Ebola epidemic over but U.N. expects further flare-ups


West Africa can expect flare-ups of Ebola in the coming year even if the world’s worst outbreak of the disease is declared effectively over, U.N. chief Ban Ki-moon said Wednesday.

The World Health Organization on Thursday declared Liberia Ebola-free, joining Guinea and Sierra Leone, which earned that status at the end of last year.

For the first time since the outbreak began in December 2013, all three countries will have registered zero cases in at least 42 days, which is twice the incubation period for the virus.

But in an address to the General Assembly, Ban warned that the virus could resurface, if in limited fashion.

“We can anticipate future flare-ups of Ebola in the coming year,” Ban said. “But we also expect the potential and frequency of those flare-ups to decrease over time.”

World Health Organization director Margaret Chan said the virus can persist in some Ebola survivors even after they have fully recovered.

Since March of last year, there have been 10 minor flare-ups of infections.

“By the end of this year, we expect that all survivors — all survivors — will have cleared the virus from their bodies,” Chan said.

More than 28,600 people have been infected by the virus in West Africa and 11,300 have died.

Chan described the next three months as “the most critical,” as foreign medical groups shut down operations in West Africa and national health ministries take over, managing disease surveillance and response.

The Ebola outbreak overwhelmed the weak health care systems in the three countries and delivered a major blow to their economies, prompting calls for aid.

Recovery will take time, Chan told the 193-nation assembly, but she asserted that there would be no return to a full-blown epidemic.

“No one will let this virus take off and run away again,” she said.

Ready for next time?

But with a cure still out of reach, and no vaccine on the market, are we better prepared for next time?

Important lessons were learned the hard way from the unprecedented devastation and suffering wrought by the outbreak, experts say.

Epidemiological protocols have been improved: At first, many infected people were not quarantined fast enough or given the right type of care.

The World Health Organization’s much-criticized reaction lag led to an overhaul of epidemic response guidelines. Deployment of medical staffers, virus-blocking suits, medicines and other material is likely to be implemented much more quickly next time.

“We know how to stop the spread,” said Liberia’s chief medical officer Francis Karteh. “Liberia is no longer at risk like the way it was.”

Lessons learned

Karteh said local doctors learned much from organizations such as Doctors Without Borders, the Red Cross and the WHO, which deployed staffers to help contain the epidemic.

A key lesson was the need for quick, safe and hygienic burials of people who died from the virus, which is transmitted through body fluids, and by speedily tracing those who had been in contact with them.

The new knowledge came in handy after Liberia — declared Ebola-free — had two further flare-ups successfully stopped in their tracks.

“During the first outbreak our doctors and health care workers were not (familiar with) the disease,” said Karteh.

“This is why a good number of them (more than 500) died.”

An ironic upside of the outbreak’s massive scale is that it yielded thousands of survivors for medical research.

This led to the discovery that Ebola virus can live for several months in the semen, spinal column and eye fluid of survivors — though the implications and transmission risk are not yet clear.

It was also recently found that survivors can suffer vision problems, hearing loss and joint pain for months after being declared cured.

Scramble for drugs

The scale of the outbreak, and the global scare caused when infected doctors started returning home from West Africa to Europe and the United States, provided impetus for the fast-track development of drugs.

The resulting pharmaceutical scramble yielded several promising vaccine candidates.

But none have yet been tested in general, non-infected populations — the gold standard for proving efficacy.

Similarly, none of the many potential treatments under investigation have so far been proven to work.

Many drug studies started when the epidemic was already declining and there were no longer enough patients for clinical trials.

Nevertheless, many studies have advanced to the point that testing can continue if there is another outbreak.

The front-runners are ZMapp, a cocktail of three artificial Ebola antibodies made by Mapp Biopharmaceutical in California, and Avigan, an antiviral tablet developed by a subsidiary of Japan’s Fujifilm Holdings.

Both were given to infected medical workers, though it is not sure that their survival owes to the treatment.

A lesser-known compound called GS-5734, developed by U.S.-based Gilead Sciences, was given to a Scottish nurse hospitalized with a serious relapse months after her initial recovery. She recovered.

Other treatments, however, did not pan out.

A study released last week concluded that transfusions of blood plasma from survivors — despite sky-high expectations — failed to significantly increase the odds of recovery.

On the upside, doctors recently said a malaria drug given to Ebola patients in Liberia seemed to improve chances for survival.

For now, the focus remains rapid response, speedy quarantine, and quality care — including intravenous drip to prevent dehydration — for those infected.

French immunologist Jean-Francois Delfraissy said keeping an eye on survivors, and boosting African early alert systems, were crucial to breaking the transmission chain.

“Continued research into vaccines, treatments and the virus reservoir, both animal and human, is indispensable,” he said.