While Americans panic at shadows, Ebola strikes hard at Africa

Summary: While hysteria about Ebola grows among the fearful sheep of America, the real epidemic burns in Africa. Here’s a status report about events over there, and the numbers about Ebola’s infectiousness and morality.

Africa

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Contents

  1. News from Africa
  2. How infectious is Ebola? How fatal?
  3. Other posts about Ebola
  4. Sources of reliable information about Ebola
  5. A history of pandemics

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(1)  News from Africa

From the WHO’s Situation Report, 14 October: “The situation in Guinea, Liberia, and Sierra Leone is deteriorating, with widespread and persistent transmission of Ebola Virus Disease {EVD}.” Paul Farmer (Prof of Global Health, Harvard) tells us what that means, from the October 23 London Review of Books:

Both nurses and doctors are scarce in the regions most heavily affected by Ebola. Even before the current crisis killed many of Liberia’s health professionals, there were fewer than fifty doctors working in the public health system in a country of more than four million people, most of whom live far from the capital. That’s one physician per 100,000 population, compared to 240 per 100,000 in the United States or 670 in Cuba. {the number of Liberian doctors in America is 2/3 the total number working in their homeland, per the WSJ}

Properly equipped hospitals are even scarcer than staff, and this is true across the regions most affected by Ebola. Also scarce is personal protective equipment (PPE): gowns, gloves, masks, face shields etc. In Liberia there isn’t the staff, the stuff or the space to stop infections transmitted through bodily fluids, including blood, urine, breast milk, sweat, semen, vomit and diarrhoea. Ebola virus is shed during clinical illness and after death: it remains viable and infectious long after its hosts have breathed their last. Preparing the dead for burial has turned hundreds of mourners into Ebola victims.

.. But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90%, should survive.

… Ebola is more a symptom of a weak healthcare system than anything else. … As Larry Brilliant, who helped to eradicate smallpox almost forty years ago, just as Ebola was being discovered, and now heads the Skoll Foundation’s Global Threats Fund, has observed, ‘Outbreaks are inevitable. Pandemics are optional.’

The numbers are still small, but growing fast as seen in the weekly cases reported: confirmed, probable, suspected, from the WHO Situation Report:

Ebola in Liberia
WHO Ebola Situation Report, 14 October 2014

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Ebola in Sierra Leone
WHO Ebola Situation Report, 14 October 2014

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Ebola in Guinea
WHO Ebola Situation Report, 14 October 2014

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Basic reproduction number
From the CDC & WHO, via Wikipedia

(2) How infectious is Ebola? How fatal?

(a) How Contagious is Ebola“, NPR, 2 October 2014:

The reproduction number, or R0, tells you how contagious an infectious disease is. Specifically, it’s the number of people who catch the disease from one sick person, on average, in an outbreak.

… In Ebola’s case, the mode of transmission helps keep its R0 low. Ebola isn’t spread through the air, like the measles or flu. It requires close contact with some bodily fluid, such as blood or vomit, containing the virus.

… {Ebola’s} R0 of 2 means one person infects two people, who then infect four people, then eight, 16, 32 — the numbers go up fast. But that isn’t likely to happen in a place with a good public health system, like the U.S. Because people with Ebola aren’t contagious until they show symptoms.

So to stop the chain of transmission, all health workers in Texas have to do is get the people possibly infected by the sick man into isolation before these people show signs of Ebola. Then R0 drops to zero. And Texas is free of Ebola.

Important to know: the R0 will drop as an infection spreads in response to efforts to control the epidemic. The rate for Ebola has dropped to aprox 1 in Guinea and Sierra Leone (per PLOS below)

(b)  How fatal is Ebola?

In West Africa the fatality rate of hospitalized cases is approximately 2/3 (per the NEJM, below). There have been too few cases in modern facilities to estimate the fatality rate in developed nations, but it will be high. Perhaps, as Professor Farmer said above, only 10%.

