My Questions About the Ebola Outbreak

The Ebola outbreak in West Africa is continuing unabated:

The death toll from the outbreak of Ebola virus in west Africa has climbed to 826, nearly double the number of fatalities of the previous worst-ever epidemic, according to figures released by the World Health Organisation.

The update suggests the outbreak is spinning out of control, with more than 50 deaths reported in three days from 28-30 July, as the spread of the virus outpaces efforts to contain it in Guinea, Liberia and Sierra Leone.

“The surge in the number of new cases . . . calls for concentrated efforts by all to address the identified problems such as health facility transmission and effective contact tracing,” the WHO said.

The rapid increase in the death toll comes after the three west African nations announced over the weekend extra measures to combat the outbreak, including calling in the army to enforce quarantines in several villages.

In a statement the trio said the new measures would focus on the “cross-border regions that have more than 70 per cent [of the cases] of the epidemic”. They added that the “border areas will be isolated by policy and the military”.

By my reckoning that means that there have been about four times as many deaths in this outbreak as in any previous one. And the outbreak hasn’t subsided. That strongly suggests to me that something has changed. What?

Additionally, I have read reports that the American healthcare workers who have been brought back to the States for treatment after contracting the disease were using the CDC’s containment protocols including containment suits. Assume that they were. How much confidence should we have that the containment protocols are effective?

Finally, many of the remarks I have read about the spread of the disease in Guinea, Liberia, and Sierra Leone have been incredibly patronizing. I’m sure they were well-intentioned. Patronizing people frequently have good intentions. Is it warranted?

I’m not advocating panic. I’m advocating skepticism. It seems to me that we may not know as much as we think we do and that isn’t much.

8 comments… add one

  • Piercello

    If this outbreak were to to jump to Central America (assuming that it hasn’t already), how long will it take our government to (1) hear about it, (2) confirm, (3) acknowledge the danger publicly, and (4) take steps to secure our wide-open southern border?

    Too long.

    Political operatives who know everything about optics and messaging and nothing about much of anything else may yet be the death of us.

  • CStanley

    Those are good questions, but the simplest explanation of the failure of containment protocols with regard to healthcare workers is that there was a breach of protocol. When dealing with such a cumbersome protocol, some breaches are inevitable, particularly in a situation where some of the workers were probably poorly trained and there was likely a situation of overwork and fatigue.

  • TastyBits

    Even with multiple layers of protection, a disaster can occur because of something that was not anticipated.

    It is the unknown unknowns that will get you every time.

  • Cstanley

    By my reckoning that means that there have been about four times as many deaths in this outbreak as in any previous one. And the outbreak hasn’t subsided. That strongly suggests to me that something has changed. What?

    The working theory is that the outbreak started months before it was recognized and reported, and several sick patients travelled to other villages and initiated new transmission chains there.

    http://www.nejm.org/doi/full/10.1056/NEJMoa1404505?query=featured_home&&&#t=article

    As far as the outbreak subsiding, I think new cases have significantly slowed in New Guinea which was where the index case occurred.

  • TastyBits

    You all are not thinking positive.

    (1) AGW – fewer humans = less CO2

    (2) unemployment – fewer humans = lower unemployment

    (3) income inequality – more dead poor people = less inequality

    (4) inner city slums – fewer poor people to displace when gentrifying

    I am sure there are others.

  • ...

    Tasty, you’re almost thinkingb like the ruling class now. You just forgot that they love having lots of poor people around to shit on.

  • TastyBits

    @Icepick

    Guess who does all the dirty work for the rich and famous? There will be at least a few who get infected, and once the relatives realize they can increase their fortunes, the fun will begin.

    When the rich are too scared to breathe the same air as the poor, they will have to clean the shitty toilets and wipe the snotty noses.

  • Dave
    As you know I’m following this carefully. My wife is a doctor who goes to Africa once a year, and we were in Tanzania across Lake Tanganyika during an outbreak in Zaire in ’95. We take this disease very seriously (and Wife’s 2015 trip to Gambia is on indefinite hold).

    As to your questions…
    1. This is the first outbreak in West Africa. West Africa is more densely populated, and has different customs regarding the handling of dead bodies than east or central Africa. It also has more connections to Europe and the outside world.

    2. Containment protocols on site are different in Africa than here. We already handle infectious diseases here in the US, some that are much more infectious than Ebola such as various strains of pneumonia. The facilities where these are handled are designed to standards that simply do not exist in Africa.
    I’ve likened the average clinic or hospital in Africa to a high school nurses office. These are often makeshift in nature and suffer from shoddy design and lack of provisions. Bandages, syringes and what not get reused NOT because Africans are stupid, but because they don’t have such supplies.
    Call me a racist bigot (people often do) but I have a higher level of confidence breathing the air outside a CDC research facility than I do the average African hospital.
    3. Patronizing commentary is endemic. I’ve met very few western reporters who take the time to truly understand Africa. Nearly every single one I’ve read thinks about “Africa” and not 40+ odd countries most containing a dozen ethnic groups following at least 3 religions. It’s difficult. The continent is humbling It’s problems are immense, complex and not easily understood by outsiders. Some of the conclusions that one must face fly-in-the-face of our values, such as, Are Africans better off today than they were 60 years ago under colonialism?
    The answer hurts.

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