New York/London: An attack on an Ebola clinic in Liberia’s capital city is complicating already strained efforts there to contain the virus’s spread.

The incident, in which patients suspected of having the disease mingled with the crowd, shows the complex nature of an outbreak that’s killed more than 1,100 people. Countries in the region are strengthening border security to limit the disease, and more airlines are discontinuing flights to some affected countries, further isolating them.

The actions come after a top official from Doctors Without Borders said it will take months to curb the outbreak, while the World Health Organization (WHO) said its running tally of Ebola cases and deaths underestimates the numbers medical workers are reporting.

Nigeria, with 12 confirmed Ebola cases so far, said it has placed almost 200 people under surveillance for the deadly disease, trying to limit an outbreak that’s killed more than 1,100 people in West Africa.

Nigeria is the fourth country where Ebola has been reported, following its spread in Guinea, Liberia and Sierra Leone. At least 2,100 people have been infected throughout West Africa, the WHO reported.

Upper hand

“We are not talking weeks; we’re talking about months to get an upper hand on the epidemic," Joanne Liu, international president of Doctors Without Borders, told reporters last week in Geneva.

Liu, whose organization has almost 700 health workers in Sierra Leone, Liberia and Guinea, said a turnaround may take six months and called for more help by global health groups. She said others need to step up to the plate in aiding the four countries battling the virus.

“It needs to happen now if we want to contain this epidemic," Liu said. “More health-care workers are needed to follow up on cases and educate the public about what the disease and the outbreak entails."

The UK has contributed $8.5 million to the disease fight, according to e-mailed statement from the UK foreign office. Japan extended a $1.5 million emergency grant to be used by the WHO and other global health agencies.

The WHO said in a statement that their staff members at the outbreak sites see evidence that the number of reported cases and deaths vastly underestimate the magnitude of the outbreak.

Food aid

The World Food Programme also said last week that 1 million people are likely to need food aid in Guinea, Liberia, and Sierra Leone, the countries hardest hit by the epidemic. “Food, including cooked meals, is being transported into the countries by truck," Steve Taravella, a spokesman, said in a telephone interview.

Guinea is among the countries strengthening security at its borders, aiming to control the flow of people from Liberia and Sierra Leone. “The country will deploy 42 added military doctors and 42 civilian doctors at crossings," Remy Lamah, Guinea’s minister of health, said in the capital of Conakry.

Kenya Air Lines Co. will suspend flights to Liberia and Sierra Leone effective 19 August, the airline said in an e-mail, citing the risk assessments by Kenya’s ministry of health and the WHO. The airline said it will continue flying to Nigeria and Ghana.

Air routes

Africa’s air routes are increasingly at risk as the Ebola virus prompts local carriers to avoid the worst-affected areas. Korean Air Lines Co. last week signalled a broader threat to the continent’s travel links as it halted services thousands of miles from the outbreak’s epicentre.

Airlines from Gambia, Togo and Nigeria have already stopped flying to the Ebola-hit states, while Korean Air will end operations to Kenya on 20 August.

“When you have long incubation periods it’s possible that someone would be exposed but not yet exhibiting symptoms and could travel unknowingly—aviation is a potential vector for this," said Robert Mann, president of aviation consultant R.W. Mann and Co. “Asian customers are especially conscious of personal security, which causes a drop in willingness travel."

Ebola, which can cause bleeding from the eyes, ears and nose, has killed as many as 90% of those infected in the past. In this outbreak more than 40% have survived. Researchers are speeding up their efforts to test experimental medicines and vaccines for the virus.

The WHO said it’s coordinating a massive scaling up of the international response, marshalling support from individual countries, disease control agencies, agencies within the United Nations system, and others.

International emergency

The WHO on 8 August declared the Ebola outbreak an international public health emergency. The US Centres for Disease Control and Prevention has added 50 public-health workers to its staff in the region.

There is no approved cure for Ebola. Normal treatment involves keeping patients hydrated, replacing lost blood and using antibiotics to fight infections. The hope is that a patient’s immune system will eventually fight off the virus’s aggressive attack.

Two American health workers infected with the virus in Liberia have received an experimental medicine from Mapp Biopharmaceutical Inc. and appear to be improving. Mapp’s antibody is one of several experimental treatments in development. A Nigerian citizen is being tested for Ebola in Spain after showing symptoms of the disease, the ministry of health said. Blood test results are expected on Monday.

Liberians treated

Three infected Liberian health workers received the Mapp drug at a hospital near Monrovia, the capital, according to Tolbert G. Nyenswah, an assistant minister of health and social welfare, the New York Times reported. Nyenswah didn’t say whether any of the three were doctors.

The Canadian government has said it will donate as many as 1,000 doses of a vaccine that could help protect medical workers as they fight Ebola in West Africa, though it may take at least a month as officials weigh whether it is safe.

The WHO warned in a statement that the public had unrealistic expectations of the experimental treatments.

While many efforts are under way to accelerate production, supplies will not be augmented for several months to come, the agency said. Even then, supplies will be too small to have a significant impact on the outbreak. Bloomberg

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