More than 60 healthcare workers have died from Ebola while treating infected patients, including leading doctors such as Dr. Sheik Humarr Khan in Sierra Leone and Dr. Samuel Brisbane in Liberia. Several health facilities in Liberia have closed because staffers refused to work out of fear of contracting the virus and patients refused to go there.
Healthcare workers—many of whom are poorly paid and equipped and inadequately trained in preventing and treating Ebola—sometimes are providing care without the heavy biohazard suits needed to protect against infection. Under the stress, some doctors and nurses are becoming lax in their precautionary measures, observers say.
Some predict these countries' healthcare systems, which were limited in staffing and resources even before the outbreak, could be particularly damaged. “They have very, very little, and yet folks are tremendously committed and work incredibly hard and have high hopes—and so to have this come along and decimate all of the rebuilding efforts since the war ended, it's just a tragedy,” said Dr. Keegan Checkett, assistant professor of medicine at University of Chicago Medicine.
Much of the health infrastructure in these countries was damaged during the long, armed conflicts of the 1990s, when civil wars in Sierra Leone and Liberia spilled over into Guinea, leaving all three nations in economic ruin.
On July 31, the WHO announced the launch of a $100 million effort aimed at containing the spread of the virus. The Centers for Disease Control and Prevention said it plans to deploy 50 experts to West Africa over the next few weeks to set up emergency operations centers, strengthen testing capabilities for quicker detection of the disease, and help track the epidemic. CDC experts also will help the affected countries with airport screening, medical consultation, and testing people suspected of being infected. But it remains to be seen whether such efforts will be sufficient.
“If you just look at the numbers, this outbreak is not slowing down,” said Dr. Nicole Iovine, associate hospital epidemiologist at UF Health Shands Hospital, Gainesville, Fla. “We don't have any evidence that the number of new infections is decreasing, so that would suggest that right now it's not under control.”
“One of the things that's occurring now is this hysteria that's increasing the outbreak,” said Dr. Babafemi Taiwo, a professor of infectious disease medicine at Northwestern University's Feinberg School of Medicine.
A shortage of trained personnel coupled with the prospect of the disease spreading to densely populated urban areas could overwhelm health systems throughout the region, Taiwo said.
Since there is no effective treatment for Ebola, health workers can only treat the symptoms by keeping patients hydrated, managing their pain, and treating subsequent infections and conditions that occur as a result of the virus, such as bleeding from the eyes, ears and nose. Under the best of conditions, a patient's chance of survival is about 50%. The shortage of staffing and resources in the affected countries means that optimal treatment of patients' symptoms often is not occurring, reducing their odds of survival.
“The big thing that determines, to a large extent, whether someone lives or dies is whether or not they are able to get supportive care,” Iovine said.
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