Ebola risk advisory 2014 - Drum Cussac

Ebola Risk Advisory

July 2014

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July 2014

Commercial in Confidence

Table of Contents

Ebola 2014 Overview ................................................................................... 3

Ebola Outbreak ............................................................................................ 4

What is Ebola? …………………………….................................................... 8

How to Protect Against Ebola …........……................................................. 10

Disclaimer .......................................................................................... ........ 12

Ebola Risk Advisory



2 Commercial in Confidence

July 2014

Ebola 2014 Overview The death toll from the 2014 Ebola outbreak has now risen above 600. There are grave fears that Africa is standing on the brink of an Ebola virus pandemic. The World Health Organisation (WHO) has held emergency meetings with eleven West African nations while Liberia, Sierra Leone and Guinea struggle to contain the suspected and confirmed cases. Following the meeting in Ghana, which feared for a while that it had its own Ebola case, the WHO urged collective, cross-border, multi-sector, concrete actions but stopped short of calling for an effective quarantine of affected countries. A sub-regional control centre has been set up in Guinea. African governments have pledged millions of dollars to combat the virus. Keiji Fukuda, the WHO's Assistant Director-General of Health Security, has said it is "impossible to give a clear answer" on how far the epidemic could spread. "I certainly expect that we are going to be dealing with this outbreak, minimum, for a few months to several months." Other countries have now been put on high alert. Even General Medical Practitioners in the UK have been urged to assess their patients for symptoms of Ebola. The UK is particularly worried about the imminent mass arrival of visitors for the Commonwealth Games in Glasgow. The organisation, which has taken the lead in treating the victims of this latest epidemic, the worst outbreak of Ebola ever, says it can no longer cope with new cases. Medecins Sans Frontieres (MSF) Director, Dr Bart Janssens, says: "The epidemic is out of control." Liberia and Sierra Leone have threatened to prosecute anyone found to be concealing sufferers of Ebola. Senegal and Mauritania have previously closed their borders to anyone from the affected countries. Foreign companies are being advised not to let their executives and employees travel to the affected areas unless essential. In this overview of the 2014 Ebola epidemic we outline which areas of the affected countries should be avoided, and how employees stationed in, or visiting, these countries should protect themselves from catching the virus. We also provide links to further information on this rapidly developing situation, so you can keep abreast of potential risks to your workforce.




July 2014

Ebola Outbreak 2014 The 2014 Ebola outbreak, which is being called the worst ever, started in Guinea where Ebola has never been diagnosed before, but the Guinea strain is 97 per cent identical to the Zaire Ebola Virus. It has now claimed more than 600 lives. The virus quickly spread to Liberia and Sierra Leone. All three countries have now declared an epidemic. The WHO has issued a warning to the states bordering the three West African nations — Mali, Ivory Coast, Senegal and Guinea Bissau — cautioning that they are at risk from the spread of the virus. The Director of Operations for Medecins Sans Frontieres (MSF), otherwise known as Doctors without Borders, Dr Bart Janssens, said in a statement: "The (current) epidemic is out of control." Since March, more than 300 MSF operatives and 40 tons of equipment and supplies have been sent to the affected areas to help fight the Ebola epidemic. But Dr Janssens says it is not enough. "Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites." MSF says key preventative messages are not getting through, and people are continuing to attend funerals where there are no infection-control measures in place, although urgent education of religious leaders is now taking place.

Because of the stigma of catching the virus many infected sufferers are choosing not to seek medical help and are dying in their homes. Their families are fleeing without informing the authorities that they themselves could be contagious. Liberia and Sierra Leone have made it a crime to shield people who are suspected of being sick from the deadly virus. Liberia’s president, Ellen Johnson Sirleaf, in a nationwide address, pledged prosecution for anyone caught hiding suspected Ebola patients. MSF operatives claim to be meeting increasing hostility, borne out of fear, in some communities. The Red Cross has suspended its work with Ebola patients in southeast Guinea because it has received threats.

"We can no longer go into a number of villages to follow up on people who have been in contact with Ebola patients," explained MSF’s Dr Janssens.




