C.D.C. Head Says Fight on Ebola Will Be Long

http://www.nytimes.com/2014/12/23/world/africa/cdc-head-says-fight-on-ebola-will-be-long.html

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There are reasons for both hope and continued worry about the Ebola epidemic in West Africa, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said on Monday.

Just back from a weeklong trip to the affected countries — Guinea, Liberia and Sierra Leone — Dr. Frieden said at a news conference, “I’m hopeful about stopping the epidemic, but I remain realistic that this is going to be a long, hard fight.”

The World Health Organization on Monday reported 19,340 Ebola cases, including 7,518 deaths in West Africa. Sierra Leone had the most cases, 8,939; Liberia had 7,830 and Guinea 2,571.

On the hopeful side, Dr. Frieden said he had visited a remote part of Guinea, where just a few months ago there was no treatment center and where resistance to visiting health workers had been intense. Now there is a center, established by the French Red Cross, with acceptance by the community, good care and patients surviving, Dr. Frieden said.

On the other hand, he said, he was alarmed to hear that on a recent day in Conakry, Guinea’s capital, there were not enough beds for all the patients who needed them. Leaving infected people in the community can lead to exponential spread of the disease, Dr. Frieden said, adding, “That’s what Conakry is at risk of.”

He said he had met with Guinea’s president, Alpha Condé, who told him that the country was working hard to open more treatment units in Conakry.

Dr. Frieden said he was also dismayed to hear about a nurse at Donka Hospital in Conakry, Guinea’s largest hospital, who contracted Ebola after starting an intravenous line on a patient who turned out to be infected. Even though it was six months into the epidemic, the nurse had failed to put on gloves.

Sierra Leone has also been struggling, Dr. Frieden said, noting that many health workers at Connaught Hospital in the capital, Freetown, have died of Ebola and that the hospital is still “largely closed.” At least 10 people a day have been dying in the surrounding community, sometimes at the hospital entrance.

But he said efforts to fight the disease in Freetown were being scaled up, and cases should decrease significantly in the next few weeks.

Of the three countries, Liberia is in the best shape, Dr. Frieden said, adding that cases had decreased quickly there.

“As of today, Liberia has the upper hand against the virus,” he said. One important step, he said, was the opening of a new cemetery for people who died of Ebola. Earlier insistence on cremation had backfired because the culture frowned on it; families resorted to secret burials, which led to infections in relatives who handled the bodies. Corpses are highly infectious.

But problems remain. For instance, Dr. Frieden said, some people in Monrovia, the capital, think treatment centers outside the city provide better care and take long taxi rides to those clinics, potentially infecting the drivers and making it harder to trace their contacts.

The epidemic will not end, he said, until every contact is traced and every chain of transmission broken.