Crisis is a disruption of normal operations which exceeds emergency response, or a condition where the entity has no preplanned mitigation to contain or control the disruption. Maintaining a state of normalcy, for any organization, is directly dependent upon the risks to their assets and processes. The key to reducing the frequency and severity of a crisis is to fully understand the organization’s Risk Profile. The organization’s Risk Profile is derived from a methodology which determines how risk varies across comparable assets and processes. When developing the Risk Profile, management assesses the:
Regardless of the industry, more and more business travelers are being placed in situations where they realize unacceptable levels of risk and personal protection tips can help. Gone is need for the ambiguous security plans of the ‘60s and ‘70s, developed to fuel the egos of corporate executives. Business travelers need protective measures and personal protection tips that are both tangible and effective.
In order to mitigate this rapidly changing risk, security consultants today must have intimate knowledge of the impact each lost asset will have on the client’s business, as well as all of the stressors their clients may face both while traveling at home and abroad. Most importantly, and sadly the most often neglected factor in the risk equation, is the need for effective risk mitigation strategies.
Remain Vigilant is Not a Tangible Tactic for Travelers
All too often we see pundits, media darlings, self-proclaimed “experts” and even consulting products provide mitigation strategies that are either just general precepts on what to do or tactics that are too ambiguous to be effective. As most of us have recently seen from the attacks in Paris and Brussels, business travelers, expatriates and students studying abroad face legitimate threats, regardless of their destinations.
The duty of care for those responsible for that travel requires that they provide effective and actionable protective measures and not lofty strategic doctrine that has no substance. But what is that exactly? What does an effective protective measure look like? Let’s continue on with our Brussels example to find the answer.
Even as the attacks were occurring in Brussels, corporate crisis management teams, newscasters and public officials were broadcasting the need to “be more vigilant” to “raise the level of awareness” and “implement a heightened sense of security,” but failed to let us know what that looks like. What actions do you take or what equipment do you deploy to “be more aware?”
Another point supporting this dynamic shows a summary of information collected on the actions taken by security professionals during the actual attacks. While most organizations did what they were trained to do, most if not all of those tasks performed would prove to be ineffective in actually mitigating the risk from a violent attack against a traveler. Let’s look at some details to better realize the difference between strategic guidance and effective protective measures.
Expert Tactics That Can Help Keep You Safe
When we tell someone to be more aware of their surroundings, by definition, we are telling them to be more cognizant or conscious of the people and objects in their environment in hopes of identifying someone or something that has the potential of causing them harm and hopefully avoiding closer contact with that person or object. So we see that by recommending that a person be more aware, we have actually asked them to perform three tasks that include:
This brings us to the point where we realize that the difference between a precept and a tactic is not so much in telling someone what to do, but how to do it. Let’s continue on with our example of becoming more aware.
While we have simple and effective methodologies for identifying your operational space and potentially hazardous substances or devices, let’s focus on how we identify someone who has the intent to commit an act of violence (or any other crime for that matter).
Keep in mind, we are using this technique to identify those who may potentially cause us harm and not imposing a death sentence. The point being is that it’s OK to move away from someone you have determined may harm you without harming that person if they are innocent.
The more you practice this, the better and more “aware” you become. While it may initially seem like a lot to do, after one overseas trip of applying this technique, you can perform this analysis in just a few seconds.
The tactic revolves around the acronym FACE:
FACE
F = Focus.
What is the focus of the person you are evaluating? People generally focus on the reason they are in a certain situation, like watching a sporting event. They are focused on the field or court, perhaps focused on a colleague with whom they are discussing a play.
Someone there to commit a crime will also be focused on their reason for being there. Searching for a place to plant an explosive, going against the grain, searching for a concentration of people or focused on the weapons they will use to commit their crime.
A = Attitude and Actions.
In this case, we are trying to determine if the attitude and actions of the person we are assessing are appropriate for the situation. You expect a deliverymen to be anxious or hurried. People waiting in line may be irate or rude.
Someone waiting in line that is mumbling to themselves, fumbling with objects in a pocket or backpack or for whatever reason, their attitude or actions do not seem appropriate, consider this person suspicious.
C = Clothing and Appearance.
Seeing someone with blue hair and blue paint on their chest would raise suspicion at the White House or the Vatican, but this same person in Kansas City would be considered nothing more than a loyal Royals baseball fan. Again, we are not looking for someone that you personally feel is odd, but someone whose clothing and appearance are not appropriate for the current situation.
