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.
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Contents
- News from Africa
- How infectious is Ebola? How fatal?
- Other posts about Ebola
- Sources of reliable information about Ebola
- 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:
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(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:
- “Estimating the Reproduction Number of Ebola Virus (EBOV) During the 2014 Outbreak in West Africa“, Christian L. Althaus, PLOS, 2 September 2014
- “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
- What you need to know about Ebola. Debunking the myths.
- An epidemic afflicting America: fear about Ebola. Avoid the carriers. Facts are the antidote.
- While Americans panic at shadows, Ebola strikes hard at Africa
- Lessons from Ebola. Let’s hope we learn.
- DoD shows its strength, mobilizing to protect us from Ebola (a sad story about America).
- We awake from fears of an Ebola pandemic in America. Now let’s ask who’s responsible…, 21 October 2014
- 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:
- “Why you’re not going to get Ebola in the U.S.“, Washington Post, 1 August 2014
- “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.”
- “Containing Hysteria About Infectious Disease“, Dr. Eugene Beresin, Psychoogy Today, 2 October 2014
- “Out of control: How the world’s health organizations failed to stop the Ebola disaster“, Washington Post, 4 October 2014
- “In the Face of Ebola, Stay Calm“, Anna Altman, op-ed in the New York Times, 7 October 2014
- “The Ebola alarmists: Stoking panic will not help America fight Ebola“, The Economist, 11 October 2014
(b) About Ebola, the disease:
- Ebola fact sheet, WHO, September 2014
- Ebola information page, Centers for Disease Control — Symptoms, methods of transmission, outbreaks
- Information Resources about Ebola, Centers for Disease Control — Infographics, video & podcasts, factsheets, posters
- “Ebola virus and U.S. preparedness: Review of research perspectives“, John Wihbey, Journalist’s Resource, 3 October 2014
- “‘In 1976 I discovered Ebola – now I fear an unimaginable tragedy’“, The Guardian, 4 October 2014 — A history of Ebola, by its discoverer.
- “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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