2014 Goals for Ebola Treatment May Not Be Met, U.N. Health Officials Say

The New York Times
By Sheri Fink and Somini Sengupta
December 01, 2014

(Click here to view the original article.)

GENEVA — The World Health Organization expressed doubt on Monday about achieving important United Nations benchmarks in battling Ebola, saying the year-end goals of isolating and treating all patients and safely burying all the dead would be major challenges.

However, the W.H.O. said, significant progress has been made in reversing the upward trajectory of Ebola cases in many places across the three West African countries ravaged by the disease.

Among the biggest challenges now, the agency’s top official for the Ebola response said, is to track down every person potentially exposed. To do this, the organization plans to nearly double the number of its experts on the ground to assist 20,000 community health workers.

“To get to zero you have to find every case,” the official, Bruce Aylward, assistant director general for emergencies, told reporters at a briefing here.

The geography of Ebola has shifted, further complicating the efforts to eradicate it: For instance, in Guinea, Ebola is now thought to be in nearly twice as many districts as it was just two months ago, when the United Nations established a new mission to coordinate the international response. And in Sierra Leone, Ebola is ravaging the western part of the country, while only a handful of new cases are surfacing in previous hot spots.

“We need to move like a school of fish or a flock of birds,” said Dr. David Nabarro, the United Nations secretary general’s special envoy for the Ebola response, speaking by telephone from Monrovia, Liberia. “As the situation changes we all need to shift how we respond without a long lag period.”

Last week, the W.H.O. estimated, there were 1,100 new Ebola patients across the three countries most affected by the outbreak — Guinea, Liberia and Sierra Leone — slightly higher than the roughly 1,000 per week at the beginning of October.

But the number of new cases is not rising as fast as it was during the summer.

“We are no longer seeing exponential growth of this and in some areas we are seeing steep decline,” Dr. Aylward said.

How residents of the worst affected countries are burying their dead also has clearly changed, reflecting growing awareness that the corpses of Ebola victims are extremely infectious.

In all three countries, more than 70 percent of those known to have died from Ebola are buried safely — although, W.H.O. officials caution, there are certainly others who have not come to their attention. Sufficient numbers of safe-burial teams are now in place in the vast majority of areas, Dr. Aylward said. But he said a few unsafe burials could accelerate the contagion, sending the number of new cases skyrocketing again.

The reported death toll has so far reached nearly 6,000. The vast majority of deaths were in Guinea, Liberia and Sierra Leone. Ebola has most recently been reported in Mali, where six people have died.

As for meeting the United Nations’ interim treatment goal, Guinea and Liberia are believed to be treating more than 70 percent of known Ebola patients.

However, even as donors add treatment capacity, the virus is racing ahead in some places. And so, in Sierra Leone, the W.H.O. said it had not met the 70 percent treatment target set by the United Nations because Ebola is spreading fast in the west of the country, where sufficient treatment units have not yet opened. Even now, patients sometimes have to be transported over long distances and are dying in transit.

Dr. Aylward speculated that some Ebola victims were not coming forward over fears about the lack of treatment capacity near their homes.

The agency has found a significant survival advantage in early treatment: About 40 percent survive with the right care, compared to under 20 percent without.

The goal of treating all Ebola patients by the end of the year is crucial to ending transmission, but is unlikely to be met. “That’s a huge challenge,” Dr. Aylward said. “You may have to extend that out a bit.”

He said there was no room for optimism even though the caseload was no longer shooting up. “It’s about zero. We have got to get to zero.”

He added: “It all began with just one case.”

A funding shortfall also looms as a problem. Of the $1.55 billion the United Nations system needs to support its programs through next spring, only $920 million has come in.