Is this person wearing a heavy coat while the rest of the crowd is in t-shirts and shorts? Are they attempting to portray a certain culture such as a US Cowboy, hip hop star or other cultural group? (Especially in an attempt to mask their true intentions.) Are they sweating profusely, despite cooler temperatures? Heavily perfumed? Do they act or appear to be under the influence of drugs or alcohol?
E = Environment.
When considering the environment, there are two factors, one is the physical environment such as time of day, weather, geography and seasons and the other is the operational environment. Has an attack already occurred? Are people evacuating an area? What environmental factor is currently impacting the behavior of those around me? These situations will all change the meaning of what is “appropriate” for the current situation.
We see that we can very quickly go from providing moderately helpful precepts, such as “remain vigilant” to specific actions you can take to actually be more aware. As leaders, executives and administrators, the responsibility is now ours to go beyond the basic factors of knowing the risk profile for people we have placed in harm’s way by knowing what we must protect, what we must protect them from and what we have to protect them with. We must also ensure that we understand how these personal protection tips will be used and ensure that they are effective in mitigating the risk to our institution assets.
Written by: EDWARD D. CLARK
Edward D. Clark is a retired Special Forces Officer with both strategic and tactical level experience in developing and implementing critical infrastructure protection programs and armed response capabilities. Edward holds a bachelor’s degree in criminal justice and master’s degree in computer information systems. He served as the security lead for the White House Homeland Security Council on Bio-terrorism and is a nationally sought after trainer and public speaker on conducting vulnerability
]]>Getting There: Easier—but Still a Hassle
The first two steps in reaching Cuba are getting the US government to give the ok, and finding a way to travel from the US. Historically, would-be travelers had to convince the US government that their trip fit into one or more of twelve “permitted” categories, which required extensive paperwork and, occasionally, interviews. In the last year, the US government travel permit process has become more flexible, accepting more applicants with less required paperwork. A second round of bureaucratic easing in September 2015 opened the door further, allowing some close family members to accompany visitors on permitted trips.
Recognizing the potential market, travel companies are moving forward with plans to expand their US-Cuba operations. Airline companies are trying to establish regular, direct US-Cuba commercial routes in 2016. In July 2015, Carnival Corp got the thumbs-up from the US government to begin docking ships as early as 2016. A planned ferry line from Miami to Havana promises to eventually turn getting to Cuba into an overnight boat ride.
Hotels: Low Quality and Quantity
Until major multinational hotel companies are able to open facilities in Cuba, travelers will have trouble finding upscale commercial accommodations. At present, the commercial hotels are owned by the Cuban government or run as public-private partnerships between the government and hotel companies. The government also sets the star rating for hotels, meaning that ratings are generous. Discrepancies on travel message boards show that some of the “five-star” hotels suffer from crumbling facilities and inconsistent electricity.
Not only are hotels limited in quality, they are also limited in quantity. According to the Cuban government, as of 2013 the country only had 60,000 hotel rooms, far fewer than needed to meet the demands of the new tourist population. Major hoteliers have been pushing to establish beachfront resorts since the December 2014 announcement, and Marriot, Hilton, and Radisson are hoping to begin building as soon as the legal situation allows. However, the buildings will not be ready for guests for the next few years.
Travelers wanting to avoid the industrial hotel system can find home-stay options, known as casa particulars, but the system is informal and unregulated.
Money Complexities: Paying to Play
Travelers to Cuba will have to navigate the complexity of a duel currency system and complications with using US bank-backed credit cards—at least for the next few months.
Cuba has the peso (CUP) for the small-purchase domestic economy and the “convertible” peso (CUC) for purchases and transfers in the government market, which includes restaurants, hotels, venue tickets, and most other purchases a traveler is likely to make. Since 1994, Cuba has been openly moving toward a single currency, but unifying the convertible peso and the small-purchase peso is complicated, and could destabilize local economies. The government is moving slowly to minimize market disruptions, but there are signs—including efforts to standardize convertible peso pricing and roll out higher-value denominations—that unification could happen in the next year.
