The Ebola News Digest

[Homesteader]

http://www.telegraph.co.uk/news/worl...n-Liberia.html


^{MSF staff carry a dead body into the Ebola clinic in Monrovia, Liberia, to be cremated (Will Wintercross/The Telegraph)}

"This is by far the most difficult challenge that I have ever faced," the 44-year-old Swede told The Telegraph during a brief break from his work in the sweltering humidity of Liberia's monsoon season. "Every day I have been faced with impossible choices, and decisions that are inhuman to make. Having to tell someone that they can't come in when they are screaming and begging to do so is an indescribable feeling, especially when you know they may go back to families who might well then get sick themselves."

[Godwit]

Rachel Graham ‏@rachels_aria 36m
Luck has kept #Ebola out of the U.S. But that's very likely to change.
http://wapo.st/1B6UWtg

“It is not unexpected that we are lucky so far,” said professor Alessandro Vespignani at Northeastern University, who runs a model projecting Ebola’s spread. There’s about a 10 percent chance of a single Ebola case getting imported to the United States in the next week. “The problem is what will happen in October, when we will likely have a much larger probability.”

And if the epidemic reaches anything close to 1.4 million cases, the worst-case projection for four months out, then Ebola in the United States becomes a near-certainty. That doesn’t mean an outbreak, but at least one case.

Adia Benton ‏@Ethnography911 2h
Need folks from #Kentucky and #Oklahoma to call their reps Rogers and Inhofe about their role in holding back #Ebola funding


Crawford Kilian ‏@Crof 31m
CIDRAP: At UN, Obama urges more countries to join #Ebola battle
http://bit.ly/1mtvsVE

[Godwit]

Martin Enserink ‏@martinenserink 4h
Key point in new CDC paper on #Ebola: Procrastinating a little makes matters a LOT worse.
http://bit.ly/1ypVWN5



Ian M Mackay, PhD ‏@MackayIM 8m
@WHO #Ebola bed capacities by country. The 3 countries with ongoing transmission need beds. No-one is offering them.






Crawford Kilian ‏@Crof 8h
Canada's new top doctor planning beefed-up #Ebola effort
http://bit.ly/1pdUuUA

Fron Jackson-Webb ‏@Fronj 6h
How Ebola started, spread and spiralled out of control – from @MackayIM @kat_arden @PathogenPhD
http://theconversation.com/how-ebola-started-spread-and-spiralled-out-of-control-32137 … via @ConversationEDU

[Godwit]

Ian M Mackay, PhD ‏@MackayIM 28m
Summary dashboard of the latest #Ebola numbers from @WHO More detail at VDU...
http://virologydownunder.blogspot.com.au/2014/07/ebola-virus-disease-evd-2014-west.html …





Ian M Mackay, PhD ‏@MackayIM 16m
#Ebola virus disease cases by reporting week. Numbers look softer, but @WHO say not.
http://apps.who.int/iris/bitstream/10665/134771/1/roadmapsitrep_24Sept2014_eng.pdf?ua=1 …

[grower]

Ebola Toll Hits 2,917 Out of 6,263 Cases: WHO

Geneva | Sep 25, 2014
Ebola Toll Hits 2,917 Out of 6,263 Cases: WHO

The world's worst-ever Ebola epidemic has now infected nearly 6,300 people in West Africa and killed nearly half of them, according to World Health Organisation figures released today.


In its latest update, the UN health agency said a total of 6,263 people had been infected across five west African countries -- 44 per cent of them over the past three weeks -- and that 2,917 had died.


http://www.outlookindia.com/news/art...ses-WHO/861416

[TheSearcher]

I suspect we get a rubber-band effect in the number of cases next week, similar to that of the first week's reporting this month.

[PyratePrincess]

Terrifying new normal? An Ebola outbreak that never really goes away.

By Abby Phillip September 25 at 6:34 AM
http://www.washingtonpost.com/news/t...lly-goes-away/

An idea long viewed as an unlikely possibility is now becoming increasingly real: Ebola might not go away for a very long time.

It has never happened before in the 38-year history of the virus. Every other time Ebola has made the unlikely jump from the animal world to the human one, it has been snuffed out within days, weeks or, at most, months.

This time, though, in Guinea, Sierra Leone and Liberia, the Ebola virus is raging like a forest fire, in the words of several public health officials. And some of them are raising the possibility that the outbreak-turned-full-fledged-epidemic could become fundamentally different from any other Ebola outbreak on record, in that it might stick around.

“What’s always worked before – contact tracing, isolation and quarantine – is not going to work, and it’s not working now,” said Daniel Lucey, a professor of Microbiology and Immunology at Georgetown University Medical Center, who spent three weeks treating Ebola patients in Sierra Leone and will soon travel to the Liberian capital of Monrovia for another five-week stint.

"In my opinion," Lucey added, "a year from now, we won't have one or two cases; we'll have many cases of Ebola."

Unlike past outbreaks, in which Ebola emerged in the sparsely populated countryside of Central Africa, this outbreak has become an exponentially spreading urban menace.

