LATEST NEWS The epidemic continues to spread and accelerate

SEPTEMBER 8, 2014

LATEST NEWS The epidemic continues to spread and accelerate 

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Public concern and media coverage regarding the West African Ebola outbreak continue to be intense as new sites have been affected and numbers have grown, but international organizations such as the World Health Organization (WHO) and the World Food Programme (WFP), expert organizations such as the Centers for Disease Control (CDC) and Médecins Sans Frontières (MSF), and all governments in the area have significantly stepped up efforts to fight the spread of the epidemic. The European Union announced on September 5th 2014 the injection of 140 million euros in the fight against the epidemic. As of August 28th 2014, the WHO has introduced its new roadmap for the fight against the epidemic. Europ Assistance - Global Corporate Solutions (GCS) clients with either operations or travelers in West Africa have been increasingly concerned about the recommendations to be made to their staff and plans to be put in place, especially since the discovery of a new fatal case in Port Harcourt in Eastern Nigeria with many contacts involved. As of September 5th 2014, and since the start of the epidemic, the World Health Organization reported: 

3,944 cases

 2,097 deaths However it seems that populations are reluctant to obey isolation directives and may be hiding cases, and therefore those numbers may underestimate the extent of the epidemic. 

The survival rate so far has been higher than in previous epidemics at 47 %. Most of the cases and deaths occurred in:  Liberia

some local populations to oppose isolation measures or airlines / airline staff to reduce or cancel their availability at a time when increased communications and transport facilities are needed to bring international relief support staff in and out of the affected countries efficiently. Since the World Health Organization (WHO) formally declared the Ebola outbreak a Public Health Emergency of International Concern on August 8th 2014, several countries have started implementing the extensive recommendations to the governments of the affected and the neighboring countries, and as a result regional travel to and from the affected countries, especially Liberia, Sierra Leone and Guinea, and even Nigeria, has become more restricted. Brussels Airlines and Royal Air Maroc still serve all the capital cities in the area. Air France has suspended its flights to Sierra Leone, and British Airways extends the suspension of flights to and from Liberia and Sierra Leone until December 31st 2014. All major air ambulance providers, except EAA (Luxemburg) still evacuate non-viral hemorrhagic fever cases from the affected countries. GCS analyzes the situation on the basis of its own experience and direct contacts in the field, and of the recommendations of major public health bodies such as the WHO and the CDC, governments and other organizations such as airlines and corporations, to initiate an ongoing surveillance scheme and to put forward regularly updated practical guidelines for its clients. As September 8th 2014, GCS recommends the following measures for the four most affected countries namely: 

GUINEA

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SIERRA LEONE

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LIBERIA NIGERIA

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Sierra Leone

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Guinea - the epidemic’s progression seems to have to have picked up again after it had recently slowed down.

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As well for the Equateur province in the Democratic Republic of Congo (DRC).

Nigeria - 18 cases and 7 deaths - several contacts identified in Port Harcourt where the risk is high.

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Senegal - 1 new case reported still being investigated.

Many of the deaths have been health care workers, a fact explained by both lack of protection and overexposure in part due to dedication and also to shortages of staff. A cluster of cases reported in Equateur province in the Democratic Republic of Congo (DRC) is definitely unrelated to the West African epidemic.

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All travelers, whether business, leisure or family visits, should postpone visits whenever possible (including funerals), and should definitely avoid all areas known to be stricken by the epidemic. However there are no restrictions as such recommended for air travelers, including airline staff.

The “fear factor” is unfortunately having a negative impact on the fight against the Ebola epidemic. It has for instance led

All rights reserved to Europ Assistance - Global Corporate Solutions, Paris, France - Insurance and reinsurance broker registered with the French Registry of Insurance Intermediaries - ORIAS No. 12066043 - 08/2014 - Photo credits: Centers for Disease Control & Prevention - Public Health Image Library (PHIL)

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SEPTEMBER 8, 2014 

 Business travelers who cannot postpone their trips due to essential work-related reasons (e.g. medical personnel involved in the management of the epidemic) and local employees should rigorously obey all recommendations on contact avoidance and others related to their area of work.

Any organization sending staff to Guinea, Sierra Leone, Liberia, Nigeria and the Equateur province of the DRC should be aware of the country’s rules regarding circulation of travelers and case detection, and should have a Medical Emergency Response Plan (MERP) in place should extraction of all eligible staff and dependents be required. 