Before Obama’s announcement, travelers could not use US bank-backed credit cards in Cuba. Major credit card companies have since lifted their block on Cuba-based transactions, but banks were wary to adjust their policies. In July the Florida-based Stonegate Bank became the first company to establish a foothold in Cuba in 54 years, allowing their customers to use their MasterCard in the country. For travelers who are not Stonegate clients, the discrepancy between bank hesitancy and credit card policies means that travelers will have to contact their specific banks to check what the policy of the minute is before attempting to use credit cards in Havana.
Criminals: Following the Money
Thieves target travelers, and as more and wealthier visitors flood into Havana, criminal groups will likely become increasingly savvy at separating tourists from their wallets, jewelry, and electronics. Low-effort, high-yield crimes like pickpocketing and purse-snatching will follow in the wake of tourist crowds. Thieves are likely to hit travelers most often at outdoor locations like restaurants or shopping districts. In 2015, the US State Department warned travelers of a growing criminal threat, citing a rash of incidents in the historically low-crime areas of the Havana.
Travelers report that criminals have developed a range of exploitative scams to relieve travelers of small sums of money. One of the most well-known ploys is the “puncture” scam: locals pop tires on parked cars and then offer their assistance—for a price. Other scams include adding additional items to restaurant bills, changing between dollars and pesos (the dollar sign is used for both), and taxi drivers insisting that the meter is broken in order to charge travelers more.
To date, there have been few violent crimes affecting foreign travelers. According to UN information, Cuba’s murder rate is the third-lowest in the Western Hemisphere, significantly lower than the US rate. It is likely that some violent crimes go unreported, and the local media do not report most crimes, but the US, UK, and Australian diplomatic services report few incidents affecting travelers. Of the known violent crimes involving foreigners, most have happened when travelers were engaging in illegal behavior, specifically when trying to hire sex workers. Attackers have been armed with knives and small caliber guns.
Civil Unrest: Rare, but US Travelers Should be Especially Careful
The Cuban government is very sensitive to dissent, so protests and demonstrations are extremely rare, but when they do occur, police will intervene quickly and foreigners who are picked up in association with unrest will be in the dangerous position of being accused of fomenting or encouraging unrest. Given the history between the US and Cuba, this is something that travelers will want to avoid.
The Cuban Government: Unwanted Attention
Historically, the government has monitored foreign travelers. Anecdotal reports suggest that the government has become slowly less concerned with visitors, and that incidents of “suspicious” attention have dropped. The US government still warns travelers that their electronics may be seized by the government for no apparent reason, and that travelers should not assume that electronic communications are private.
Natural Disasters: When It Rains, It Pours, and Then It Floods
Cuba is hit periodically by severe storms and hurricanes that bring high winds and flooding, and occasionally severe earthquakes strike the island. The government is usually proactive in evacuating people during bad weather, but roads and buildings are not built to withstand strong seismic activity or severe weather. Some of the rural areas have very limited infrastructure, and if travelers are in the area during a disaster, they could be entirely cut off from rescue.
Communication Issues: “Can you hear me now? No? Now?”
The embargo severely hampered the development of cellular infrastructure in Cuba. In 2012, the country had a 23 percent telephone density, according to the CIA’s World FactBook. To compare, the US has a 100 percent telephone density, and India hovers around 76 percent. Government plans to develop the telephone cable system, but extending service outside of Havana and other urban areas has been hampered by the weak peso, meaning that coverage is spotty at best. But on the good side, Verizon is now providing service in the country, so US Verizon customers can use their phones in Cuba. It is expensive—as of September, almost USD 3 a minute—but prices are likely to improve over the next few years, as telecom companies move into the Cuban market.
Medical Facilities: Some Good, Some….Not-So-Much
Medical facilities in Cuba are not standardized. Some facilities are clean and well-stocked, and some treatment is less expensive than in the US. However, investigative reports have found facilities in the cities and in rural areas with filthy conditions, insufficient beds, and poor care. Ambulance response is also inconsistent in urban areas and extremely limited outside of cities.
As a side note: Since 2010, the Cuban government has required all visitors entering the country to show evidence of travel insurance that includes medical emergency coverage. The first round of new rules from the Treasury and Commerce departments following Obama’s announcement lifted some of the restrictions on insurance companies, which can now provide travelers with coverage while they are in Cuba. However, travel companies arranging individual visits to Cuba are still urging US citizens to get additional coverage before they leave.
