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

[Laidback Al]

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

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

Problem: If you didn't 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 sentence. People go and never come back. . . .

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

As novel infectious disease outbreaks flare up, we often forget that common illnesses and trauma continue to occur in a region. These sick and injured people need medical attention, too. While it may be difficult to quantify, increased morbidity and mortality in these countries from non-ebola medical issues will be collateral damage from the outbreak. Especially when health care workers have been stricken by Ebola.

Perhaps the most important task at hand is to help the residents in these areas (beside providing for basic needs such water, food, and shelter) is to provide information that will allow people to learn how to avoid infection and to learn how to avoid transmissions. Once the chain of infections stop, eradication of the outbreak will occur quickly.

 

[Sharky]

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

Given the scale of the outbreak, it seems unlikely to me that centralized care is going to be effective. New facilities have been quickly filled, and some people are being turned away. Others are afraid to go to the facilities, in fear that they might get sick if they aren't already. In addition, the centralized model just doesn't fit well with local cultural needs.

I wonder if an alternative strategy would be to have people quarantine themselves or symptomatic family members at home. Use inexpensive plastic sheeting to improve separation. Make bleach and some basic, re-usable PPE readily available. Then combine that with education about how the infection spreads, basic infection prevention measures, and the importance of quarantine. Have public health workers go around to deliver supplies, collect blood samples from suspected cases, and to further educate. Plus rapid response to reports of deaths, and collection of bodies.

At the same time, recruit and train survivors to do more of the same.

Yes, I realize this probably wouldn't actually work very well. But maybe it's the best that can be done under the circumstances?

My two cents.

 

[Vibrant62]

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

OK - good thoughts..

So a 'do-it' list for us might be some information on how to DIY care or minise risks for some of the collateral diseases (typhoid, gastroenteritis), as HCWs may not be available and/or populaces in infected areas may be too fearful of hospitals (as per L. Als comment), and developing a DIY home isolation and quarantine procedure if people live in an area where there are no isolation centers or there is no room there for them, to help families minimise thier risks.

Just as an example: On the first point, there are details somewhere on a rehydration solution containing sugar and salt. However the proportions have to be just right, and it is this simple solution that has saved countless lives during cholera outbreaks. Perhaps we could find the exact recipe? It could also help perhaps in ebola during the acute diarrhoea and vomiting stage?

I know there may be some issues with this ethically, but gathering together any such guidance here must be better than nothing at all for these people? Until or unless there are 'official' solutions or centers, it would be better to try and empower people or even isolated HCWs on what they could do, rather than them have nothing at all?

Perhaps we can start hunting existing documents that we can post as attatchments up here?

What do we think people?

 

[Thornton]

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

In this thread I am reading that the Western developed countries must adapt and respond in non-Western ways.
Although we (Westerners) believe all our support is the best way to manage things, from another view we may see some failures as the result of not obtaining voluntary informed community consent for the interventions.
A multipronged approach is necessary,
1. Understanding the afflicted communities? view of the illness and their concepts on solutions
2. Matching assistance plans with the community view
3. Logistics
I attach 3 articles in support of this effort.
In response to questions raised by Vibant62 I attach WHO guidelines for oral rehydration. Unfortunately these guidelines are dependent on clean water and purchased supplies (ingredients).
Schaetti et al describe the cultural factors and difference?s in 3 African communities in addressing cholera. The common denominator is the need for clean water.
The WHO 2010 pamphlet describes an overall approach to helping small communities develop clean water supplies.
None of the above is as appealing as swooping in with millions of doses of zMAPP or an Ebola vaccine, but the dual use benefits of supporting infrastructure and cultural integrity warrants parallel efforts.

 

[Vibrant62]

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

Thank you Thornton - that is a good start, and has sparked another thought. You raised some very good points.

MSF etc are at full stretch in outbreak countries, and as a whole, across west africa and DRC. Lack of water is a major issue in enacting guidance for containment and control. Hand washing cant happen without water.

