Friday, August 29, 2014

Africa: " Count the hours 'til dawn and bring out your dead "

The World Health Organization ( WHO ) advises

WHO issues roadmap to scale up international response to the Ebola outbreak in west Africa

                                                            Colorised transmission electron micrograph (TEM) of ebola virus 

The aim is to stop ongoing Ebola transmission worldwide within 6–9 months, while rapidly managing the consequences of any further international spread. It also recognizes the need to address, in parallel, the outbreak’s broader socioeconomic impact.

It responds to the urgent need to dramatically scale up the international response. Nearly 40% of the total number of reported cases have occurred within the past three weeks.

Interestingly this report gilds the lily but the roadmap pulls no punches. 

" This Roadmap assumes that in many areas of intense transmission the actual number of cases may 
be 2-4 fold higher than that currently reported. It acknowledges that the aggregate case load of EVD 

could exceed 20,000 over the course of this emergency. "

The roadmap was informed by comments received from a large number of partners, including health officials in the affected countries, the African Union, development banks, other UN agencies, Médecins Sans Frontières (MSF), and countries providing direct financial support.

It will serve as a framework for updating detailed operational plans. Priority is being given to needs for treatment and management centres, social mobilization, and safe burials. These plans will be based on site-specific data that are being set out in regular situation reports, which will begin this week.

It should be a useful tool. But its utility will be compromised I would suggest to the point of being useless if the scale of underreporting continues. The count to date is cases have risen to 3,069, with 1,552 deaths, that may of course be just the tip of the iceberg. 

The situation reports map the hotspots and hot zones, present epidemiological data showing how the outbreak is evolving over time, and communicate what is known about the location of treatment facilities and laboratories, together with data needed to support other elements of the roadmap.

The New York Times points out one logistical problem:

" Mr. Aylward, picking out details of the road map, said it would take at least 750 international and 12,000 local health workers. 

“That is very difficult in the current environment,” he added, alluding to fears arising from the high number of medical workers — 250 as of Monday — who had contracted the disease. Recruiting international staff may be harder than finding local personnel, he added, debunking the notion that locals were running away from the crisis.

Health workers were getting infected because they were exhausted from working extraordinary hours, Mr. Aylward said. "

The roadmap covers the health dimensions of the international response. These dimensions include key potential bottlenecks requiring international coordination, such as the supply of personal protective equipment, disinfectants, and body bags.

The WHO roadmap will be complemented by the development of a separate UN-wide operational platform that brings in the skills and capacities of other agencies, including assets in the areas of logistics and transportation. The UN-wide platform aims to facilitate the delivery of essential services, such as food and other provisions, water supply and sanitation, and primary health care.

This situation was entirely predictable ( and predicted ) yet only now is the International Community starting to get a grip on it. Obviously it will get worse before it starts to improve but now is the critical time. If we screw up now the consequences will be horrendous.

" That is very good news isolation is the key to beating this. If it gets to a major city or population area well it doesn't bear thinking about. But one day it will. "

Resource flows to implement the roadmap will be tracked separately, with support from the World Bank.

As I observed nearly two years ago $2 million was chicken feed, I have no idea what this epidemic will cost but it is irrelevant, the lowest price tag I have seen is in the region of half a billion dollars and I very much doubt it will be that low. 

"If nothing is done now, the disease will reach other places, and even major towns will be threatened," he said, adding that an estimated $US2 million had to be urgently found to pay for measures to tackle the disease.


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