The Ebola outbreak that has killed thousands in West Africa might finally be starting to subside.
There are signs — imperfect measurements, rife with caveats, but significant indicators nonetheless — that the outbreak is abating. Health authorities are cautious, though, about saying that a corner has been turned, emphasizing that until the disease has been fully eradicated, there is always the risk it will pop up again.
But the picture looks much better now than it did in the summer, when the U.S. Centers for Disease Control and Prevention warned of a worst-case scenario in which there could be more than a million cases worldwide by January.
“The U.N. Mission for Ebola Emergency Response does feel, does see that there are signs that the strategy is working,” Mathias Gillmann, a spokesperson for the U.N. Secretary General’s office, told TPM on Wednesday. “Where the money has been put and where the means have been put, it looks like the strategy seems to be working.”
“But,” he added, “as long there is one single case that remains, then we can’t let up the effort.”
Statistics from World Health Organization have shown in the last few weeks a steady decline in the numbers of cases reported, particularly in Liberia. There, less than 100 new cases were reported this week after reaching nearly 500 new cases a week during several weeks in mid-September.
“It’s certainly early to say that this is over. It’s even early to say that this is getting better,” Daniel Epstein, a WHO spokesperson, told TPM. But, he said: “It appears to have stabilized.”
Chart via WHO.
The toll is still staggering. WHO has documented 15,145 cases across six nations, including in the United States, and 5,406 deaths from the time the outbreak began until this past Sunday.
Previously, the biggest death toll from a single strain, according to the CDC, was in 1976, which was the first time medical authorities recognized the disease. During that outbreak, 280 people died, all of them in what is now the Democratic Republic of the Congo.
It was only a few months ago that the United States seemed to be gripped with Ebola hysteria. American health care workers who treated patients in West Africa became infected with the virus and had to be brought back home. In one case, the person transmitted the disease to one of the nurses who was treating him. Politicians and talking heads sounded dire warnings about what was coming to American shores in the lead-up to the midterm elections.
But since then, those worst fears haven’t materialized. Precautions by U.S. health officials appear to have stemmed any sort of U.S. outbreak and the disease has largely receded from the national conversation.
In reality, the epicenter is and always was in three African countries — Liberia, Sierra Leone and Guinea. For a long time, international authorities struggled to get the disease under control, even as U.S. attention turned to those handful of cases here.
Even into September, the situation appeared that it could get much worse. It’s notoriously difficult to predict worst-case scenarios, but that month the CDC warned as many as 1.4 million people worldwide could be infected by early January if the response wasn’t adequate.
During Senate testimony on Wednesday, however, the agency’s director, Thomas Frieden, said officials no longer believed that would occur.
“We don’t think the projections from over the summer will come to pass,” Frieden said, according to the Associated Press.
The WHO was more reserved in its predictions about how bad things could get in West Africa. A month ago, the organization projected that as many as 20,000 people could be infected by early November. Not even that came to pass. The organization’s spokesman, Epstein, told TPM that if the current trend holds, the group’s worst-case scenario won’t likely be reached.
There have been media reports that also suggest to observers the situation might really be improving.
Earlier this month, the BBC reported that two-thirds of Libera’s Ebola treatment-center beds were empty. In late October, the New York Review of Books similarly reported that beds were empty and funeral directors were reporting decreased business.
“There are some pretty hopeful signs,” Christopher Dickey, a global health professor at New York University who has worked with groups like WHO and the United Nations before entering academia, told TPM this week. “There are empty beds in (the Liberian capital) Monrovia. Presumably, that wouldn’t happen if it was raging out of control.”
Hundreds of millions of dollars have been spent to make that happen. Much of it has gone to sending more health workers to West Africa and constructing treatment centers there. American soldiers have parachuted in to assist. The United Nations requested $1.5 billion through March 2015 (and has received about $739 million so far.) The United States has committed $350 million as well.
Those resources have been paired with a still-ongoing public education effort and strict burial regulations from the Liberian government, which have helped prevent citizens from coming into contact with dead bodies when they are most contagious.
“It doesn’t surprise me that it’s starting to be taken under control,” Charles Bailey, a former Army doctor who studied African viruses and is now a biology professor at George Mason University, told TPM.
But nobody is declaring victory. There are concerns that cases are being underreported in rural Liberia. Sierra Leone has not seen the same decline in reported cases that Liberia has. A handful of cases have been reported in Mali, which borders Guinea, indicating that the virus could still spread to new places that have not constructed the same infrastructure to fight it.
All of that helps explain why, even when health experts acknowledge progress is being made, they have remained very guarded about how they describe it.
“The whole epidemic itself was so surprising to many people because of the way Ebola behaved in the past,” Michael Merson, director of Duke University’s Global Health Institute and a former CDC and WHO official, told TPM. “These countries are so fragile that I think people are a bit nervous about declaring victory, but I think that’s appropriate.”
“I don’t think people want to shut off the response,” he said. “We really do need now to be serious about helping these countries strengthen their health systems and avoid these problems in the future.”