July 2014

MSF is now calling for a massive deployment by regional governments and aid agencies. Dr Janssens insists the medical contingent alone cannot halt this epidemic. ECOWAS has pledged ten million US dollars towards research into a cure. The WHO has admitted that it made mistakes at the beginning of the outbreak. A spokesman for the WHO said that a failure to gauge the severity of the initial outbreak, and a subsequent relaxation of counter-measures, had helped give rise to a "second wave" of the disease: "At the end of April, we started to see a decrease in the number of cases and we maybe saw a relaxation by the teams in the three countries, and this relaxation allowed things to restart. In addition, there were some problems with the affected populations which were sometimes not fully listened to."

Officials from the affected countries were joined by the Ministers of Health from Ivory Coast, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Mali, Senegal and Uganda in Accra for the emergency meeting. In Guinea, there have been 406 suspected and confirmed cases of Ebola Haemorrhagic Fever, 304 of them fatal. Please consult the following web address for the constantly updated Ebola statistics for Guinea: http://www.nathnac.org/DiseaseReport.aspx?OUTBREAKID=10702&AREAID=29&COUNTRYID=21&DISEASEID=80&PERIODID=2&ANIMALINDICATOR=2 The vast geographic spread of the Guinea outbreak is worrisome because of the sheer logistics of containment.




July 2014

In Liberia the president says Ebola has become a national public health emergency. The number of suspected and confirmed cases in the country is still rising steadily. There are now 172 cases, which have resulted in 105 deaths. On June 26th there were 63 suspected or confirmed cases, and 41 deaths.

All cases reported in June 2014 have been from Lofa and Montserado districts. Health workers in Liberia are said to be fleeing their assignments and heading home. The authorities admitted there had been 12 cases of health workers infected and ten of those had died.




July 2014

Please consult the following web address for the constantly updated Ebola statistics for Liberia: http://www.nathnac.org/DiseaseReport.aspx?OUTBREAKID=10729&AREAID=33&COUNTRYID=25&DISEASEID=80&PERIODID=3&ANIMALINDICATOR=2 In Sierra Leone there have now been 386 suspected and confirmed cases, with 194 deaths. To put that figure in perspective, on June 26 there were 176 suspected and confirmed cases with 46 deaths attributed to Ebola. The districts of Kailahun, Kambia, Port Loko, Western and Kenema are the worst affected. Sierra Leone is maintaining an 'Active Surveillance Protocol' making all visitors from Guinea or Liberia subject to a health screening process upon arrival. Please consult the following web address for the constantly updated Ebola statistics for Sierra Leone: http://www.nathnac.org/DiseaseReport.aspx?OUTBREAKID=10830&AREAID=50&COUNTRYID=42&DISEASEID=80&PERIODID=3&ANIMALINDICATOR=2

Senegal and Mauritania previously closed their land borders with Guinea but they have since been reopened. The United States' Centre for Disease Control (CDC) is in regular communication with its international partners, the WHO and MSF, regarding the outbreak. Currently CDC has a four-person team in Guinea and a staff member in Sierra Leone assisting the respective Ministry of Health officials.




July 2014

What is Ebola? Ebola Virus Disease (EVD) or Ebola Haemorrhagic Fever (EVF) is a severe acute viral illness, which kills up to 90 per cent of those infected. It is actually a group of six viruses, five of which are known to affect humans.

There are various strains of Ebola, generally named after the area where they were first diagnosed: Zaire Ebola Virus; Sudan Ebola Virus; Reston Ebola Virus; Cote D'Ivoire Ebola Virus; Bundibugyo Ebola Virus and the Tai Forest Ebola Virus. The latest pandemic outbreak of Ebola in West Africa has not yet been named.

The symptoms are generally the same and begin two days to three weeks after a person contracts the virus, with the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by nausea, vomiting, diarrhoea, a rash, and impaired kidney and liver function. The US Embassy in Sierra Leone states that a sufferer cannot transmit the virus to another human until they are showing acute signs of the illness.

All sufferers experience an impaired circulatory system and blood clotting problems. Bleeding from mucous membranes and puncture sites happens in about half of all cases. There can also be internal bleeding in the stomach and digestive tract, as well as from the nose and in the vagina. Severe bleeding is rare, and if it does happen it is generally centred in the gastrointestinal tract. Doctors treat patients with anti-coagulants as soon as an Ebola diagnosis is confirmed. Other treatments are supportive in nature such as painkillers, electrolytes and antibiotics, as secondary infections are common.

