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The WHO has said real numbers of cases are believed to be much higher than reported: by a factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in Liberia, while the death rate is thought to be about 70 percent of all cases. That would suggest a toll of almost 15,000.
A U.N. plan to stop the epidemic, known as 70-70-60, involves isolating at least 70 percent of cases and safely burying at least 70 percent of those who die by Dec. 1, a 60-day deadline from the start of the plan. That is supposed to rise to 100 percent by the 90-day deadline on Jan. 1.
"Under-reporting" has been a constant feature of the world's worst Ebola outbreak. Cases have gone missing, deaths are uncounted, and "there is widespread under-reporting of new cases," warns the World Health Organization.
The WHO has continually said that even its current dire numbers don't reflect the full reality. The estimated 8,000 Ebola cases in West Africa could just be the tip of the iceberg. Here's a breakdown of why so many cases go under-reported.
These health teams work under constant stress and uncertainty. During this outbreak, they've faced violence, angry crowds, and blockaded roads. They can't wear protective gear because they'll frighten locals. They do their jobs while maintaining a distance from the people they're trying to get information from and staying outside of potentially contaminated houses.
When they finally locate an Ebola victim, he or she may not always be lucid enough to talk or even still alive. So the investigators need to interview friends, family or community members to determine whether it's Ebola that struck.
If this chase appears to have led to an Ebola patient, the health team notifies a dispatcher to have that person transported by ambulance to a nearby clinic or Ebola treatment center for testing and isolation.
If the person is already dead, they notify a burial team, which arrives in full personal protective gear. They put the body in a body bag, decontaminate the house, swab the corpse for Ebola testing, and transport the body to the morgue.
oes WHO acknowledge that the numbers are too low?
Absolutely. In August, it said that the reported numbers "vastly underestimate" the epidemic's magnitude. WHO’s situation updates frequently point out gaps in the data. The 8 October update, for instance, noted that there had been a fall in cases in Liberia the previous 3 weeks, but this was “unlikely to be genuine,” the report said. “Rather, it reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data. It is clear from field reports and first responders that [Ebola] cases are being under-reported from several key locations, and laboratory data that have not yet been integrated into official estimates indicate an increase in the number of new cases in Liberia."
What does WHO think is a reasonable correction factor?
WHO hasn't published an estimate. “It's a point that has been greatly discussed but there is a tremendous amount of uncertainty,” Dye says. For its internal planning purposes, however, WHO uses a correction factor of 2.0. When WHO’s Bruce Aylward said at a press conference last week that the agency is expecting to see between 5000 and 10,000 cases per week by early December, “the difference between the 5000 and the 10,000 is that factor of two,” Dye says. A correction factor of 2.0 would mean that the total number of cases has now crossed 18,000 and the number of deaths 9000.
But numbers are tricky prisms of reality, and even if everyone agrees that the case numbers are dropping off, not everyone agrees on why — or whether the threat from Ebola is dropping off, too. In fact, there’s no one in Liberia who actually knows exactly how many people have died of Ebola. To understand why, you have to understand how Liberia counts its Ebola dead. There’s one set of numbers — the one that gets reported everywhere — that offers a snapshot of what’s happening, as far as anyone knows, on a given day. In Liberia, that snapshot is called the SitRep, short for “situation report.” Every county emails the new cases it finds every day (though the SitRep itself is often published only twice or so a week, because there’s just not enough manpower to keep up). These daily figures get added up and forwarded to the World Health Organization (WHO), which every week or so updates the world on the total number of cases across West Africa. But trying to picture what Ebola is doing through those daily snapshots is a little bit like trying to guess how a finished painting will look by peeking at the painter’s palette.
But some of Liberia’s top Ebola responders say they are more worried about overestimation. “The estimates we are getting are totally wrong,” said Jallah, at the National Ebola Command Center, “Not ‘probably’ higher — they are definitely higher than the actual numbers.” In particular, Jallah objected to projections by the CDC and the WHO. Last month, the CDC projected that, with no intervention, 1.4 million cases could be seen by mid-January. And last week, Dr. Bruce Alyward, the assistant director-general of the WHO last week said he expects to see between 5,000 and 10,000 cases a week in the region by mid-December. “For the WHO, we understand, they want to raise money,” Jallah said. “But it’s good to raise money while clarifying the facts. Sometimes they themselves make this statement without laying the emphasis on ‘if nothing happens.’” The WHO refused repeated requests for comment.
The government's worst-case scenario forecast for the Ebola epidemic in West Africa won't happen, a U.S. health official said Wednesday.
In September, the Centers for Disease Control and Prevention estimated the number of people sickened by the Ebola virus could explode to as many as 1.4 million by mid-January without more help.
Things have changed. On Wednesday, CDC Director Dr. Tom Frieden said, "We don't think the projections from over the summer will come to pass."
Frieden did not provide new estimates. He was speaking in Washington at a U.S. Senate hearing on preparedness and response to public health threats.