Via The London Review of Books, Paul Farmer posts a Diary: Ebola. Excerpt:
As of 1 October, a third of all Ebola cases ever documented were registered in September 2014. More than seven thousand cases have been recorded since March, more than half of them fatal. In epidemiological terms, the doubling times of the current Ebola outbreak are 15.7 days in Guinea, 23.6 days in Liberia and 30.2 days in Sierra Leone. The US Centers for Disease Control and Prevention suggested at the end of September that unless urgent action is taken, more than a million people could be infected in the next few months.
The worst is yet to come, especially when we take into account the social and economic impact of the epidemic, which has so far hit only a small number of patients (by contrast, the combined death toll of Aids, tuberculosis and malaria, the ‘big three’ infectious pathogens, was six million a year as recently as 2000). Trade and commerce in West Africa have already been gravely affected.
And Ebola has reached the heart of the Liberian government, which is led by the first woman to win a presidential election in an African democracy. There were rumours that President Ellen Johnson Sirleaf was not attending the UN meeting because she was busy dealing with the crisis, or because she faced political instability at home. But we knew that one of her staff had fallen ill with Ebola. A few days ago, we heard that another of our Liberian hosts, a senior health official, had placed herself in 21-day quarantine. Although she is without symptoms, her chief aide died of Ebola on 25 September.
Such developments, along with the rapid pace and often spectacular features of the illness, have led to a level of fear and stigma which seems even greater than that normally caused by pandemic disease.
But the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus.
The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence.
Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.
The Americans, Spaniards, and Norwegians are demonstrating the truth of Farmer's assertion. But a solid public health system doesn't need to reach American standards to deal with Ebola. It just needs to be there at all.