Is The Ebola Epidemic Just Getting Started?

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Maryn McKenna flags a paper that attempts to calculate the outbreak’s reproductive number (i.e., the number of cases likely to be caused by one infected person) and comes to a startling conclusion:

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. … They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others. You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.

In an NYT op-ed last Thursday, Michael Osterholm sounded an even more dire warning:

The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice. If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico. Why are public officials afraid to discuss this? They don’t want to be accused of screaming “Fire!” in a crowded theater — as I’m sure some will accuse me of doing. But the risk is real, and until we consider it, the world will not be prepared to do what is necessary to end the epidemic.

What is necessary, in his view, is a Security Council resolution that would “give the United Nations total responsibility for controlling the outbreak”. The Pentagon has asked Congress for “up to $500 million” to help fight the outbreak, but there’s a catch:

The Defense Department plans to also use at least a portion of those funds to respond to the growing refugee crisis in Iraq. When the Pentagon wants to shift that much money between its accounts, it’s required to send what’s called a reprogramming request to Congress. The Defense Department has offered no details about the breakdown, which means it’s theoretically possible the United States could spend $1 on Ebola and $499,999,999 on Iraq.

“The situations in both Iraq and West Africa are dynamic, and the funds we are seeking to reprogram will help enable [the Defense Department] to be responsive to needs on the ground in both areas as they arise,” a defense official told Foreign Policy. “Therefore, the total amount that may be used in either West Africa or Iraq under this reprogramming request may not be determined at this time.” Without more information, one is left guessing about the scale to which the Pentagon plans to respond to either problem.

The Economist reviews how the spiraling crisis has spurred the development of new drugs to treat the virus:

The arrival of new medicines will encourage health-care workers who have given up their posts to return to attend the sick. It would also help address the fear and panic that is proving so disastrous in the infected countries. But there are other difficulties. One is highlighted in a forthcoming working paper for the National Bureau of Economic Research, which finds that some Indian drugmakers are taking advantage of the lack of regulatory oversight to send their lowest-quality antibiotics to Africa.

The biggest problem remains containment, especially in the months before new medicines arrive. Virologists, such as Dr Ball at Nottingham, worry that increasing human-to-human transmission is giving Ebola the opportunity to become more transmissible. Each time the virus replicates, new mutations appear. It has accumulated and hung on to some mutations, like “cherries on a one-armed bandit”, he says. Nobody knows what would happen if Ebola hit the jackpot with a strain that is even better-adapted to humans. But the outcome could be grim, for Africa and the rest of the world.