WHO: Number affected by Ebola 'vastly' underestimated

There is evidence that the reported numbers of dead and sickened by Ebola in West Africa may "vastly underestimate the magnitude of the outbreak," the World Health Organization (WHO) said Thursday.

With estimates of more than 1,060 deaths and 1,975 infected, the Ebola outbreak in West Africa is already the deadliest ever.

It will take about six months for the epidemic to be controlled, Joanne Liu, head of Doctors Without Borders (MSF), said Friday. She compared the Ebola outbreak to "wartime" and said that abating it would require greater leadership from the WHO.

"If we don't stabilize Liberia, we will never stabilize the region," Liu said after a 10-day trip to West Africa. The deadly Ebola virus has hit Liberia particularly hard.

"Over the next six months we should get the upper hand on the epidemic, this is my gut feeling," she said, adding more experts were needed on the ground.

In Liberia, officials faced a difficult choice Thursday: deciding which handful of Ebola patients will receive an experimental drug that could prove lifesaving, ineffective or even harmful.

The experimental Ebola drug ZMapp arrived in the West African country late Wednesday — a day after the WHO approved the use of experimental drugs to address the epidemic. By Thursday, it appeared no one had yet received the treatment, which officials said would go to three people.

The outbreak, which was first identified in March in Guinea and has since spread to Liberia, Sierra Leone and Nigeria, has overwhelmed the already strained health systems in West Africa and raised questions about whether authorities are doing enough to respond.

There is no licensed treatment for Ebola, a virus transmitted by contact with bodily fluids, so doctors have turned to the limited supply of untested drugs to treat some cases.

The Liberian government had previously said two doctors would receive ZMapp, but it was unclear who else would. Information Minister Lewis Brown said Thursday it would probably be another health care worker.

These are the last known doses of ZMapp. The San Diego-based company that developed it has said it will take months to build up even a modest supply.

The outbreak has sparked an international debate over the ethics of giving untested drugs to the sick and of deciding who should get the drugs. So far, only two Americans and one Spaniard have received ZMapp. The Americans are improving — but it is unclear what role the drug has played. The Spaniard died within days.

Now Liberian officials are facing those questions. In this outbreak, over 50 percent of those sickened with Ebola have died, according to the U.N. health agency.

"The criteria of selection is difficult, but it is going to be done," said Dr. Moses Massaquoi, who helped Liberia obtain the drug from Mapp Biopharmaceutical. "We are going to look at how critical people are. We are definitely going to be focusing on medical staff."

He added people past the "critical phase" who looked likely to survive would not be chosen.

Massaquoi said there was only enough of the drug to treat three people. Treatment will be staggered, so doctors can observe the effects in one patient before moving on to the next. Late Thursday, he said the treatment had not yet started.

Arthur Caplan, director of medical ethics at NYU Langone Medical Center, said the choice of who to treat would have to balance helping the largest number of people with learning the most from the treatments.

He said the question is not "whose life do we save?" but "who gets the chance to be experimented on?"

For that reason, recipients need to be good experimental subjects — people who have recently contracted the disease and are more likely to respond to treatment, or perhaps younger patients, Caplan said. In order to study the long-term effects, doctors will likely prefer people who can be observed for months, which might eliminate those living in remote places, he added.

Compounding concerns over treatment, U.S. authorities have warned against fraudulent Ebola drug claims.  

The U.S. Food and Drug Administration said on Thursday it has become aware of products being sold online that fraudulently claim to prevent or treat Ebola.

The FDA warning comes after comments from Nigeria's top health official, Onyebuchi Chukwu, who reportedly said earlier Thursday that eight Ebola patients in Lagos, the country's capital, will receive an experimental treatment called nano-silver.

Erica Jefferson, a spokeswoman for the FDA, said she could not provide any information about the product referenced by Chukwu.

Meanwhile, the U.S. State Department ordered families of embassy personnel to leave Sierra Leone on Thursday because of concerns that the crisis would make it difficult to get treatment for even routine health problems.

U.S. President Barack Obama spoke by phone Thursday about the Ebola outbreak with Liberian President Ellen Johnson Sirleaf and in another call with President Ernest Bai Koroma of Sierra Leone. The White House said Obama expressed his condolences for the hundreds who have died in both countries and underscored the U.S.'s commitment to work with West African nations and U.N. agencies to contain the outbreak.

International concerns over the epidemic have spurred the International Olympic Committee (IOC) and local organizers to bar three teenage athletes from West Africa from competing at the Youth Olympics in China because of the risk of possible infection, the IOC said Friday. Organizers maintained that the delegations from the four Ebola-affected nations were still "welcome" at the games.

The WHO has advised against imposing travel bans to the affected countries since the disease cannot be transmitted by air. 

Also, Nigeria announced Thursday that another person had died from Ebola, bringing the country's death toll to four. The Health Ministry said the person was a nurse who helped treat the country's first Ebola case, Liberian-American Patrick Sawyer who flew in last month and died.

The ministry corrected its total number Ebola cases to 10 instead of 11 as it had reported earlier in the day.

Al Jazeera and wire services