Thousands left to die as ebola went unchecked

Christopher Stokes, the general director of Médecins Sans Frontières, with a staff member of the non-governmental French organisation at Elwa hospital in Monrovia, Liberia.

Médecins Sans Frontières says its warnings that the ebola epidemic was spiralling out of control and that it could not respond were dismissed as alarmist, writes Misha Hussain

The slow international response to the West Africa ebola outbreak created an avoidable tragedy that cost thousands of lives, a leading medical charity said on the one year anniversary of the first confirmed case.

The world’s worst ebola epidemic has killed more than 10,200 people in the three most affected countries of Guinea, Liberia and Sierra Leone since March 2014, when it was first confirmed in the forest region of Guinea.

Médecins Sans Frontières (MSF), which raised the alarm over ebola, said in a report that everyone from national governments to the World Health Organisation (WHO) had created bottlenecks that prevented the epidemic being quickly snuffed out.

“The ebola outbreak has often been described as a perfect storm: A cross-border epidemic in countries with weak public health systems that had never seen ebola before,” Christopher Stokes, MSF’s general director, said in the report.

“Yet this is too convenient an explanation. For the ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”

In a scathing report titled ‘Pushed to the limit and beyond’, MSF said its warnings in June that the epidemic was out of control and that it could not respond on its own were dismissed as alarmist.

Guinea and Sierra Leone downplayed the epidemic and accused MSF of spreading fear and panic. In June, the Sierra Leone government told the WHO to report only lab-confirmed deaths — falsely reducing the death toll, the report said.

Kenema hospital in the southeast, where some of the first cases were reported in Sierra Leone, also withheld crucial epidemiological data, preventing MSF from identifying affected villages and responding, the report said.

“The Ministry of Health and the partners of Kenema hospital refused to share data or lists of contacts with us, so we were working in the dark while cases kept coming in,” MSF’s emergency co-ordinator in Sierra Leone, Anja Wolz, said in the report.

Liberia was transparent and asked for help almost on a daily basis. MSF, which reported this to the WHO in June, said the outbreak could have been halted if immediate action was taken, but these warnings were again ignored.

When MSF first declared there was an unprecedented ebola outbreak at the end of March, the WHO rejected the assessment. It finally declared a public health emergency on August 8, prompting a belated international response.

MSF branded the response a “global coalition for inaction” and said by the end of August, it had to turn away patients in Liberia, leaving many to die in their homes or on the streets.

“We had to make horrendous decisions about who we could let into the centre,” said MSF co-ordinator Rosa Crestani, who worked at the organisation’s ebola centre in Monrovia. It could only be opened for 30 minutes a day because of the demand for beds.

“We could only offer very basic palliative care and there were so many patients and so few staff that the staff had on average only one minute per patient. It was an indescribable horror.”

The number of ebola cases dropped dramatically over the new year in Sierra Leone, Liberia, and Guinea. The presidents of all three countries announced a target to reach zero ebola by mid-April. However, Guinea recently reported a doubling of cases in a month, Sierra Leone has a whole neighbourhood under quarantine and Liberia announced on Friday its first new case 16 days after its last ebola patient was released.

The ebola outbreak is not considered to be over until there are zero cases in the region for 42 days.

Tracking the fight against a deadly disease from 1976 to the present day

1976 — A school teacher in Zaire, now the Democratic Republic of Congo, becomes the first documented person to contract the ebola virus and later dies.

1976 to 2013 — A number of small outbreaks affect West Africa, with the highest death toll at one time reaching just over 250.

December 2013 — A handful of people in Guinea die of an unidentified fever, which is later confirmed as ebola.

March 2014 — The World Health Organisation (WHO) reports a major ebola outbreak in Guinea, while Liberia identifies its first case and over the next few months the virus spreads to neighbouring Sierra Leone.

July 20 — Liberian government employee Patrick Sawyer travels to Lagos, Nigeria, where he dies of ebola, sparking fears that the virus could cross wider borders.

