Nigeria reports another Ebola case – experts warn magnitude of the crisis not understood nor comprehended

August 2014AFRICA – Nigeria’s health minister, Onyebuchi Chukwu, has announced there is another Ebola case in Africa’s most populous country, bringing the total confirmed cases there to 11. Chukwu told reporters in Abuja, the capital, Thursday that the latest patient is a doctor who helped treat the first Ebola case in the country, Liberian-American Patrick Sawyer who arrived from Liberia last month with the virus and died on July 25. All those who are ill with Ebola in Nigeria had direct contact with Sawyer. Nigeria has recorded three deaths: Sawyer, a Nigerian nurse who helped treat him as well as an employee of the Economic Community Of West African States who helped transport Sawyer to a hospital after he landed in Lagos, the commercial capital, and collapsed at the airport. –ABC
 Magnitude of crisis not understood: There is evidence the numbers of dead and sickened by Ebola in West Africa may “vastly underestimate the magnitude of the outbreak,” the World Health Organization said Thursday. The U.N. health agency said it was prepared for the crisis to continue for months. With more than 1,060 deaths and 1,975 sickened, the Ebola outbreak is already the deadliest ever. Liberian officials faced a difficult choice Thursday: deciding which handful of Ebola patients will receive an experimental drug that could prove life-saving, ineffective or even harmful. ZMapp, the untested Ebola drug, arrived in the West African country late Wednesday. A day later, no one had yet received the treatment, which officials said would go to three people. The outbreak, which was first identified in March in Guinea and since spread to Liberia, Sierra Leone and Nigeria, has overwhelmed the already strained health systems in West Africa and raised questions about whether authorities are doing enough to respond. There is no licensed treatment for Ebola, a virus transmitted by contact with bodily fluids, so doctors have turned to the limited supply of untested drugs to treat some cases. The Liberian government had previously said two doctors would receive ZMapp, but it was unclear who else would. Information Minister Lewis Brown said Thursday it would probably be another health care worker.
These are the last known doses of ZMapp left. The San Diego-based company that developed it has said it will take months to build up even a modest supply. The outbreak has sparked an international debate over the ethics of giving such untested drugs to the sick and of deciding who should get the drugs. So far, only two Americans and one Spaniard have received ZMapp. The Americans are improving — but it is unclear what role the drug has played. The Spaniard died within days. Now Liberian officials are facing those questions. In this outbreak, over 50 percent of those sickened with Ebola have died, according to the U.N. health agency. “The criteria of selection is difficult, but it is going to be done,” said Dr. Moses Massaquoi, who helped Liberia obtain the drug from Mapp Biopharmaceutical. “We are going to look at how critical people are. We are definitely going to be focusing on medical staff.” He added people past the “critical phase” who looked likely to survive would not be chosen. Massaquoi said there was only enough of the drug to treat three people. Treatment will be staggered, so doctors can observe the effects in one patient before moving on to the next. Late Thursday, he said the treatment had not yet started. Arthur Caplan, director of medical ethics at NYU Langone Medical Center, said the choice of who to treat would have to balance helping the largest number of people with learning the most from the treatments.
 He said the question is not “whose life do we save? but who gets the chance to be experimented on?” For that reason, recipients need to be good experimental subjects — people who have recently contracted the disease and are more likely to respond to treatment or perhaps younger patients, he said. In order to study the long-term effects, doctors will likely prefer people who can be observed for months, which might eliminate those living in remote places, he added. –ABC
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