The Worst Ebola Outbreak In History, Ctd

Keating looks at why the current epidemic has been so severe:

As political scientist Kim Yi Dionne notes, a number of factors have combined to make this the most deadly Ebola outbreak in history, and most of them are political rather than biological.

For one thing, none of these countries has experienced an outbreak of the disease before, so knowledge of it is low. For another, the fact that it’s spread to multiple countries makes a coordinated response more difficult. (Liberia has now shut almost all of its borders.) As Dionne notes, all three countries have poor health infrastructure, due in part to years of civil war in Liberia and Sierra Leone. Liberia has just .014 doctors per 1,000 people, and a common joke is that JFK Medical Center, Monrovia’s main hospital, has long had the unflattering nickname “Just For Killing.”

Which is why a major Ebola outbreak in America is unlikely. Olga Khazan tries to determine how this outbreak started:

Researchers still don’t know the exact cause of this particular outbreak, but it might have to do with the local practice of eating bats for food, according to Jonathan Epstein, an epidemiologist at EcoHealth Alliance. “It’s unclear whether it occurred due to butchering a bat, exposure to bat bodily fluids, or eating some food or fruit that was contaminated by saliva, urine, or feces from the bat, which may contain Ebola virus,” he said. Pig farms in Africa also often attract bats, which also may have been a cause.

Once the infected person begins to show symptoms—flu-like aches, nausea, and vomiting—local customs continue to play a big role. There aren’t enough doctors or supplies available to treat all the Ebola patients in the area, but even if there were, many locals are suspicious of Western medicine.

John Herrman reflects on the West’s detachment from these kinds of diseases:

I’ll read almost anything about infectious diseases, and in retrospect, most of this reading was cold and sociopathic. Richard Preston’s The Hot Zone was an escapist thriller; The Great Influenza was an apocalyptic period piece; The Coming Plague was an engrossing feat of science fiction world-building, about a planet that contrives, almost at random, new and hideous microscopic monsters to destroy sophisticated life, and that will not give up until it has succeeded. Nature finds a way, a narrator intones, except that this narrator is a doctor who has spent her whole life watching people die in pain and confusion, and I’m just sort of dozing off, because I’ve been reading too long and it’s time for bed.

This is of course an insane way to read about deadly diseases. It is also standard in areas of the world where these rare viruses feel utterly remote. It provides comfort that your incidental version of civilization at least shields you from the most vividly horrific diseases.

An Ebola vaccine is still at least a few years away:

There are quite a few preventative vaccines in development, with three to five that have been shown to completely protect nonhuman primates against Ebola. Some of these vaccines require three injections or more and some require just a single injection. Most of them are being funded by the U.S. government, so they’re in various stages of development, but none of them are ready to be licensed.

The hang-up point with these vaccines is the phase I trials in humans. That’s where scientists get frustrated because we know these vaccines protect animals and we don’t quite understand the regulatory process of why things can’t move faster. I can’t give you an answer as to why it’s taking so long.

The Economist maps current and former Ebola hot-spots. All the Dish’s coverage of the latest epidemic is here.

The Worst Ebola Outbreak In History

Ebola Deaths

We’re in the midst of it:

The outbreak is unprecedented both in infection numbers and in geographic scope. And so far, it’s been a long battle that doesn’t appear to be slowing down. The Ebola virus has now hit four countries: Sierra Leone, Guinea, Liberia, and recently Nigeria, according to the country’s ministry of health. The virus — which starts off with flu-like symptoms and often ends with horrific hemorrhaging — has infected 1,201 people and killed an estimated 672 since this winter, according to the numbers on July 23 from the World Health Organization.

Dish alum Gwynn Guilford is alarmed by the spread of Ebola to Lagos:

So far, Ebola has been confined to Guinea, Sierra Leone, and Liberia—war-torn and largely rural west African countries. But Lagos is different; not only is it Africa’s biggest city, with 21 million people. It’s also one of the world’s most densely populated. And perhaps scariest of all, it’s a center for international travel—meaning that if it’s not contained, the virus could easily go global. [Patrick] Sawyer’s was the first-ever recorded case of Ebola in Nigeria, according to the Nigerian Tribune.

So far, the Nigerian government’s efforts to contain it inspire little confidence.

The Bloomberg editors call for a Pan-African response to the outbreak:

There is a reservoir of talent elsewhere in Africa — the doctors, nurses, epidemiologists, lab technicians and administrators in Uganda, Republic of the Congo, Democratic Republic of the Congo and Gabon who have been through this and know how to handle Ebola. By organizing teams of them to help with the current epidemic and pass their skills on to their counterparts in Guinea, Sierra Leone and Liberia, the World Health Organization could establish a pan-African partnership that central and east Africa could, in turn, rely on down the road.

