I’ve been watching Ebola with concern. I hoped we’d have more time. We can still gain control but every week matters. What we do now will be so much easier than what we have to do if we leave it to run.
The summary: The WHO warns that there may be 10,000 new cases a week in West Africa by early December. Can you imagine trying to set up new beds to cope with that each week? Meanwhile the Centre for Infectious Disease Research has advised the CDC that the evidence suggests some airborne spread of Ebola is occurring, which may explain the toll on health workers. Sadly a second health-worker has also been infected with Ebola in Texas (and she was on flight 1143 from Cleveland to Dallas the day before – the CDC wants passengers to call.). Sixteen members of Doctors without Borders have been afflicted, and nine have died. That team deserves medals more help.
There are different versions of airborne infections, hopefully this is in the “only just airborne” category. Just being barely airborne is not the same as, say, being spread like measles. Nonetheless, the game has changed. Healthworkers need even more serious, much more expensive masks.
Update to clarify: There is a spectrum of “airborne spreadability”, and it may be that the virus has not suddenly changed, but has been spreading slightly through an airborne mechanism for months. If that is the case, the new awareness is good news and will help. As reader Lawrence Cooper points out, it’s rare or even unknown for viruses to transform completely from one form of transmission to another. On the other hand it’s well known that the evolution of viruses will generally make them less deadly, but easier to spread. This is what I’m talking about. With mortality running at 70%, there is still a lot of room to reduce the death rate but ultimately kill a lot more people. There is some very ugly maths under those curves. Evolution is inevitable: more infections means more mutations. Virologists are debating it here.
We are very fortunate the virus doesn’t spread until people show symptoms. There don’t seem to be pockets of new mysterious outbreaks that spring up unexplained, which would happen if the virus was truly airborne. But it was very odd that healthworkers in close contact to patients and in protective gear were getting sick so often.
On the plus side, the outbreaks in Nigeria and Senegal may get cleared as officially over by October 20. Those two countries appear to have overcome their outbreaks. At least one epidemiologist departing Liberia sees hope for controlling the infection in the region where it first broke out. There is hope, but very little time to get control in Liberia, Sierra Leone, and Guinea. Also on the plus side, there are several promising vaccines in development, which I feel optimistic about (trials have started though delays are frustrating). Blood from survivors contains antibodies that could save people, and seem to be helping the nurse in Texas (I wonder why aren’t we doing more of this for health-care workers everywhere?). Mark Zuckerberg has donated $25 million to the Ebola cause. Good on him.
Right now, the most useful thing we can do is help our bureaucrats to understand how fast this could get beyond control. This is about making sure there is not a modern plague. We can do it, but we need to do it in Africa. The Ro (Reproduction number) is estimated to be between 1.5 and 2.2 at the moment. If we can bring the Ro down below one, the disease will most likely gradually fizzle out. Simple measures can still make a big difference in a land where doctors are rare.
It’s Airborne: Breitbart reports
Medical Research Org CIDRAP: Ebola Transmittable by Air
The highly respected Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota just advised the U.S. Centers for Disease Control (CDC) and World Health Organization (WHO) that “there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles,” including exhaled breath.
CIDRAP is warning that surgical facemasks do not prevent transmission of Ebola, and healthcare professionals (HCP) must immediately be outfitted with full-hooded protective gear and powered air-purifying respirators.
CIDRAP since 2001 has been a global leader in addressing public health preparedness regarding emerging infectious diseases and bio-security responses. CIDRAP’s opinion on Ebola virus is there are “No proven pre- or post-exposure treatment modalities;” “A high case-fatality rate;” and “Unclear modes of transmission.”
10,0000 new cases a week by December The Guardian:
WHO warns 10,000 new cases of Ebola a week are possible
UN agency says fatality rate at 70% and that ‘a lot more people will die’ unless world steps up its response to crisis
The Ebola outbreak could grow to 10,000 new cases a week within two months, the World Health Organisation warned on Tuesday as the death toll from the virus reached 4,447 people, nearly all of them in west Africa.Dr Bruce Aylward, the WHO assistant director-general, told a news conference in Geneva that the number of new cases was likely to be between 5,000 and 10,000 a week by early December.
WHO’s regular updates show that deaths have resulted from 4,447 of the 8,914 reported cases, but Aylward said that any assumption that the death rate was 50% would be wrong. He put the death rate at 70% because many deaths are not reported or recorded officially.
Where detailed investigations have been carried out, it was clear that only 30% of people were surviving, he said, adding that the figure was almost exactly the same in the three hardest hit countries, Guinea, Liberia and Sierra Leone. “This is a high-mortality disease in any circumstances but particularly in these places,” said Aylward.
The toll on Doctors without Borders JEMS:
These people are angels.
16 Members of Doctors Without Borders Infected with Ebola, Nine Dead
Workers have had inadequate help from international community
JOHANNESBURG (AP) — International aid organization Doctors Without Borders said that 16 of its staff members have been infected with Ebola and nine of them have died.
Speaking at a press conference in Johannesburg Tuesday, the head of Doctors Without Borders in South Africa Sharon Ekambaram said medical workers have received inadequate assistance from the international community.
“Where is WHO Africa? Where is the African Union?” said Ekambaram who worked in Sierra Leone from August to September. “We’ve all heard their promises in the media but have seen very little on the ground.”
Four of the organization’s medical workers who had just returned from Sierra Leone and Liberia said they were frustrated, “chasing after the curve of the outbreak,” according to Jens Pederson, the aid organization’s humanitarian affairs adviser.
“To manage Ebola is not rocket science. It’s very basic infection control and very basic protection of staff,” said Pederson who said clean water, chlorine and soap were enough to disinfect an affected area.
2nd health care worker tests positive for Ebola at Dallas hospital
A second health care worker at Texas Health Presbyterian Hospital who cared for Thomas Eric Duncan has tested positive for Ebola, health officials said Wednesday — casting further doubt on the hospital’s ability to handle Ebola and protect employees.
The worker reported a fever Tuesday and was immediately isolated, health department spokeswoman Carrie Williams said.
The preliminary Ebola test was done late Tuesday at the state public health laboratory in Austin, and the results came back around midnight. A second test will be conducted by the Centers for Disease Control and Prevention in Atlanta.
I’ll be back to add images and more information, and as much good news as I can find.
Matt Ridley wrote a good article in The Australian. “Beat Ebola or face a pandemic as bad as the Black Death “
Sources: US Dept of Health — Information | Science Mag | Clinical features | Genome Ebola Portal | Timeline | Projection | CDC on Ebola | Twitter #ebola |