinea, Sierra Leone and Liberia have continued to rise .

While still generally confined to specific groups in high risk situations (ex. those participating in traditional burial practices; eating bush meat), and of little risk to travellers who maintain previously outlined prudent hygiene practices,  the regional response to the outbreak threatens to pose significant impediments to foreigners’ movements, especially if they are seeking treatment or evacuation for illness.

 Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, and Sierra Leone, as of 27 July 2014

 

	New (1)	Confirmed	Probable	Suspect	Totals by    country
Guinea
Cases	33	336	109	15	460
Deaths	20	218	109	12	339
Liberia
Cases	80	100	128	101	329
Deaths	27	72	62	22	156
Nigeria
Cases	1	0	1	0	1
Deaths	1	0	1	0	1
Sierra Leone
Cases	8	473	38	22	533
Deaths	9	195	33	5	233
Totals
Cases	122	909	276	138	1323
Deaths	57	485	205	39	729
1. New cases   were reported between 24 and 27 July 2014.

Several key developments have occurred in recent days that should be noted:

1)     Today, the United States Center for Disease Control issued a travel warning that any non-essential travel to Guinea, Sierra Leone or Liberia be deferred

2)     An air ambulance from a major assistance company attempting to evacuate a prominent physician from Sierra Leone who was infected with Ebola was prevented from doing so by the local authorities. He expired while awaiting evacuation and unconfirmed reports indicate the aircraft was grounded until it can be secured as “clean.”

3)     A Liberian national flew by commercial airline to Lagos, Nigeria.  After arrival in Nigeria he was admitted to hospital where he died of Ebola.  He was reportedly symptomatic during his travels. Health authorities are tracing his contacts during travel.  He passed through Ghana and Togo to transfer planes. No new Ebola cases are reported in these countries so far.

4)     Two African airlines (ASKY and Arik) have suspended flights and from the Ebola –affected countries and Nigeria.

5)     Liberia has closed its ground borders entirely, though the airport in Monrovia remains open.

6)     Sierra Leone has declared a state of emergency and will take more proactive measures perform contact tracing and enforce home isolation for suspected contacts.

7)     Airport screening of travelers is not yet common, even in the affected nations.  Monrovia airport is screening passengers who intend to travel. Ethiopia and Nigeria announced they will conduct airport screening of all passengers arriving from the affected countries.

8)     Monrovia:   Unconfirmed reports are that JFK Medical Center, the top level hospital facility in Monrovia is closed to new patients and under quarantine because of Ebola cases within the hospital. ELWA medical center in Monrovia is the regional treatment center for Ebola.  We advise travelers to avoid these two facilities when seeking medical care.

As the outbreak evolves, it is anticipated that affected and surrounding nations will impose increasing restrictions on crossing borders and at airports.  International health and immigration authorities will likely place tighter restrictions on travelers attempting to enter other countries from the affected countries.   For this reason, the general advise is that all non-essential travel or stays in these 3 countries be curtailed.   Please be prepared for the following realities in case of urgent travel requirements or illness:

1)     Travelers with any form of febrile illness are likely to be subject to close screening and evaluation for the possibility of Ebola and may even be quarantined in their locality until authorities are satisfied they are not infected with Ebola virus.  Since the early symptoms of many other infectious illnesses (such as flu, malaria/paludisme, gastroenteritis, a common cold) may be indistinguishable from early Ebola, patients who turn out to have these maladies may find themselves subject to such handling.

2)     Airports and airlines at both departure and reception points will likely screen for symptoms or exposure history for possible Ebola and deny passage, boarding or entry into the destination country.

3)     Similar restrictions may be set up at land border crossings with neighboring countries.

4)     If hospitalized with an illness of any sort, especially of a febrile or infectious nature, authorities may restrict evacuation from these countries and regular transportation providers may be reluctant to transport the patient until  Ebola has been definitively ruled out. We expect there will be an increasingly limited supply of air ambulance providers willing to service requests in the affected countries.

5)     If suspected of or diagnosed with Ebola, please anticipate the patient will not be allowed to exit the country.  Rather, they will likely be obliged to be admitted to a local Ebola treatment center.

For obvious reasons, request to evacuate travelers or expatriates with suspected/confirmed Ebola will receive even greater scrutiny with uncertainty as to whether they will be allowed to leave the affected country or enter another. This will be case-by-case dependent. No privately organized evacuation of an Ebola patient has yet taken place.