International donors such as the U.S. and the European Union could help fund and provision the African teams. They could enlist the help of international mining companies present in Guinea, which have certainly extracted value from these countries and have both a humanitarian and an economic interest in stability and ending the epidemic.

Ishaan Tharoor finds that one “of the continuing challenges is getting local populations to abide by the edicts of government authorities and foreign health workers.” A reason this has proven difficult:

The hysteria caused by the spread of Ebola has led also to the spread of rumor and conspiracy theories. Angry crowds have accused foreigners of bringing the virus in their midst: In April, the threat of violence forced [Paris-based medical NGO] MSF to evacuate all its staff from a treatment center in Guinea. In Sierra Leone, which has the largest number of Ebola cases at present, thousands protested over the weekend outside the country’s main Ebola treatment facility in the eastern city of Kenema.

Police had to disperse the crowd with tear gas and a 9-year-old was injured in the leg by a police bullet, Reuters reports. The demonstration was sparked, the news agency claims, by a rumor spread in a nearby market that the disease was a ruse used to justify “cannibalistic rituals” being carried out in the hospital.

Abby Haglage explains that a “full 42 days (double the potential incubation time of the disease) without any new infected are needed before the CDC can declare the outbreak officially over”:

“The concern is the outbreak can be reseeded much like a forest fire with sparks,” says [Stephan] Monroe [of the CDC]. “Until we can identify and interrupt every chain of transmission, we won’t be able to interrupt the outbreak,” he says, reinforcing the need to track those who may have come in contact with carriers. “Until we get all the fires put out, there’s still a possibility that it will reignite.”

Ebola Is Back, Ctd

In an analysis of nearly 40 years of “lessons learned” since the first Ebola outbreak, Laurie Garrett stresses the importance of avoiding infected animals:

[T]he index case – the initial person contaminated with the Ebola virus – is usually a hunter or villager who recently spent time deep in a tropical forest and came into contact with an animal carrying the virus. In Yambuku, the index case was a hunter; in Kikwit he was a charcoal-maker who spent a week burning wood in the forest to sell in town; in a prior West African outbreak, the index case was a family that killed and ate an ailing chimpanzee. Stopping the spread must include cutting off contact between forest animals and human beings, especially tropical fruit bats that harbor the virus without harm to themselves, and the monkeys and apes that eat the bats or fruit that they chew on, contracting Ebola in the process.

Unfortunately, climate change makes it increasingly difficult for humans to maintain that distance:

Across Africa, typically shy bat species pollinate the trees of the rain forests as they nocturnally scour for fruit. As the heat increases in the upper canopies of forests, due to climate change, and as humans increase their logging operations, the bat populations are now under great stress. When distressed by such environmental changes, animals are more likely to venture near human habitation in search of food, and come down from the upper tiers of forests into tree levels filled with predatory monkeys and chimps.

Recent Dish on the new outbreak here. Update from a reader: “For the record, contrary to the suggestion in the video you posted, there is no ebola outbreak in Canada.”

Ebola Is Back

Fruzsina Eördögh relays the bad news:

Ebola, which may well be the most terrifying virus on the planet, has killed 59 people in Guinea in a month in the first outbreak of the virus seen in West Africa. There are 80 confirmed cases so far and officials are concerned the virus has spread to neighboring countries Sierra Leone and Liberia, as a 14-year-old Sierra Leone boy who attended the funeral for one of the earlier victims is now showing signs of infection.

Other West African countries are on high alert:

Mali’s government yesterday warned against unnecessary travel to the contaminated area, after the health ministry held a crisis meeting and called on citizens to be “vigilant.” Liberia’s New Democrat newspaper ran an editorial in which it said there was an immediate need for increased surveillance on all border posts with Guinea. Many of the goods sold in Monrovia, Liberia’s capital, come from Guinea. Ivory Coast set up a coordinating post in Man on the border with Guinea and will increase surveillance and run awareness campaigns, the country’s health ministry said. Gambia, an enclave in Senegal, is monitoring the situation, its health ministry said.

But Kent Sepkowtiz urges Americans not to worry:

While this sort of thing makes for frightening headlines and occasional dud movies (here and here for starters), Ebola and its related group of devastating infections will never become a threat to the US. The disease simply sickens and kills too quickly, plus anyone in the US with an odd febrile illness and rapid progression to prostration is placed into gown and glove isolation at just about every hospital in the country.