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WHO: Ebola case count could surpass 20,000 by November
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The WHO Ebola Response Team predicts the number of Ebola cases throughout Guinea, Liberia and Sierra Leone to exceed 20,000 by Nov. 2 if there are no changes in control measures for the outbreak, according to a report in The New England Journal of Medicine.
As of Monday, there have been 5,843 cases and 2,803 deaths from Ebola throughout the affected countries. The investigators estimated that the case counts are doubling every 15.7 days in Guinea, 23.6 days in Liberia and 30.2 days in Sierra Leone.
“Notwithstanding the geographic variation in case incidence within and among Guinea, Liberia and Sierra Leone, the current epidemiologic outlook is bleak,” the investigators wrote. “Forward projections suggest that unless control measures — including improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement and support from international partners — improve quickly, these three countries will soon be reporting thousands of cases and death each week, projections that are similar to those of the CDC.”
In a similar analysis, a CDC Ebola Response model that corrected for underreporting suggested that if these trends continue, the case count could reach 1.4 million by Jan. 20 in Liberia in Sierra Leone, according to a report in MMWR. But if 70% of the patients are placed in Ebola treatment centers (ETUs) or other settings with reduced risk for disease transmission by late December, the epidemic would instead almost end by Jan. 20.
“If conditions continue without scale-up of interventions, cases will continue to double approximately every 20 days,” the CDC investigators wrote. “However, the findings also indicate that the epidemic can be controlled. Ensuring that approximately 70% of the patients are in ETUs is necessary, or, when ETUs are at capacity, that they are at home or in a community setting such that there is a reduced risk for disease transmission (including safe burial when needed).”
CDC Director Thomas Frieden, MD, MPH, said in a statement that the estimates published in MMWR are based on data from August, before significant increases in efforts to improve treatment and isolation, including actions planned since August by the United States and other countries.
Thomas Frieden
“We anticipate that these actions will slow the spread of the epidemic,” Frieden said. “This model shows that there are severe costs of delay, the need for increased resources and immediate and ongoing action by the international community. It is still possible to reverse the epidemic and we believe this can be done if a sufficient number of all patients are effectively isolated. Once a sufficient number of Ebola patients are isolated, cases will decline very rapidly — almost as rapidly as they rose.”
In an editorial accompanying the NEJM paper by the WHO Ebola Response Team, Jeremy J. Farrar, MD, PhD, professor of tropical medicine and global health at the University of Oxford, and Peter Piot, MD, PhD, director of the London School of Hygiene and Tropical Medicine, wrote that this epidemic “has evolved into a major humanitarian crisis that has finally mobilized the world.”
They said the outbreak highlights three transformations needed when approaching rapidly emerging public health emergencies: certain conditions can cause a limited outbreak to become an uncontrollable epidemic; the current control efforts are not sufficient for epidemics of this size; and the development of diagnostic tools, therapies and vaccines need to be prioritized and have an approved, ethical mechanism for accelerating development when epidemics arise.
“There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections,” Farrar and Piot wrote. “Yet, our response to such events remains slow, cumbersome, poorly funded, conservative and ill prepared. We have been very lucky with SARS, H5N1 and H1N1 influenza, and possibly MERS coronavirus, but this Ebola epidemic shows what can happen when luck escapes us. With a different pathogen and a different transmission route, a similar crisis could strike in New York, Geneva and Beijing as easily as this one has in West Africa.”
For more information:
Farrar J. N Engl J Med. 2014;doi:10.1056/NEJMe1411471.
WHO Ebola Response Team. N Engl J Med. 2014;doi:10.1056/NEJMoa1411100.