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Nations Intensify Efforts to Suppress Ebola Outbreak in West Africa Emergency Efforts in Africa to Contain Ebola as Toll Rises
(about 9 hours later)
ABUJA, Nigeria — West African leaders quickened the pace of emergency efforts on Thursday in response to a mounting tally of fatalities from the worst known outbreak of the deadly Ebola virus, canceling travel plans and authorizing measures to combat the disease including house-to-house searches and the deployment of the army and the police. ABUJA, Nigeria — As the death toll mounted from the worst outbreak of the Ebola virus, West African leaders quickened the pace of emergency efforts on Thursday, deploying soldiers and authorizing house-to-house searches for infected people in an effort to combat the disease.
The World Health Organization said the death toll had risen to 729 from 672, after 57 more people died during a four-day period between July 24 and 27 in Guinea, Liberia, Sierra Leone and Nigeria, Africa’s most populous nation. In the same period, 122 new cases were detected, bringing the total of confirmed and probably infected patients to 1,323. The toll is the highest in a single outbreak since the virus was identified almost four decades ago. International efforts to contain the virus also gained momentum and urgency. The World Health Organization announced a $100 million plan on Thursday to get more medical experts and supplies to the overwhelmed region, as the head of the Centers for Disease Control and Prevention in the United States committed the agency to sending 50 more experts there in coming weeks.
Federal health officials in the United States on Thursday advised Americans to avoid nonessential travel to the West African countries Guinea, Sierra Leone and Liberia because of the Ebola virus outbreak. The Centers for Disease Control and Prevention issued a “Level 3” warning, its most serious type of travel notice, indicating “high risk” to visitors in the affected countries. This kind of advisory is uncommon and reserved for grave situations: It has been used in the past for the outbreak of the highly contagious respiratory disease SARS, and for the earthquake in Haiti. First recognized in March in Guinea, the Ebola outbreak has surged through porous borders to invade neighboring countries, quickly outstripping fragile health systems and forcing health officials to fight the battle on many fronts. Past outbreaks have been more localized, but the current one has spread extensively over a vast region.
Desperate to contain the outbreak, President Ernest Bai Koroma of Sierra Leone declared a public health emergency calling for the deployment of security forces to quarantine the epicenters of infection. He also said he would not be making a planned visit to the United States. The stepped-up effort is long overdue, according to some analysts. They say the initial response was inadequate on both the national and international level and allowed the disease to mushroom from a local outbreak to an international threat.
His actions followed steps announced in Liberia to close schools, put nonessential government workers on compulsory leave for 30 days and order the deployment of security forces to combat the outbreak. The Peace Corps, an outreach program run by the United States government, said it was withdrawing its 340 volunteers from the three countries most affected by the virus. The viral illness has exacted a terrible toll, killing 729 people, including top physicians in Liberia and Sierra Leone, nations that already faced an acute shortage of doctors. The outbreak has also sickened two American aid workers, who were being rushed back to the United States for treatment.
“The epidemic is very big, very dispersed,” said Dr. Hilde de Clerck, the interim emergency coordinator in Sierra Leone for Doctors Without Borders. “It seems logical that the country is reacting. I do understand that the central government has to do something. Cases are now being reported in more southern regions. There is a geographical spread. We do see that it is several districts that are hit now.” “The whole thing has been very incompetently handled,” said Lansana Gberie, a historian from Sierra Leone. “If the government had quarantined this area” where the outbreak started, in the remote northeast, “they could have contained it. Instead they opened a treatment center in Kenema, a major population center.”
Nigeria recorded its only known death from Ebola when an American working in Liberia died there after landing in Lagos earlier this month. The airport authorities said on Thursday they had begun checking passengers arriving from the three main affected countries — Liberia, Sierra Leone and Guinea — for high temperatures, and would order compulsory blood tests for those with worrisome symptoms. Airport checks are also in force in Sierra Leone, and Ghana announced new screening procedures on Thursday. On PoliticoSL, a widely followed website in Sierra Leone, a journalist, Umaru Fofana, has written recently that “the country seems leaderless in the fight.” Now that cases have spread so widely, controlling the outbreak will be more costly and difficult.
