With surge in Liberia, Ebola case toll above 4,200

DAKAR — A surge in Ebola infections in Liberia is driving a spiraling outbreak in West Africa that is increasingly putting health workers at risk as they struggle to treat an overwhelming number of patients.

A higher proportion of health workers has been infected in this outbreak than in any previous one. The latest infection was of a doctor with the World Health Organization treating patients in Sierra Leone. The organization gave no details, but an American who became infected while working in West Africa landed in the US yesterday to get treatment at Emory University Hospital.

This is the second WHO staffer to be infected in Sierra Leone, and the UN health agency said yesterday that after an investigation of the first case, staffers battling Ebola there now have better working conditions — including larger, more private quarters.

The outbreak sweeping West Africa is thought to have killed more than 2,200 people, and public health experts agree that it is out of control. More than 4,200 people have believed to have been sickened in Guinea, Liberia, Sierra Leone, Nigeria and Senegal.

The disease is spreading particularly quickly in Liberia, where WHO figures published yesterday showed that more than 500 new cases were recorded in a week. The organization warned Monday that it expects thousands of new cases in the country in the coming weeks.

Sierra Leone said it is also expecting to uncover potentially hundreds of new cases during a three-day nationwide lockdown later this month. While people are confined to their homes, thousands of volunteers will go house to house to search for those infected, Sidie Yahya Tunis, a Health Ministry spokesman said yesterday.

Health workers in Liberia have also paid a heavy toll; 160 have been sickened in that country, and 80 have died, according to Karin Landgren, the UN envoy to the country. Health workers are at particular risk because of their close contact with the sick since Ebola is only spread by contact with bodily fluids of those who have symptoms.

A shortage of doctors and nurses to care for these patients is being exacerbated by the sheer number of health workers becoming infected. But that shortage may also be the reason they are getting infected, experts say.

"The fact that people that are highly trained are getting infected is because the number of cases is bigger than the bed capacity," said Jorge Castilla, an epidemiologist with the European Union's Department for Humanitarian Aid. "When you have too many patients, you have too much to do, you get tired and when you're exhausted, you make mistakes."

Staffing shortages have been exacerbated by strikes, and nurses and doctors have also fled their workplaces simply out of fear. Staff at a hospital in the Liberian capital went on strike this week; a local pastor called the place a "slaughterhouse" because it is not equipped to handle treatment for Ebola.

Castilla said doctors face the impossible choice between turning away patients they don't have room for — knowing that they will continue to spread the disease — and taking those patients in, thus putting their own health at risk.

That choice is starkly illustrated by the fact that Doctors Without Borders, which runs most of the Ebola clinics in West Africa, has never recorded a single infection among its staff. Castilla said that's likely because they don't open more centers than they can properly staff.

While many facilities are working with a fraction of the staff they need, he said, Doctors Without Borders adheres to its rule that every caretaker treating a patient enters the ward with a buddy, who watches the caretaker to ensure his suit doesn't slip, for instance.

"If (protective equipment) is worn properly, there is no risk of infection," said Dr. David Heymann, a professor at London's School of Hygiene and Tropical Medicine. "Unfortunately, in the case of Ebola, a mistake can be fatal."

After a Senegalese epidemiologist with WHO working in Sierra Leone tested positive for Ebola last month, the agency conducted an investigation into how he became infected.

While the agency is not releasing the results of the investigation, spokeswoman Nyka Alexander said yesterday that staff living and working quarters in Sierra Leone have been expanded to make them less cramped and workers no longer share living space with other agencies.

Changes were also made to working procedures, including more temperature checks for everyone coming into the WHO office and living quarters, Alexander said.

Michael Osterholm, a professor at the University of Minnesota who advises the US government on infectious diseases, said while the infections of two WHO staffers didn't yet constitute a pattern, the cases were worrying.

"If we see more numbers getting infected, we will have to ask serious questions about whether there were any lapses," he said.