People are hiding from health care workers. New cases are turning up in unexpected places. And even at funerals, proper precautions aren't taken to stop the spread of the disease.
These are a few of the signs that, in the words of public health specialist Armand Sprecher of Doctors Without Borders, the Ebola outbreak that began in West Africa in February is "not under control yet."
The first cases were in Guinea but the virus has since spread to Sierra Leone and Liberia. The death toll has risen to 330, making this the deadliest Ebola outbreak since the disease was first detected in 1976. The staff of Doctors Without Borders are "overwhelmed" by the need to set up new isolation wards and track down people who may be infected, Sprecher told NPR's Jason Beaubien.
In past outbreaks, there have been what are called "satellite cases," where the disease appears in different locations. But "not nearly as many as we've seen in this outbreak," says Sprecher. That may be because people move around a lot in West Africa.
"More manpower would certainly help," Sprecher says. "We are spread thin." When a new case is reported, medical staff tries to visit everyone that person has had contact with. The villages they must go to may be many miles from each other. In addition, Doctors Without Borders has had to launch operations in two additional countries, building isolation units in Sierra Leone and Liberia as well as in new locations in Guinea.
The reaction of locals makes it harder for medical workers to do their job. "The populations are scared. They would prefer that the Ebola outbreak went away," Sprecher says. So when a medical worker comes knocking on their door trying to identify cases, "people hide."
Previous Ebola outbreaks have been controlled with a matter of weeks or months. That's partly because victims die so quickly, sometimes just days after the virus sets in. And when the outbreak is confined to a relatively small area, quarantines are easier to enforce.
This time around, says Sprecher, the fear is that the outbreak will become "a regional health issue" that will not go away.
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