There are plenty of non MSF NGOs without HCWs but who specialise in e.g. solving local water supply issues - digging wells etc.

Could such groups be encouraged to re: prioritise the outbreak countries for assistance, do we think? They may not have staff to send to help build isolation centers, but they could send teams to help sort wells etc, which would solve part of the logistics i.e water supplies for disease containment and control. It would be a start.

 

[Sharky]

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

Good info and ideas here. I think it wouldn't be too difficult to come up with a long laundry list of things that could be done or tried. Even finding supplies and/or funding shouldn't be too hard.

However, a significant challenge will be finding the right people on the ground who are in a position to implement various strategies, and who are willing to do so. My sense is that they have their hands very full, and that there's also a fair amount of political maneuvering going on in terms of who knows best about what to do or try next. On top of that, many officials are clearly being less than truthful with outsiders about what's actually happening in terms of things like case details, the number of people affected, and so on.

 

[Vibrant62]

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

I dont think we would do any harm in developing the laundry list.

I have found MSF and other practical guidance documents, we already have CDC guidance, it is a question of organising and presenting the information in FT as a reference resource for HCWs who are isolated in outbreak countries, or who are concerned that an outbreak may come to their country and wish to prepare as far as they can. We cannot assume that this information is being provided from elsewhere at this stage. If it is, I suspect we would find it, so collating what we find here - or at least useful links - could be a good place to begin.

IMHO the first step is to develop and quantify what the problems are as far as we can, based on our understanding, and as highlighted in independent scientific analysis, studies and reports of past experience.

What are the key problems?

Then we can find information on potential solutions, and/or which NGO organisations already have programs in place and might be best placed to help in the region.

The knowledge, insofar as it exists, is out there. Its a case of bringing it together.

I do think that where we are coming up with ideas for solutions, we need to be very clear that these are just ideas, and that we do not in anyway misrepresent anything as guidance when it is not... If we can stick to referenced material, studies or WHO or similar guidance as much as possible, we should.

 

[Sunfish]

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.

I agree Sharky.

It is also important to remember that bushmeat has always been a significant source of protein for poverty stricken people who cannot otherwise afford to give their families domesticated and safer meat. Considering the closed boarders in the affected countries, and the inevitable increase in prices on basic food items like rice (that Liberia has already reported), bushmeat might become the only affordable protein source in the coming days. This is a frightening prospect, considering how dangerous it can be to handle and consume.

In addition to thinking of ways to build awareness, help the people, and understand why the response from the West has been lacking, we need to remember that in order to tell the local people they need to stop doing something, we need to provide a reasonable alternative. They need food as well as medical supplies in this time. The prospect of starving might be more frightening than a virus that some still deny exists. To understand this outbreak, we need to look at it holistically. These countries need saline, IV?s, and basic supplies, but they also need food, people to volunteer with the harvest (which may have been disrupted by the outbreak in affected areas), and compassion on the ground from people who can dispense supplies without hoarding them or reselling (like the gloves being sold individually in Sierra Leone?s capital).

 

[Vibrant62]

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

Bushmeat leads to new introductions: right now the greater concern is eradicating the transmission this has created in human populations. Completely agree on the food and other practical aid.

But as far as bushmeat is concerned, yes, in the longer term, this is an ongoing threat - but right now I would suggest it is the least of our worries.

 

[Vibrant62]

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

Without help they will lose @50% of their population at minimum, perhaps more, as well as posing a considerable threat to the rest of the world as ebola will be exported to other countries. Viruses do not discriminate about who they infect nor who they kill.

The more a novel virus passages through humans, the greater the risks of increased adaptation; increased adpatation could then move the infection beyond even 1st nation healthcare system capabilities.

This is above and beyond your normal humanitarian crisis.

