MONROVIA, Liberia -- Liberian officials faced a difficult choice Thursday: deciding which handful of Ebola patients will receive an experimental drug.
ZMapp, the untested Ebola drug, arrived in the West African country late Wednesday. It is not yet known whether the drug will be lifesaving, ineffective or even harmful, but the World Health Organization on Tuesday endorsed the use of untested drugs to try to control a deadly outbreak.
On Thursday, no one had yet received the treatment, which Liberian officials said would go to three people. The government previously said two doctors would receive it. Information Minister Lewis Brown said Thursday that the third treatment probably would go to another health care worker.
These are the last known doses of ZMapp left. The San Diego-based company that developed it has said it will take months to build up even a modest supply.
The Ebola outbreak was first identified in March in Guinea. It has since spread to Liberia, Sierra Leone and Nigeria. There is no licensed treatment for Ebola, a virus transmitted by contact with bodily fluids such as blood, sweat and urine.
The WHO said Thursday that there is evidence the number of people killed and sickened by Ebola in West Africa so far may "vastly underestimate the magnitude of the outbreak."
The United Nations health agency said it was prepared for the crisis to continue for months. With more than 1,060 confirmed deaths and 1,975 sickened, the Ebola outbreak is already the deadliest ever.
The outbreak has overwhelmed the already strained health systems in West Africa and raised questions about whether authorities are doing enough to respond.
On Thursday, the U.S. State Department ordered families of embassy personnel to leave Sierra Leone because of concerns that the crisis would make it difficult to get treatment for even routine health problems. Family members of U.S. personnel at the American Embassy in Liberia's capital city, Monrovia, were previously ordered to leave.
Meanwhile, police in riot gear dispersed an angry crowd Thursday in Monrovia that blocked city buses to protest delays in clearing away the infectious body of an Ebola victim.
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 those who have died and underscored the U.S.' commitment to work with West African nations and United Nations agencies to contain the outbreak.
The outbreak has triggered 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, more than 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."
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 New York University's Langone Medical Center, said the choice of whom 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 experiment 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 likely prefer people who can be observed for months, which might eliminate those living in remote places, he added.
Nigeria announced Thursday that another person had died from Ebola, raising the country's death toll to four. The Health Ministry said the victim was a nurse who helped treat the first known person with Ebola in the country, Liberian-American Patrick Sawyer, who flew in last month and died.
The ministry corrected its total number of Ebola cases to 10 instead of 11 as it had reported earlier in the day.
Information for this article was contributed by Wade Williams, Abbas Dulleh, Bashir Adigun and Darlene Superville of The Associated Press.
A Section on 08/15/2014