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HICprevent

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

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March 18th, 2015

After more than a year of ongoing Ebola transmission in Guinea and more than 7 months of infections in Liberia and Sierra Leone, we hail the coming New Year with this literally life affirming fact: more than 12,000 people in the three African nations at the epicenter of the largest Ebola outbreak in history acquired the deadly infection but survived infection to tell the tale. Twelve thousand.

I’ll hazard a guess such a cohort has never walked the Earth before because past outbreaks were explosive but short lived and contained. But 12,000 Ebola survivors is more than another unprecedented number in an outbreak that has already broken duration and case count records. It is a testament to the human will, remarkable resilience, and a fierce compassion in the care givers who risk death to save life. Indeed, many have died in doing so.

The outbreak has hit 20,000 cases now, with the death count at some 8,000 for a mortality rate in the 66% range. Initially this level of mortality rate was actually considered good news by some, given the reported 90% death rates in some Ebola outbreaks. Others have observed that perhaps the lower mortality rate gave the virus a more sustainable foothold, while its predecessors burned through populations so quickly potential transmitters died before they could sustain the chain of transmission.

There are encouraging signs that the redoubled response is beating back the devil, particularly in Liberia. That said, there remains a looming threat of an Ebola surge in the Guinea capital of Congary, where more than a million people live.

“In Guinea, I met with the head of MSF -- Doctors without Borders -- who told me the scariest thing I had heard in travels to the three countries,” said CDC chief Tom Frieden, MD, who recently returned from a second trip to the outbreak region. “He said, for the first time since the outbreak started -- which is now over a year ago in Guinea -- they had not had enough isolation beds for Ebola patients in the capitol city of Conakry, for just one day in the previous week. That's so risky, because when there are more patients than there are isolation beds, the spread of disease can exponentially increase.”

Overall, some clear gains against the epidemic have been made, though they can scarcely be celebrated in the face of the complex challenges remain.

“It is inspiring to see how much better the response has become in the past two months, how much international commitment there is, and, most importantly, how hard people from each of the three countries are working to stop Ebola,” Dr. Frieden said. “But it is sobering that Ebola continues to spread rapidly in Sierra Leone and that in parts of Monrovia and Conakry Ebola is spreading unabated. Improvements in contact tracing are urgently needed.”