Ebola update

I've had a couple of people suggest that I'm an alarmist about Ebola.  I emphatically deny that.  I don't believe we're going to have a major epidemic or endemic situation in the USA, if only because we'll shut out the sources of infection before it gets that bad.  This will happen whether President Obama wants it to or not.  If he doesn't act, State governors will;  and if they don't, the people of America will.  If (as I do expect and predict) Ebola or something similar starts gaining a foothold in South America, and new floods of 'refugees' try to cross into the USA to get away from it (or to get treatment), I expect them to receive very short shrift indeed from local citizens and militias.  The 'Three-S treatment' is likely to be the order of the day - questions of ethics, morality and law be damned.  I don't think law enforcement is likely to get very far in stopping that, either;  partly because they live there too and want themselves and their families to stay healthy, and partly because they know what their own citizens will do to them if they believe their own authorities are actively trying to endanger them.

A strong hand is needed to stop Ebola's spread.  Africa has had one shining success story in Nigeria, thanks largely to the self-sacrificial courage of a doctor who recognized that country's index patient and slapped him into quarantine (despite his frenzied, even manic attempts to get away).  She paid for her courage with her life, dying of Ebola along with several of her colleagues:  but she gave the local authorities a head start by identifying the disease before it could spread very far, enabling them to quarantine everyone who'd had contact with an infected person.  (Questions of individual rights and civil liberties went out of the window right from the start.  Affected persons were quarantined under pain of being shackled to the wall if necessary;  and if they tried to escape, sterner measures were threatened and may have been implemented.)  It worked.  Nigeria is today officially regarded as Ebola-free.

The other West African nations where Ebola has been running rampant . . . not so much.  It's getting worse and worse, and the mathematics don't care about political correctness or propaganda.  You can read here a very good summation of the numbers and what they imply.  (I highly recommend that you do, because unlike official statements, the numbers are inexorable and don't lie.)  Médecins Sans Frontières (a.k.a. Doctors Without Borders) is one of the organizations leading the fight against the disease.  Yesterday they were brutally blunt about what they're seeing on the ground in Sierra Leone.

"The situation is catastrophic. There are several villages and communities that have been basically wiped out. In one of the villages I went to, there were 40 inhabitants and 39 died," [an MSF spokesman] said.

The World Health Organization (WHO) published revised figures on Friday showing 4,951 people have died of Ebola and there was a total of 13,567 reported cases.

"The WHO says there is a correction factor of 2.5, so maybe it is 2.5 times higher and maybe that is not far from the truth. It could be 10,000, 15,000 or 20,000," said Zachariah.

He stressed that "whole communities have disappeared but many of them are not in the statistics. The situation on the ground is actually much worse."

He added that in some places the local healthcare systems were overwhelmed.

"You have one nurse for 10,000 people and then you lose 10, 11, 12 nurses. How is the health system going to work?"

There's more at the link.

Several weeks ago authorities in Sierra Leone basically gave up the fight in the short term.  They announced they were going to encourage people to treat patients at home rather than bring them to hospitals or central facilities, because there were so many patients the system had broken down.  The situation has only grown worse since then, and it's likely to be just as bad in Liberia and Guinea.

David Nabarro, the UN special envoy for Ebola ... warned that without the mass global mobilization to support the affected countries in West Africa, "it will be impossible to get this disease quickly under control, and the world will have to live with the Ebola virus forever."

In Sierra Leone, the effort to prop up a family’s attempts to care for ailing relatives at home does not mean that officials have abandoned plans to increase the number of beds in hospitals and clinics.

But before the beds can be added and doctors can be trained, experts warn, the epidemic will continue to grow.

CDC officials acknowledged that the risks of dying from the disease and passing it to loved ones at home were serious under the new policy. "You push some Tylenol to them and back away," Kilmarx said, describing its obvious limits.

But many patients with Ebola are already dying slowly at home, untreated and with no place to go.

So officials said there was little choice but to try the new approach as well.

Again, more at the link.

We're talking well upward of ten thousand cases in West Africa by now - possibly double or triple that figure - yet the US military mission to West Africa is talking about building a total of '17 treatment units with 100 beds each'.

Drop, meet bucket.  Bucket, drop.

As I've said before, I've traveled in the areas affected by Ebola, and I understand the scale of the problem at first hand.  Furthermore, Ebola's only the latest and most virulent of a large variety of hemorrhagic fevers that have plagued Africa for centuries.  As it mutates, it may get worse . . . or it may mutate with other viruses to form something even more horrific.  It's happened before in that part of the world.  (How do you think Ebola originated in the first place?)

