Liberian soldiers have set up a blockade stopping people from western regions affected by the Ebola outbreak from entering the capital, Monrovia.

It follows the president’s declaration of a state of emergency to tackle the outbreak that has killed more than 930 people in West Africa this year.

In Sierra Leone the security forces have now imposed a complete blockade of eastern areas hit by Ebola.

Health experts in Switzerland are discussing a response to the outbreak.

It is the world’s deadliest outbreak and the two-day World Health Organization (WHO) meeting will decide whether to declare a global health emergency.

Ebola, a viral haemorrhagic fever, is one of the deadliest diseases known to humans, with a fatality rate in this outbreak of between 50% and 60%. It is spread through contact with the bodily fluids of Ebola patients showing symptoms.

Source : BBC World News

In 2 years time the Ebola virus will celebrate the 40th year of its discovery. It really is a twin birthday because it was 1st reported in 1976 in humans in both Zaire (now the Democratic Republic of the Congo) and Sudan writes Dr. Charlie Easmon, Medical Director at ALC Health and Your Excellent Health

I am privileged to know two of the original investigators/discovers of the virus who both work at the London School of Hygiene and Tropical Medicine, Professor Peter Piot and Dr David Heymann.

We know now that this virus has 5 subtypes, 4 of which can cause severe illness in man. The 5th affects monkeys and can infect man but does not cause any significant illness.

How long this virus has been on the earth is unknown but we do know that it has animal reservoirs such as bats. How it first gets into a human is not definitely known but it probably starts with eating infected animals (so called ‘bushmeat’)

Interestingly the virus is known to survive several weeks in semen but we do not know if that is a definite mode of transmission.

We know that once a human is infected the mortality without treatment will be between 50-90% depending on the strain. We know that it spreads by contact with infected blood or mucus. To date we do not know if the virus can be air-borne but fortunately we think it is not.

The symptoms start as sudden but non-specific with headache, muscle pains malaise, diarrhoea and fever. These are quickly followed by a bleeding tendency which is often fatal. Bleeding occurs from every orifice or any inflicted wound or medical access point. The incubation period is 2-21 days, which means that if you are exposed and not ill after 21 days you are safe.

Health care workers are infected by contact with blood or mucus and hence the need for basic precautions such as gloves, masks, goggles and where available bio-suits.

Relatives get infected by caring for the living and direct exposure to blood or mucus or as in many traditional African practices washing and cleaning the dead body. In the 1st outbreak it is now clear that non-medically trained nuns spread the infection by using unsterilised needles on a few hundred patients.  Controlling this virus in a country with good public health, trust in medical services, non-traditional practices and rule of law is relatively straightforward.

The spread within Africa is an indictment of lack of early political will, public health and lack of trust (understandably) in poorly functioning health systems.

With WHO and the African Development Bank offering millions to help control this infection let us hope that the money is used wisely.

What can you and your staff do to reduce the risk?

One option is not to go until the whole thing is declared over and recently borders have closed and airlines have stopped flying to affected countries.

However, business still needs to go on and you may have existing staff there.

Your staff should know the symptoms of Ebola, they should know who to send home when ill. They should know where to seek appropriate medical help.

A suspected contact case should be monitored for 21 days with daily temperatures.

If a local clinic does not have the basics such as gloves, masks, goggles and is suspected of reusing unsterilised medical equipment such as needles do not go there. You may need to supply your staff with their own kits including thermometers..

Local staff need to be educated about the disease and the public health measures required to control it. Traditional burial practices that involve washing or handling dead bodies need to cease.

Is there treatment for Ebola?

There is currently no vaccine and given the huge cost of vaccine development this may never happen. There are experimental drugs which use serum antibodies such as that used on the doctor flown to the USA.

The bleeding tendency and fluid loss need well-managed fluid regulation which is difficult and increase the risk to medical staff.

Conclusion

The spread of Ebola could have been stopped in the earlier stages for a few thousand of pounds but is now going to cost the UN agencies and African governments million in lost revenues and costs of control.  As long as the virus does not become airborne with the correct draconian public health measures it will be controlled within the next few months and business will return to normal.

This infection reminds every company to review its disaster recovery/business continuity plans since Ebola is just one bio-threat. There are things out there that we do not yet know about. We still have the possibility of another pandemic flu, extremely drug-resistant Tuberculosis and Middle East Respiratory Virus to contend with. So all companies should be bio-vigilant!

Dr Charlie Easmon
MBBS MRCP MSC Public Health DTM&H

Medical Director, ALC Health
Medical Director, Your Excellent Health

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

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.