For travelers, visiting Cuba could be an ideal destination: history, culture, beautiful beaches, architecture, nightlife—and the opportunity to see history unfolding. But Cuba in the next few years will stay complicated, and travelers operating in the new and raw space will need to get savvy quickly. For young or novice travelers intent on experiencing the new cuba libre, the best defense will be information and preparation: by knowing what to expect travelers can anticipate the bureaucratic loops, the hotel issues, the crime, and the limited support structure in country—and work with more experienced travelers plan how to get to, through, and safely back from Cuba.
Witten by: Erin Mahrer, Senior Intelligence Analysts, XDS at iJET International
]]>Seasonal influenza has begun to increase in the Northern Hemisphere, where influenza season typically peaks between December and March. However, the current influenza season has increased more rapidly and earlier than usual in North America, while Europe has seen medium-to-low influenza activity so far. Seasonal influenza can be prevented by receiving the annual influenza vaccine, which protects against three strains of influenza: one strain each of A(H1N1), A(H3N2), and an influenza B strain. Quadrivalent vaccination, offering protection against an additional influenza B strain, is also available in some regions.
Key Judgments:
• The US reports intense and widespread influenza activity.
• Canada reports almost half of infections in the province of Quebec.
• Europe reports increasing, but currently low-to-medium, activity.
• Spain and the UK are reporting the highest numbers of influenza cases in several years.
• Vaccination remains the best approach to avoid infection.
North America
During the week ending Dec. 20, 125 influenza outbreaks were reported in seven provinces in Canada, 94 of them in longterm care facilities. National public health officials reported that influenza cases have mostly occurred in the provinces of Alberta, Ontario, and Quebec. Increasing influenza activity has been reported in Newfoundland and Labrador, and in Saskatchewan. Furthermore, health officials in Quebec announced Dec. 18 that the influenza season had started earlier than expected and will likely be more intense than in previous years. Quebec reported 1,238 new infections, out of 2,740 total for all of Canada, during the week ending Dec. 20.
In the US, health officials have reported widespread influenza activity in 43 states, with 29 states reporting high influenzalike illness patient visits during the week ending Dec. 27. Although the proportion of deaths due to pneumonia and influenza had surpassed the epidemic threshold during the week ending Dec. 20, those numbers dropped below the threshold during the following week.
The most common strain this season is the influenza A(H3N2) virus, accounting for more than 95 percent of reported US cases. Unfortunately, most of the infections have been caused by an A(H3N2) strain that is slightly different from the one in this season’s vaccine, which may compromise its effectiveness. Still, vaccination is highly recommended, even if a person has already had the flu this season. The most updated vaccine effectiveness studies will be available from the CDC in mid-to-late January. Patient visits and hospitalizations are almost at same level as the peak of the 2012-13 season, the most recent A(H3N2)-predominant season, but higher than the 2013-2014 season, which was an A(H1N1)- predominant season. This matches historical trends, in which A(H3N2) strains typically cause more severe influenza seasons than A(H1N1) strains. The CDC predicts that pneumonia- or influenza-related deaths will increase again before the season is over.
In both the US and Canada, numerous hospitals have implemented restricted visitor policies to reduce the number of people capable of spreading influenza in a healthcare setting.
Mexico, on the other hand, reported a 42-percent decrease in influenza cases as compared to the same period in the 2013-2014 season, as of the last week in December. In Mexico, the dominant strain is A(H3N2).
Europe
For the first week in 2015, the European Centre for Disease Prevention and Control (ECDC) reported medium-to-low influenza activity. More countries have started reporting an increase in activity compared to the previous week. The ECDC also reported that 11 of the 13 countries whose data was received have influenza A(H3N2) as the dominant strain.
Although many countries report to this agency, there is a delay in data availability; some countries have more updated information on their own disease surveillance websites.
England reported 74 outbreaks during first week in 2015, mostly in care homes. The most recent major influenza season in the UK occurred in winter 2010-2011. Although the current outbreak has not reached those levels, rates so far are higher than the latest three seasons. Health authorities have stated that approximately half of reported cases are A(H3N2), infections, but it is unclear which strain will dominate this season.
In Spain, health officials have reported a marked increase of patients in emergency rooms with influenza-like symptoms.
Some hospitals in Galicia (Hospital do Salnes in Galicia), Madrid (Hospital Universitario de Fuenlabrada), and Toledo (Hospital Virgen de la Salud) have reported considerable disruptions in their ability to care for patients in a timely manner.
