Without more powerful disease control measures in West Africa, more than 20,000 people will be infected by November 2, according to a World Health Organization report. Previously, the WHO has warned that 20,000 could be infected before the disease is contained. Today's report is less optimistic.

Already there have been more than 4,000 confirmed cases and almost 2,300 confirmed deaths from the disease, but those numbers are almost certainly underestimates, according to WHO data published by the New England Journal of Medicine. The number of cases is continuing to double every 16 days in Guinea, every 24 days in Liberia and every 30 days in Sierra Leone, the report says.

"Without a more-effective, all-out effort, Ebola could become endemic in West Africa."



It's crucial to get the infections under control, because "without a more-effective, all-out effort, Ebola could become endemic in West Africa," according to an accompanying editorial written by Jeremy Farrar of the Wellcome Trust and Peter Piot of the London School of Hygiene and Tropical Medicine. If that happens, then Ebola may spread to other parts of Africa and beyond.

The epidemic is "unprecedented in scale," the report says. The previous largest outbreak had 425 cases over the course of three months in 2000 and 2001 in Uganda. The severity of the current outbreak isn't because the virus has changed; it hasn't. Rather, the problem is that disease control efforts haven't been good enough.

Though the outbreak began in December 2013 in some districts of Guinea, the WHO wasn't notified of the outbreak until March 23, 2014. Nine months since the first case, the epidemic is still growing, despite international efforts to control the spread of the disease.

The number of Ebola patients is now greater than the number of hospital beds in Guinea, Libera and Sierra Leone, the WHO report said. There are shortages of healthcare workers and basics like soap and water in some of the countries. Because Ebola is spread mostly through contact with the bodily fluids of infected people—sweat, tears, blood, vomit—transmissions can be halted with early diagnosis, patient isolation, infection control, and safe burial. Also crucial is tracing anyone who's been in contact with an infected person and monitoring those people for symptoms for 21 days, by which time most people who have been infected are sick. "We basically need 20,000 more healthcare workers on the ground."



"The infrastructure has been a huge factor," says Daniel Epstein, a spokesman for the WHO. "There were very few clinics and hospitals. The few they had were overwhelmed rapidly, and they didn't have great infection control practices, so they lost a lot of healthcare workers."

Determining the fatality rate of this epidemic is tricky, since some patients weren't diagnosed with Ebola until after their deaths. That's because the symptoms of Ebola look an awful lot like the symptoms of the more-common malaria: fever, fatigue, and loss of appetite. Still, WHO estimates that roughly 70 percent of people who are infected will die.

Previous Ebola outbreaks have suggested that the pattern of disease spread can be broken within 2 to 3 weeks of infection control measures, the report says. To reduce the spread, monitoring contacts of a patient is important; so too is getting someone who's sick to the hospital immediately—right now, most patients don't come in until a mean of 5 days after their symptoms begin.

"We basically need 20,000 more healthcare workers on the ground," Epstein says. "We need doctors and nurses and we need to set up functioning Ebola treatment centers. We need 3,000 vehicles to carry the patients. We need to contract tracers, who can monitor everyone in contact with an infected person and take them in for treatment if they're positive for Ebola."

Last week, the US announced it would send 3,000 troops to the affected areas, and help build medical centers in Liberia, which has been hardest-hit by the epidemic. More than $500 million will be drawn from defense spending to aid the affected countries. Britain and France have also agreed to build treatment centers, while the World Bank and Unicef have sent supplies—100 metric tons of them on September 17.

In their editorial, Farrar and Piot characterize international response as "highly inadequate and late." Not only did it take 3 months to determine that an Ebola outbreak was taking place, but it was not until 2 months had passed and 1,000 people died that anyone declared a public health emergency.

"This epidemic, in other words, was an avoidable crisis," they write.