With the number of infected and dead in the thousands and growing quickly -- and the U.S. Centers for Disease Control and Protection warning that it could surge past 1 million within four months -- finding and quarantining every person who might come into contact with the virus is a herculean task.

In cramped and chaotic large cities, Lucey said, it might be near impossible to adequately track Ebola infections without the help of medical interventions such as vaccines, anti-viral drugs or immune therapies, most of which could be months or more away from approval. "We would need a campaign like the global smallpox eradication program from the '60s and '70s," he said.

Even in the rural areas, there are worrying signs.

In some parts of West Africa, such as the rural area in southwestern Guinea near where the outbreak began, there are troubling indications that infections are continuing at relatively low but steady level from week-to-week.

That suggests a simmering, steady-state rate of transmission that is just as troubling as the exponential growth observed in the outbreak as a whole, according to Christopher Dye, the World Health Organization's director of strategy. In a new study he co-authored in the New England Journal of Medicine, Dye even raised the possibility that Ebola might become endemic in West Africa.

"The question we're raising is to put in people's minds that the epidemic might not be eliminated from the human population completely for a very long time," Dye said this week in an interview from Geneva. Unless global intervention begins to kick in soon, "at the moment we see no reason why that steady state will not continue to go on and on," he said.

Epidemiologists consider a disease "endemic" if the transmission rate hovers around one per infection, and a region that's grappling with a constant low level of continued Ebola transmissions could find it impossible to resume normal public health operations.

In late August, when Lucey was in Sierra Leone, the country's only large referral hospital for children -- nicknamed Cottage Hospital -- shuttered its doors to keep Ebola out. A single child out of a steady stream of hundreds that passed through the facility on a regular basis had been treated for two days before anyone realized he had Ebola.

With Cottage Hospital closed, children and pregnant women in Sierra Leone have nowhere else to go to be treated for basic, life-saving medical care, Lucey said. In Liberia, the situation is similar: With Ebola crippling the health system, Liberians are dying of routine medical problems, as The Post reported last week.

That is how things are right now, with Ebola raging unabated.

But with this virus, there is no middle ground. The presence of even a small number of continued transmissions of Ebola can also wreak havoc on already fragile health-care systems.

When Ebola is present in the population, it is nearly impossible to know whether a patient who walks in is sick with the deadly virus rather than another of the many other conditions that can result in similar symptoms.

"So when a child has a fever and they spit up and they have some loose stools and diarrhea — that is very, very common in a child,” said Lucey. "How can you tell it’s not Ebola or something else? That means that the health-care providers have to wear this really comprehensive, hot, personal protective equipment for all of them."

Most public hospitals are closed because they do not have the ability to treat Ebola patients safely; the risk of treating non-Ebola conditions with similar symptoms – such as dengue fever or even diarrhea — is simply too great.

In Sierra Leone and Liberia, some of these concerns are already coming to pass.

Lassa fever – a similar, but less deadly hemorrhagic fever – is on the rise as the dry season begins.

"There's not even a place really to put all the Ebola patients, so now we're going to have to be thinking about how do we separate the lassa patients from the Ebola patients – because that is not something that we want to mix," Joseph Fair, a virus expert and special adviser to the health minister of Sierra Leone, said in testimony before Congress on Wednesday. "The chances of survival with lassa are much greater than with Ebola."

It is possible, however, that Ebola is not capable of enduring in the human population for long – in part because it is far too deadly. Daniel Bausch, an associate professor in the Department of Tropical Medicine at Tulane University, has spent years researching Ebola and other viruses at the CDC; he is an endemic Ebola skeptic.

"I actually don't buy it; I don't see how this disease could become endemic," Bausch said. "It would have to become much less deadly so you would have something where this can be maintained in a human population independently, long-term -- independently of its maintenance in the wild. You would have to have drastic mutations of the virus."

At least so far, there is no evidence that the virus has mutated significantly to make it any more or less deadly. According to Dye's WHO study of the first nine months of the outbreak, the mortality rate for the virus is 70 percent -- which is on par with previous outbreaks.

But whether Ebola becomes endemic or a just a very long, sustained epidemic that eventually ends, both outlooks are fairly grim.

"We'll either get a handle on it and stop transmission in those places, or we won't and the virus will rifle through the population," Bausch said. "Once it’s gone through population, then pretty much everybody gets Ebola and lives or dies."
_

[Blacknarwhal]

But whether Ebola becomes endemic or a just a very long, sustained epidemic that eventually ends, both outlooks are fairly grim.

"We'll either get a handle on it and stop transmission in those places, or we won't and the virus will rifle through the population," Bausch said. "Once it’s gone through population, then pretty much everybody gets Ebola and lives or dies."
_

That was what the graph said, no? January 2015 at the current rate, everyone's got ebola and most of them die?

[naturallysweet]

December 2015, not January 2015. Still horrible, but it gives us a little more time

[Blacknarwhal]

December 2015, not January 2015. Still horrible, but it gives us a little more time

Ah, right; thanks for the detail; knew it was sometime next year. Well, it'll likely prove out one way or another before too much longer; at that rate you'll have to see it everywhere fairly soon.