Several health institutions have been asking patients only to go to the hospital if it is really an emergency, and to try to visit their primary care physicians instead. Health officials report Asturias and Galicia have widespread activity. Madrid is experiencing localized activity only, though at its highest levels in three years.
Seasonal Influenza
“Seasonal influenza” refers to a variety of human influenza viruses that follow seasonal trends in specific geographic regions. These viruses peak during the winter months in temperate areas and cycle year-round in tropical areas. Seasonal influenza viruses include several strains of influenza A(H3N2) and influenza B, as well as the influenza A(H1N1) virus that caused the 2009 pandemic, and has replaced the previous A(H1N1) seasonal strain. Seasonal influenza viruses do not include avian influenza viruses such as A(H5N1) or novel influenza viruses such as the A(H3N2)v strain linked to swine in the US since 2011. These types of influenza are monitored and reported separately.
Seasonal influenza viruses generally cause mild-to-moderate illnesses, but can be severe and even life-threatening in individuals with certain underlying health conditions. Influenza is not the same as a cold. Symptoms of influenza include cough, sore throat, runny or stuffy nose, muscle and body aches, headaches, and fatigue; in some cases, influenza also causes fever, vomiting, and diarrhea. Most individuals recover from an influenza infection in a few days, and most infections resolve within two weeks. However, some cases can develop complications such as pneumonia, bronchitis, and sinus or ear infections. Some of these complications can be life-threatening, especially in individuals with certain health conditions.
Severe influenza infections and potentially life-threatening complications are more common in individuals with certain chronic medical conditions.
Influenza is primarily spread by droplets released when infected individuals cough, sneeze, or speak. Other susceptible individuals can then breathe in these droplets and become infected. Less often, individuals can contract influenza by touching a surface or object containing the influenza virus and then touching their own mouth, eyes, or nose. Individuals with influenza are contagious for a period beginning one day before the onset of symptoms and five-seven days after symptoms begin. This means that it is possible to transmit influenza to others before the patient realizes he is sick.
Conclusion and Advice
Like all respiratory diseases, individuals can reduce their risk of influenza infection by taking strict respiratory hygiene precautions: washing hands regularly and avoiding large crowds or apparently sick individuals. However, because influenza can be spread before symptoms are apparent, these measures are only partially effective. Even though the 2014-2015 season vaccine may be less effective than in previous years, all individuals – unless medically contraindicated – should be vaccinated. These immunizations – which are available in either inactivated or live attenuated versions and can be delivered intramuscularly, intradermally, or nasally – protect against influenza infection within 2-3 weeks of immunization. Experts reformulate the seasonal influenza vaccine every year to account for changes in the influenza viruses active in the community, and the effectiveness of the influenza vaccine depends on how well-matched the vaccine is to active influenza viruses.
Influenza does not need to reach pandemic status to affect business continuity; seasonal influenza accounts for USD billions per year in economic losses in the US alone. The most useful resource for a company to minimize potential losses is a thorough business continuity plan. Disruptions should be expected not only in internal sectors, but also in immediate and local infrastructure. In the case of an influenza or other type of pandemic, these preparations are crucial. One of the key functions of the iJET Integrated Intelligence Operations is to provide clients with resources and design and tailor pandemic planning to their particular needs.
Originally published on Tuesday, March 31, 2015
315 views at time of republishing
Although the risk of actually contracting EVD remains extremely low for most travelers and expatriates, serious ancillary risks have created significant travel and business disruptions -particularly in Guinea, Liberia, and Sierra Leone – for which many nations now recommend against nonessential travel. Other concerned African countries have taken additional measures to attempt to prevent importation of the disease by refusing entry to any traveler who has been in countries experiencing EVD outbreak within the previous 21 days.
