The World Health Organization (WHO) has recorded that as at December 18, Liberia’s Ebola death toll has reached a reported figure of 3,376, making it the highest recorded death yet from the disease.
WHO yesterday said 19,340 infections have now been reported, including 7,518 deaths. Sierra Leone has had the highest number of cases since early December, which is at 8,939 as of Dec 20. However, Liberia has the highest number of deaths, of which 3,376 have been reported as of Dec 18.
Following his meeting with President Ellen Johnson Sirleaf recently, the United States Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, has given his impression to US journalists about his second tour of all three of the hardest-hit Ebola outbreak countries.
Dr. Friedensaid yesterday that sobering challenges remain in the response but that real progress and momentum have occurred in the region since his last visit in August and September.
Frieden's assessment comes on the heels of another high-profile tour of the outbreak region, that of United Nations (UN) Secretary-General Ban Ki-moon, who warned the global community against complacency in the Ebola battle, which has seen some progress, especially in many parts of Liberia.
Country-specific observations, lessons
At a media telebriefing, Frieden stated that Liberia presently has the upper hand over the disease, "but that's as of today," Frieden said. He indicated that the situation can change quickly and that complacency is another challenge the outbreak region faces in the weeks ahead.
He spoke of a mixed picture of what he observed in Guinea, from an encouraging drop in Ebola cases in a rural areas where response teams had originally faced community resistance, to deep worries about a lack of isolation beds in Conakry, the country's capital. He said a lack of beds raises the risk of people sick with Ebola remaining in the community, the key factor that fuels chains of transmission.
Regarding Sierra Leone, Frieden said that although high levels of disease in Freetown are a major concern, health officials are hoping the heightened response level there and in the western part of the country will mirror progress seen in another urban Ebola setting—Monrovia in Liberia. In describing the Ebola battle in Sierra Leone, he said the situation is more like trying to manage many brush fires than a forest fire.
On the positive side in Sierra Leone, safe burial teams have made some headway, using an approach that is culturally sensitive and involves family, he added. Despite Sierra Leone's surge in cases over the past several weeks, the country has an impressive and well-organized command center staffed by British officials, the country's health ministry, and other partners, he said.
One worrying indication he saw in Monrovia was a belief by some that the urban Ebola treatment centers aren't safe, driving certain individuals to seek care in other districts, which can spread the disease and complicate contact tracing as people hire taxis or use other transportation to carry sick family members out of the capital. On the positive side, a new cemetery is opening in Monrovia, which should ease the need to cremate Ebola victims, a practice that goes against cultural practices and that health officials think may have led to clandestine burials, which are known to spread the disease.
Frieden shared several examples of outbreak responders transforming grim situations into hopeful ones, such as a social worker in Sierra Leone who lost both of his parents to Ebola but is now caring for children orphaned by the disease, and of now-idled gravediggers in Liberia who have started making furniture for Ebola survivors. He said health officials in all three of the countries are eager to learn how to manage the disease themselves and that he's encouraged by support and epidemiology expertise coming from the African Union.
The next phase of the response is to break the cycle of exponential growth, trace each chain of transmission, and strengthen health systems in areas that are free of Ebola, Frieden said. He said it's impossible to project when the outbreak will be extinguished but that Congress's recent passage of Obama's Ebola response spending request in the overall budget legislation will help the CDC do more to help the countries track cases and respond quickly to new infections.
Frieden said experiences battling Ebola in each country are yielding important lessons for the others. For example, Liberia has had success with the RITE (Rapid Isolation and Treatment of Ebola) strategy for addressing hot spots, an approach that could be implemented in Guinea and Sierra Leone. Meanwhile, sensitivity on the part of burial teams in Sierra Leone can be employed elsewhere to support safe burial goals. He added that all three countries, but especially Guinea, need infection control improvements.