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Ebola Virus Disease EVD • Reveals basic health inequalities, now is time to respond, Ebola Virus Disease EVD • Reveals basic health inequalities, now is time to respond, build

October 4, 2014 “Our people are dying, children are being orphaned, most of the October 4, 2014 “Our people are dying, children are being orphaned, most of the dead are women. Over 2/3 of those infected belong to the economically active age of 15 to 50. Children do not go to school; farmers are being felled in the food production and commercial crop centers of the land; doctors and nurses are dying, non-Ebola illnesses are adding to the toll of death and suffering due to further strains and weakening of the healthcare delivery system in the country. The existence of my country is at stake; the future of our region is in peril. By the time I get home from this meeting, there would be over 50 new cases of my people contracting the disease, and based on case fatality rates, more than half of them may die. “ -Statement by his excellency Dr Ernest Bai Kormoa, President of Sierra Leone, October 2014

October 4, 2014 Sierra Leone urgently needs the support of people to combat this October 4, 2014 Sierra Leone urgently needs the support of people to combat this virus; without you we cannot succeed, without your quick response, a tragedy unforeseen in modern times would threaten the wellbeing and compromise the security of people everywhere.

1976 What is Ebola is one of the world’s most deadly diseases. It is 1976 What is Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 per cent of the people who catch it, causing terror among affected communities. “Now I fear an unimaginable tragedy. ” Dr. Peter Piot who first identified it in the DRC in 1976.

This outbreak March 2014 • MSF was in Guinea when the outbreak began. A This outbreak March 2014 • MSF was in Guinea when the outbreak began. A Swiss team doing malaria control near the borders with Liberia and Sierra Leone, got a letter from Guinea’s Ministry of Health on March 12 detailing an illness that struck eight people, including a doctor who died after caring for a patient from Gueckedou.

How is it transmitted • In some areas of Africa, infection has been connected How is it transmitted • In some areas of Africa, infection has been connected to handling infected animals such as chimpanzees, fruit bats, monkeys, forest antelope found dead or ill in the rainforest. • It is not an airborne disease. • Human-to-human transmission occurs through close contact with blood, secretions or other bodily fluids from an Ebola-infected person.

Transmission • Direct contact with dead bodies is main way Ebola is transmitted. Funerals Transmission • Direct contact with dead bodies is main way Ebola is transmitted. Funerals are a significant practice in communities affected by this outbreak. In last hours before death, the virus becomes extremely infectious and the risk of transmission from the dead body is much higher. Ensuring safe burials crucial for managing an outbreak • Healthcare workers have been infected while treating patients through close contact with them while not using gloves, masks or protective goggles.

nurse Lucie Peradel checks her goggles, and essential part of the protective gear, Guinea nurse Lucie Peradel checks her goggles, and essential part of the protective gear, Guinea 2014, MSF

Symptoms • In the early stages of infection, symptoms are nonspecific, making Ebola difficult Symptoms • In the early stages of infection, symptoms are nonspecific, making Ebola difficult to diagnose. The disease is often characterized by the sudden onset of fever, weakness, muscle pain, headaches and a sore throat. Can be followed by vomiting, diarrhea, rashes, impaired kidney and liver function, and hemorrhagic symptoms such as nosebleeds, bloody vomit, bloody diarrhea, internal bleeding and conjunctivitis. • hemorrhagic symptoms seen in less than 50 % of cases.

How treat? Supportive care • no specific treatment or vaccine available is proven effective How treat? Supportive care • no specific treatment or vaccine available is proven effective in humans and is registered for use in patients. Experimental drugs and vaccines are being considered for use in accelerated clinical trials. • Standard treatment is supportive therapy: hydrating patient, maintaining oxygen status and blood pressure, high quality nutrition, treating with antibiotics for complicating infections. Supportive treatment helps a patient survive longer, extra time may be what patient’s own immune system needs to start fighting the virus. • Once a patient recovers from Ebola, he or she is immune to the strain of the virus contracted.

beyond humanitarian • MSF calls for help June 23, 2014 “The epidemic is out beyond humanitarian • MSF calls for help June 23, 2014 “The epidemic is out of control. We have reached our limits. ” • MSF at Security Council requests military Sept 16, 2014 calls UN members to dispatch (civil and military) disaster response teams, backed by the full weight of logistical capabilities. “The response remains totally, and lethally, inadequate, ” Dr. Joanne Liu

October 4, 2014 Peter Piot • This isn't just an epidemic any more. This October 4, 2014 Peter Piot • This isn't just an epidemic any more. This is a humanitarian catastrophe. We don't just need care personnel, but also logistics experts, trucks, jeeps and foodstuffs. Such an epidemic can destabilise entire regions.

Peter Piot on why did WHO react late? On the one hand, it was Peter Piot on why did WHO react late? On the one hand, it was because their African regional office isn't staffed with the most capable people but with political appointees. And the headquarters in Geneva suffered large budget cuts that had been agreed to by member states. The department for haemorrhagic fever and the one responsible for the management of epidemic emergencies were hit hard. But since August WHO has regained a leadership role. (Guardian)

Washington Post Oct 4, 2014 Washington Post Oct 4, 2014

September 2014 Critical gaps • MSF teams in West Africa note critical gaps in September 2014 Critical gaps • MSF teams in West Africa note critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilization.

