Ebola: not down and far from out

The news media has allowed reporting about the Ebola crisis in West Africa to die down to a dull background murmur, but things are still pretty bad over there.  The disease is now having a 'knock-on' effect across the entire health care sector.  The Telegraph reports:

Ebola is devastating Sierra Leone's health-care system, with a dozen medics and more than a hundred healthcare workers dead so far.

At the Princess Christian Maternity Hospital in Freetown, Ebola’s deadly legacy greets visitors the moment they walk in the doors. Occupying pride of place on the peeling lobby wall, in a spot where a portrait of the hospital’s founder might normally hang, is a picture of staff member, Samuel Batty. A caption above reads: “In loving memory of our beloved brother and colleague.”

Mr Batty died from Ebola on December 2 at the age of 37. He was one of about 110 health-care workers killed by the virus since it hit Sierra Leone last March. Yet when his colleague Amadou Jawara walks past the picture each day, he feels pride as much as sadness.

Like Mr Batty, Mr Jawara is not a doctor but a community health worker, and the pair were on a training programme to teach them how to deal with basic surgical operations and the complications of childbirth. In a country where the health service is patchy at the best of times, it helps for even the most junior health workers to be able to “act up” – and when Ebola hit Sierra Leone, that is just what Mr Batty and Mr Jawara found themselves doing.

“In November, the junior doctors in Sierra Leone went on strike for two weeks, saying it wasn’t safe enough for them to work, and wanting better protective equipment,” said Mr Jawara, 40. “During that time, those of us on the surgical training programme helped fill the gaps, but it was very tough work.”

Too tough, as it turned out, for Mr Batty. Quite how he contracted the virus remains unclear, but his colleagues believe it was on a particularly busy day in late November, when a pregnant woman came in with a mild fever. Mr Batty had no choice but to conduct the usual internal examinations, in the interests of her unborn child. “The woman died shortly afterwards [from Ebola], and by that time it was too late for Samuel,” said Mr Jawara.

As ever with Ebola, the tragedy did not end there. Mr Batty’s wife also died, meaning that his son (who also caught the virus but recovered) and four other children are now orphans. Mr Jawara also spent time in quarantine, fearing he had become infected, too. “The whole thing was terrible,” he said. “And Samuel was such a decent, gentle and hardworking man.”

Such tales can be heard these days in nearly any hospital in Sierra Leone. It is now the worst-infected of all the West African nations hit by the Ebola epidemic, with 3,145 of the 8,641 deaths recorded so far since this outbreak began in Guinea in December 2013.

. . .

The deaths of so many health workers – coupled with the ongoing reluctance of many others to return to work – has thrown a health service already crippled by civil war into an all-out crisis. Many of the country’s hospitals and clinics remain shut or are operating at a fraction of their normal capacity, meaning that people seeking routine A&E treatment, be it after a car crash, for malaria or just for severe diarrhoea, may die.

“We estimate there are 3.8 deaths from normally treatable diseases for every Ebola death,” says Adam Forrest, an NHS consultant gynaecologist with Plymouth Hospitals NHS Trust.

There's more at the link.

To make matters even more complicated, just as Ebola is merely the latest in a long line of viral hemorrhagic fevers in Africa (its genetic 'ancestors' include Lassa fever, Marburg virus, etc.), so it's now beginning to mutate into something different.  The BBC reports:

Scientists tracking the Ebola outbreak in Guinea say the virus has mutated.

Researchers at the Institut Pasteur in France, which first identified the outbreak last March, are investigating whether it could have become more contagious.

More than 22,000 people have been infected with Ebola and 8,795 have died in Guinea, Sierra Leone and Liberia.

Scientists are starting to analyse hundreds of blood samples from Ebola patients in Guinea.

They are tracking how the virus is changing and trying to establish whether it's able to jump more easily from person to person

"We know the virus is changing quite a lot," said human geneticist Dr Anavaj Sakuntabhai.

"That's important for diagnosing (new cases) and for treatment. We need to know how the virus (is changing) to keep up with our enemy."

It's not unusual for viruses to change over a period time. Ebola is an RNA virus - like HIV and influenza - which have a high rate of mutation. That makes the virus more able to adapt and raises the potential for it to become more contagious.

"We've now seen several cases that don't have any symptoms at all, asymptomatic cases," said Anavaj Sakuntabhai.

"These people may be the people who can spread the virus better, but we still don't know that yet. A virus can change itself to less deadly, but more contagious and that's something we are afraid of."

Again, more at the link.

An asymptomatic form of Ebola would be really, really scary.  All the precautions set up at entry points to most nations, and the initial assessment centers backing them up, focus on detecting the symptoms of the disease and responding to them.  If there are no symptoms, the entire screening process is at risk.  If an asymptomatic carrier of a new form of Ebola gets into a country, he or she could infect literally hundreds, if not thousands of people before the disease manifests itself in its final stages, just before it kills the carrier.

It looks like within a year or two, the 'Ebola' being treated in West Africa will not be the same 'Ebola' that we saw last year.  Will it bear the same name?  Who knows?  Those infected with it won't care, because they'll likely suffer just as badly.

Peter