(c)  For more about these crucial numbers see:

  1. Estimating the Reproduction Number of Ebola Virus (EBOV) During the 2014 Outbreak in West Africa“, Christian L. Althaus, PLOS, 2 September 2014
  2. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections“, WHO, The New England Journal of Medicine, 16 October 2014

(3)  Other posts about Ebola

  1. What you need to know about Ebola. Debunking the myths.
  2. An epidemic afflicting America: fear about Ebola. Avoid the carriers. Facts are the antidote.
  3. While Americans panic at shadows, Ebola strikes hard at Africa
  4. Lessons from Ebola. Let’s hope we learn.
  5. DoD shows its strength, mobilizing to protect us from Ebola (a sad story about America).
  6. We awake from fears of an Ebola pandemic in America. Now let’s ask who’s responsible…, 21 October 2014
  7. Good news about Ebola and its terrifying mortality rate, 5 November 2014

Much of the hysteria results from our loss of confidence in experts; see posts about this problem here.

(4)  Reliable information about Ebola

(a)  Debunking the hysteria:

  1. Why you’re not going to get Ebola in the U.S.“, Washington Post, 1 August 2014
  2. How calm can counter Ebola“, editorial in the Christian Science Monitor, 3 August 2014 — “Health officials say they must act as much to calm fears of Ebola as to contain the outbreak. Media-driven hysteria about Ebola doesn’t help.”
  3. Containing Hysteria About Infectious Disease“, Dr. Eugene Beresin, Psychoogy Today, 2 October 2014
  4. Out of control: How the world’s health organizations failed to stop the Ebola disaster“, Washington Post, 4 October 2014
  5. In the Face of Ebola, Stay Calm“, Anna Altman, op-ed in the New York Times, 7 October 2014
  6. The Ebola alarmists: Stoking panic will not help America fight Ebola“, The Economist, 11 October 2014

(b)  About Ebola, the disease:

  1. Ebola fact sheet, WHO, September 2014
  2. Ebola information page, Centers for Disease Control — Symptoms, methods of transmission, outbreaks
  3. Information Resources about Ebola, Centers for Disease Control — Infographics, video & podcasts, factsheets, posters
  4. Ebola virus and U.S. preparedness: Review of research perspectives“, John Wihbey, Journalist’s Resource, 3 October 2014
  5. ‘In 1976 I discovered Ebola – now I fear an unimaginable tragedy’“, The Guardian, 4 October 2014 — A history of Ebola, by its discoverer.
  6. Controlling Ebola: next steps“, Ranu S Dhillon, Devabhaktuni Srikrishna, and Jeffrey Sachs, The Lancet, 8 October 2014

(5)  A history of pandemics

(a)  A nicely done graphic providing an introduction to pandemics.

(b)  The Daily Mail’s interactive graph of The World’s Deadliest Outbreaks

With Africa reeling from the recent Ebola outbreak, global attention is focused squarely on the danger of an uncontrollable outbreak of disease. In this interactive piece, we look at the world’s deadlist outbreaks, as well as history’s most dangerous diseases.

Click on the title to see the interactive graphic. Use the scroll bar at the top to view the history of outbreaks, or click any of the diseases at the bottom for more info.

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9 thoughts on “While Americans panic at shadows, Ebola strikes hard at Africa

  1. What is NOT being mentioned … the “protective gear” (Hazmat suits) that they are giving to medical personnel is completely inadequate to prevent the spread of Ebola. Ebola is a biosafety-level 4 (BSL-4) pathogen. To prevent the spread of the disease, health workers need to be wearing BSL-4 equipment. But that equipment is very, very expensive, and so our health officials have been cutting corners. And as WND recently reported, there is only one BSL-4 care facility in the entire country available to the general public… Have you wondered why Ebola patients are being sent to Omaha, Nebraska? It is interesting that the DOD purchased 160,000 inadequate biohazard suits, knowing full well that they are putting people at risk .. perhaps they didn’t realize people would realize the obvious. What is of further concern is that the thousands of military personnel sent to Africa have compromised suits to wear, which can only be construed as an intentional effort to bring the virus to the US … but the virus is not easily spread, anyway … but the fear mongering is the real problem, because it is part of a sociopolitical control dynamic in play. What with the proliferation of false flags with crisis actors, this whole thing is 90% false flag hype, 10% incompetence by administrations that are more interested in control and manipulation of the minds of populations for political purposes than anything else. There are many other issues that have arisen, as well. People have been caught putting formaldehyde in wells in Liberia, confessing to have been paid to do so (creates symptoms of Ebola and is fatal). All the countries in Africa that have these problems are also areas in which USAMRIID (US biological warfare program) operates, and they are countries that have vital natural resources … it doesn’t take much to conclude that depopulation of these areas is the overall agenda. But, MOST of the population will fall for the lie, because they aren’t astute enough and eclectic enough to step back and analyze the overall dynamic. They would rather go out and ‘vote’ ….

