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WHO: 21,000 Ebola Cases if No Changes  09/23 06:13

   LONDON (AP) -- New estimates from the World Health Organization warn the 
number of Ebola cases could hit 21,000 in six weeks unless efforts to curb the 
outbreak are ramped up, according to an analysis published online Tuesday by 
the New England Journal of Medicine.

   Since the first cases were reported six months ago, the tally of cases in 
West Africa has reached an estimated 5,800 illnesses. WHO officials say cases 
are continuing to increase exponentially and Ebola could sicken people for 
years to come without better control measures.

   But the U.N. health agency has warned that tallies of recorded cases and 
deaths are likely to be gross underestimates. For instance, it noted Tuesday 
that the true death toll for Liberia, the hardest-hit country in the outbreak, 
may never be known, since bodies of people dying in a crowded slum in the 
capital have simply been thrown into rivers.

   Based partially on the assumption that cases are being underreported, the 
U.S. Centers for Disease Control and Prevention is expected to release far 
direr predictions Tuesday. A draft version of the report obtained by The 
Associated Press says there could be as many as 21,000 cases in Liberia and 
Sierra Leone alone by the end of the month and that cases could balloon well 
past 1 million by late January. Experts caution those predictions don't take 
into account response efforts.

   In recent weeks, health officials worldwide have stepped up efforts to 
provide aid, but the virus is still spreading. There aren't enough hospital 
beds, health workers or even soap and water in the hardest-hit West African 
countries: Guinea, Sierra Leone and Liberia.

   Last week, the U.S. announced it would build more than a dozen medical 
centers in Liberia and send 3,000 troops to help. Britain and France have also 
pledged to build treatment centers in Sierra Leone and Guinea and the World 
Bank and UNICEF have sent more than $1 million worth of supplies to the region.

   "We're beginning to see some signs in the response that gives us hope this 
increase in cases won't happen," said Christopher Dye, WHO's director of 
strategy and co-author of the study published by the New England Journal of 
Medicine, who acknowledged the predictions come with a lot of uncertainties.

   "This is a bit like weather forecasting. We can do it a few days in advance, 
but looking a few weeks or months ahead is very difficult."

   They also calculated the death rate to be about 70 percent among 
hospitalized patients but noted many Ebola cases were only identified after 
they died. So far, about 2,800 deaths have been attributed to Ebola. Dye said 
there was no proof Ebola was more infectious or deadly than in previous 

   WHO is just one of the groups that have attempted to calculate the 
epidemic's future toll.

   The agency's numbers seem "somewhat pessimistic" and do not account for 
infection control efforts already underway, said Dr. Richard Wenzel, a Virginia 
Commonwealth University scientist who formerly led the International Society 
for Infectious Diseases.

   Other outside experts questioned WHO's projections and said Ebola's spread 
would ultimately be slowed not only by containment measures but by changes in 
people's behavior.

   "It's a big assumption that nothing will change in the current outbreak 
response," said Dr. Armand Sprecher, an infectious diseases specialist at 
Doctors Without Borders.

   "Ebola outbreaks usually end when people stop touching the sick," he said. 
"The outbreak is not going to end tomorrow but there are things we can do to 
reduce the case count."

   Local health officials have launched campaigns to educate people about the 
symptoms of Ebola and not to touch the sick or the dead. Previous Ebola 
outbreaks have been in other areas of Africa; this is the first to hit West 

   Sprecher was also unconvinced Ebola could continue causing cases for years 
and said diseases that persist in the environment usually undergo significant 
changes to become less deadly or transmissible.

   Dye and colleagues wrote they expected the numbers of cases and deaths from 
Ebola to continue rising from hundreds to thousands of cases per week in the 
coming months --- and reach 21,000 by early November. He said it was worrisome 
that new cases were popping up in areas that hadn't previously reported Ebola, 
like in parts of Guinea.

   Scientists said the response to Ebola in the next few months would be 

   "The window for controlling this outbreak is closing," said Adam Kucharski, 
a research fellow in infectious disease epidemiology at the London School of 
Hygiene and Tropical Medicine.


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