Disaster Prep Wednesday: Stopping Ebola (Revisited)

Just last month, Ebola appeared in Disaster Prep Wednesday here.

Included in that post was this:

Summary of epidemiological facts and experience

 Person-to-person transmission by means of direct contact with infected persons or their body fluids/secretions is considered the principal mode of transmission. In a household study, secondary transmission took place only if direct physical contact occurred. No transmission was reported without this direct contact. Airborne transmission has not been documented during previous EVD outbreaks.

What am I saying? It is improbable that you will get Ebola by flying on the same airplane with an infected person, unless you have "direct contact" or share bodily fluids.

The World Health Organization seeks to dispel myths regarding Ebola here:

To prevent the transmission of Ebola virus disease from one person to another it is necessary to take the following precautions:

• Do not touch sick people who show symptoms of Ebola including for example fever, diarrhoea, vomiting, headaches and sometimes heavy bleeding.
• Do not touch the dead bodies of suspected or confirmed Ebola patients.
• Wash your hands with water and soap regularly.

It makes little sense at this time to cast blame for the continuing spread of Ebola as is done in this Foreign Policy piece,"We Could Have Stopped This", which call for a massive international (read heavily U.S. response), but it does post some interesting epidemiological information about what happens if you don't follow the guidelines set out in that CDC poster shown above:

And now the epidemic is skyrocketing -- nearly half of the cumulative case burden of Ebola in the three countries has occurred in just the last 21 days, according to the WHO. This week CDC Director Tom Frieden returned from Liberia visibly stunned, flabbergasted by what he had witnessed, warning that "There is a window of opportunity to tamp this down, but that window is closing."

Disease fighters reckon the contagious potential of an outbreak in terms of its RO, or reproduction number. (RO = 1 means that each infected person is statistically likely to infect one more person, so the epidemic will neither grow, nor shrink in size. RO = 0 signifies that the disease cannot be passed from person to person. Any RO above 1 connotes an expanding epidemic.) Christian Althaus of the University of Bern in Switzerland just released a grim new calculation of the RO for this epidemic that finds that when the outbreak began in Guinea, it was RO = 1.5, so each person infected one and a half other people, for a moderate rate of epidemic growth. But by early July, the RO in Sierra Leone was a hideous 2.53, so the epidemic was more than doubling in size with each round of transmission. Today in Liberia, the virus is spreading so rapidly that no RO has been computed. Back in the spring, however, when matters were conceivably controllable, Liberia's then-small rural outbreak was 1.59.
***
There are two factors contributing to the rate of spread: the genetic capacities of the virus itself and the behaviors of human beings that put them in contact with one another, thereby passing the virus. Though there is strong evidence that the Ebola virus is mutating and evolving right now as it passes through large numbers of people, none of the roughly 300 mutations detected to date have given the virus capacities that change its inherent infectiousness. So any change in the RO is due to people taking terrible risks, or lacking equipment and knowledge to protect themselves. (empahis added)

2014 Ebola Outbreak in West Africa

While the piece goes on to point out issues with the world outside the affected region shunning both refugees from the affected area and the facilitation of rendering aid by opening staging areas for aid agencies, it also points out that the real key to stopping Ebola lies not so much with outside aid as with the establishment of trusted local agencies who can calm the panic and:

As in Kikwit [NB E1: Kikwit was a 1995 outbreak of Ebola in Zaire], Kerstiens says, the Ebola responses in Liberia, Sierra Leone, Guinea, and possibly Nigeria each need a "national force/brigade that tells people, 'this is what you do and what you do not,' and that does surveillance -- this brigade has to have the trust of the people."

The trust of the people: Attaining that is clearly the primary challenge these desperate governments face.***

Clearly, without both education on how to prevent spreading the disease and self-help, this problem is unlikely to fade away except as the disease runs out of hosts.

To repeat good advice, here's a list of preventative measures suggested by the Mayo Clinic:

• Avoid areas of known outbreaks. Before traveling to Africa, find out about current epidemics by checking the Centers for Disease Control and Prevention website.
• Wash your hands frequently. As with other infectious diseases, one of the most important preventive measures is frequent hand-washing. Use soap and water, or use alcohol-based hand rubs containing at least 60 percent alcohol when soap and water aren't available.
• Avoid bush meat. In developing countries, avoid buying or eating the wild animals, including nonhuman primates, sold in local markets.
• Avoid contact with infected people. In particular, caregivers should avoid contact with the person's body fluids and tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or Marburg are most contagious in the later stages of the disease.
• Follow infection-control procedures. If you're a health care worker, wear protective clothing, such as gloves, masks, gowns and eye shields. Keep infected people isolated from others. Dispose of needles and sterilize other instruments.
• Don't handle remains. The bodies of people who have died of Ebola or Marburg disease are still contagious. Specially organized and trained teams should bury the remains, using appropriate safety equipment.

I presume the last four items are germane for people who haven't followed the advice in the first item . . . but there is this report from Democratic Republic of the Congo:

On August 26, 2014, the Democratic Republic of the Congo (DRC) Ministry of Health notified the World Health Organization of an outbreak of Ebola virus disease (EVD) in Equateur Province. The index case was a pregnant woman from Ikanamongo Village who butchered a bush animal. She became ill with symptoms of EVD, reported to a private clinic in Isaka Village, and died on August 11, 2014. Local customs and rituals associated with death meant that several healthcare workers were exposed to Ebola virus.

A total of 24 suspected cases and 13 deaths have been identified. Human-to-human transmission has been established. The index case and the 80 contacts have no history of travel to the EVD-affected countries in West Africa or history of contact with people from the affected areas. The outbreak in DRC is unrelated to the ongoing outbreak in West Africa.

Ignorance kills.

If you were wondering, except for infected people coming into the U.S. - there No cases have been reported in the United States.

Yet.