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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Heart of darkness: CDC director returns from Africa with a dire assessment of Ebola epidemic

The Ebola epidemic in Africa is rapidly overwhelming containment efforts, increasing the threat of spread to other countries and continents while giving the virus ample time to mutate as it burns through the human population in a jungled epicenter that borders three nations.

“The border of the three areas -- where Guinea, Sierra Leone and Liberia meet -- is a dense forested region with about one million people in it roughly,” said Tom Frieden, MD, director of the Centers for Disease Control and Prevention. “That has been the epicenter, if you will, the crucible of this outbreak. That has been where most of the cases have been, where it's continued to smolder and burn throughout all of these outbreaks, and where we believe it likely started.”

Having just returned from the region, Frieden said the number of cases is increasingly rapidly and it will take a global response to stop the worst Ebola outbreak on record.

“Everything I’ve seen suggests over the next few weeks it's likely to get worse,” he said at a Sept. 2, 2014 press conference at the CDC. “We're likely to see significant increases in cases.”

As of Aug. 28, the outbreak in West Africa included 3069 confirmed and probably cases with 1552 deaths. However, the actual number of infections may be much higher, as cases are going undiagnosed and many contacts lost to follow-up. Transmission is occurring to people caring for the infected in hospitals and homes. Compounding the problem are unsafe burial rituals where the bodies of people who have just died of Ebola are handled and washed.

The harsh conditions and lack of public health infrastructure make the laborious work of tracking down contacts of cases and monitoring for symptoms for a three-week incubation period all the more difficult. Disease fighters may face both ignorance and distrust, as they are seen by some as spreading the virus rather than trying to eradicate it. For example, a recent spike of cases in Guinea has been met by resistance to prevention measures in some villages.

“This is a community which does not have access to radio, which has been isolated, and which has a lot of misconceptions,” Frieden said. “For example, when people were going in with sprays of bleach to sterilize after people had died; the rumor went around that [the spray] was spreading Ebola. So there are a lot of misconceptions that need to be dealt with.”

Though the global effort must rapidly increase to meet the threat, Frieden cited the establishment of laboratories and other assistance by teams from the European Union, China, South Africa and Canada. Still, much more assistance is needed if the outbreak is to be contained, he warned.

“The number of cases is increasing so quickly that for every day's delay, it becomes that much harder to stop it," Frieden said. "There are three key things that we need. The first is more resources. This is going to take a lot to confront. The second are technical experts in health care and management to help in country. And the third is a global coordinated unified approach. This is not just a problem for West Africa, it's not just a problem for Africa, it's a problem for the world and the world needs to respond.”

Given that this is the longest lasting Ebola outbreak in history, concern is mounting that the virus could mutate and become more transmissible as it continues to infect people.

“That risk may be very low, but it's probably not zero,” he said. “The longer it spreads, the higher the risk.”

It what appears to be an incredible case of bad luck – given the relatively rare occurrence of Ebola – an unrelated outbreak possibly involving a different viral strain has erupted in the Democratic Republic of the Congo. A total of 24 suspected cases of Ebola, including 13 deaths, have been identified and linked to that outbreak, which is occurring in central Africa were Ebola was first detected near the river that bears its name. The Congo outbreak has been traced to a single patient who became infected after preparing bushmeat. The outbreak in West Africa is thought to have begun when a toddler became infected by handling a fruit bat, one of the known wild reservoirs for the virus.

Art credit: Cover art by Mike Mignola. Heart of Darkness. (Penguin Classics Deluxe Edition) by Joseph Conrad.