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The International Community underestimated the severity of the Ebola outbreak, says representative of the Doctors Without Borders

The Brazilian chief of the organizations medical unit avoided blaming only WHO for the delay in containment measures against the disease in África


Regarding local governments and the international community, there were gaps in nearly all aspects

The 2014 Ebola outbreak in Africa had among its main chapters, the duel between two large entities: The World Health Organization (WHO) and the international organization Doctors Without Borders (Médecins sans frontièrs, MSF). The reason was the delay by WHO in acknowledging that Guinea, a country in western Africa, was under an unprecedented outbreak in scope and duration. However, it would be a mistake to blame a single entity for the entire dysfunctional response. This is the opinion of Dr. Maria Rodrigues Rado, chief of the MSFs Brazilian Medical Unit.

The entire international community underestimated the severity of the outbreak and there was a general failure taking responsibility towards a robust action to combat the virus. It is also a fact that the affected countries exchanged little information with WHOs representatives, said Rado, who is an infectious diseases expert.

In March 31, 2014, according to Dr. Rado, the MSF stated they were facing an unprecedented outbreak in scope and duration. At that moment, five regions of the African country had confirmed patients, including the capital, Conacri. In the next day, WHO publicly questioned the doctors organization arguing the virus dynamics was not different from previous outbreaks and affirmed the outbreak was not unprecedented. Only months later, in July, WHO took head in the response and triggered an international operation to give the affected countries technical support.

In a note released this April, WHO admitted its response to the outbreak was slow and insufficient, and not aggressive enough, to avoid over 10 thousand deaths in the most affected African countries, as Guinea, Liberia and Sierra Leone.

WHO informed by the end of August, that all international health regulations would be revised to fix the errors found in the Ebola response and prepare the world for unavoidable future outbreaks. Our  challenge is to find solutions to make the world better prepared for the next unavoidable epidemic outbreak, said Margaret Chan, director-general at WHO to the committee of doctors and scientists who will revise the regulations.

WHO was contacted to comment the MSFs statements and the reasons the international actions in this case were delayed, but until the closure of this edition had no response.

Factors for the outbreak

The Ebola outbreak in western Africa, according to Dr. Maria Rodrigues Rado, owes to a series of aspects. Among them, the populations mobility in the affected region, the fact that some infected people concealed their conditions for fear and lack of confidence in the local health structures. Another fundamental reason was the lack of prepare in the funerals, when hundreds of people were exposed – i.e. without the proper protection – to bodies infected with the virus.

Regarding the response by the local governments and the international community, there were critical gaps in nearly all aspects, said Dr. Rado.

The direct contact with bodies, during the funeral services, for example, is one of the main causes of transmission of the disease. Funerals are important practices in the communities affected by the outbreak and involve touching and washing the corpses, as a sign of respect to the religious rituals. In the last hours before death, the virus becomes especially infectious and, for this reason, the risk of transmission from the corpse is much greater, explained the expert.

This outbreak also registered a large number of health professionals who were infected while treating Ebola patients. This happened through close contact with the patients without the use of gloves, masks or protection goggles. The three affected countries – who already suffer for poor health systems and are affected by civil wars, registered the deaths of nearly 500 professionals in 2014.

In some African regions, there were reports of infections from inappropriate management of chimpanzees, gorillas, bats, monkeys, antelopes and porcupines later found dead or sick in the forest. The illness was identified among humans for the first time in 1976 in Sudan and in the Democratic Republic of the Congo, by the margins of the Ebola River.

An unsolved issue

According to the Brazilian MSFs director, it is not possible to ensure the problem has been solved because the outbreak in Guinea and Sierra Leone is not over, but there was a significant decrease in the cases in the whole region and other affected countries were declared free of the disease. To consider the outbreak to be controlled, the place cannot have reports of new cases for the past 42 days. Sierra Leone has no more infected people, but the count is not over. The last patient was released in August 24, what means that if no new cases arises, the end of the outbreak could be announced in October 5. Liberia ended its counts in September 3.

Ebola left more than thousands of dead; it left orphans and people with chronic pain. It also left visual issues that can lead to blindness, especially because the number of eye doctors in the region able to treat these patients is very limited. The consequences of this outbreak are medical, social and economic, regrets Dr. Rado.

Over a year and a half (the outbreak started in December, 2013) after Guinea declared its epidemic, which spread very rapidly to Sierra Leone and Liberia, the Ebola virus is still circulates in the two first countries. At all, 28 thousand people were infected during the outbreak and 11.300 were killed.