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Why Ebola is proving so hard to contain

September 2, 2014 at 6:29 PM EDT
The international head of Doctors Without Borders has charged that many of the efforts to curtail the Ebola outbreak in West Africa have actually made it worse. Jeffrey Brown joins director of the Centers for Disease Control and Prevention, Dr. Tom Frieden, who just returned from surveying the situation in West Africa, to discuss the impediments to containing the disease, and the prospects of it spreading.
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JEFFREY BROWN: The director of the U.S. Centers for Disease Control just returned from surveying the situation in West Africa. And in a press conference this afternoon, he too added strong words and warnings. Dr. Thomas Frieden joins us now from Atlanta.

And, Dr. Frieden, there was a level of urgency and concern put forward today that I don’t think we have heard from you and other officials so far. Have we entered a new and frightening phase in all this?

DR. THOMAS FRIEDEN, Director, Centers for Disease Control and Prevention: Well, unfortunately, the situation is bad.

It’s worse than I and others had feared. The number of cases is increasing rapidly. The human tragedy is heartbreaking. And we anticipate that, in the next few weeks, we’re going to see significant further increases in cases and in the places where it’s spreading.

So, this is definitely an epidemic and really the world’s first epidemic of Ebola, meaning spreading widely. And it’s spiraling out of control.

What’s really important to understand is that we know how to under — we know how to control it. And there is this window of opportunity that’s closing, but it’s not too late. We have to act now. Urgency couldn’t be higher. Speed is of the essence.

JEFFREY BROWN: Well, tell us — you use this kind of language, the window of opportunity is closing, the challenge is so great. You said today the epidemic is so overwhelming that it now requires an overwhelming response.

What specifically did you see on your trip and are you getting from responses from health officials around the world that is so alarming now?

DR. THOMAS FRIEDEN: Well, I will tell you an example.

Doctors Without Borders, MSF, is doing phenomenal work. They’re working an extraordinarily difficult situation and trying to really do whatever they can to help patients and stop the outbreak, but they’re overwhelmed by the number of patients. So they’re opening new hospital beds as fast as they can, but only safety — they have a terrific track record of safety for the people working in the Ebola treatment units.

But in order to do that, they can’t open them as fast as the patients are requesting hospitalization. What that means is that patients are not being hospitalized, and they are spreading Ebola in communities, including in urban communities, where it can spread quite widely.

JEFFREY BROWN: Well, so you said today and you just said to us again that, in essence, we know how to contain Ebola, but then why the lack of success?  What are the greatest impediments and what do you most need right now?

DR. THOMAS FRIEDEN: It’s fundamentally about speed and scale. Every day we delay in getting the proven treatments and prevention out there, it spreads more widely and we have more of it.

One of the encouraging things I did see was people throughout the region willing to help, willing to really work to make a difference. Ninety percent of the staff at the Doctors Without Borders hospitals are local staff who have been rigorously trained and are working hard to stop the outbreak and care for patients, but the challenges really are enormous, and the urgency is so great.

The sooner we increase beds, the sooner we make burials safer, the sooner we help health care workers be safer from infections, we are going to be better off in terms of beginning to turn this outbreak around. Time is lives here.

JEFFREY BROWN: One of the things you said today really jumped out at me. You were talking about as the world isolates itself from these countries, it is having an adverse effect.

It’s harmful to the countries and it’s ultimately harmful to the rest of the world, including us, and you said, like it or not, we are connected. So explain that. Should we not be isolating those countries?

DR. THOMAS FRIEDEN: The fact is, people are going to move around the world, and the only way to really protect ourselves from this is to stop it at the source.

It’s not dissimilar to the dynamic that’s happened within these countries. Frankly, against the advice of many, some of the countries enforced quarantines in some areas. And the — as Dr. Liu from MSF said earlier on your program, that’s really counterproductive, because it drives patients underground, it increases hostility. And it’s not a way to help.

What we need to do is to get services to patients, to families, get people into care and isolation quicker, so they stop spreading disease and so they have a better chance of survival, because early treatment does improve survival.

JEFFREY BROWN: But given the interconnectedness that you’re talking to, what about the potential for a spread in the U.S.?  And given this new alarm of how quickly this is spreading, what do you tell people tonight who are afraid here in this country?

DR. THOMAS FRIEDEN: Well, given the large increase in cases that we’re seeing and think we’re likely see in the coming weeks, I would be surprised if we didn’t see other cases in other parts of Africa.

For the U.S., it’s certainly possible we will get someone here who develops symptoms of Ebola and may have Ebola. That’s a possibility. That’s why we have asked doctors working in emergency departments and elsewhere to be on the lookout for people who have been in an area with Ebola in the past three weeks, and, if they have fever or other symptoms consistent with Ebola, to isolate and test them.

That’s also why we have worked with about 10 states from around the country to have tests for Ebola up and available, so that they can be tested in a regional approach, so we’re prepared in this country.

Ebola doesn’t spread through casual contact. It doesn’t spread through the air naturally. The way it spreads is by physical contact with a sick person or their body fluids or someone who’s died from Ebola with their body fluids.

And standard infection control in hospitals has prevented spread of five cases of hemorrhagic fevers that have been in the U.S. in the past decade.

JEFFREY BROWN: I just want to ask you in our last minute about one other frightening scenario that you raised today, which was the possibility that Ebola might become easier to spread through genetic mutation.

You said you didn’t see signs of it yet, but it’s — the possibility is not zero, I think is the way you put it. Explain that, because that would be a quite frightening new step.

DR. THOMAS FRIEDEN: Well, the genetic material of the virus has been quite stable for 40 years. So we don’t think of this as a virus that changes much.

But the longer it spreads and the more people it spreads to, the more what’s called selective pressure that might favor strands that do spread more easily. And that’s a concern. It’s something we will be tracking for.

But the bottom line here is, we have to surge our response and act now. By bringing down the number of cases, we will protect ourselves, we will protect West Africa, we will reduce the humanitarian crisis, insecurity that’s there, and we will make it less likely that there are patients traveling to other parts of the world, and less likely that we could get that kind of a mutation.

JEFFREY BROWN: All right, Dr. Thomas Frieden of the CDC, thank you so much.

DR. THOMAS FRIEDEN: Thank you.