The PJ Tatler

Official Ebola Toll at 5,000 With Real Number Closer to 15,000

The World Health Organization (WHO) announced on Wednesday that the official death toll of Ebola cases around the world stood at 4877 as of October 19, with nearly 10,000 cases recorded.

But the WHO noted that the real death toll was at least 3 times higher.

The WHO has said real numbers of cases are believed to be much higher than reported: by a factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in Liberia, while the death rate is thought to be about 70 percent of all cases. That would suggest a toll of almost 15,000.

Liberia has been worst hit, with 4,665 recorded cases and 2,705 deaths, followed by Sierra Leone with 3,706 cases and 1,259 deaths. Guinea, where the outbreak originated, has had 1,540 cases and 904 deaths.

On Friday the WHO put the toll about 300 lower with more than 745 fewer cases.

In the past week, transmission of the disease was most intense in the capital cities of Monrovia and Freetown, while Guinea’s capital Conakry reported 18 confirmed cases, its second highest weekly total since the outbreak began.

Although Ebola has been contained in Nigeria and Senegal, the disease is spreading towards Ivory Coast in both Liberia and Guinea, including in Guinea’s Kankan district on a major trade route with Mali. Kankan saw its first case in the past week.

However, the WHO said the Liberian district of Lofa had seen a third consecutive week of decline in the number of cases, which reports from observers suggested was a result of disease control measures.

Among the thousands of cases are 443 health care workers, 244 of whom have died. The WHO said it was undertaking extensive investigations to determine why so many had caught the disease.

“Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care,” it said.

The reason for the vast difference between the official death toll and what is probably the real count is that more deaths are occurring in areas where there are fewer health care facilities than in population zones. That, and the lack of beds means that people are contracting the disease and being treated at home. Since authorities in Liberia, Sierra Leone, and Guinea are doing a poor job so far of tracking those who comes in contact with infected people, many of those patients will die with health authorities not being aware of the casualty.

The world got a late start in addressing the crisis, fell way behind, and now faces the daunting prospect of racing a deadline set by WHO of December 1:

A U.N. plan to stop the epidemic, known as 70-70-60, involves isolating at least 70 percent of cases and safely burying at least 70 percent of those who die by Dec. 1, a 60-day deadline from the start of the plan. That is supposed to rise to 100 percent by the 90-day deadline on Jan. 1.

The number of isolation beds had increased substantially to 1,126 but remained only 25 percent of the 4,388 expected to be needed in 50 Ebola treatment units. There were also firm commitments from foreign medical teams to staff only 30 units.

Without those beds in those units, families have to care for sick relatives at home and risk infection.

The WHO also estimates 28 laboratories are needed in the three worst-hit countries, with 12 now in place, and 20,000 staff will be needed to keep track of people who have had contact with Ebola patients and may be at risk.

The three worst-hit countries will also need 230 dead-body-management teams by Dec. 1, it said. They have 140.

Can the international community create this kind of massive medical and health infrastructure in a few weeks? It’s 40 days until December 1 and it doesn’t seem likely that any of those goals will be met. And now that the virus has spread to large cities like Monrovia and Freetown, it is likely that many more people will be exposed to the virus, straining the capability of these third world government to track them all.

Part of the reason some African countries like Nigeria and Senegal have been able to avoid large outbreaks was a determined public education program about the disease. But in desperately poor countries like Liberia and Sierra Leone, communications are poor and getting the word out to most of the population has proved to be a challenge.

And what information gets out to the people is not always welcome:

Even as Liberians fall ill and die of Ebola, more than half the beds in treatment centers in the capital remain empty, an unintended consequence of the government’s order that the bodies of all suspected Ebola victims in Monrovia be cremated.

Cremation violates Liberians’ values and cultural practices and the order has so disturbed people in the West African nation that the sick are often kept at home and, if they die, are secretly buried, increasing the risk of more infections

President Ellen Johnson Sirleaf issued the cremation decree for Monrovia and the surrounding area in August, and the government has brought in a crematorium and hired experts. The order came after people in neighborhoods of the capital resisted burials of hundreds of Ebola victims near their homes.

Since then, a recent analysis of space at Ebola treatment centers shows that of 742 beds available, more than half — 391 — were vacant, said Assistant Health Minister Tolbert Nyenswah, who heads the government’s Ebola response.

“For fear of cremation, do not stay home to die,” Nyenswah admonished Liberians at a news conference last week.

In her statement declaring the state of emergency and the cremation order, Sirleaf acknowledged the edict runs contrary to national tradition. “Ebola has attacked our way of life,” she said.

That way of life includes honoring deceased ancestors.

On the second Wednesday of March each year, Liberians flock to cemeteries to honor their deceased loved ones on a public holiday known as National Decoration Day, scrubbing the headstones of relatives, clearing away brush from graves and decorating them with flowers and other mementoes.

In many parts of Liberia, tradition has also called for relatives to handle the bodies of loved ones before burial. Bodies are kept in the home for days or weeks, during which time people honor their loved ones by dancing around the corpse, washing it and cutting and braiding the hair. Before burial, church congregations also pray over the body.

Since the latest outbreak of Ebola, these burial customs have been ordered halted when it comes to victims of the deadly virus because of the dangers they pose. The Ebola virus is spread through the body fluids of an infected person and can endure in corpses, posing a danger to those who handle them.

A million Ebola cases by the end of January, is what the WHO is saying unless they meet their goals. With that many infections, the math becomes grim, indeed, and the chances of the virus breaking out of Africa increase substantially.