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Two Ebola Outbreaks Put Health Workers Most at Risk

Global health officials are now rushing to put out two Ebola outbreaks – the West African epidemic and a new one in the Democratic Republic of Congo.
Image: A health worker prepares to examine patients for Ebola
A health worker prepares to examine patients for Ebola inside a screening tent at the Kenema Government Hospital in the Eastern Province of Sierra Leone, Aug. 11, 2014. Over the decades, Ebola cases have been confirmed in 10 African countries, including Congo where the disease was first reported in 1976. But until this year, Ebola had never come to West Africa. Michael Duff / AP

Global health officials are now rushing to put out two separate Ebola outbreaks — the giant West African epidemic that’s affecting four countries, and a possible new one in the Democratic Republic of Congo. In both, health workers are most at risk as they try to care for violently ill patients who may be vomiting and suffering diarrhea.

There’s not enough protective gear for any of them, and clinics are being overwhelmed with patients as soon as they open

One of the Liberian doctors given an experimental treatment called ZMapp has died, and the World Health Organization calls the risk to doctors, nurses and technicians unprecedented.

“To date, more than 240 health care workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died.” WHO says in its latest update. “Ebola has taken the lives of prominent doctors in Sierra Leone and Liberia, depriving these countries not only of experienced and dedicated medical care but also of inspiring national heroes.”

Ebola has killed 1,400 people out of 2,600 infected in the current outbreak. There are 14 cases in Nigeria, linked to a single traveler. It’s the worst outbreak of the virus ever seen, and is not anywhere near to being controlled, WHO says.

In fact, there may be many more cases than have been tallied.

"For example in Monrovia, Liberia’s capital, an Ebola treatment center with 20 beds, which opened last week, was immediately overwhelmed with more than 70 patients. This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system," WHO said.

“Ebola has taken the lives of prominent doctors in Sierra Leone and Liberia."

Ebola often looks like something else at first, especially malaria, which is not transmitted from one person to another. Doctors and nurses may not see the need to protect themselves until it's too late, WHO says.

“Some documented infections have occurred when unprotected doctors rushed to aid a waiting patient who was visibly very ill. This is the first instinct of most doctors and nurses: aid the ailing,” WHO said.

“In many cases, medical staff are at risk because no protective equipment is available – not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used.”

Two of the latest victims are British and Senegalese health workers, the Briton flown home for treatment over the weekend.

There’s a debate about the use of experimental treatments – two U.S. medical missionaries have recovered after being flown home for treatment and after getting ZMapp. California-based Mapp Biopharmaceutical provided the drug to Nancy Writebol and Dr. Kent Brantly, as well as to three Liberian doctors, exhausting its own supply.

But now one of the three doctors has died, Liberian Information Minister Lewis Brown said Monday. Dr. Abraham Borbor died on Sunday after initially seeming to do well, Brown said. Medical experts point out that there is no way to know if a new drug is helping people outside of a clinical trial, where all the various factors that affect recovery can be watched and accounted for.

“In many cases, medical staff are at risk because no protective equipment is available – not even gloves and face masks."

Nonetheless, Japan’s Chief Cabinet Secretary, Yoshihide Suga, told a news conference that his country would consider making a Japanese experimental flu drug available for use against Ebola under certain conditions.

The drug, called drug favipiravir, or T-705, has not even advanced in animal trials and has not yet been tested in people. "I am informed that medical professionals could make a request for T-705 in an emergency even before a decision (on approval) by the WHO. In that case, we would like to respond under certain criteria," Suga said, according to Reuters.

Dr. Ezekiel Emanuel, a bioethicist at the University of Pennsylvania, says even though WHO supports the use of experimental drugs and vaccines to fight Ebola outbreaks, other medical support is far more important.

“Now that the global response to the Ebola outbreak is picking up, the international community needs more focus on strengthening of health systems and infrastructure and less on experimental treatments,” Emanuel wrote in a commentary in the New England Journal of Medicine last week.

Doctors say getting quick, supportive treatment such as fluids and fever reducers can help save patients with Ebola.

U.S. Centers for Disease Control and Prevention director Dr. Tom Frieden is scheduled to visit Liberia, Guinea and Sierra Leone this week to see the outbreak first hand. CDC has sent nearly 70 scientists and staff to help organize the response to the outbreak. Doctors Without Borders (Medecins Sans Frontieres) is advertising for help but wants people experienced in fighting infectious diseases. And WHO has said it’ll cost $430 million to control the West African outbreak, Bloomberg news reports.

Officials in the Democratic Republic of Congo say as many as 13 people have died of Ebola in a separate outbreak there. The strain of Ebola is a different one from the strain affecting West Africa. WHO says it’s testing people but says other diseases that cause similar symptoms are also affecting people in the area. WHO has not confirmed any of the deaths in Democratic Republic of Congo’s latest outbreak are due to Ebola.