Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

[Gemineye]

Lindis Hurum, the Doctors Without Borders) emergency coordinator in Monrovia has been quoted as saying:

"It is simply unacceptable that, five months after the declaration of this Ebola outbreak, serious discussions are only starting now about international leadership and coordination," said Brice de le Vingne, director of operations at Doctors Without Borders. Referring to other countries that have the potential to help, he says, "They can do more, so why don't they?"

In my opinion, here are some possible reasons. It is not my intent to be critical but to point out why people are reluctant to get involved.

1. It's simply too dangerous to reasonably ask anyone to volunteer for direct patient care. At least 150 health care workers have already died. Healthcare workers are physically threatened and barred from entering certain hot zone areas.

2. Much of the money donated to African countries ends up in the pockets of corrupt politicians, greedy bureaucrats and other unscrupulous people. Western countries have donated tens of billions of dollars on Africa with little to show for it.

3. This Ebola outbreak is the "African humanitarian crisis of the month". Just another in a long line of such disasters. Compassion fatigue is a factor in the lack of response. People reasonably ask the question: "When will African nations stand up on their own two feet?"

4. The affected countries themselves are not doing enough to combat the outbreak. Doctors and nurses run away from treatment centers. Politicians beg for money but do not get directly involved. Healthcare workers are not adequately protected by the military or police.

I'm am hoping to spark a dialogue on this issue and hope people will add their thoughts! Please be nice.

 

[Vibrant62]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

I believe that top policy makers and politicians fail to grasp the seriousness of the situation, and do not see how it would become a global threat in the same way as e.g. a high CFR flu pandemic.

For a long time now top virologists and other experts have preached several characteristics of ebola. This has firmly entrenched a 'not our problem' and a 'not a global threat' mentality. As it is quite a horrible prospect to contemplate a global ebola pandemic, the 'dont worry, not a problem for us' mentality is psychologically more comfortable to take refuge in - i.e believe in the established thinking for ebola.

For example, the established mantra is:-

1. That the CFR of ebola is so high that the virus will burn itself out in outbreak areas, and that as such, does not produce a global threat unless as a result of terrorism.

This has now been thoroughly disproven, but such historical thinking has firmly established a 'not a problem for us' mentality amongst government departments and their scientific advisors.

There is also a firm belief that as things historically stand vis a viz the behaviour of ebola, any imports of the virus can easily be controlled by western healthcare systems. This however may not be true if the virus behaviour changes e.g. if carriers becomes infectious far earlier in the infection cycle, and whilst they only show mild symptoms. In such a situation, an infected person could easily set up multiple transmission chains in the period before they seek help. Also remember that with an incubation period of up to 21 days, someone could enter the country without fever, and bypass all screeing efforts until they became symptomatic.

2. That the virus only transmits when someone is highly symptomatic and cannot travel = no threat to us.

Again, I believe that the evidence of how this outbreak is spreading and transmitting shows that this is not the case, in every case. Many people who are sick and infectious are remaining at work, and it isnt until the terminal stages of the disease that they are too sick to move about.

3. That dead bodies are the greatest threat, and this aspect can be easily managed.

With sufficient resources, still true. One caveat is that MSF and other NGO workers have reported atypical deaths, where it has not been immediately apparent that the person died from ebola. This has only come to light after others have been infected.

4. That the virus is stable, and unlikely to change.

Disproven by the research published yesterday. With multiple passages through human hosts the virus is changing from an animal virus to a human one. With that we can expect refinements in adaptation, of which the main evolutionary pressure would be to increase infectivity and transmissibility.

With so many other humanitarian crises in the world just now, this one is sinking in the mire. Competing contenders for attention include Syria, Iraq, not to mention the situation in Gaza or the political crisis of Ukraine, as well as domestic issues aplenty for every major western government.

Until our leaders start to see this as a threat of national / global security proportions, they wont act.

Truly expert scientists, such as the ones who published the paper yesterday, do understand. Its just that scientists dont like to raise alarm or shout loudly. I hope that they start to do so as they see the lack of response. They are perhaps the only ones that can, and have a chance of being heard.

 

[Gemineye]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Vibrant62, that was a very thoughtful reply. Thank you. :applause:Everyhing you say is true. I'm also worried that this Ebola virus is behaving in different ways from the ones causing previous outbreaks.

 

[mac68DC]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

At least here in the United States, the narrative that the threat is so low that there is no need to panic equates to very little motivation to send resources into harms way. Unfortunately, if anything, there is motivation NOT to send resources.

