|NY Times, Sept. 23 2014
Ebola Cases Could Reach 1.4 Million in 4 Months, C.D.C. Estimates
By DENISE GRADY
Yet another set of ominous projections about the Ebola epidemic in West
Africa was released Tuesday, in a report from the Centers for Disease
Control and Prevention that gave worst- and best-case estimates for
Liberia and Sierra Leone based on computer modeling.
In the worst-case scenario, Liberia and Sierra Leone could have 21,000
cases of Ebola by Sept. 30 and 1.4 million cases by Jan. 20 if the
disease keeps spreading without effective methods to contain it. These
figures take into account the fact that many cases go undetected, and
estimate that there are actually 2.5 times as many as reported.
The report does not include figures for Guinea because case counts there
have gone up and down in ways that cannot be reliably modeled.
In the best-case model — which assumes that the dead are buried safely
and that 70 percent of patients are treated in settings that reduce the
risk of transmission — the epidemic in both countries would be “almost
ended” by Jan. 20, the report said. It showed the proportion of patients
now in such settings as about 18 percent in Liberia and 40 percent in
“My gut feeling is, the actions we’re taking now are going to make that
worst-case scenario not come to pass,” Dr. Thomas R. Frieden, the C.D.C.
director, said in a telephone interview. “But it’s important to
understand that it could happen.”
The figures in the C.D.C. report are based on data from August, but Dr.
Frieden said the situation appeared to have improved since then because
more aid had begun to reach the region.
The current official case count is 5,843, including 2,803 deaths,
according to the World Health Organization.
The W.H.O. published its own revised estimates of the outbreak on
Monday, predicting more than 20,000 cases by Nov. 2 if control does not
improve. That figure is more conservative than the one from the C.D.C.,
but the W.H.O. report noted that many cases were unreported and said
that without effective help, the three most affected countries would
soon be reporting thousands of cases and deaths per week. It said its
projections were similar to those from the C.D.C.
The W.H.O. report also, for the first time, raised the possibility that
the disease would not be stopped but would become endemic in West
Africa, meaning that it could become a constant presence there. The
report from the C.D.C. did not discuss that possibility, but it is
something that health officials have feared all along, and the reason
they say help is needed so quickly.
President Obama’s promise last week to send 3,000 military personnel to
Liberia and to build 17 hospitals there, each with 100 beds, were part
of the solution, Dr. Frieden said. He said the Defense Department had
already delivered parts of a 25-bed unit that will soon be set up to
treat health workers who become infected, a safety measure he said was
important to help encourage health professionals to volunteer. He added
that aid groups were flooding into the region and setting up treatment
The W.H.O. reported on Wednesday that a new treatment center had just
opened in Monrovia, the Liberian capital, with 120 beds for treatment
and 30 for triage. Patients were already lined up at the door.
The report from the C.D.C. acknowledged that case counts were rising
faster than hospital beds could be provided. It said that in the
meantime, different types of treatment would be used, based in homes or
community centers, with relatives and others being given protective gear
to help keep the disease from spreading.
The United States government is also sending 400,000 kits containing
gloves and disinfectant to Liberia to help families take care of
patients at home. The kits reflect the recognition that even the most
ambitious new program will not be able to add hospital beds fast enough
to keep up with the disease.
At least one aid group working in Liberia is already shifting its focus
to teaching people about home care and providing materials to help. Ken
Isaacs, a vice president of the aid group Samaritan’s Purse, said, “I
believe inevitably this is going to move into people’s houses, and the
notion of home-based care has to play a more prominent role.” He said
there could be 100,000 or more cases by the end of 2014.
“Where are they going to go?” Mr. Isaacs asked. “It’s too late. Nobody’s
going to build 100,000 beds.”
Though providing home-care kits may seem like a pragmatic approach, some
public health authorities said they were no substitute for beds in
isolation or containment wards.
But Dr. Frieden said that home care had been used to help stamp out
smallpox in Africa during the 1960s. The caregivers were often people
who had survived smallpox themselves and were immune to it. Some experts
have suggested that Ebola survivors might also be employed to care for