Specific concerns are two-fold. The first concern is the rapidly increasing number of cases, which appear to be undeterred by extensive attempts at control measures (e.g., intense world health response; quarantine and isolation of confirmed patients, suspected cases, and contacts of those confirmed and suspected cases; treatment of the infected; intense screening activity at borders and points of entry/exit; application of experimental treatments; etc.), coupled with the continued circulation of rumors among local populations that medical practitioners are actually seeking to harm those at risk or infected, causing the sick to hide, flee, or even riot in some cases, thereby spreading the disease – potentially across borders. The second concern is that the operational and travel threat matrix in West Africa has increased exponentially, as those operating in the region may encounter border closures, strict security and health screenings when attempting to cross borders, a lack of goods and services as personnel – especially healthcare professionals – vacate for what they believe are “safer” areas, and the potential for quarantine. Additionally, many global and regional commercial air carriers have begun to suspend travel to the most affected areas. Recent guidelines provided by global health authorities and international partners, as well as nations who have implemented internal EVD protocols, have eased medical evacuations some, but air carrier service for providers, as well as intensive permissions necessary for transporting patients, are still a hindrance in many areas.
SummaryWest Africa EVD Outbreak
As of Sept. 5, international authorities have reported at least 3,970 EVD cases and more than 2,030 EVD deaths in West Africa. These include 823 EVD cases and 522 deaths in Guinea, including 621 confirmed cases; 1,839 EVD cases and 1,051 EVD deaths in Liberia, including 606 confirmed cases; 1,292 EVD cases and 452 EVD deaths in Sierra Leone, including 1,174 confirmed cases; 21 EVD cases and seven deaths in Nigeria, including 16 confirmed cases; and one confirmed case in Dakar, Senegal. As these figures demonstrate, the focus of EVD activity has shifted to Liberia and Sierra Leone since May, and persistent disease activity has finally led to the international exportation of infections to additional countries.
Whereas disease activity during the first wave of the outbreak March-May was centered in rural areas of southeast Guinea and northwest Liberia – with a significant focus in the city of Conakry with epidemiological links to southeast Guinea – disease activity has now shifted to include significant urban centers such as Freetown, Sierra Leone and Monrovia, Liberia, where quarantine facilities and treatment centers have been erected to render management options to a growing number of cases. Additionally, the Nigerian foci in Lagos and Port Harcourt – both populous centers of business – via the travel of infected individuals highlight the enormous challenges to the tracing of all contacts of potentially infected individuals and the prolonged isolation of potentially exposed individuals to prevent further spread of disease. In some locations, armed military escorts have been called upon to accompany the transport of high-risk patients to quarantine centers and to ensure the safety of healthcare personnel at these locations.
Media have reported significant numbers of healthcare workers abandoning their posts due to EVD concerns. For example, nurses at JFK Hospital in Monrovia called a strike Sept. 3 over lack of appropriate personal protective equipment (PPE). Although the Nigerian Ministry of Health was able to end the long-standing physician strike in Nigeria in an effort to address staffing needs in the wake of hundreds of isolated patient contacts and other clinical requirements, Guinea, Liberia, and Sierra Leone have not been as fortunate. The infection of several prominent physicians volunteering with aid organizations in the course of this crisis – as well as multiple local national doctors, nurses, and ancillary staff – has led to several violent incidents targeting local government offices and hospitals treating EVD patients. Increased security has been provided to facilities and towns to discourage protests and mass gatherings, which can also facilitate disease spread, and governmental and non-governmental officials have promised increased protection through more personal protective equipment (PPE) and cleansing materials. However, after a UN staff member contracted EVD and necessitated medical evacuation to Germany, the WHO removed more than 60 staff members from Sierra Leone, which has hampered efforts there to accurately diagnose and adequately treat the disease. Many aid organizations are calling for global assistance from any provider with expertise in infectious disease processes and handling special virus samples, as fatigued crews and staff shortages not only underserve the afflicted but create room for error while working and may be partially a cause of the heightened rate of healthcare worker infections, despite careful protocols.
The shortages are not only affecting healthcare workers. Shortages of food and clean water are increasing dangerously due to a number of secondary economic effects: businesses closing due to the outbreak or the repatriation of expatriate workers, farmers being unable to tend to their crops, and cargo vessels refusing to dock at ports where the virus may be present. Disease control efforts at international borders further restrict the delivery of food and other products. Economic recovery in Guinea, Liberia, and Sierra Leone may be slow, even when EVD is finally controlled – which experts have projected to take at least six to nine months.