August 8 — The WHO declares ebola an “international health emergency”. Four days later, the death toll exceeds 1,000.

August 24 — British volunteer nurse William Pooley, 29, is urgently flown to London for treatment after contracting the virus. He makes a full recovery and later returns to west Africa.

September 17 — The first healthy human volunteer is injected with an experimental ebola vaccine in Oxford as part of a fast-tracked British trial.

September 19 — The WHO describes the outbreak as a “social crisis, a humanitarian crisis, an economic crisis”, with cases doubling around every four weeks and a death toll of over 2,500.

October 6 — Spanish nurse Teresa Romero becomes the first person known to have caught the disease outside the outbreak zone in West Africa.

October 8 — Thomas Eric Duncan becomes the first person to die on US soil after supposedly contracted the disease in Liberia. Two nurses at the Texas hospital where he was treated are also infected.

October 9 — The British government announces screening for passengers arriving at Gatwick and Heathrowairports, and warns some Ebola cases will reach the UK.

October 17— David Cameron says Britain is “leading the way” in its efforts to tackle the outbreak, committing “well over £100m, 750 troops, training 800 members of health staff, providing 700 beds” to the region.

UN chief Ban Ki-moon launches another urgent appeal for funds as the death toll hits 4,500.

October 29 — The WHO says the rate of new infections in Liberia appears to be declining and could represent a genuine trend.

November 17 — Surgeon Martin Salia, who contracted ebola in his native Sierra Leone, dies after receiving aggressive treatment at a US hospital.

November 22 — The first NHS volunteers , including GPs, nurses, psychiatrists and emergency medicine consultants, leave for Sierra Leoneto join the fight against Ebola.

December 24 — The WHO says there have been 19,497 reported cases of ebola, with 7,588 reported deaths.

December 29 — The Scottish government announces that a female healthcare worker who returned from Sierra Leonehas been diagnosed with ebola in Glasgow. Save the Children confirms the woman had been working with the charity at the Ebola Treatment Centre at Kerry Town.

December 30 — Pauline Cafferkey, 39, is flown from Glasgow to the Royal Free Hospital in north London by RAF jet where her condition deteriorates over the next few days and becomes critical.

January 24, 2015 — Ms Cafferkey is discharged from hospital after making a full recovery.

January 29 — The WHO says the three worst affected countries —Guinea, Sierra Leone and Liberia — have reported fewer than 100 cases in the past week, for the first time since June. The death toll is at over 8,000.

January 31 — Public Health England (PHE) announces that a British military healthcare worker has been brought back to the UK for ebola monitoring following a needle-stick injury when treating a person in Sierra Leone. They are discharged some days later after testing negative for the virus.

February 2 — PHE announces that a second British military healthcare worker has been brought back to the UK for Ebola monitoring following a needle-stick injury in Sierra Leone. They are also later discharged after testing negative.

A trial of an ebola vaccine starts in the Liberian capital, Monrovia.

February 17 — PHE says a British healthcare worker has been brought back to the UK after being potentially exposed to ebola. They are later found not to have it.

February 20 — The WHO says it has approved a quick test for ebola that will dramatically cut the time it takes to determine with reasonable accuracy whether someone is infected.

February 25 — PHE says another British health worker has been brought back to the UK after potential exposure from a needle-stick injury. It is later confirmed that they do not have ebola.

February 27 — Development secretary Justine Greening says ebola could be eradicated from Sierra Leone within months. Speaking during a visit to the country, Ms Greening said Britain could be ”incredibly proud” of the efforts of staff from the NHS, the armed forces, the Department of International Development and Public Health England.

March 11 — PHE announces that a UK military healthcare worker has tested positive for ebola in Sierra Leone. Six other Britons are also brought back in the following days for tests but none have the disease.

March 12 — The WHO announces the death toll from the ebola epidemic has surpassed 10,000.

March 23 — A year is marked since the WHO received lab confirmation that ebola had broken out in Guinea.

More analysis and comment here

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