  2. @ Val Valerian

    Conspiracy Theory much?

    It is rather more likely that some unfortunate decisions are caused by incompetence and stupidity.

    1. Actually, the information I discussed is backed up by valid news articles … yeah ,,, there is a lot of incompetence and stupidity involved with these people … they have no foresight or ingenuity to get out of their manipulative experiential loops … it’s why the massive problems of the civilization never get resolved …

    2. Correction: of course Val probably didn’t make all that up. It’s probably a combination of fact with stuff other people made up, picked up from talk radio, unreliable websites, tabloid newspapers, and rumors from the news media. It’s the toxic stew we always see circulating in these events.

    3. MMK,

      “caused by incompetence and stupidity.”

      Yes, because our health care system is not staffed by people as perfect as you. So people in it, like every large system, handles are rare situations with less than perfection.

      We go through this with every crisis, where the Gods among us judge the people handling it to be guilty of “incompetence and stupidity.” It’s sad that I don’t meet these perfect people in my daily life. I wonder what their spouses and coworkers would say. I doubt “OMG, they’re always wonderful!”

  3. The real problem with America’s health care system has little to do with incompetence and a great deal to do with greed. Rapacious MBA’s have slashed preparedness to the bone, fired employees left and right, and cut pay and essential services, all in the name of making a buck for their for-profit healthcare corporations. The result?

    I have a perspective tying together today’s big news brouhahas. My wife is an ER nurse at a major urban hospital owned by the Hospital Corporation of America, the hospital chain once run by Rick Scott. It’s the largest for-profit medical system in the world, and is of course also notable for its ‘creative billing’ practices in the largest Medicare fraud settlement in history. Scott was booted from the CEO position following that fraud investigation, so he’s not directly responsible for current conditions in those hospitals.

    But it is obvious to those who work there that the combination of lax training and toxic labor relations ‘leaders’ like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of ebola or other infectious disease occurs. My wife’s ER has an ‘ebola cart’ with some lightweight protective gear and written instructions for putting on a PPE, but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk. It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far. As we all now know, PPEs are not easy to put on and take off correctly. Even though nurses all have experience with standard droplet control (they see TB and HIV all the time), ebola is a special case. They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.

    Source: “It’s an object of gallows humor for the staff,” Talking Point Memo website, 15 October 2014.

    Texas has led the nation in cutting its essential services, including health care, far beyond the point of degredation into outright lunacy. Is anyone surprised that the first ebola cases showed up in Texas?

    Ladies and gentlemen, this is what you get when you hurl bushels of money at CEOs while cutting essential services like healthcare and schooling and public transportation. Greedy MBA’s have cut costs by firing skilled personnel and downgrading equipment to the point where a major epidemic will face utterly underequipped and thoroughly untrained underpaid healthcare workers. And as I’ve pointed out, the real danger isn’t ebola — it’s another Spanish Flu.

    America has become the land of collapsing bridges, buckling sewer lines, disintegrating water mains, and giant sinkholes that swallow entire streets. Community after community in America can’t afford to keeps its streetlights lit or run its busses anymore; throughout America, small towns and large are ripping up their highways and repaving them with gravel because they can’t afford the upkeep on paved roads. No wonder America’s healthcare system is so grossly underequipped and unprepared. As Glenn Greenwald points out, this is what a collapsing empire looks like. Hundreds of billions for useless Buck Rogers superweapons that don’t work, trillions for endless unwinnable foreign wars, but not a dime for paving our streets or paying for minimally adequate equipment for our healthcare workers.

    If this country winds up decimated by another super-Spanish flu epidemic because greedy rapacious healthcare CEOs stripped essential services to enrich themselves far beyond the wildest dreams of avarice, it will get what it richly deserves.

  4. @ e.F.M.

    Please note that I didn’t call the entire system stupid and incompetent. Of course it almost always comes down to individuals. Unfortunately, the perception of performance is one of those classic examples where selective memory bias steps in. We tend to fixate on the bad instead of the constant backgraound noise of good.

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