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WHO says Ebola outbreak continues to spread in West Africa

Ebola is racing ahead of efforts to contain its spread, according to the World Health Organization. There are now nearly 10,000 reported cases – a tally that clearly underestimates that true scope.

Liz Szabo
USA TODAY
Medical staff, wearing protective masks, checks health forms belonging to passengers arriving from Conakry in Guinea at the airport in Abidjan on October 20, 2014 as Ivory Coast's airline resumed flights to the three west African countries worst-hit by Ebola -- Guinea, Liberia and Sierra Leone. The worst-ever outbreak of the deadly virus has killed more than 4,500 people, almost all in west Africa, with close to 2,500 deaths registered in Liberia alone.  AFP PHOTO / ISSOUF SANOGOISSOUF SANOGO/AFP/Getty Images ORG XMIT: 1034 ORIG FILE ID: 534579445

Ebola is racing ahead of efforts to contain its spread, according to the World Health Organization.

There are nearly 10,000 reported cases -- a tally that underestimates the true scope of the epidemic as overwhelmed health workers fall behind in their record-keeping, the WHO says. About half of Ebola patients have died.

Ebola has now reached every district in Sierra Leone and all but one district in Liberia, with "intense transmission" in these countries' capital cities, according to the WHO.

West Africa today is nowhere near goals set by the United Nations to get the outbreak under control, according to the WHO.

Even with the modest goal of meeting 70% of the region's needs by Dec. 1, affected countries would need at least 16 more labs to help medical staff quickly diagnose patients, 230 more "dead body management teams" to bury or cremate bodies in ways that don't spread Ebola, ​; 4,388 more hospital beds; and 20,000 contract tracers to find and isolate potential cases.

Today, Liberia has enough beds for only 23% of patients, according to the WHO. That means 77% of Ebola patients are languishing and dying at home or, worse, in the street.

Infectious disease expert Michael Osterholm said he's concerned that Ebola is poised to spill over the borders to other African countries, such as Ivory Coast. Of the eight districts in Guinea and Liberia that border Ivory Coast, all but one have reported Ebola cases, the WHO said.

In August, Ivory Coast closed its borders with Ebola-affected countries and temporarily suspended flights.

Two of the four areas of Guinea with new Ebola cases this week are near the border with Ivory Coast, a country of 20 million people, according to the WHO. With a metro area population of more than 7 million, Ivory Coast's economic capital, Abidjan, is the second largest city in West Africa, behind Lagos, Nigeria.

"There is no magic boundary at the border," said Osterholdm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We shouldn't be surprised if we see cases."

Osterholm notes that farmers often leave home in the fall, as they finish harvesting their crops, and migrate to other countries looking for work. He fears that those seasonal migrations could help spread Ebola across Africa.

Countries with Ebola virus reports in West Africa.

Flights between Ivory Coast and the three Ebola-affected countries -- which were suspended this summer over Ebola fears -- resumed this week.

Osterholm said migrant workers often bypass official border checkpoints because they travel on foot through the countryside.

Like Guinea, Sierra Leone and Liberia -- three countries hit hardest by Ebola – Ivory Coast has weathered years of political instability and civil war, said William Moss, a professor at the Johns Hopkins School of Public Health.

The WHO has blamed Ebola's spread through West Africa on poverty, lack of education and crumbling public health systems, which were battered during years of conflict. Although the first Ebola case apparently occurred in Guinea in December, local health officials didn't realize they were dealing with an Ebola outbreak until March, when there were already nearly 50 cases.

At a press conference Thursday, WHO officials addressed rumors that Ebola had been detected in other West African countries.

"At WHO, we hear about many rumors of cases in different countries. Most of these turn out to be negative," Keiji Fukuda, the WHO's assistant director-general for health security and environment, said following a meeting on Ebola.

"Ebola is one of these things that is really hard to cover up," Fukuda said. "There is reasonable confidence that we are not seeing widespread transmission into neighboring countries. ... .We think it would be very difficult to miss."

The WHO is working to prepare Ivory Cost and 14 other countries with borders or strong travel ties to the Ebola-affected nations. The WHO will stage simulation drills, for example, and provide other types of technical assistance.

Beginning with trips to Ivory Coast and Mali, "WHO teams will build on previous work with each country to help identify any gaps in their capacity to identify and respond" to Ebola, according to a WHO report issued Wednesday.

Even Doctors Without Borders, which has been fighting Ebola since March, has had to suspend routine care of women and children at one of its hospitals in Sierra Leone, which once admitted more than 10,000 people per year. The organization's overwhelmed staff can no longer maintain "flawless infection control" in that hospital, putting staff lives at risk.

"It is our intention to resume our activities ... as soon as possible, but for that we need to first put all of our energy in fighting Ebola," said Brice de le Vingne, director of operations at Doctors Without Borders. "We really hope that in a few months, we'll be able to focus once again on treating mothers and children."

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