This fact file examines the current Ebola virus disease (EVD) situation regionally and nationally in the greater West Africa region. It also examines the latest guide lines by international bodies and highlights any potential challenges. The coastal states spanning from Senegal to Angola are addressed in this report totalling 19 countries and updates will be conducted on a fortnightly basis. The contact number and emails are provided with the World Health Organization (WHO) liaison facility in each respective country below, as well as any collaborative focal point centres specifically dealing with EVD. The collaborative centres are testing facilities and research centres that are addressing containment and other specific medical issues.

Summary

The 2014 EVD outbreak, which originated in rural Guinea, is so far the worst in history with an estimated 3,069 confirmed cases and 1,841 deaths. According to the WHO, the fatality rate is 52%, while the outbreak acceleration rate is increasing with 40% of the total number of cases having occurred in just the past 21 days.

Currently, Guinea, Sierra Leone, Liberia, Nigeria, Senegal, and the Democratic Republic of Congo (DRC) are facing outbreaks. All of the confirmed West African cases, excluding those in the DRC, are connected to the Guinea outbreak, which has effectively spread eastbound. Unlike outbreaks in previous years, this EVD strain has become increasingly more difficult to contain due to the increased movement of people in comparison to previous years. The increased use of air travel has complimented this outbreak’s proliferation. However, the most common transmission method for EVD has remained via overland routes, although there have been select related outbreaks connected to air travel. So far, there have been no cases connected to the shipping sector and spread by maritime transport.

Actions

The WHO declared the current outbreak as an ‘international health emergency’ in July 2014 prior to confirmed EVD cases in Nigeria, which was the fourth country affected. The WHO is the primary body tasked with handling the EVD outbreak on behalf of the United Nations. Co-ordination between the WHO and affected countries has been challenging due to a lack of transparency in the affected countries. In addition, certain governments such as Guinea have been accused of suppressing numbers, particularly those that have occurred in the country’s capital, Conakry. Despite numerous forewarnings and the risk looming due to the large number of regional flight networks out of Dakar, upon the first confirmed EVD death in Senegal, the Senegalese government hastily requested proper personal protective equipment (PPE) from the WHO and immediate medical support, displaying a lack of contingency planning.

The maritime sector

So far, the International Maritime Organization (IMO) has deferred to the WHO on this issue. In the maritime sector, on 4 August 2014 the International Chamber of Shipping (ICS), International Maritime Employer’s Council (IMEC), and International Transport Workers’ Federation (ITF) issued joint statements, while on 11 August 2014 the Philippine Overseas Employment Administration (POEA) issued guidelines, which were unanimously welcomed within the industry.

These included: the enforcement of the ISPS Code measures in preventing unauthorised persons on board while in port; requirements for proper PPE for all crew; and limiting shore leave and discouraging crew changes in the affected countries. The guidelines also suggest that the crew should be aware of the signs and symptoms exhibited and the need for immediate reporting to the Master or designated on-board medical officer. At sea, the EVD outbreak, and particularly the global and regional reaction to it, has strained operations in West Africa. Many in the shipping industry allege that a state of paranoia is in play while others deeply fear an increased proliferation at sea and via air travel. Even those with confirmed cases, such as Nigeria, have been quick to put a blanket ban on all vessels that have called on ports in one of the original so-called ‘Ebola 3’ countries (Guinea, Sierra Leone, and Liberia). Logistically, this has made trading in the region extremely difficult while the economies of the Ebola 3 have witnessed the greatest impact. So far, only specific vessels are being used to trade on specialised routes focusing on the Ebola 3 feeder ports before returning to transhipment hubs such as Tangier and Algiers.

Medical challenges EVD signs and symptoms, short of haemorrhaging in the final stages before death, can be easily confused with a wide array of other fever-related illnesses that are trea-table. Current guidelines and response will generally seek to isolate anyone who is experiencing diarrhea and vomiting while having been to Africa recently. At sea, this would mean isolating the seafarer and reporting the incident for consultation. A coastal state is highly unlikely to accept a crewmember showing even just the basic symptoms that could easily be a fever, which inherently denies the patient the proper tests and possible treatment for an illness that is not fatal (if treated). Furthermore, guidelines currently do not address the challenges of evacuating a patient showing symptoms while operating essentially anywhere between Senegal and Angola. The patient would therefore have to be isolated until reaching Tangier or Algiers and then evacuated for testing and treatment. The predominant issue is that there is no simplified testing methodology available for EDV, which requires complex blood testing in specific laboratories compared to, for example, testing malaria.

The current guidelines set forth by the POEA and backed by the ITF, ICS and IMEC are primarily focused on prevention and isolation. However, they do not properly understand the need for immediate access to testing in order to positively rule out EVD and effectively treat any illnesses displaying similar symptoms but with a high survival rate. The guidelines also do not address the contingency planning process needed for the merchant sector to deal with an EVD patient via telemedicine or external support.

There could also be greater collaboration between international bodies such as the WHO and maritime organisations, particularly the IMO, in order to pre-plan potential scenarios where seafarers displaying symptoms can be properly tested.

The British healthcare worker who contracted EDV while in Sierra Leone was flown out by Royal Air Force aircraft to the United Kingdom and successfully treated. The rapid casualty evacuation saved his life. Although select countries are prepared to protect their citizens in a similar fashion with repatriation, it is unlikely that nationals from the bulk of seafaring nations will receive the same treatment. This lays the responsibility in the manning companies and appropriate level of insurance cover for evacuation. This, however, creates a new issue with respect to a workable airstrip for evacuation, which would have to be within a country that would allow an infective person ashore for transfer and repatriation.