These infections have also prompted several foreign missions, including the US Peace Corps, to suspend operations in Guinea, Liberia, and Sierra Leone and to repatriate personnel operating in the region. Other organizations, such as mining, extraction, and financial organizations, have reduced staff to essential personnel or have vacated entirely. Nigeria may be able to cope better due to its more fully established infrastructure and more coordinated response efforts, but international authorities have expressed concern that the cluster of EVD cases in Port Harcourt could surge following that index patient’s many contacts with coworkers, friends, and family members. So far, few nations have recommended against travel to Nigeria. However, media have reported that some hospitals in Lagos are rejecting patients with non-EVD-related complaints due to fears that healthcare personnel may be unknowingly exposed to EVD.
Analysis
In both scope and scale, this outbreak has become the largest recorded EVD outbreak in history. Previous EVD outbreaks largely occurred in extremely remote areas that prevented the geographic spread of disease activity. However, this outbreak has affected nearly the entirety of three neighboring countries, including significant areas of urban and peri-urban transmission. Prior to this outbreak, the largest known Ebola epidemic occurred in Uganda in 2000, when officials reported 425 confirmed, probable, or suspected cases. In this epidemic, though, officials have identified nearly 4,000 suspected, probable, and confirmed EVD cases, and some experts anticipate up to 20,000 cases before the end of the outbreak.
One of the primary explanations for the severity of EVD activity in Guinea, Liberia, and Sierra Leone relates to widespread community resistance to disease control measures. This outbreak is the first known incidence of EVD activity in West Africa, and – unlike populations living in countries such as Uganda or the DRC – communities in Guinea, Sierra Leone, and Liberia were largely unfamiliar with the measures necessary to control this disease. Even after more than six months of disease activity and response efforts, local populations remain suspicious of authorities. In at least one instance, a community rioted when officials sprayed disinfectant, because local residents believed that they were being sprayed with the disease and intentionally infected. Although many teams are making headway with cultural relations and communications, it is generally accepted that more connection is needed for wider messaging. Recently, the government of Uganda and the African Union had both pledged assistance in durable goods, personnel, and financing to aid in control measures. As Uganda has vast experience in EVD outbreaks, this may assist quite a bit in cultural sensitivity and processing.
Many communities are also deeply distrusting of international medical teams. In some cases, local communities blame these teams for bringing the disease into their country; at other times, communities merely believe that infected individuals will receive better care at home. In either case, media have reported many instances in which community members have forcibly removed confirmed or probable EVD patients from isolation, or patients have eloped quarantine to return home. For example, the EVD cluster in Lagos, Nigeria was caused by an EVD-infected traveler, who may have been seeking more advanced medical care outside Liberia, according to his wife. Furthermore, the EVD cluster in Port Harcourt, Nigeria was caused by a companion of that traveler, who fled quarantine in Lagos to seek care elsewhere.
Unrelated to the cases in West Africa, the Democratic Republic of the Congo (DRC) notified the WHO of a confirmed case of EVD on Aug. 26. In the midst of a hemorrhagic gastroenteritis outbreak not caused by EVD in or near the Equateur Province, the Ministry of Health was able to delineate that a separate strain of EVD had, in fact, occurred in a woman from Ikanamongo Village near Boende and spread to family members and healthcare workers who were caring for her. In total, 58 suspected and confirmed cases and 31 deaths from EVD have been reported as of Sept. 4. Experts from the DRC and WHO have isolated the area, and other expert aid partners have been called to manage the outbreak, which so far appears confined to that specific area.
With disease projections continuing to increase in Guinea, Liberia, and Sierra Leone, the risk profile for most travelers and expatriates remains unchanged: individuals should strongly consider deferring nonessential travel to these areas. The risk of EVD is highest for healthcare workers, family members caring for ill patients, those attending traditional funerals or burials, and the consumption or proximity to processing primate or bat bushmeat, which has since been ruled illegal in the affected areas. However, even individuals not involved in such activities – for whom EVD risk is low – are at risk of increasingly severe healthcare shortages and increasing potential for civil unrest in disease-affected areas. Furthermore, individuals requiring medical evacuation, even for non-EVD-related issues, face extreme challenges when leaving outbreak zones.