 

[Emily]

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

JFK started the Peace Corps in approximately 1961. Fifty-three years later people in Western countries are still looking for ways to help the people of Africa. Am I the only one who sees something wrong with this picture? Our good-faith efforts are being undercut by something beyond our control. Corrupt officials? The international diamond trade? Or maybe it's a culture that is resistant to adopting technologies introduced by foreigners? In cynical moments I sometimes wonder if we shouldn't stop pestering these folks with our help, and let them figure it out on their own.

Welcome, hcc! Hope you can stay around awhile. I sometimes also get cynical, but then mistakes with horrible consequences can be made with the best of intentions:

http://www.flutrackers.com/forum/showpost.php?p=444428&postcount=2
http://www.nytimes.com/interactive/...as/how-the-haiti-cholera-epidemic-spread.html

 

[Emily]

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

Without help they will lose @50% of their population at minimum, perhaps more, as well as posing a considerable threat to the rest of the world as ebola will be exported to other countries. Viruses do not discriminate about who they infect nor who they kill.

The more a novel virus passages through humans, the greater the risks of increased adaptation; increased adpatation could then move the infection beyond even 1st nation healthcare system capabilities.

This is above and beyond your normal humanitarian crisis.

Ebola could also become less virulent to humans as it adapts, couldn't it? And I'm not sure that this crisis is worse than what happened in Haiti when an earthquake was complicated by introduction of cholera by UN workers, or when the Fukushima disaster was complicated by radiation contamination. Both those crisis are still raging.

 

[Vibrant62]

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

Yes - I would sincerely hope that any additional adaptation resulted in a reduction in the CFR.

To place this in perpective however, the Spanish Flu had an estimated CFR of between 1.5 - 2.5%. Spanish flu was a society changing event.

Ebola currently has a CFR of between 50 - 90%. There is no vaccine, nor any proven treatment as of now, although work is being carried out with the utmost urgency to develop both. It should be pointed out that after 20 years we have been unable to develop an effective HIV vaccine, so there is (for now at least) no certainty that the early stage developmental vaccines will work, nor any clear timescales about how quickly one can be successfully developed or achieved. There then is the lag time for production of a 'proven' vaccine; it took 2 years to manufacture enough H1N1 pandemic vaccines to fulfil all the orders.

Ebola has a very long way to fall to become as lethal as Spanish Flu was, and that was the worst natural pandemic the world has seen since the great plagues. It is for this reason that the world needs to give all the help it can to stop this ebola outbreak where it is. We cannot afford to take the risk of leaving this, because if we do, we run the risk (although there is no certainty) of this becoming a global pandemic.

 

[Emily]

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

Here's some more context on the Spanish Flu:

https://www.princeton.edu/~achaney/tmve/wiki100k/docs/World_War_I_casualties.html

World War I casualties

The total number of casualties in World War I, both military and civilian, was about 37 million: 16 million deaths and 21 million wounded. The total number of deaths includes 9.7 million military personnel and about 6.8 million civilians. The Entente Powers (also known as the Allies) lost about 5.7 million soldiers while the Central Powers lost about 4 million.

Unlike most (if not all) conflicts that took place in the 19th century and before, the majority of military deaths in World War I were caused by combat as opposed to disease. Improvements in medicine as well as the increased lethality of military weaponry were both factors in this development. Nevertheless, disease (including the Spanish flu) still caused a significant proportion of military deaths for all belligerents.

Fortunately we are not embroiled in that much conflict currently, even if sometimes it feels that way.

 

[Vibrant62]

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

Thanks Emily. Its a good idea to quantify numbers to create context.

The deaths from World War 1 were dwarfed by the deaths globally and overall from Spanish Flu. Estimates and opinions vary widely about what the precise death toll was from 1918 flu.

The 1918 flu pandemic (January 1918 – December 1920) was an unusually deadly influenza pandemic, the first of the two pandemics involving H1N1 influenza virus.[1] It infected 500 million[2] people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—three to five percent of the world's population[3]—making it one of the deadliest natural disasters in human history.[2][4][5][6]

http://en.wikipedia.org/wiki/1918_flu_pandemic

But I think the numbers researched by Taubenberger and Morens are more reliable.