By the time the narrative changes, simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

 

[ming]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I agree with the first poster - and also think that no country is going to order it's troops or medical personnel into west Africa, this disease is too terrible to do that without a massive public outcry.

 

[Laidback Al]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

. . . simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

Yes, trained personnel with the right supplies will stem the tide of cases. But we may have already passed the point of no return with local medical staff in these countries. More than 120 health workers have already died and at least that many more have been infected. (WHO link) It will take outside medical specialists to help bring this outbreak under control.

 

[Vibrant62]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

At least here in the United States, the narrative that the threat is so low that there is no need to panic equates to very little motivation to send resources into harms way. Unfortunately, if anything, there is motivation NOT to send resources.

By the time the narrative changes, simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

I would agree that the window is closing fast.

The thing that governments fear more than anything else is panic. Look at what is going on West Africa: this concern is there for good reason. So official pronouncements are designed to play things down, but it must also be remembered that nothing is certain. In discussions like this all we can talk about are possible futures. They may not come to pass. But highlighting risks allows expedient measures to be taken so that some possible futures do not become reality.

The only problem with this approach is that authorities (and individuals within them) will believe their own propaganda when its repeated often enough.

 

[mac68DC]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

I would agree that the window is closing fast.

The thing that governments fear more than anything else is panic. Look at what is going on West Africa: this concern is there for good reason. So official pronouncements are designed to play things down, but it must also be remembered that nothing is certain. In discussions like this all we can talk about are possible futures. They may not come to pass. But highlighting risks allows expedient measures to be taken so that some possible futures do not become reality.

The only problem with this approach is that authorities (and individuals within them) will believe their own propaganda when its repeated often enough.

Totally agree. Ironically, if narratives are overly sugar coated - trust is broken when the story changes. If it changes dramatically enough - people stop believing and trusting anything the institutions put out there - which ends up being a disaster.

 

[Gemineye]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I also agree. A perfect example is Nigeria. The government recently declared the outbreak was contained and the next day they had two new cases in another part of the country. That kind of behaviour really undermines your credibility.

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

While the on the ground ex-patriot works have adequate PPE many of the local HCWs have little or no kit and have suffered badly.

While I understand that governments may not be keen to send their nationals I do not see why they have not shipped all the PPE they can. Had this been done early in the outbreak the current situation would be a lot smaller and more manageable.

 

[AnnaLisa]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

 

[mac68DC]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

I don't think so, but not sure. Mostly because there is no panic here yet. I remember in the past n95 masks sold out, but not this time around.

Not sure if that is an indication of non-hording?

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

I suspect there may be now.

At the outset they should have donated the PPE but now, I suspect, they are more cautious. Despite their 'it won't be a big problem in developed health care settings' mantra I would not be surprised if they are now wondering if shipping their PPE stockpiles may become a political disaster if EBOV does get a foot hold within their territory. I can not see the-powers-that-be relishing explaining that they can not safely treat the growing number of case because they gave their stockpile away to a deserving cause.

The need now is massive. It was small and could have been met with relatively modest donations.

 

[Vibrant62]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

A key question is what the manufacturing capabilities are of PPE. I do not expect any country has large stocks in hand, except for national strategic reserves, and they wont let those go. There is a domestic obligation to maintain such stocks.

It may be that the PPE is simply not available, and that donating countries are having to wait for additional/ new manufacture.

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

PPE is not the only thing they need.
Looking at some of the lists of supplies they were low on Wellington boots, body bags, various disinfectants and many others which are not likely to be due to supply chain bottlenecks. As there is only supportive treatment they badly need IV drips, and salts & sugars for them. Treatment of the US patients shows you also need blood tests to determine the blood chemistry to formulate your drip. Given the nature of the disease taking and analysing blood tests safely must be challenging.

 

[Sharky]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

In a culture where clinics are looted, supplies are stolen, the existence of Ebola is vigorously denied, sorcery is blamed, infected people hide or run instead of coming forward, dead bodies are thrown in the street without contact tracing, and where burial rituals result in new infections -- no amount of money or aid is going to stop the outbreak.

I'm not saying we shouldn't try. Many lives could certainly be saved, but it's going to be a long, long road.

 

[Vibrant62]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

All of the behaviours here in my amateur opinion (anyone a clinical phsychologist? could do with input here) are a manifestation of fear.

Fear is understandable with ebola, so if the people are to be brought onside, they need to be either taught to cope with this fear, or, we have to come up with strategies to address thier fears with what is currently available right now.

Now, the health teams are running 'sensitisation' exercises with communities - the hard bits about 'what must be done' in the event that someone within their community develops ebola. However, this does not address the 'fear'.

