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Whatever Happened to Ebola?

2015-01-26

Last fall we had several posts on the Ebola epidemic that struck Liberia, Sierra Leone, and Guinea.  We noted that the experts had predicted the possibility of 1.4 million cases of Ebola by this time (the end of January.)  That prediction was a worst-case possibility based on nobody doing anything to put the brakes on the spread of the virus.

Since that time, much has happened.   In particular, local people have dramatically changed their behavior, partly on the basis of government propaganda and instructions on how to prevent the virus from jumping from person to person.  In particular, the traditional both-cheeks kiss greeting has been abandoned by many Liberians.   Families have been allowing government workers in protective suits to pick up corpses (the body is actually most infectious after death.)  Some families are still hiding in the bush with their sick relatives to avoid the possibility of the corpses being buried in unmarked graves or cremated.  Cremation, or an unmarked grave, would make it impossible for relatives to mourn properly (horrifying eventualities to traditional West African sensibilities.)

In addition, the US military has set up numerous Ebola treatment centers where patients can be cared for safely, and small amounts of international money have helped to bring more resources to bear on the problem.  There is still a dire shortage of funds and workers to care for Ebola patients, but things have improved.

As a result of these changes, the number of new cases of Ebola has dropped dramatically, especially in Liberia.  A total of more than 21,000 cases have been counted, with over 8,600 deaths, but there are now only 5 new cases in the entire country of Liberia (which was seeing over 300 new cases a week last fall.)  There are still people falling ill every day, especially in Sierra Leone, and the death rate is still approximately 60%, but fewer patients are coming to light and treatment centers are no longer overflowing with patients waiting for others to die to free up beds.

There is every reason to believe that the epidemic can be brought under control, especially since companies producing Ebola vaccine are starting to deliver limited amounts to the epidemic areas (with more to come.)  The greatest risk is that people will forget about Ebola now that the epidemic is no longer raging out of control.

The World Health Organization, recognizing its failure to respond in a timely fashion to this Ebola outbreak, and remembering that it failed to put in place recommendations given after the 2009 influenza epidemic, has finally endorsed the program developed back then.  They are now more serious about establishing a global cadre of emergency health workers, a fund to be used in new epidemics, and stepped up efforts to work on vaccines, diagnostics, and treatments for new epidemic infectious diseases.  In addition, the head of WHO has publicly recognized that they are the only agency with a global mandate to be a first responder to emerging infectious diseases.  This is a reversal of the policy stated last summer, which was based on a very limited budget and the political nature of the organization.  The political emphasis of WHO personnel has both hampered its ability to respond to emergencies with high expertise personnel, and inhibited early use of large monetary appropriations.

Perhaps a realignment of WHO’s priorities to expertise from political appointments and the development of an emergency fund will allow the necessary vigilance to respond appropriately to future infectious emergencies.

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