The #1 nightmare currently disturbing the sleep of those fighting Ebola in Africa has to be the prospect of the disease taking root in the slums of one of the major cities on that continent.  Nigeria has several, Lagos being by far the largest;  there's Kinshasa in the Congo;  and so on.  Once entrenched in those slums it would be completely unmanageable, thanks to the lack of First World medical infrastructure, personnel and supplies.  That same prospect must be scaring the living daylights out of other countries in the Second and Third Worlds.  Imagine Ebola getting loose in the slums of Mumbai or Kolkata in India, or the favelas of Rio de Janeiro in Brazil, or the tight-packed poorer quarters of Jakarta in Indonesia.  It'd be almost impossible to contain it before it had spread far and wide.

Quarantine is unlikely to provide a satisfactory answer to the problem, for numerous reasons - not least of which is that quarantines almost always have holes in them.  It takes strong, determined measures (as employed by Nigeria) to enforce a city-wide quarantine, including a certain ruthlessness in dealing with those who break it;  and if the latter are prepared to be ruthless in their turn (as often happens), that's a whole new can of worms.  'Civil disobedience' is far too mild a term for it - try 'civil war', at least on a localized scale.  Think I'm joking?  I'm not.

Forbes published a thought-provoking article examining some of the issues with quarantine.  Here's an excerpt.

The critical reckoning over forced quarantines is still to come.

Consider this scenario.

Sometime in January or February – as the Ebola epidemic explodes out of West Africa – we’ll start experiencing larger, more frequent outbreaks in American cities. With the flu as a background to confound suspected cases of Ebola, public health departments will be hard pressed to “track and trace” all of the potential “contacts” when perhaps dozens of Ebola cases pop up in their cities.

Unable to pinpoint who might have come in close contact with Ebola, and be at risk of contracting the virus, they will reach for their most absolute tool – forced quarantine – as a way to mitigate threat amidst uncertainty. The number of people who will be placed into forced quarantines could easily number in the hundreds.

If this scenario sounds far fetched, take a closer look at the accelerating epidemic in West Africa. If the rate of spread doesn’t start to subside soon (there are some encouraging signs of deceleration in Liberia, but spread is accelerating in Guinea and Sierra Leone) it’s just a matter of time before Ebola breaks out to a region with closer connections to the U.S. — like Latin America. Once it goes to such a market, and becomes epidemic, the U.S. would be importing far more than the sporadic case.

This begs the question, how will state and federal governments exercise their authority to quarantine people in such a scenario.

There's more at the link.

The trouble with that Forbes article is that it doesn't consider quarantine on a large enough scale.  I'm indebted to Mr. B. for drawing my attention to this article and this map (click the image for a larger view):

Half the population of the USA lives in the blue-shaded counties on that map.  That's over 150,000,000 people.  They're crowded together like sardines in comparison to the rest of the country . . . but those counties are precisely where most illegal immigrants are likely to head, because they'll have relatives or contacts there, and there are more jobs to be had in such locations.

Think about that from an epidemic perspective.  If any infectious disease takes root in such heavily-populated areas, it'll be a nightmare to eradicate it.  Ebola is less infectious than many diseases - at least, in its present form - but if it mutates (as it already has - the current Ebola strain is different from those that have preceded it) who knows what might happen?  How do you quarantine Los Angeles County in California, or Cook County in Illinois, or Miami-Dade County in Florida?  There are almost innumerable ways in and out of such areas.  It'd take an army to block them all.  Furthermore, many of those living there are armed, and disinclined to be ordered around when their lives are at stake.  Even those trying to enforce a quarantine in those areas will be disinclined to take too many risks that might subject themselves and their families to the risk of infection.

I repeat:  I don't think that we're in danger of a US epidemic of Ebola under present circumstances.  We may (and probably will) have more cases of it, but I think there's little likelihood of it spreading as virulently here as it has in West Africa.  On the other hand, if it mutates to a more easily transmitted form, and/or if we get a flood of refugees from South America trying to cross our southern border to get away from the disease and/or seek treatment for it here, that would change things.  Let's hope and pray that doesn't happen.

Let's also do all we can to encourage our politicians and those in other First World nations to try their damnedest to provide the resources needed to contain Ebola in West Africa.  Yes, it'll cost us money in the form of foreign aid;  but I'd much rather see it used for this purpose than given as weapons to dictatorships, or wasted as commercial aid to corrupt governments, politicians and officials who'll divert much of it into their own pockets.  This really is a crisis, as MSF has pointed out (see above).  We've got to act now to stop Ebola arriving on our doorsteps.

Peter