Expert analysis of west Africa's response to Ebola outbreak
Liberia's President Ellen Johnson Sirleaf has announced the closure of most of the country's land borders as her government struggles to contain an outbreak of the deadly Ebola virus. Sirleaf said late on Sunday night that Monrovia's international airport, a provincial airport and three major border crossings will be exempt from the closure, but at these entry points testing centres will be established. There have been 127 deaths from Ebola in Liberia and at least 660 people across the region have died from the outbreak. Ebola is highly contagious with symptoms include vomiting and diarrhoea as well as internal and external bleeding. RFI spoke to David Heymann, a leading expert on infectious diseases at the London School of Hygiene and Tropical Medicine.
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Liberia has closed most of the country’s borders and introduced so-called stringent medical checks at airports and major trade routes. Is this enough to stop this Ebola outbreak from spreading?
Borders can never stop an infectious disease from spreading. It can help, it can be a measure which helps. But people can cross borders in the incubation period, or when they aren’t really extremely ill and they can then go on to another country and take a disease with them. Most important is not border control as much as understanding which countries are at risk, those countries must then let their hospital staff understand the importance of isolation if a patient comes from an area where there’s Ebola. Also communities must understand how to deal with cases.
The Nigerian carrier Arik Air has said that it is going to stop flights to and from Liberia and Sierra Leone. This isn’t really a major concern of yours, this way of spreading the virus?
The virus can spread in many different ways, it can cross borders in people who are sick, in people who are not sick, but in the incubation period and then it can cause an outbreak on the other side of the border. The most important public health measure is systems to detect and then respond if a person comes in from an area where there’s Ebola and develops a fever and illness.
The death rate from this Ebola outbreak in West Africa is around 60 per cent. It has previously been recorded as 90 per cent. Why is there this discrepancy in the number of people dying from this particular outbreak?
There are several different Ebola viruses, there’s not just one. Each one has a different fatality rate associated with it. Some are as low as 50 per cent and others up to 90 per cent. It also depends on how patients are managed. Whether or not they’re managed well enough to survive the serious illness and then go on and recover. So they’re different virus strains of Ebola, different virulence with the strains and also different ways in which patients are managed, that all count towards the mortality.
How concerned are you about public panic at this point? For example, in Sierra Leone a family forcibly took a woman from hospital.
It is very concerning if communities don’t understand the importance of isolating patients and of keeping away from patients who have a disease which might be Ebola. This is a job for the community, volunteers, the Red Cross, others to do, to help communities understand the importance of Ebola. At the same time it’s the responsibility of health centres if patients do return home, to make sure that they go home and help the family understand the dangers and also the risks.
There’s currently no vaccine for Ebola. But there may be in the future. Is that true?
That’s correct, there’s a vaccine which has been studied in animals but not yet in humans. The vaccine has been shown to be effective in animal protection.
The government in Liberia has also banned public gatherings, including events and demonstrations. How significant is this in ensuring that the outbreak is contained?
This makes good sense in epidemiology and containing an outbreak. To make sure that there are no gatherings of people where the disease could be spread from person to person. Fortunately, Ebola does not spread through the air. It spreads only by body secretions, blood and vomit. Things that come from the human body, not through the air, but directly.
The health care systems in Liberia, Sierra Leone and Guinea are stretched at the best of times. How important is it that they continue to get support from organisations like the World Health Organisation and Doctors Without Borders?
It’s very important that the international community respond with the country to outbreaks such as this, if the country requests. So if the country feels that they need international support, it should be made available to them.
Do you have a concern that this could spread beyond west Africa to Europe, to America, to Asia?
There have been importations of Ebola to hospitals in South Africa and also to a hospital in Switzerland. The hospitals didn’t know what the cause of the illness was, that they didn’t have a diagnosis, so they isolated the patients. Then they made sure that the health workers were protected and in Switzerland there was no further spread. The diagnosis was made after, well after the patient was admitted to hospital. In South Africa, there was one intensivist who was infected, but the rest of the hospital staff were not. So there are measures that can prevent infection and they must be implemented when a disease starts to travel, whether it’s to another African country, to Europe or to North America.
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