Mamadee, 11, was admitted to MSF's Ebola management centre in Foya, Liberia on 15 Mamadee, 11, was admitted to MSF's Ebola management centre in Foya, Liberia on 15 August 2014. He tested positive for Ebola, but recovered, and was discharged on 4 September 2014.

 workers spray disinfectant inside a taxi after a man arrived at the treatment workers spray disinfectant inside a taxi after a man arrived at the treatment facility in the back seat on Sept. 13 in Monrovia. The man showed symptoms of Ebola.

House-to-house leafleting, messages on local radio stations, enlisting “Nollywood” stars to deliver messages. Doing House-to-house leafleting, messages on local radio stations, enlisting “Nollywood” stars to deliver messages. Doing the Ebola no-hands-greeting with well known Nollywood leading romantic lead and hero Jide Kosoko, who was visiting the Ebola. Alert team

Required international response: • EARLY ACCESS TO TREATMENT SAVES LIVES. The response model implemented Required international response: • EARLY ACCESS TO TREATMENT SAVES LIVES. The response model implemented in Guinea proved early treatment can decrease mortality from 90% to 40% (Nigeria 30%). Partners implemented successful ETC care in locations since the epidemic onset and continue to scale -up in West Africa. (WHO)

When is it an outbreak over? • An Ebola outbreak is officially considered at When is it an outbreak over? • An Ebola outbreak is officially considered at an end once 42 days elapse without any new confirmed cases. Nigeria October 23, 2014 4 lessons how to stop Ebola • Trace isolate treat • Detect early, before lots of people can be exposed • Strong leadership • Public part of solution (National Geo)

Needs • Donors matching needs • Training • Materials, Ebola clinical standards and protocols Needs • Donors matching needs • Training • Materials, Ebola clinical standards and protocols • Logistics • Sanitation, infection control

 • • Psychological support Community educators, liaison People of influence, elders, chiefs Medical • • Psychological support Community educators, liaison People of influence, elders, chiefs Medical and non-medical personnel Logisticians, administration Contingency, management, reporting Innovation, science, data

 • Epidemiological support including contract tracing, safe burials and analysis of epidemiological statistics • Epidemiological support including contract tracing, safe burials and analysis of epidemiological statistics reported by clinics • Fuel, water, waste • Restocking medical supplies • Laboratory diagnostics (24 hour turnaround)

Serious concerns • Fear, misinformation, discrimination of victims, families, survivors, health care workers, response Serious concerns • Fear, misinformation, discrimination of victims, families, survivors, health care workers, response workers, racism • Slow, inadequate, underfunded response compared to need • Risk: continually ignoring ‘neglected’ diseases

October 24, 2014 Clinical Trials vaccine • “The message we heard from WHO that October 24, 2014 Clinical Trials vaccine • “The message we heard from WHO that the people fighting the epidemic will be among the first to test Ebola vaccines and treatments is exactly the one we needed to hear, ” Dr. Bertrand Draguez, Medical Director for MSF

Dr Paul Farmer • Africa’s Ebola problem is now America’s Ebola problem. • The Dr Paul Farmer • Africa’s Ebola problem is now America’s Ebola problem. • The best way for the US to free itself of the terror of this virus is to ensure that it is wiped out at the source, where the epidemic is currently out of control. That will happen only through a coordinated effort to provide the kind of basic, front-line health care that we take for granted in the developed world but which is tragically scarce in impoverished countries.

UN Ebola Coordinator Sept 17, 2014 • $500 million not enough David Navarro • UN Ebola Coordinator Sept 17, 2014 • $500 million not enough David Navarro • World Bank pledged $200 M to help contain, improve health systems, help with economic impact throughout West Africa • More needed to help with poverty, food insecurity, protection • Capacity can be legacy of outbreak e. g. training, distribution, logistics, case management

Investment and incentives to develop treatments essential • investment in front-running vaccines, drugs and Investment and incentives to develop treatments essential • investment in front-running vaccines, drugs and diagnostics vital, and sufficient resources for clinical trials and post-trial access need to be mobilized by donors now. • scientific data generated for each product under clinical trials should be published in real time. • The lack of approved Ebola products highlights a key issue that must be urgently addressed: the lack of sufficient investment and incentives to develop them.

 • UN emergency Ebola mission says 19, 000 nurses doctors & paramedics needed • UN emergency Ebola mission says 19, 000 nurses doctors & paramedics needed by Dec 1 • “MSF understands and shares the concerns about Ebola in this country[US], but anyone who is concerned about the spread of Ebola, anywhere, to anyone, should have been, and should now be, advocating for a more robust, comprehensive, and active operational response to the outbreak where it began and where it has done the most damage, in West Africa. ” Oct 29 2014

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How does Ebola impact you & your work? • • • Awareness, risk in How does Ebola impact you & your work? • • • Awareness, risk in perspective, fact, science Education Advocacy Disaspora outreach Innovation Future planning