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Containing Ebola May Hinge on Volunteers, Not Money

Congress appears ready to commit tens of millions of dollars to respond to the Ebola outbreak in West Africa, but containing the deadly virus will hinge more on finding enough private sector volunteers and government scientists to disinfect corpses, monitor individuals likely to come into contact with infected patients and test the blood of tens of thousands of people suspected to having the disease in four affected nations.

A global appeal for help issued by the World Health Organization on Aug. 28 is generating only a handful of responses, complicating efforts on the ground that require as many as three health care workers for each patient and are hindered by a shortage of beds in isolation units. The WHO estimates that 20,000 will contract the disease in the next six months — a figure many experts say could be low because some African nations can’t yet tally all of the cases.

“People are scared,” said Ariel Pablos-Mendez, the U.S. Agency for International Development’s assistant administrator for global health, in an interview. Part of the challenge is ensuring that any health worker who gets sick will get the care needed to survive. “If you go into the fire, you want to have guarantees that you will be rescued yourself,” he said.

That could involve finding ways to better reimburse health professionals who donate their time and making sure there is adequate gear to protect workers against a virus with roughly a 50 percent mortality rate. USAID, which is helping coordinate the U.S. response, is actively pushing professional groups, such as the American Medical Association, to publicize specific needs in the hot zone.

Nongovernmental groups, including Doctors Without Borders, already are caring for the sick in medical units set up to isolate Ebola victims from the rest of the population. And the Obama administration has asked congressional appropriators for at least $88 million to counter the outbreak — a request House Appropriations Chairman Harold Rogers, R-Ky., said will be accommodated in some fashion.  

But the worst epidemic in the four-decade recorded history of the disease has made the challenge one of manpower rather than financial resources.  

The WHO said it needs help disinfecting corpses so that mourners aren’t infected by the disease, which is spread through body fluids, and assisting with up to 13,500 burials over the next half year. Volunteers also are needed to monitor an estimated 160,000 people expected to come into contact with a sick person to see if they, too, fall ill. That will involve testing some 80,000 lab samples. And health professionals also are needed to run about 10 new logistical offices in Guinea, Sierra Leone, Liberia and Nigeria set up to coordinate the responses from government agencies, humanitarian groups, the United Nations and foundations.

All told, the WHO estimates that about 760 worldwide foreign volunteers will be needed at any one time over the next six months, when the epidemic may begin to wane. Another 12,900 workers will need to be recruited from the affected countries. The total number involved is unknown, because it’s unclear how frequently workers will be rotated out of the affected nations and replaced with fresh forces. And the numbers could rise if the disease spreads more rapidly than expected.

“If the scale continues at its current pace, we will be going beyond this predicted number in a very short time,” said James Campbell, director of the WHO health workforce department, in an interview.

Federal Response
So far, more than 120 U.S. federal workers are on the ground in Africa, including 26 USAID disaster relief workers, 93 Centers for Disease Control and Prevention employees and a handful of Defense Department and State Department personnel. The number of CDC employees rose from 79 late last week to 93 on Monday, said agency spokeswoman Kristen Nordlund.

The number of federal personnel is projected to double within a month from August levels, and CDC Director Thomas Frieden said on Sept. 2 that his agency’s personnel will be staying longer than the 30-day rotations that were originally scheduled.

About 40 U.S. Public Health Service Commissioned Corps members are expected to be sent to the region soon, said Pablos-Mendez. The Public Health Service Corps includes about 6,500 health professionals overseen by the Surgeon General.

But Pablos-Mendez said that because U.S. health system is largely private, most of the clinicians will have to come from the private sector.

Doctors without Borders is currently supplying about 210 international volunteers. The U.S. government response is helpful, the group’s spokesman, Jason Cone, said, but could be far more robust, since some health workers in the affected countries are refusing to come to work unless they receive protective gear and their salaries.

The WHO estimated that it takes about 200 to 250 medical workers to care for 80 Ebola patients at one center. The high ratio is because medical workers can spend only about an hour in the protective suits before risking dehydration, Cone said. That affects some basic care that could help patients survive, such as the administering of intravenous fluids.

While they wait for volunteers to materialize, health officials in Africa are trying to add beds in isolation units of 14 clinics and hospitals while creating or repurposing other health care facilities as referral centers. But humanitarian groups say that the efforts to ramp up the number of isolation units are painfully slow and inadequate.

“We’re seeing a lot of words and money but no real action,” said Cone. “As far as we’re concerned, rhetoric and money means nothing until we see more things happening on the ground.”

John Reichard contributed to this report.

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