In an address to the nation in Sierra Leone posted late Wednesday on the presidential website, Mr. Koroma said the emergency would “enable us take a more robust approach to deal with the Ebola outbreak.” Dr. Thomas R. Frieden, the director of the C.D.C., warned on Thursday that the worsening outbreak could take at least three to six months to bring under control, “even in a best-case scenario.” Hostility and violence directed at health workers are making the job harder, he said.
Mr. Koroma, who had been planning to attend a United States-Africa summit meeting in Washington, said that he would instead travel to Guinea on Friday to discuss a regional response to the outbreak. President Ellen Johnson Sirleaf of Liberia was also reported to have canceled her attendance at the gathering in Washington. President Alpha Condé of Guinea still plans to attend, a spokeswoman at the Guinea Embassy in Washington confirmed on Thursday. The C.D.C. advised Americans to avoid all nonessential travel to the three countries hardest hit by the virus: Guinea, Sierra Leone and Liberia. The agency issued a Level 3 travel warning, reserved for grave situations. It was also used for the outbreak of the highly contagious respiratory disease SARS.
“We need to tell everyone that the epidemic is here, it is happening, and it is serious,” said Amara Jambai, the director of prevention and control at the Sierra Leone Health Ministry. Dr. Frieden said that a major concern is that travelers who become ill or injured and need medical care may risk being exposed to Ebola at hospitals in the region. When infection-control measures are poor, hospitals become “amplification points,” spreading the disease they are supposed to contain, he said.
In the address, Mr. Koroma said security forces would be deployed to support health professionals and that “all epicenters of the disease will be quarantined” along with “localities and homes where the disease is identified.” The measures would remain in force for 60 to 90 days. The White House press secretary, Josh Earnest, said Thursday that the United States was considering a medical evacuation to bring home American aid workers diagnosed with Ebola. Two, infected in Liberia, were in grave condition, according to a statement on the website of a charitable organization, Samaritan’s Purse.
Public meetings will be restricted, houses will be searched for infected people, Parliament will be recalled and top officials will be obliged to cancel all but essential overseas travel. The measures also promised “active surveillance” to “trace and quarantine Ebola victims and suspects.” Emory University Hospital in Atlanta issued a statement on Thursday saying it had been told of plans to transfer a patient with Ebola to its special containment unit, set up in collaboration with the C.D.C., in the next several days. Because of privacy laws, the hospital declined to name the patient.
“The disease is beyond the scope of any one country, or community to defeat,” Mr. Koroma said. “Its social, economic, psychological and security implications require scaling up measures at international, national, interagency and community levels. Extraordinary challenges require extraordinary measures.” The W.H.O. said the tally of deaths from Ebola rose after 56 more people died during the four days ending Sunday in Guinea, Liberia and Sierra Leone. Nigeria had one fatality. In the same period, 122 new cases were detected, bringing the total of confirmed and suspected cases to 1,323.
He added: “Sierra Leone is in a great fight. We are a resilient people. And we must not fail. The sustainability of our actions for prosperity depends on winning this fight. Failure is not an option.” The virus causes high fever, vomiting, diarrhea and, in some cases, bleeding. In the current outbreak, about 60 percent of the cases have been fatal. It is transmitted by contact with bodily fluids from someone who is ill.
With reports of the disease spreading around the world and graphic images of people suffering, there was some concern that the disease could spread much farther afield, including to airports in Britain and elsewhere in Europe. There is no vaccine to prevent the illness, and no specific treatment for it, only care to try to nurse people through the worst of the fevers, bleeding and other symptoms. The only way to stop an outbreak is to isolate each infected patient, trace all their contacts, isolate the ones who get sick and repeat the process until, finally, there are no more cases.
