WHO warns of ‘shadow zones’, hidden cases in Ebola outbreak

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A health inspection and quarantine researcher (L) demonstrates to customs policemen the symptoms of Ebola, at a laboratory at an airport in Qingdao, Shandong province August 11, 2014. REUTERS/China Daily

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GENEVA (Reuters) – The scale of the world’s worst Ebola outbreak has
been concealed by families hiding infected loved ones in their homes and
the existence of “shadow zones” that medics cannot enter, the World
Health Organization (WHO) said on Friday.

The U.N. agency issued a statement detailing why the outbreak in West
Africa had been underestimated, following criticism that it had moved
too slowly to contain the killer virus, now spreading out of control.

Independent
experts raised similar concerns a month ago that the contagion could be
worse than reported because suspicious local inhabitants are chasing
away health workers and shunning treatment.

More than 1,300 people
have died from the disease and many experts do not expect the epidemic
to be brought under control this year.

Under-reporting of cases is
a problem especially in Liberia and Sierra Leone. The WHO said it was
now working with Medecins Sans Frontières (MSF) and the U.S. Centers for
Disease Control and Prevention to produce “more realistic estimates”.

The
head of MSF, which has urged the WHO to do more, told Reuters in an
interview on Thursday that the fight against Ebola was being undermined
by a lack of international leadership and emergency management skills.

The
stigma surrounding Ebola poses a serious obstacle to efforts to
calibrate the outbreak in Liberia, Sierra Leone, Guinea and Nigeria,
which has claimed far more victims than any other episode of the disease
that was first discovered nearly 40 years ago in the forests of central
Africa.

“As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home,” the WHO statement said.

“Others
deny that a patient has Ebola and believe that care in an isolation
ward – viewed as an incubator of the disease – will lead to infection
and certain death. Most fear the stigma and social rejection that come
to patients and families when a diagnosis of Ebola is confirmed.”

Corpses
are often buried without official notification, the WHO said, while an
additional problem is the existence of numerous “shadow zones”, or rural
villages where there are rumours of cases and deaths that cannot be
investigated because of community resistance or lack of staff and
transport.

In other cases, where treatment is available, health
centres are being immediately overwhelmed with patients, suggesting
there is an invisible caseload of patients that is not on the radar of
the official surveillance systems.

STRATEGY PLAN

The WHO
said it had drawn up a draft strategy plan to combat Ebola in West
Africa over the next six to nine months, implying that it does not
expect to halt the epidemic before the end of the year.

“WHO is
working on an Ebola road map document; it’s really an operational
document how to fight Ebola,” WHO spokeswoman Fadela Chaib said at a
news briefing. “It details the strategy for WHO and health partners for
six to nine months to come.”

Chaib, asked whether the timeline meant that the United Nations
health agency expected the epidemic now raging in Guinea, Liberia and
Sierra Leone to continue into 2015, said: “Frankly, no one knows when
this outbreak of Ebola will end.”

Ebola will be declared over in a
country if two incubation periods, or 42 days in total, have passed
without any confirmed case, she said. Nigeria is the fourth country with
known cases.

“So with the evolving situation, with more cases
reported, including in the three hot places – Guinea, Sierra Leone, and
Liberia – the situation is not yet over,” Chaib said.

“So this is a planning document for six to nine months that we will certainly revisit when we have new developments.”

The WHO expects to issue details of the plan early next week, she said.

In
a sign of spreading international alarm, Senegal, West Africa’s
humanitarian hub, said it had blocked a regional U.N. aid plane from
landing and was banning all further flights to and from countries
affected by Ebola, potentially hampering the emergency response to the
epidemic.

(Reporting by Stephanie Nebehay in Geneva, Ben Hirschler in London and Emma Farge in Dakar; Editing by Mark Heinrich)

| Reuters

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