MatauAdvisory – Ebola-(20150209)  Update Epidemic in Decline

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Strong support by international aid has resulted in a dramatic retreat of the epidemic in West Africa. Aid agencies are down-sizing some facilities. Notwithstanding the strong improvement in conditions the disease has not been eradicated and there remains a strong threat of further escalation of the epidemic if not rigorously pursued. New small scale flare-ups are still being reported in the three West African countries (Liberia, Sierra Leone and Guinea). Focus is moving to identifying potential cases. Meanwhile schools are now re-opening in locations in West Africa, a positive sign.

Description

  • Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans, with a Case Fatality Rate (CFR) of 50% to 90%. It is highly contagious and there is no established cure. However parameters for effective containment were identified in 1976.
  • Despite the high CFR in Liberia, Sierra Leone and Guinea, the numbers of cases have declined rapidly since our last report (26 Sep 14). This is a major and positive achievement. In September, it was estimated by WHO that it may take 6-9 months to bring the epidemic under control.
  • Treatment of patients has been comprised primarily of isolation and support, coupled with rehydration of fluids with particular attention to electrolytes. Because of the urgency of the epidemic, experimental drugs are being trialled (without the usual rigorous testing protocols required for certification). This is ongoing, in the many locations, including new ones, that the disease is being identified.
  • The current Ebola outbreak began in Guinea in March 2014, and spread to Sierra Leone and Liberia where its incidence was, for a period, uncontrolled and widespread, resulting in a CFR of about 60%. The epidemic was largely confined to those three countries. Isolated cases in Senegal, Mali and Nigeria were localised and swiftly contained by the respective health authorities.
  • The 2014 outbreak was the first to encroach major population centres, the earlier outbreaks tending to be in relatively remote locations near jungle. WHO has declared this an International Public Health Emergency (IPHE).
  • The disease is actively spreading within the countries immediately bordering Mali and Cote d’Ivoire, however no cases have been declared by these two countries as yet.
  • While it registered the first case in the 2014 outbreak, Guinea has dealt with the outbreak in a more orderly way, without the same issues being seen in Sierra Leone and Liberia. This had much to do with structural, government, and cultural differences between the countries.
  • Many borders against the countries with Ebola virus outbreaks have been closed to traffic and many commercial flights cancelled. Most nations isolate and screen passengers who have travelled from an outbreak area.
  • Isolation / quarantine is one of the key methods of limiting spread of this disease, but there is a real risk that the complete quarantine of infected regions may inhibit vital support responses reaching areas in need.
  • Companies with operations in the region have generally adopted and are actively implementing, four-stage Disease Outbreak Management Plans. These processes assess, and act on, the seriousness of the outbreak and the probability of it reaching or materially impacting company operations and or logistics of the operation(s). Most (mining) company operations are not locations that sick people would seek out for assistance, nor are most operations in or near major population centres. The recent downturn in incidence of new cases will be welcomed.
  •  Containment, control, and ultimately a cure for this disease must continue to be a top priority for every government, company and organisation around the world. The focus is moving beyond treatment, to identify and monitor all potential contacts made by new cases that could become the next cases, in order to “end the epidemic”

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