Ebola Virus Talking Points: Wednesday Focus for October 1, 2014
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Lives lost from Ebola to date are tiny, even in west Africa, compared to HIV, TB, and malaria. Ebola still not (yet) the biggest public health problem in West Africa.
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Yes, the epidemic will spread to more countries.
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Ebola will not become the biggest public health problem in West Africa unless deaths reach the high seven figures–which they may: it is highly likely that deaths in the six figures are now baked in the cake.
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Unless the virus changes dramatically, we are almost surely safe. If you want to worry, worry that influenza or something already airborne will become more deadly, not that Ebola will become airborne.
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Those at risk from the Ebola virus are overwhelmingly (a) those who love them and (b) those medical professionals who treat them–you get it from direct fluid contact with symptomatic patients. Thus risks here in the United States are very low. It is scary, but unlikely to be a serious problem here.
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Why, then, are risks high in West Africa? The major problem with control is that there is no functioning health system in most of sub-Saharan Africa. Not only are resources poor, but they are uncoordinated. What we really need is a helicopter drop of trained people.
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The health system was especially poor in Liberia. You have issues like no supply of gloves to hospitals. Few doctors even to begin. Had the epidemic started in Ethiopia or even Uganda, the probability of it getting out-of-control epidemic would have been much less–Uganda, for example, has excellent hospitals, good supply, competent public health, and even a decent medical school. Just how bad Liberia’s system was should not be underestimated.
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Secondary problems in West Africa are that: (1) Ebola can be difficult to diagnose; (2) Ebola is easily transmitted in cultures where people are expected to die at home in non-sterile and non-antiseptic environments; and (3) Ebola is easily transmitted in cultures where people–still infectious–are prepared for burial at home.
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The economic cost of Ebola to the countries most affected is and will be immense, in addition to the loss of life.
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In general, we are not well-equipped for some types of global pandemics. The advance from years of nothing on AIDS to stopping SARS in its tracks was immense. But it relies on functional organizations–and we did and do not have any such in the affected West African areas.
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Nevertheless, it is surprising how unprepared the WHO and international community was for for this kind of emergency. The WHO is a UN organization, and it is a mistake to expect much bureaucratic competence of UN organizations. Nevertheless, the international response should have been swifter and more effective.
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The Ebola crisis is eating up resources in West Africa that are desperately needed in other areas of health and society. It’s not so much money as people–doctors pulled in from caring for pregnant women to manage Ebola patients, NGOs working on violence reduction in Sierra Leone now counting the dead. Really sad. We are likely to lose most of the health-care professionals in the most severely affected sub-Saharan African countries.
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The importance of investing in strong public health infrastructure–which is both massively underfunded and very cost-effective compared with acute care.
Courtesy of Chris Blattman, David Cutler, Ann Marie Marciarille, and others…