Ebola Outbreak 2014
After looking at the above article "WHO: Changes at Ebola epicenter may be slowing down outbreak"
I am not sure this is the change they were referring too…
Mr. Duncan was symptomatic in the community for 5 days or so with perhaps a hundred contacts close enough for real concern, people in the same apartment, people in a treatment room, people in the back of an ambulance. Of those contacts there has only been one known transmission of the disease so far in Dallas and that was to someone doing bedside care for a patient at the end of life. This is an extremely intimate level of care, as in gently cleaning stool from a patients labia or scrotum intimate.
The fact he was wandering around for 5 days and only his caregiver at the hospital was infected supports the information from Emory about the tests they did that found no Ebola RNA on the surfaces of the patient's room
I'm not trying to minimize the issues of danger for our healthcare heroes, but my sense is, for the general population, unless you are cleaning up after a patient, taking care of a patient, engaging in too-personal funeral rites, or having intimate relations with a patient, odds are decent you won't get anything.
Here's an article about how one doctor skilfully communicated the realities of Ebola to a bunch of villages in one county in Liberia, and got the number of new cases to drop off precipitiously:
“They [now] call us when anyone is sick,” he says. “We no longer have to go looking for the patients. The communities understand and they help us.”
The impact is significant. Today, there are only a few patients in the MSF clinic and it is the only place in the country an Ebola clinic is planning to downsize beds — from 140 to 40.
The essence of the solution is, removing infected people from their homes and providing safe burial services dramatically lowers the transmission rate. Seems pretty simple to me.
Looking over the double times, I can't imagine that those rates will be sustained.
The worst may not have come in yet, but I don't think we're going to see 1.4 million cases by February… Unless something significantly changes about the virus itself.
We may have gotten very lucky to avoid a terrifying pandemic while still getting a chance to brace for impact. This is pretty significant to me, since we still will probably see major socio-economic impacts on account of Ebola, and it doesn't look like it will be gone for some time, yet.
But, I think it's impact on the first world will be mainly fear…
Someone who tested positive for Ebola was forcibly removed from the hospital by her family. No one knows where she is. This happened in the largest city in Africa, with an estimated 21 million inhabitants. And an airport.
Who knows how many people are already infected? The incubation period is 2 to 21 days.
Anyone familiar with Reston’s work The Hot Zone has been expecting this sort of crisis for quite some time; an outbreak of a slightly less lethal strain that reaches a major population center. Currently it looks fatal to around 60% of victims; while this is less than the 90% rate typically seen in previous outbreaks it’s horrific. If you look at the NIH blue ribbon panel scenario for a lab instigated outbreak of Ebola, they don’t even provide values for R0, the basic reproduction number, which is a measure of expected secondary infections stemming from one infection in a susceptible population. It is likely quite high even outside an aerosol context (less than pertussis, higher than polio). The only people who may have formally simulated such a scenario are the classified elements of USAMRIID (Army) and NBACC (HomeSec). For what it’s worth, Tom Clancy covers a potential Ebola outbreak in the USA in his novel, Executive Orders. It’s instructive.
While everyone is wondering about the whereabouts of this woman, consider what was going on prior to and during her hospitalization. An infectious vector wavefront has been propagating this entire time; it simply hasn’t been detected/measured yet. If you’ve watched this latest outbreak from the beginning you will have noticed the lackadaisical response with respect to regional isolation and complete shortage of qualified personnel to handle escalating ward requirements. 660 deaths as of this morning.
God help us all.
Flash in a Pan?
I sure hope so. Something is going to give, the system is unstable.
Thanks for the update, Wendy. It seems that the story to which you were referring about the woman whose family forcibly removed her from the hospital took place in Freetown, the capital of Sierra Leone, and not Lagos. Freetown has about 1 million people and, while still a big city, is the 44th largest city in Africa.
The twitter feed was limited and I am starting to listen to the conference. If I hear anything else that might be helpful I will pass it on to the forum 🙂
some points from the twitter feed:
1. they really don't think they have evidence that its airborne at this time
2. community based care: survivors of Ebola may be the best people to take care of patients since they are immune. (good news) this is especially important in countries in the hot zone imho. still sort of a "good news/bad news"idea but for Africa at this time it certainly makes good sense to recruit and train survivors to care for the ill. They provided a plan for how to do this. It will help cut down on transmission among other benefits.
3. deforestation has increased "vector density" and has increased contact probability, presumably with animal hosts
4. goal of care is to decrease transmission and decrease mortality in patient who become ill
5. outcomes can be significantly improved with aggressive medical care
6."Ebola is a contagion of fear and distrust "(agreed)
7. "this is not a healthcare worker issue, it is a systems issue" (agreed) with respect to HCW infections
8. Liberia is overwhelmed, schools are closed, up to 90 percent unemmployment
9. collateral damage (treatment of malaria, diarrhea, pneumonia) significant as well as impact on economy, community cohesiveness, trust in government and trade
10. Vaccine is the one of the ultimate answers to the outbreak
The best news I see is that treatment helps reduce case fatality rates (CFR) SIGNIFICANTLY.
And then there were three.
As the Texas Department of State Health reported an hour ago, just three days after the shocking announcement that the late Thomas Eric Duncan had managed to infect one nurse in the first person-to-person transmission of Ebola on US ground, a second Texas Health Presbyterian Hospital worker has been infected with the deadly virus.
Perhaps it would be LESS alarming to suppose that Texas Health Presbyterian does not have the competence to handle Ebola cases. Looks like three glaring errors in a row while other health centers seem to be getting the job done.
It sure is of keen interest to me that (so far) two health care workers at Texas Health Presbyterian have tested positive for Ebola, but NONE of Duncan's contacts at home before he was hospitalized have. What's up with that? Is being in the hospital MORE dangerous for contracting the virus than unprotected interactions while living with the patient while he's contagious at home? CDC's Frieden needs to sit down and shut up.