Ebola crisis 'could last months'

Liberian officials faced a difficult choice - deciding which handful of Ebola patients would receive an experimental drug that could prove life-saving, ineffective or even harmful.

ZMapp, the untested Ebola drug, arrived in the country on Wednesday. A day later, 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 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 yesterday it would probably be another health care worker.

These are the last known doses of ZMapp left and the San Diego, California-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 such untested drugs to the sick and of deciding who should get them. So far, only two Americans and a 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% of those who contracted Ebola have died, according to the UN 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 said people past the "critical phase" who looked likely to survive would not be chosen.

Dr 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.

Arthur Caplan, director of medical ethics at NYU Langone Medical Centre, 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 was 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, he said. In order to study the long-term effects, doctors will probably prefer people who can be observed for months, which might eliminate those living in remote places, Mr Caplan added.

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

President Barack Obama spoke by phone about the Ebola outbreak to Liberian president Ellen Johnson Sirleaf and in another call with President Ernest Bai Koroma of Sierra Leone.

The White House said Mr Obama expressed his condolences for the hundreds who have died in both countries and underscored the America's commitment to work with west African nations and UN agencies to contain the outbreak.

Nigeria announced 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.