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An outbreak of Ebola virus that straddles the border between at least two west African countries has World Health Organization officials running — and worried.
At least 157 people have been infected or are suspected to be infected in Guinea and Liberia, and 101 of them have died, WHO officials said Tuesday. They are chasing down suspected cases in three more countries and trying to track 600 people at risk of becoming infected.
“This is one of the most challenging Ebola outbreaks that we have ever faced,” said Dr. Keiji Fukuda, assistant director-general for health security at WHO.
It’s the first outbreak of the virus in west Africa — previous outbreaks have been in Uganda, Gabon, the Democratic Republic of Congo and other central African countries. It’s also affecting Guinea’s capital, Conakry, a busy and crowded port city. Other outbreaks have often been in hard-to-reach rural areas.
“This is one of the most challenging Ebola outbreaks that we have ever faced."
One of the toughest tasks is fighting the rumors, Fukuda said — from folk tales that eating onions can protect you to nasty insinuations that medical aid workers carried the virus to the region.
“If they believe that eating onions or taking some kind of food is protective, this makes it less likely that they are going to be taking the kind of preventive measures that they need to do,” Fukuda said.
“It is absolutely critical to get out as much accurate information as possible to the communities…really to address the anxiety and the rumors as much as possible so people have facts to work with, not just rumors,” Fukuda said.
The strain of Ebola infecting people is one of the worst known, killing 90 percent of its victims. Ebola is a hemorrhagic fever, causing some internal and external bleeding along with other horrific symptoms. There’s no specific treatment, no cure and work on a vaccine is in very early stages.
Luckily, it does not spread very easily, requiring direct person-to-person contact with bodily fluids. “Outbreaks can be stopped through many of the public health measures being taken,” Fukuda said. That includes wearing gloves, limiting contact and keeping careful watch on people who have been in contact with patients or victims.
One hospital had a notable record of containing infections because it already had a policy in place of health workers using gloves and washing hands before and after seeing every patient, no matter what the diagnosis or symptoms.
But Ebola also has a long, 21-day incubation period, which makes for a nerve-racking period of tracing potential patients. “Our expectation is that we will probably continue to see cases for some number of months,” Fukuda said.
Dr. Stephane Hugonnet, a WHO medical officer who was in Guinea to help organize efforts, said so far there are no “mystery” cases. “Most of the cases that are now being identified can be linked to a known transmission chain,” he told reporters.
They include family members of victims, health care workers who treated victims and people who handled the bodies of victims. Some people have funeral rites that involve touching the body, and WHO is working to find a balance between allowing people to keep their rituals without risking infection.
“There is a right balance to find between safe burials and burials with humanity,” Hugonnet said.
"We will probably continue to see cases for some number of months.”
Reports that people have been infected in Ghana have proven untrue so far. There are nine suspected cases in Mali, but two tests so far have come back negative for Ebola. There are other common hemorrhagic fevers, including dengue and yellow fever.
WHO has sent more than 50 people to the affected countries to help distribute equipment, to find and treat patients and to help educate the public about the right things to do. They include a team from the U.S. Centers for Disease Control and Prevention. Other United Nations agencies and non-profit groups such as Medecins sans Frontieres (Doctors Without Borders) are helping, also.
One of the biggest problems is social outreach, Hugonnet said. “That there is no cure is extremely important,” Hugonnet said. “Why would you go to a hospital if you have a zero chance to get out?”
This is especially true for families in which several members have already died. “They are not very keen to go to the hospital,” he said.
So workers stress that pain medication and other supportive care is available at the hospital, as well as measures to protect remaining family members. But it’s hard getting that word out.
This is not yet the biggest outbreak of Ebola, which first arose in Zaire, now the Democratic Republic of Congo, in 1976. In that outbreak, 318 people were sickened and 280 died, with a mortality rate of 88 percent. The biggest outbreak affected 425 people in Uganda in 2000, killing 224 of them.
WHO has no immediate plans to recommend travel restrictions, Fukuda says. “We don’t think stopping people from travel is going to help,” he said.