Experts are increasingly predicting that the West Africa outbreak will likely persist in the region for at least six to nine months, setting back development in the affected countries to a significant degree, even as another outbreak of the virus simultaneously erupts in the DRC.

Dr David Nabarro, a British physician appointed by the UN to coordinate the global response to the crisis, noted the epidemic could take six months to quell as it affects “unprecedented” numbers of medical staff, and that “the effort to defeat Ebola is not a battle but a war.”

While Dr Tom Frieden, the director of the U.S. Centers for Disease Control and Prevention, said, “I wish I didn’t have to say this, but it is going get worse before it gets better,” at the end of a visit to Liberia, where he described the situation as dire, as cases overload facilities.

Liberia now has recorded the highest number of cases and deaths among the three most afflicted countries, and Doctors Without Borders disclose that all 120 beds at a treatment centre just recently opened in the country’s capital were filled up almost immediately.

The World Health Organization now believes the fight to end the Ebola outbreak will require $430m, according to a draft document for its battle strategy to reverse the trend of new case of the disease within two months and stop all transmission within six to nine months.

The organisation noted that the epidemic “continues to evolve in alarming ways, with Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of compromised health systems, significant deficits in capacity and rampant fear.”

Seeing Double

A separate strain of Ebola has also emerged in the Democratic Republic of Congo, in a development that initially baffled aid agencies after 70 died, including one doctor, from an unidentified  haemorrhagic illness that the authorities and WHO initially denied as Ebola.

The outbreak began in the remote jungle province of Equateur, where the first case of Ebola was reported in 1976, with very similar symptoms to the current outbreak of hemorrhagic gastroenteritis in West Africa, but with a fatality rate closer to 12% rather than 55-60%.

It has since emerge that the haemorrhagic fever in the DRC is indeed Ebola after three samples from two patients and sent to a laboratory came back positive. However, it also revealed that the virus was an entirely separate strain from the one in Western Africa.

Health Minister Felix Kabange Numbi noted that two cases that tested positive for a Sudanese strain of the disease, while the other mixed the Sudanese and the Zaire strain, which is the most lethal variety, as well as the version of the virus present in West Africa.

DRC’s UN mission has now allocated $1.5m to combat the new outbreak, but it could double that sum as it releases an emergency fund, while Uganda has put itself on alert, and its health experts are closely monitoring developments in the neighbouring country.

Evolving Epidemic

In West Africa, the infection among health workers, who are especially vulnerable due to their close proximity to patients and their bodily fluids, continues to be the most worrying aspect of the epidemic. The WHO says that at least 240 health workers have been infected.

Early hopes for a potential relief for health workers in the form of a limited supply of ZMapp, an experimental anti-viral serum that was delivered to Liberia at the request of the country’s president. However, at least one of the three Liberian doctors treated with the drug has since died.

Dr Sahr Rogers, an epidemiologist that had been working for the WHO at a hospital in the eastern town of Kenema in Sierra Leone has also become infected with Ebola, making him the first of the agency’s 400 workers in the affected countries to fall ill with the deadly virus.

Dr Rogers is the third top doctor in Sierra Leone to succumb to Ebola since the emergence of outbreak – a significant blow in a country with only two doctors per 100,000 people.

Christy Feig, director of communications at the WHO, cautioned: “The international surge of health workers is extremely important and if something happens, if health workers get infected and it scares off other international health workers from coming, we will be in dire straits.”

Canada, which has 2.5 physicians per 1,000 people in 2012, has since recalled three of its medical workers from a laboratory testing for the Ebola virus in Kailahun, in Sierra Leone, as, the WHO said, “a temporary measure to take care of the welfare of our remaining workers.”

Tracking Transmission

Sierra Leone’s occurrence of the disease has now been tracked back to one traditional herbalist healer, who claimed to have the cure for the disease and encouraged infected individuals to travel across the border from Guinea for treatment.

Mohamed Vandi, the top medical official in the hard-hit district of Kenema, told AFP, “She got infected and died, and during her funeral, women around the other towns got infected.”

An ethnically-diverse, Krio-speaking city of 190,000, Kenema already has the world’s highest incidence of Lassa fever, another viral haemorrhagic disease. Twelve nurses were among the 277 people to die since the first cases at Kenema hospital, while ten survived.

The outbreak in the DRC was quickly traced to a hunter who found a dead bush animal and had his pregnant wife butcher the remains. Bush meat is similarly implicated as the source of Ebola in West Africa, where it is thought to have come from bats.

Economic Setback

Concern is also growing over the economic impact of the epidemic, with Abdoulaye Mar Dieye, a director for development at the UN, noting, “Some of these countries were showing encouraging economic growth rates and development progress after long periods of turmoil.

“This could set them on a backward path. Emerging sectors such as tourism, agriculture and private sector investment could take a hit, and development programmes may have to be interrupted in the affected areas, which need them the most.”

Measures such as border containment, quarantine, airport screening, and medical protection gear could also cost the region, “hundreds of millions of much needed dollars.”

The Ebola outbreak could set the formerly war-torn countries of Sierra Leone and Liberia back a decade, Ireland’s first ambassador to the region has warned.

Sinead Walsh, Ireland’s Ambassador to Sierra Leone and previously the head of the Irish Aid office responsible for programmes in Sierra Leone and neighbouring Liberia, told the Irish Examiner, “We have seen a lot of progress in Sierra Leone and Liberia over the last 10 years.

“Poverty has halved since the end of the war and we were feeling quite encouraged in recent years about the progress, but now there is enormous panic here in Sierra Leone, and it really risks undermining everything we have been doing.”