Expatriates whose presence is not essential in the country should either leave the country or delay their return should they be abroad. Those required to stay in country should also rigorously obey all recommendations on contact avoidance and others related to their area of work. Any organization with expatriate staff in Guinea, Sierra Leone, Liberia, Nigeria and the Equateur province of the DRC should be aware of the country’s rules regarding circulation of travelers and case detection, and should have a Medical Emergency Response Plan (MERP) in place should extraction of all eligible staff and dependents be required.

GCS does not recommend any travel restrictions to neighboring countries.

GENERAL RECOMMENDATIONS PREVENTIVE MEASURES The activities most at risk involve contact with sick or dead people, all body fluids, or with animals.    

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Avoid all physical contacts (including handshakes) with all people Frequently wash hands with soap or alcohol based solutions Do not buy, stock or eat bush meat Avoid contact with people who are sick and for whom Ebola fever has not been excluded as a diagnosis and do not visit or seek care at facilities where Ebola patients are treated. For people in contact with the patients, avoidance of contact with the body or body fluids by wearing gloves, masks, gowns,

shoe covers and goggles or face shields is mandatory to avoid transmission of the virus through the skin or the mucous membranes. Training for the proper use of these is essential.

SYMPTOMS It can take 2 to 21 days for symptoms to appear after a person is exposed to the virus. Early symptoms include: Fever and chills  Severe headaches  Joint and muscle aches  Sore throat and weakness  Vomiting and/or diarrhea  As the patient’s condition worsens he may experience bleeding from mucosae including the eyes. WHAT TO DO WITH A SUSPECTED PATIENT  Any suspected patient should be immediately isolated. Contacts must be identified. 

A log of persons entering the area should be kept, and the number of caregivers should be restricted.

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No visitors are allowed and authorities must be contacted. Most countries in the region have designated hospitals and other health care facilities for the diagnosis and treatment of Ebola fever.

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The investigation will include non-specific blood testing, including for malaria that can co-exist with Ebola, but specific serological testing is not readily available and it takes 24 to 48 hours to obtain results.

EVACUATION CAPABILITIES Patients, families and employers should be aware of the fact that should they become sick the likelihood of being evacuated home is extremely low as countries try to limit the spread of the disease by limiting the circulation of ill people and of the viruses they carry. At the time of writing the current advisory note, air ambulance companies have clearly indicated they will not transport anyone suspected of suffering from any hemorrhagic fever including Ebola fever, and public authorities in most countries of potential destinations, especially European countries with tropical medicine expertise, will not as a rule allow entry to such patients.


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SEPTEMBER 8, 2014 Care will therefore in general be restricted to the country of occurrence, bearing in mind that no specific preventive or curative treatment exists. Repatriation cases reported in the media are exceptional and there should be no expectation in this regard, although some countries are putting mechanisms in place for selected potential patients such as workers directly involved in fighting the epidemic. Experimental immunological unregistered treatments have being initiated on a limited basis as they are considered ethical in the circumstances, but those will be offered in limited quantities to carefully selected candidates and are NOT for general use. This said, early successful results are encouraging and a vaccine may be available as soon as November according to the WHO. IMPACT ON GCS-OPERATED SITES GCS has taken strict measures in the facilities it maintains in one of the affected countries, Guinea, and in addition to the above these include check points at the entrance of the sites to enforce the measures listed and an escalation protocol for possible evacuation. The services are maintained on GCS sites as we speak. GCS is also ensuring that on all sites it operates in the region, staff is properly trained and equipped, and that it assists clients in the preparation of customized Medical Emergency Response Plans (MERP). USEFUL MATERIAL GCS strongly encourages readers who wish further information to read the following material produced by the CDC and the WHO: th

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Ebola Response Roadmap Situation Report No. 2 - September 5 2014 - WHO

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Ebola Response Roadmap - WHO

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Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola - WHO

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Fact Sheet - Ebola Hemorrhagic Fever - CDC

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Infographic - Ebola virus life cycle - CDC

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Infographic - Facts about Ebola - CDC

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Infographic - Stopping the Ebola Outbreak - CDC

Europ Assistance - Global Corporate Solutions Medical Department


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