Ebola - The Death Toll Rises

The death toll in West Africa has recently exceeded an astonishing 1,000 dead. Official numbers, updated as of this morning, amount to 2,127 cases and 1,145 deaths from Ebola. In terms of infected people, this exceeds the previous worst Ebola outbreak by a factor of 5! To follow up on my last blog, a science/ethics panel which convened last week on the issue of administering experimental medication to infected Ebola patients has concluded that such medication is ethical to use given the severity of the current outbreak, provided that certain criteria are met, such as transparency about care, informed consent, freedom of choice, etc. Further details about the meeting are scheduled for release tomorrow.

When I look at the staggering disease statistics for Ebola and compare them with historic numbers, two things jump out at me. One, the frequency of major outbreaks has increased since the virus was first recognized in 1976. Maybe this is due to better reporting, or maybe not. That this phenomenon is real, however, supports the sensible hypothesis that we will see more and more infectious disease outbreaks as human populations encroach more and more into the native habits of disease-carrying animals. The second thing that popped out at me was the sheer scale of the current outbreak. For a given year, 2014 has already seen over three times more Ebola cases than any previous year, and five times more than any single outbreak, as mentioned. To better put things in perspective, I decided to compile WHO data into a graph, which I’ve shared with you below. I think the graph really elucidates things!

Different ideas are floating around as to what is causing the explosiveness of the present Ebola outbreak, one of which I discussed in my last blog; namely, airborne transmission. Though we put that hypothesis to rest, we have yet to answer the pressing question. That is, to what can we attribute the severity of this ongoing outbreak? To answer this, one must realize that West Africa has previously never been afflicted by Ebola. In fact, previously many West Africans went as far as to deny the existence of the deadly disease. That said, when the 2014 outbreak hit this previously unaffected region, many health workers were largely underprepared to deal with Ebola patients and were not taking the necessary measures to prevent transmission to themselves and others. Local residents too were unaware of the precautions necessary to prevent infection. Furthermore, as the outbreak worsened, the capacity of the local medical system to deal with the enormous influx of severely ill and contagious patients was such that the entire system became quickly overwhelmed; in turn exacerbating the problem and leading to even higher infection rates. These factors, in conjunction with the ease of modern day transport, made for a dreadful combination. In brief, the explosiveness of this outbreak is not due to mutation and aerosolization of Ebola, but simply and tragically to lack of preparedness and infrastructural capacity in a world of better transportation. At present, the WHO and others are working tirelessly to combat the problem. But from what I can tell from recent online interviews, such efforts have not translated to enough in terms of getting real resources to the ground in Africa.  In my next blog, I will create a graph of this outbreak’s infection and fatality rates in order to give us an idea as to whether this catastrophe is near stabilizing or whether things are only getting worse. See you then!

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                                                                                       -Shahir Masri, MS