The Duck of Minerva

Thursday Morning Linkage: Ebola Edition

7 August 2014

The death total of the Ebola viral outbreak in West Africa now exceeds 900, leading the World Health Organization to declare it a “global health emergency.” Urbanization and weak states in the region, coupled with rural practices of bush meat consumption, appear to be some of the problematic drivers of the epidemic. Local populations skepticism of health workers and attachment to traditional practices of care and burial are making the situation worse. The army is being deployed in Liberia to contain the spread and be able to enforce quarantine policies. The potential spread to Nigeria by a Liberia American official is especially worrisome.

Ebola spreads only through bodily fluids (i.e. saliva, urine, blood) and appears to have a low transmission rate (1 to 1.5 people per infected person on average) but high lethality (killing about 70% of those it infects). At present, there is no vaccine or treatment, other than palliative care, though there are some promising possible therapies. Two American aid workers who were infected received an experimental treatment and appear to be on the mend. They are now back in the United States for continued care, which has spurred a spate of public and media interest and irrational fear. In the midst of this crisis, the weakness of the international community, the World Health Organization in particular, loom large. It’s unclear if the topic will be added to the margins of the agenda of the on-going African leaders summit in Washington. Links below.

  • Jeremy Youde brings us up to speed on why the Ebola outbreak is so bad

Ebola is a difficult disease to contain under the best of circumstances. Its origins remain uncertain; it appears to spread to humans from animals, though the exact animal reservoir for the disease is not definitively known. Once it enters a human population, Ebola spreads from person-to-person through contact with blood or other bodily fluids. Within 2 to 21 days of infection, symptoms like fever, weakness, and muscle pain appear. From there, the infection progresses to vomiting, bleeding, diarrhea, and eventually multiple organ failure. There exist no treatments or cures for Ebola, so health care workers can only attempt to manage symptoms as they appear. Upwards of 90 percent of those infected die from the disease. [4]

  • Kim Yi Dionne writes of the weakness in local West African health care systems and the lack of local confidence in institutions
  • Laurie Garrett and John Campbell transcript of CFR discussion of Ebola with Laurie’s plea for international leadership on this problem, noting that there is no strategic plan and the WHO is dangerously under-funded because of recent cuts, particularly in infectious disease
  • Susannah Locke on Vox offers this 7 not-so-easy step explainer on how to end the Ebola outbreak – (1) find all infected (2) identify who they came in contact with (3) let health care workers do their jobs (4) isolate infected (5) prevent transmission in health care settings (6) stop transmission from dead bodies (7)
  • WHO convenes emergency meeting today, notes that it has a funding gap of $71 million (!) for $100 million plan to contain the outbreak
  • Ebola overshadowing African leaders’ summit? It’s not on agenda so yes and no.
  • Flu message board gives the sequence of Liberia-American Patrick Sawyer and how he came to get the virus from his sister and pass on to other Liberians in the hospital before departing for Nigeria where he ultimately died (this news report on his final hours also remarkable)
  • Reuters reports on how relatives in Liberia are leaving bodies in the road rather than allow officials to come in and decontaminate their homes
  • Risks to health care workers high, this story on top Liberia doctor who died at end of July, one of several, hard to keep protocol when its 120 degrees with the equipment on!
  • Nurse who treated Liberian-American in Nigeria now dead and five others infected and isolated, a worrisome turn in Nigeria
  • Peace Corps pulls out of region temporarily
  • CNN reports on remarkable recovery of American missionary with experimental therapy, left him well enough to walk into Atlanta hospital

  • Why Americans should not be worried about an Ebola outbreak domestically because patients are being treated in the United States: this is a disease you get when you are in close proximity to caring for someone infected

The doomsday scenario of Ebola being brought to the U.S. and spread via passengers on airplanes is very unlikely, unless an infected and symptomatic person is allowed to board and then swaps spit with or bleeds on fellow passengers.

  • Olga Khazan argues that a vaccine is not the answer for a sporadic outbreak that kills only a few periodically