1918 Influenza: the Mother of All Pandemics


Abstract

The "Spanish" influenza pandemic of 1918–1919, which caused ≈50 million deaths worldwide, remains an ominous warning to public health. Many questions about its origins, its unusual epidemiologic features, and the basis of its pathogenicity remain unanswered. The public health implications of the pandemic therefore remain in doubt even as we now grapple with the feared emergence of a pandemic caused by H5N1 or other virus. However, new information about the 1918 virus is emerging, for example, sequencing of the entire genome from archival autopsy tissues. But, the viral genome alone is unlikely to provide answers to some critical questions. Understanding the 1918 pandemic and its implications for future pandemics requires careful experimentation and in-depth historical analysis.
http://wwwnc.cdc.gov/eid/article/12/1/05-0979_article

 

[Emily]

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

The deaths from World War 1 were dwarfed by the deaths globally and overall from Spanish Flu.

Some people consider them as civilian war deaths. (Deaths of the military only to flu were included in the Princeton numbers.)

 

[Vibrant62]

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

I think the princeton numbers only include flu deaths whilst the war was still on, and does not include the deaths that occurred after the cessation of hostilities.

So Princeton numbers total 9.7m military deaths, of which a significant proportion were caused by disease including flu.

Spanish flu alone, for war and post war periods are estimated at 50 - 100 million deaths globally for civilians and military personnel.

The CFR for ebola is 20x greater (at best) or 50x greater (at worst) than spanish flu as things currently stand, and the worlds population is considerably larger than it was in 1918.

We cannot allow ebola - or rather, we cannot take the risk of allowing ebola - to become a global pandemic; hence the need for international action on an unprecedented scale, to make sure it is brought under control and the outbreak ended as rapidly as possible.

For as long as this outbreak continues to circulate in humans anywhere on the planet it remains a risk to us all.

 

[Gemineye]

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

I'm rapidly coming to the conclusion that the rest of the world, by default, is going to allow this outbreak to burn itself out in Africa. As far as I know, there has hasn't been even one locally transmitted case outside of Africa so the danger does not seem "real". Countries and charitable organizations will donate vitally needed supplies and some medical personnel but what is needed to bring an end to this disaster is "boots on the ground". I think either WHO or MSF said that several thousands of healthcare and ancillary personnel would be needed to accomplish this. The only way I see this happening is the Ebola virus mutating to become more highly transmissible, which the experts say is very unlikely. So, I see this outbreak smoldering and occasionally bursting into flame in various spots for months to come but not turning into an out of control wildfire. But God help us if it does.

 

[Lizw]

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

Close the borders (assuming it's possible to do that at all) and leave them to die, in other words? Many people in the US have been suggesting just that, along with more extreme suggestions like dropping nukes on them.

This is a perfect opportunity to do things right for once, but I don't see much likelihood of it happening in time, because Western mindsets are so hardened that it's almost impossible to change them. What I think will work to change minds in Africa is proof that Western medicine does work. For that, you need survivors. You need local people who were known to have contracted Ebola and have survived it to go back into their communities, as some have already done, and "tell the good news," as it were. Confirm that the Western doctors and nurses are making them better, that sanitizing and isolation and medicine and body bags do work. It isn't going to happen overnight, but showing people the change always works better than just talking about changing.

Another thing that Westerners take for granted is infrastructure. Clean running water, roads that haven't been wiped out by monsoon rains, and a reliable flow of medical supplies and equipment. The Western nations can provide those things. I suspect that Asian nations may see an opportunity for public relations here and take it on themselves if the rest of us don't. That would be good for the ones who need help, but how much better it would be if we could all work together. I have more thoughts on this but only a phone to type on, so it's hard to say much at one time.

 

[Gemineye]

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

Close the borders (assuming it's possible to do that at all) and leave them to die, in other words?QUOTE]

I certainly do not want to leave the impression that I personally am in favor of this "solution" to the outbreak. Only a person with a heart of stone would propose this.