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Ebola continues to rage in Sierra Leone

UNITED NATIONS – While focus on the Ebola outbreak has faded in the U.S. and the death toll in Guinea and Liberia has eased, the virus is still “running ahead” of efforts to contain it in West Africa, says Dr. Margaret Chan, director general of the World Health Organization.

The number of Ebola deaths in Guinea, Liberia and Sierra Leone stands at 6,331, with more than 17,800 confirmed, probable and suspected cases.

Sierra Leone has become the new epicenter of the Ebola outbreak, with the WHO reporting 6,317 confirmed cases there, compared to 2,830 in Liberia and 2,035 in Guinea.

On Wednesday, Chan gave an update in an interview with the BBC.

“It is not as bad as it was in September,” Chan said. “But going forward, we are now hunting the virus, chasing after the virus. Hopefully we can bring [the number of cases] down to zero.”

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In August, the WHO had announced the numbers infected with Ebola in West Africa were vastly underestimated, due to lack of reliable reporting.

Chan agreed the quality of data has improved since August, but she said frightened communities are still attacking teams going into infected areas.

“When they see people in space suits coming into their village to take away their loved ones, they were very fearful,” Chan noted. “They hide sick relatives at home, they hide dead bodies. [This is] extremely dangerous in terms of spreading disease. So we must bring the community on our side to fight the Ebola outbreak. Community participation is a critical success factor for Ebola control.”

As part of the effort to contain the Ebola outbreak, Sierra Leone has opened a new ambulance dispatch center in Freetown along with an Ebola hotline to identify possible cases and remove the patient from the community.

On Wednesday in Geneva, the WHO also issued an alert on the 2014 virus outbreak that highlights how quickly the epidemic can proliferate in the absence of a functional health-care system that can monitor the situation and develop an integrated response.

“If the epidemic does not trigger substantial investments in national and sub-national health systems and appropriate reforms in the worst affected countries, the effects of the outbreak will exacerbate the pre-existing weakness in the national and sub-national health systems, which will become even more fragile,” the WHO said.

To address the broader systemic issues, the African Development Bank, the West African Health Organization, the World Bank and the WHO are convening a high-level international meeting on “Building Resilient Health Systems in Ebola-affected Countries” to be held Wednesday and Thursday this week in Geneva, Switzerland.

In her opening remarks to the international conference, Chan declared “no society is secure.”

“No resilience exists to withstand shocks, whether coming from a changing climate, a natural disaster, or a killer virus like Ebola,” she said. “Prior to the outbreaks, these countries had only one to two doctors to treat a population of nearly 100,000 people. That number has been diminished as more than 600 health care staff have been infected.”

She listed the health-care system deficiencies that made treating the Ebola epidemic particularly difficult in the three West African countries affected by the virus outbreak.

“At the start of the outbreak, weaknesses existed throughout the health systems. Laboratories were few in number and concentrated in cities,” she stressed. “Many large referral hospitals had no electricity and running water or were made unsafe by electrical fires and floods. Isolation wards were rare, mostly dedicated to the care of Lassa fever patients.”

The health-care inadequacies were numerous.

“The numbers of ambulances and other vehicles, also for the transportation of diagnostic specimens, were inadequate,” she detailed. “Supplies of essential medicines and personal protective equipment were unreliable, and systems for civil registration and vital statistics were nascent. Populations in all three countries remain deeply distrustful of health systems, especially Western medicine and foreign medical teams. Care from traditional healers is the preferred and, in rural areas, often the only option.”

Risk to health-care workers

In a special report, NBC News highlighted the concern that health-care workers have more than 100 times the risk of contracting Ebola in Sierra Leone than the general public.

The WHO repeatedly has expressed concern over the risk to health-care workers, including doctors and nurses. It reports that 622 health-care workers have been infected with the disease, with 346 of them having died, including 10 physicians, in the three West African countries.

Interns at Connaught Hospital in Freetown, the capital of Sierra Leone, went on strike Monday to protest the lack of medical equipment to fight the disease following the death in the previous two days of three doctors who had become infected with Ebola after treating patients, according to Agence France-Presse.

Notably, in the U.S., Dr. Martin Salia, a Maryland man, died of the disease after having been transferred from Sierra Leona to Nebraska for treatment.

The Centers for Disease Control and Prevention said Wednesday that in the U.S., officials screened at airports nearly 2,000 travelers for Ebola symptoms over 31 days in October and November, with none found to have the disease, USA Today reported.

Malaria risk

The WHO also warned this week that although global deaths due to malaria have fallen dramatically, the gains are fragile, particularly in the West African countries affected by the Ebola crisis.

A WHO official said deaths due to malaria fell worldwide by 47 percent between 2000 and 2013.

But malaria remains a huge global health concern, threatening over 3 billion people in 97 nations. The WHO estimated that in 2013, some 198 million people were reported to be infected with malaria, with 82 percent in Africa.

The WHO currently estimates that in 2013, some 584,000 people worldwide died of malaria, including an estimated 453,000 children under the age of 5.