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Have world leaders abandoned hope of stemming the continued spread of Ebola in Western Africa? Is the current strategy to let the virus burn itself out in that region, while officials focus efforts on containing Ebola’s geographic migration?
While this assessment may overstate the shifting tactics, there’s an unmistakable change in the strategy for confronting the unprecedented outbreak.
Efforts to stem continued spread in the three most heavily struck nations seem to be giving way to a strategy aimed at containing it within those regions. If this strategy continues to unfold, it will represent a historic failure of public health agencies to respond effectively to this evolving crisis. Having been slow to focus resources on this region, the shift may signal that they believe they’re too late.
This is an unmistakable impression created by the tactics being instituted in the three most heavily struck nations – Guinea, Liberia and Sierra Leone. Those nations are now confining people to the affected regions, restricting who can enter and leave. In the latest such move, this week the World Health Organization called on countries affected by Ebola to check people departing at international airports, seaports and major border crossings and stop any people with signs of illness from traveling.
These measures are prudent, but the travel restrictions follows a remarkable decision by the affected countries to send in their armies to cordon off entire regions that are hardest hit by the virus, restricting anyone from leaving those areas. Observers have noted that similar cordons haven’t been used for almost a century. The last time a large scale cordon was adopted was on the border of Poland and Russia in 1918, as part of an effort to stop a Typhus outbreak from spreading west.
As the New York Times reported, plans for the new cordon were hatched at an emergency meeting of a regional association of Guinea, Sierra Leone and Liberia. The plan is to isolate a triangular area where the three countries meet, separated only by porous borders, and where 70 percent of the known cases have been found.
Troops began closing internal roads in Liberia and Sierra Leone two weeks ago. In Sierra Leone, large sections of two of the hardest hit regions — the Kailahun and Kenema districts, an area the size of Jamaica — have been cut off by military roadblocks, according to the New York Times report and Agence France-Presse news service. Soldiers are being used to check the credentials and make medical assessments of those trying to go in or out of the region. In Liberia, similar restrictions have been imposed north of the capital, Monrovia.
As Laurie Garret recounts in an excellent piece in the New Republic, nearly all commercial flights to the cordoned off region have been cancelled, roads out to neighboring nations are blockaded, and “the continent is watching, praying the Ebola killing fields remain on Liberian, Sierra Leonian, and Guinean soils.”
Those cordons turned violent yesterday when trapped Liberians stormed barbed-wire barricades, trying to break out of a neighborhood that had been isolated by government troops as a result of the mounting epidemic in that area — an impoverished section of the capitol, Monrovia, that’s known as West Point.
While Ebola generally isn’t regarded has being highly contagious (catching it requires direct contact with the body fluids of a stricken patient) we’ve never had as large of an outbreak as this one. Moreover, we’ve never had an outbreak unfold in so many urban settings. In the past, outbreaks have been mostly in rural communities.
As a consequence, our existing models to predict how the virus will spread are probably unreliable when it comes to the current epidemic. In all likelihood, this outbreak will grow far worse before it is brought under control as more cases arise, and reporting of the existing cases start to catch up with the scope of the spread.
We should put a concerted effort behind the programs that might deliver an effective therapeutic. While most of these compounds are still in the early stages of development, a crash effort to prove out one of these drugs may be our best chance.
Indications are that the current efforts are shifting to military-led tactic of containment. This is a troubling turn in the strategy. The public health focus on identification, isolation, and treatment is being subordinated to cordons.
It may be a reflection of the practical truth that medical facilities have closed down and many providers either succumbed to the virus or vacated large areas, fearing its further spread. Whatever thin medical infrastructure existed are now in shambles.
More ominous, it may also suggest a worry among local officials that the epidemic, at least in parts of the affected West African region, may be out of control. If this were the conclusion, it would represent a historic failure of international public health organizations to treat this crisis in time enough to quell it, and save lives.
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