Disease response efforts continue in Lagos and River State, Nigeria. Impacts to travelers or expatriates in these areas should be nominal, and the risk of spread outside of these areas is generally low to moderate given the current climate. The one case identified in Dakar, Senegal, with multiple contacts under surveillance, should not pose any significant risk to travelers or expatriates. However, the general reaction of other countries to nations having had EVD has so far been significant. The WHO has still not instituted any travel or trade restrictions on any of the affected countries, but many countries have implemented enhanced health screenings at borders or international airports and restricted flights or border crossings from affected countries. Individuals and organizations should review risk tolerance levels in anticipation of sudden changes in security and travel impact. Furthermore, individuals in or near EVD-affected areas should practice diligent personal health precautions, keeping in mind the following EVD-specific information:
| Although EVD is considered “highly contagious,” it is not highly transmissible. The risk of transmission among people not involved in healthcare or funeral settings is small.Local hospitals in the three most affected areas are at overcapacity, and personnel operating in the area and requiring nonemergency care may consider soliciting provider care at a hotel in lieu of a clinic. Many times, intravenous fluids, respiratory therapy, and other types of care can be administered by healthcare professionals in quality hotels. However, durable medical equipment, fluids, and medications are in short supply. Healthcare workers currently operating in the area are most at risk, since EVD is passed through blood, organs, tissues, bodily fluids, and close personal contact with infected individuals. Occupations with personnel at risk of trauma need to consider their proximity to appropriate care facilities and the possibility of exposure to EVD or other diseases while being treated. Managers charged with site safety and health should be able to recognize the signs of EVD and other hemorrhagic fevers: headache behind the eyes, flu-like symptoms, high fevers, diarrhea, and petechiae – a red or purple “rash” that may appear under areas with pressure. Bleeding, which may only be a late symptom in EVD and also appears in a number of other infections, cannot be relied upon for identification. Frequent and thorough hand-washing with soap and water may reduce the incidence of disease. If soap and water is unavailable, use of a hand sanitizer with at least 60-percent alcohol is an adequate substitution.Do not consume “bushmeat” or the meat from any primate, rodent, dog, or bat in the affected areas. Social distancing and avoidance of crowded venues may reduce risk of disease transmission, and in some areas, it is now mandated. Be aware of increasing travel disruptions related to this outbreak Plan ahead for increased processing times at borders and international airports as countries implement health screenings of travelers from affected areas. Consider deferring nonessential travel to Guinea, Liberia, and Sierra Leone due to infrastructure difficulties and significant travel and medical evacuation restrictions. Be very aware of recent updates in travel restrictions and take these into your risk threshold matrix. Consider the potential supply chain difficulty as borders become restricted, inspections become more thorough, and transit times become more cumbersome. Some goods and services may take longer than others to arrive. Check with your insurance provider and assistance/response company prior to your departure to understand your level(s) of service, their policies and protocols, and their threshold for rapid decision making. Maintain contact with these partners during your trip and keep abreast of the current information for your decision making. |
Bear in mind that some restrictions may not apply only to Guinea, Liberia, and Sierra Leone. Some West African nations may be seen as “at risk” and treated with similar precautions of screening by other nations upon arrival. Certain facilities and laboratories throughout the world have been designated by their respective countries to receive and isolate any “suspected” EVD cases upon screening at points of entry. Special guidance and precautions have been sent out through many health ministries regarding the signs and symptoms of the disease, as well as the potential areas of exposures. There are a various other diseases that may mimic the initial phases of EVD. Fever, headache, nausea, vomiting, aches, and fatigue are seen in a plethora of West African ailments, including malaria, dengue, influenza, and others. Taking appropriate precautions against these diseases will lessen your chance of being identified and potentially quarantined by health personnel when entering or exiting a country.
There currently remain no definitive preventive vaccines or treatment options for EVD. Although recent research and efforts into several unique pharmaceuticals have shown promise in nonhuman primates and have been used experimentally during this crisis, it remains to be seen whether or not these are effective or safe treatments or preventive measures. Data from the field during an epidemic – which lacks supporting data or controls – is extremely difficult to assess. Numerous variables may account for the apparent success or failure of such an agent in any given individual. For example, the administration and subsequent recovery of two American patients from EVD after receiving one such medication may be due to the effectiveness of the medicine, may be coincidental, or may also be dependent on other factors. Likewise, the death of a Spanish missionary after receiving the same experimental treatment may or may not be indicative of that drug’s efficacy. Conclusions as to the effectiveness of these drugs are extremely premature at this juncture.
Originally published on Wednesday, October 29, 2014
1405 views at time of republishing
Originally published on Tuesday, June 17, 2014
822 views at time of republishing
237 downloads at time of republishing