Liz Szabo

USA TODAY

If the world doesn't get the Ebola outbreak in West Africa under control quickly, the disease could become a permanent fixture in the region, spreading as routinely as malaria or the flu, the World Health Organization warns Tuesday in a new report.

In the worst-case scenario – if nothing is done to effectively control the outbreak — there could be 1.4 million Ebola cases in Liberia and Sierra Leone by the end of January, according to a report released Tuesday by the Centers for Disease Control and Prevention.

That sort of exponential increase in cases makes it more likely that Ebola will become entrenched in West Africa, said Robert Murphy, a professor of medicine and biomedical engineering at Northwestern University.

If there are hundreds of thousands of Ebola cases, then "many more countries will have cases, and it won't be just West Africa," Murphy said. "There is so much mobility now, this can spread anywhere."

CDC officials say it's still possible to avoid this worst-case.

"It is still possible to reverse the epidemic, and we believe this can be done if a sufficient number of all patients are effectively isolated, either in Ebola Treatment Units or in other settings, such as community-based or home care," said Tom Frieden, director of the Centers for Disease Control and Prevention.

"Once a sufficient number of Ebola patients are isolated, cases will decline very rapidly – almost as rapidly as they rose. … A surge now can break the back of the epidemic."

The notion that Ebola could become endemic in West Africa —— spreading routinely, rather than in sporadic outbreaks — is "a prospect that has never before been contemplated," according to a report published online in the New England Journal of Medicine.

There could be 20,000 cases by Nov. 2, with thousands of new cases per week, the report said. About 70% of patients are dying from the illness.

"We are concerned that without a massive increase in the response, way beyond what is being planned in scale and urgency ... it will prove impossible to bring the epidemic under control," wrote disease researchers Jeremy Farrar, of the Wellcome Trust, and Peter Piot, of the London School of Hygiene and Tropical Medicine, in an accompanying editorial.

The Ebola virus has caused more than 20 outbreaks in the past four decades, mostly in remote villages in Central Africa. Although some outbreaks were severe, public health officials were always able to put a stop to them -- even without effective treatments or vaccines -- by quickly and methodically diagnosing patients, making a list of everyone those patients might have exposed and then monitoring those contacts.

The current outbreak appears to have begun the same way in the West African country of Guinea, with the first cases in December. The virus spread for three months, however, before public officials realized they were dealing with an Ebola outbreak. In contrast, doctors in the Democratic Republic of Congo took just days to confirm an Ebola outbreak after seeing the first cases.

In West Africa, Ebola has now infected at least 5,864 people — killing 2,803 — in Guinea, Sierra Leone, Liberia, Nigeria and Senegal, according to the WHO, which notes that the total number of cases likely is much higher, because many victims haven't yet been counted.

Farrar and Piot note that the WHO didn't declare a public health emergency until August, after the epidemic had been recognized for five months and had killed 1,000 people.

Last week, the Centers for Disease Control and Prevention's Beth Bell warned that the West African outbreak could last for years if the world doesn't halt its spread.



