Friday, August 8, 2014

Ebola Opinion / Nass

Despite an estimated 69% death rate, Medicins Sans Frontiers (Doctors Without Borders or MSF) doctors and nurses have not come down with the disease.  MSF has 676 staffers working on the ground in Africa.  CDC has 31 to help with case-finding, but none treating victims.  WHO says it has 141 people in West Africa sent to help manage the epidemic.

An Aug 7 Congressional hearing was told that "the international community was comfortable in allowing [only] 2 relief agencies (private NGO charities, MSF and Samaritan's Purse) to provide all of the clinical care for Ebola victims in 3 countries" until 2 Americans became ill (at 1:11).  Truly, this is disgraceful.

Ebola is not the world's first or only high-mortality viral hemorrhagic fever.  We do know how to manage these infections safely.  But it requires intense attention to detail.  Staff must be very well trained, and very careful.  They will make mistakes if they are overworked. They needs lots of equipment too: materials to isolate patients, deal with body wastes safely, and huge numbers of gowns, gloves, goggles, boots, etc.

Ebola may possibly be "airborne"but that is not as ominous as it sounds.  C. diff (Clostridium difficile) is a bacterium that forms a spore. Explosive diarrhea sends C. diff airborne--but Americans are not dying of it in droves.  Pneumonia is caused by airborne viruses and bacteria, but most of those exposed do not get sick.  Some become immune. My guess is that this occurs very rarely with Ebola.  

UPDATE:  See Dr. Ian Mackay's blog for more on the subject of droplet nuclei and the lab transmission of Ebola under certain conditions.

When a disease is new, or rare, we only hear about the worst cases--at first.  Later, when serologic sampling is performed, we learn that many more people were exposed, did not become ill or experienced mild disease, and recovered, often with long-lasting immunity. Then we learn that the mortality rate is actually much lower than at first thought.

The Washington Post reporting 4 cases in Lagos (population 20 million) today tells me that there are or soon will be hundreds or thousands of cases in Lagos.  Controlling the outbreak in one of the world's largest cities, made up of miles of slums and without a sewerage system is going to cost plenty:  not the 10 or 100 million dollars being collected for the entire outbreak.  Compared to the billions spent on the 2009 swine flu, which was milder than most seasonal flu, what on earth has led to the six month delay by the world's rich nations to seriously try and control this outbreak?  (This Ebola outbreak was first noted in West Africa between December 2013 and March 2014.
 The lack of interest shown in it till recently makes one wonder about population control.

The birth rate in Africa is over 5 births per female, more than twice that of the rest of the world. According to The Economist:

In 1970, there were 360m Africans and they amounted to a tenth of the world’s population. If fertility were to drop roughly in line with Asia’s 1970-2000 trajectory, there would be 2.1 billion Africans by 2050. If it continues on its current path, there will be 2.7 billion—a quarter of the global population then. Africa’s population will almost triple in 40 years.
According to UN predictions reported in the Washington Post in late 2013 (see below), Africa will have 4 billion people by 2100, approaching the predicted population of all Asia.

You cannot control urban Ebola without a sanitation system and access to clean water. These require huge investments and lots of time. Time may be running out to stop this outbreak without huge numbers of deaths in Africa, and tremendous dislocations globally.

UPDATE:  Just learned there are cases in Conakry, Monrovia and other large urban areas. MSF says the situation in Monrovia is catastrophic.

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