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In Liberia, the total number of cases of the Ebola virus is being doubled about every three weeks. Dr. Kevin De Cock, the director of the CDC Center for Global Health, says that unless the outbreak is slowed down, there may be hundreds of thousands of cases by early next year. Jeffrey Brown interviewed him in Nairobi, Kenya, about possible worst-case scenarios.
The prospect of an even greater Ebola epidemic is keeping health officials all over Africa awake at night.
Dr. Kevin De Cock, an American, is country director for the Centers for Disease Control in Kenya. He and members of his team have traveled to Liberia and the other affected countries in recent weeks.
Our Jeffrey Brown spoke to him this weekend in Nairobi, Kenya.
Dr. Kevin De Cock, thanks for talking to us.
There is a report that a new estimate is in the works that may have a worst-case scenario of as high as half-a-million people. Can you comment on that?
DR. KEVIN DE COCK, Centers for Disease Control and Prevention: Yes.
The doubling time of new cases of Ebola virus disease in Liberia is about every 20 days. So there is a total number of cases doubling about every three weeks. We're now up to 3,000, 4,000 cases, reported cases, which may be a slight underestimate.
So, very rapidly, we do expect to see some tens of thousands of cases, and quite possibly, by the end of the year, early next year, some hundreds of thousands, unless this is — unless this is slowed down.
This is exponential growth. So, I mean, at this point, this is out of control?
DR. KEVIN DE COCK:
At the moment, the increase in cases has been described as exponential, yes. And, yes, clearly the epidemic in West Africa in the three most affected countries, Liberia, Sierra Leone and Guinea, I do think it's out of control. And many senior leaders have said that.
You know Liberia and these countries well. And you were there fairly recently.
These are countries that have little health infrastructure to begin with, right? What did you see? What did you see there now?
I think it needs to be emphasized that these are amongst the weakest states in the world. If you look at per capita income, Liberia per capita income is less than 500 dollars per year. The literacy rate in Liberia is about 60 percent. These are very fragile countries. Sierra Leone and Liberia both have come out of civil wars.
So infrastructure is weak, systems are weak, and it's a very difficult working environment. And for any country, an outbreak like this would be a challenge. But for these countries, it's very serious.
Can you give me an example of what you saw there that — I mean, to exemplify the kind of challenge for health workers?
The health workers have paid a very heavy toll in this outbreak. In Liberia, about at least 15 percent of cases of Ebola virus disease have been in health workers. And Liberia, of course, has not many health workers to start with, less than 200 doctors, for example, well under 200 doctors. And quite a few have died.
The epidemic, it has really had a major effect on the health care system, with many hospitals abandoned. But it's the secondary effects we're also beginning to see, the economy grinding down, the health care system halted, the fear in society, and so on and so forth. So the secondary effects of all of this are very, very serious as well.
What about the legal of level of distrust among people there, a fear that this is a Western plot, or that it doesn't really exist? How much is that a concern? How much is that an impediment to getting things done?
It is an impediment.
And you — I think we're all aware of the tragic deaths of colleagues in Guinea just a few days ago, people who were kidnapped and ended up being killed. It is a tremendous obstacle. It's gotten better in many places. But it remains a problem in some — particularly in some of the rural areas, in the three border areas.
And then it's sort of it — it also is accompanied by an opposite, a sort of opposite reaction, which is tremendous impatience that more is not being done. So, it…
You can understand that.
Which you can understand, so it's a difficult working environment.
We're sitting here in Nairobi, far away. Do you sense a — or how much of a sense of fear, concern, even psychological concern, do you sense here?
There's a low-level concern.
And I think the government is doing the right things. They certainly are investing in preparedness, in screening at the airport of incoming travelers, particularly from West Africa, in strengthening surveillance and preparedness in hospitals, having an isolation facility ready and so on.
So the right things are being done. I think what this whole experience demonstrates is that we really are an interconnected world and the — you know, we have to pay attention to the weakest links in the chain, because we're — vulnerability is shared between us all because of that.
Because the government in Kenya has stopped flights between here and the West African countries. But people can still go via other countries, right?
Yes. And the stopping of flights is something that needs to be discussed, actually. We…
Discussed or changed?
Changed? What concerns you?
The World Health Organization and CDC and other public health authorities, you know, say that's probably not the best thing to do.
It's understandable — because it gives a false sense of security.
We — you know, we cannot close our borders and live like an island. Plus, the fact, actually, this is now — if the flights do stop or if those that have stopped don't recommence, it actually complicated the response to the epidemic, because we have to get people and supplies into these countries.
The worst — I guess a truly worst-case scenario that some people look at would be a spread to other major cities outside that region, to places like this, Nairobi.
I think the worst-case scenario would be exportation of infection into some other urban center that is not well-equipped to address the epidemic.
And there's — I think Kenya is trying to assure the appropriate preparedness. But there are, of course, many vulnerable cities across the continent or even in other parts of the world.
And so, as we sit here, how concerned are you about the ability to control this or its spread?
I think we can control this.
But I think we're in this for quite a long time. We're in this for a long haul. And I think a lot more needs to be done.
All right, Dr. Kevin De Cock of the CDC in Kenya, thank you.
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