Ebola is not an airborne virus transmittable between humans, at present. (However in 2012 the deadliest form of the virus was transmitted by air between pigs and monkeys that had had no direct contact).

Ebola can be spread from animals to humans by contact with the blood, secretions, organs or other bodily fluids of infected animals, such as monkeys and fruit bats. Fruit bats are believed to be asymptomatic carriers of the virus, and pigs may be too.

Human-to-human transmission is through broken skin or mucous membranes coming into contact with the blood, secretions, organs or other bodily fluids of infected people, and in direct contact with environments contaminated with such fluids. However, the advisory from the US Embassy in Serra Leone states that the virus can be destroyed by soap, bleach, exposure to sunlight or drying. A washing machine will kill the virus on clothing saturated with infected body fluids.




July 2014

No vaccine for Ebola is available as yet. Several vaccines are now being tested, but none are available for clinical use. A vaccine has been developed which protects non-human primates but the immunisation process is six months long making it useless as a counter-epidemic solution. In 2011 a vaccine against Ebola was successful in protecting mice from the virus. Severely ill Ebola sufferers require intensive care. Patients quickly become dehydrated and require intravenous fluids.

Survivors of Ebola may remain contagious for months after they have recovered from the virus. Men have been found to still have the virus in their semen at least 61 days after recovering from Ebola. Anyone who has suffered from Ebola and survived should be tested a few months afterwards for either antibodies to the virus, the viral DNA or the virus itself.

The bodies of the deceased also remain infectious for a significant period and have to be disposed of very carefully in sterile conditions. Ebola is a World Health Organisation Risk Group 4 pathogen requiring strict containment.




July 2014

How to protect yourself against Ebola Because there is, as yet, no antidote to the virus for humans, the only protection is prevention. As with all infectious and tropical diseases, the traveller should take basic precautions to avoid coming into contact with the virus. The traveller is advised not to frequent crowded places, public transport or hospitals and medical clinics unless seeking treatment. Only bottled mineral water should be consumed and it is inadvisable to drink it from the bottle. The traveller is advised to distil it into a preferably sterilised container. Reliable food sources should be sought and supplies reserved. Care should be taken not to share cutlery or crockery, telephones, safety clothing etc. Hands should be washed frequently, preferably in disinfectant or soap. This virus is specifically transmitted by various animals, and the food products, which come from them, so contact with, or consummation of, monkeys, fruit bats and pigs should be avoided. Forest antelope and porcupines are also known to have fallen victim to Ebola so should also be avoided. It may be advisable to avoid all meat products in an area where Ebola is known to be present. This particular virus may also be hidden by those who are affected because of the stigma of a diagnosis, so it is important that you are aware and able to identify the symptoms, and take additional measures to avoid accidental exposure. If you become unwell seek medical advice immediately. If a friend or colleague becomes unwell quarantine the patient immediately, and only have contact with the patient while wearing protective clothing including surgical gowns, masks, gloves and eye protection. Wash clothing with soap or disinfectant to kill the virus. If you are working in the vicinity of an Ebola outbreak it may be advisable to leave the area until the outbreak is contained. Should there be multiple outbreaks in the country it would be advisable to consider leaving the country for a period of time. If an epidemic in any country becomes severe, there is a chance that flights will be halted by airlines, and land borders closed by governments until the epidemic is brought under control. In that event, if you cannot or do not wish to leave the country you should consider reserving fuel and batteries and other essential consumable items. If you decide to take a flight be aware of your own state of health and that of your fellow passengers. Do not travel if you feel ill.




July 2014

About US Drum Cussac is a global business risk consultancy advising corporations, organisations and institutions in emerging and complex markets. We provide bespoke, flexible and cost-effective solutions to protect people, business assets, reputation and profitability. Our Information Services team deliver 24/7 analysis services from Drum Cussac hubs in Europe, the Middle East, Africa, Asia-Pacific and North America. We work closely with our clients to provide customised research, analysis and intelligence to support our clients' risk management priorities. Drum Cussac's Global Risk Monitor provides online Country Risk Reports with global situation alerts emailed in real-time, or daily, according to client preference, to keep executives abreast of the latest risks to their businesses. For a free trial of our GRM service, with up-to-the-minute Ebola advisories direct from West Africa please see www.drum-cussac.info. For more information on our services please contact [email protected] or Hamza Sahi on +44 1202 802 060.




July 2014

Disclaimer

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