Lucy Moreton, the head of the Immigration Service Union, which represents immigration staff in Britain, said there were concerns about how staff should react if they suspected that a traveler had been infected. “There is no health facility at the border, there is no containment facility and until extremely recently there has been no guidance issued to staff at all as to what they should do,” she said. President Ernest Bai Koroma of Sierra Leone declared a public health emergency. He said security forces would be deployed to support health professionals, and that “all epicenters of the disease will be quarantined” along with “localities and homes where the disease is identified.” The measures would be enforced for 60 to 90 days.
Governments, experts and international bodies sought to tamp down the worries. Public meetings will be restricted, houses will be searched for infected people, Parliament will be recalled and top officials will be obliged to cancel all but essential overseas travel.
Dr. Peter Piot, co-discoverer of the virus and the director of the London School of Hygiene and Tropical Medicine, said there was little risk. Liberia has announced steps to close schools, put nonessential government workers on compulsory leave for 30 days and order the deployment of security forces to combat the outbreak.
“Spreading in the population here, I’m not that worried about it,” he told Agence France-Presse. Nigeria recorded its only known death from Ebola when an American working in Liberia died there after flying into Lagos in late July. Fear of the disease is so great that courier companies have refused to transport a blood sample from the patient to a laboratory in Senegal for testing, according to the W.H.O.
“I wouldn’t be worried to sit next to someone with Ebola virus on the Tube as long as they don’t vomit on you or something,” he said, referring to London’s underground train system. “This is an infection that requires very close contact.” Nigerian airport authorities said on Thursday that they had begun checking passengers arriving from the affected countries for high temperatures, and would order compulsory blood tests for those with worrisome symptoms. Airport checks are also in force in Sierra Leone, and Ghana announced new screening procedures on Thursday.
The French minister of health, Marisol Touraine, offered a similar assessment in an interview with the daily newspaper Le Parisien on Thursday, saying the risk of importing the virus into Europe was low, and that no such case had been documented. Nevertheless, she called for extreme vigilance against an ailment she characterized as both “very serious” and “very contagious.” Mr. Koroma, the president of Sierra Leone, who had planned to attend a United States-Africa summit meeting in Washington, said that he would instead travel to Guinea on Friday to discuss a regional response to the outbreak. “The disease is beyond the scope of any one country, or community, to defeat,” he said.
In Geneva, the International Air Transport Association, which represents most of the world’s major airlines, also played down the hazards outside the affected region in West Africa, saying in a statement on Thursday that the World Health Organization had not recommended travel restrictions or border closures, and that the risk for travelers was low. As news of the Ebola outbreak has spread globally, there was some worry that the disease could spread beyond West Africa.
“In the rare event that a person infected with the Ebola virus was unknowingly transported by air, W.H.O. advises that the risks to other passengers are low,” the statement said. Lucy Moreton, the head of the Immigration Service Union, which represents immigration staff in Britain, said there were concerns about how staff members should react if they suspected a traveler had been infected. “There is no health facility at the border, there is no containment facility and until extremely recently, there has been no guidance issued to staff at all as to what they should do,” she said.
Ebola is spread only by people with severe symptoms that include vomiting, diarrhea, impaired kidney and liver function and finally internal and external bleeding, the statement said. “It is highly unlikely that someone suffering such symptoms would feel well enough to travel.” Governments, experts and international bodies sought to tamp down fears.
In a poignant episode, the university clinic in Hamburg-Eppendorf in Germany, which specializes in tropical viruses, said on Tuesday that it had been asked by the government of Sierra Leone to treat its leading doctor after he came down with the disease. In New York, Dr. Jay Varma, the deputy commissioner for disease control at the city’s health department, said that someone at an area airport with symptoms that could be from Ebola would immediately be isolated and tested, briefly quarantined at the airport and quickly taken to a hospital where the department has standing arrangements for just such an event.
Physicians prepared a special isolation station to receive the patient, who at the time was too weak to make the journey to Germany, the clinic said. Later that day, the chief medical officer in Sierra Leone was quoted by Reuters as saying the doctor, Sheik Umar Khan, had died of the virus. In Geneva, the International Air Transport Association, which represents most of the world’s major airlines, also played down the hazards outside West Africa, saying in a statement on Thursday that the W.H.O. had not recommended travel restrictions or border closings.