Why are they afraid? Well - still worth stating the obvious.

1. Ebola has a CFR of up to 90%, but can be closer to 50% with early intervention and care.

Problem: there are insufficient resources to provide the level of care needed to improve survival to this lower level - not enough isolation beds, insufficient IV use (either because of shortages or shortages of enough HCWs to set them up - dont know which).

Solution: increase bed numbers and IV supplies and possibly train survivors on how to insert an IV? There must be some non HCWs who could learn to do this with training? Many of the affected who have presented to treatment centers have been HCW close contacts, so could this be feasable? How else could affected countries address increasing bed numbers in the absence of additional aid help?

2. The disease looks a lot like gastroenteritis and malaria in its early stages.

Problem: If you didnt have ebola, but go to a treatment center for assessment you probably end up with ebola through exposure with real cases whilst you are there. In this way going to the assessment and other centers appear to be a death sentance. People go and never come back.

Solutions: ?? Ideas please.

3. The outbreak is occuring in a region where the population is already heavily traumatised from poverty, very bloody civil wars, and a witch doctor culture still exists.

Soloutions: ??
In areas where the outbreak has been extensive, people DO believe in ebola, according to NGO reports. Its only areas where the outbreaks that are in early stages where people are full of mistrust, or dont believe that ebola exists. Until people see the effects of a full on outbreak in thier community, they wont believe in ebola or that it could happen to them. Perhaps increased media coverage of actual people in the outbreaks with interviews with individuals from affected communities who DO now believe in ebola?

4. The biggest element: there is currently no treatment for ebola.

Problem: Research is going on at high speed, but for now there is no treatment or vaccine. That can only be fixed as quickly as the work can be done, but even in a best case scenario, a vaccine in any quantity is at least a few years away, assuming that live 'trials' show that the ones currently under development actually work.

We actually dont know how to make an ebola vaccine that we know works; this is not like influenza, and scientist have been trying to develop an HIV vaccine for decades without success, so the speedy development of a vaccine is not a certainty. Same goes for putative treatments. And then there are manufacturing capability issues and supply issues, never mind how such an exercise might be funded, because vaccines are expensive, one way or the other.

Possible interim solution? We know that ebola manifests as a cytokine storm and immune system dysregulation, so perhaps whilst we wait for a treatment or a vaccination, we should be looking to ways and means to modulate the immune response to ebola?? If there was some nutritional or similar protocol that could be developed that meant if people caught ebola, they may increase their chances of survival, it might help address the fear, and give people some measures that might a) help people to come forward and b) help people to feel protected and c) give them some measures they can proactively take to protect themselves and thier loved ones. If this could be done, we may lessen the fear, which will make the other isolation and control measures easier to do??

There are some avenues that may be worth exploring here, but some research work would need to be done. Please add your thoughts as this is not an exhaustive list.

Can we use the collective scientific and hive mind at FT to research and debate the problems and try and find solutions? Rather than merely observing the problems unfolding? Although both aspects are important. Just a thought..

 

[Sharky]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Good list. I would add two more items:

1. Significant cultural issues. Things like a belief in sorcery, burial rituals that are extremely important to them, eating bush meat, and so on. I think a damaged sense of morality also fits in here.

2. A government that has lied to them repeatedly, and who they are therefore rightly skeptical of.

Historically, I think it's pretty clear that people have the best chance of getting past this kind of thing (to the extent it's possible) if they act rationally. Unfortunately, that's not something that can be forced. People will have to freely choose the right path.

For that reason, IMO, education should be front-and-center. Due to the historical problems with the government, the spokespeople / educators should not be government officials. Ideally, they should be local survivors.

Having said that, changing the course of any culture is difficult even in the best circumstances. In a time of fear and death, it's likely to be that much harder; if anything, people tend to cling to their beliefs more strongly.

 

[AnnaLisa]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

It must be extremely difficult to get an IV inserted with all those layers of gloves on. That said, I don't think they have access to IVs. They don't even have enough PPEs to go around. Given the social unrest going on now, I would think most foreign HCW would be having second thoughts about volunteering or even going there for pay. The conditions are just so very difficult and the risks so very high.

I don't think that we have any where close to an accurate count of cases at this time either.

 

[Vibrant62]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I think we need to assume that massive large scale increases in overseas aid itsnt going to happen, for one reason or another.

So its going to be more about teaching local medics and others who can act as support staff, how to take the necessary measures. That is just to start with.

OK - we all acknowledge there is insufficient PPE. That needs addressing, but are there any DIY solutions? Eg heavy duty bin bags used as suits with gaffer tape etc?

Just trying to think laterally.