Here is an alarming update to the heartbreaking news about the Ebola outbreak in Western Africa reported by Nick Cumming-Bruce of the New York Times, who writes Ebola Epidemic Most Likely Much Larger Than Reported, W.H.O. Says. Dr. Joanne Liu, president of Doctors Without Borders, the most reliable source of information so far declared that the number of reported cases is “likely the tip of the iceberg,” and that the number of cases is increasing, not decreasing at most of the sites they are working.
So far, 2,127 cases of the disease and 1,145 deaths have been reported in four nations — Guinea, Liberia, Nigeria and Sierra Leone — the W.H.O announced Friday. But the organization has also warned that the actual number is almost certainly higher, perhaps by a very considerable margin.
Even the W.H.O. is now admitting that "the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak.” Health authorities can not even get into vast rural regions in the multiple epicenters of the epidemic. Even four months ago I've reported articles here describing the eerie scenes of authorities discovering entire villages being abandoned and finding the dead bodies of entire families killed by Ebola with no one left to tell the stories of what happened to those who fled or where they fled to. Now it is becoming clearer that they've been spreading the contagion in their invisible flights.
The epidemic is still growing faster than efforts to keep up with it, and it will take months before governments and health workers in the region can get the upper hand, Joanne Liu, the president of Doctors Without Borders, said on Friday, calling conditions on the ground “like a war.”
The situation “is moving faster and deteriorating faster than we can respond,” Dr. Liu told reporters in Geneva after returning a day earlier from a tour of the affected nations.
The epidemic’s front line “is moving, it’s advancing, but we have no clue how it’s going to go around,” Dr. Liu said. “Over the next six months we should get the upper hand on the epidemic,” she added, but this was only a “gut feeling” and it would happen only if sufficient resources were put in place.
Reports that the number of new cases is increasing are consistent with an epidemic still driven primarily by the positive feedback loop where contacts between the infected and uninfected population are not sufficiently restrained by behavioral modification necessary to bring the epidemic under control.
Please also notice this is the first report from a major media source using the terminology of "epidemic" rather than "outbreak," since the initial reports in the first weeks. Back in March, when leading doctors from Doctors Without Borders described the Ebola "epidemic," leaders of the W.H.O. strenuously objected, insisting that the media only use the word "outbreak," which I have also capitulated to until tonight.
Doctors Without Borders and the World Health Organization have repeated clashed with DWB implying the W.H.O. was downplaying the seriousness of the epidemic, while he W.H.O. has implied DWB was being alarmist. The last weeks reports of shockingly higher numbers, areas vast areas being cordoned off, and admissions that the epidemic is now completely out of control in many regions of Liberia and Sierra Leone vindicate Doctors Without Borders, and raise questions of the W.H.O. degree of political independence.
Another eyebrow raising item buried in this report includes the news that the International Olympic Committee will not allow athletes from afflicted countries to compete in contact sports or swimming events in the Youth Olympic Games being held in Nanjing, China.
The W.H.O. admitted planning a "massive scaling up," of its efforts to bring this counter the epidemic. In contrast, Dr. Liu of the DWB notes that so far the majority the "international response was still at the level of promises," a not significantly veiled suggestion that once again we may be hearing more "happy talk" than effective action.
Dr. Liu warns that if health authorities are in danger of losing control of the epidemic in LIberia's capital of Monrovia, a city of 1.3 million people, where the health infrastructure is vastly inadequate and already overly strained, and reports that the quarantine zones announced with great fanfare yesterday, appear to be ineffective with reports of people walking around them.
“I’ve seen it: People are fleeing, people are running around,” she said, describing a checkpoint she had passed where people were walking around it. The local population was not fully supportive and without that, she said, it would be difficult to make the measure effective.
What more can I add, except that this is perhaps the most dismal assessment I've read so far out of hundreds, but also the most honest. With the only exception of the reports by Doctors Without Borders several months ago warning the world that this epidemic was totally out of control and beyond its capacity for adequate response.
Last month, just before taking off or my move for Florida, I informally observed that the doubling time for the epidemic seemed to be approximately one month. Unless constrained by behavioral interventions the doubling times in positive feedback loops tend to remain relatively constant.
These shocking numbers near double from last month, "2,127 cases of the disease and 1,145 deaths" combined with the reports of a largely unconstrained epidemic suggest that the most reasonable guesstimate we should expect about a month from now will again be at least double these numbers, even without considering the extraordinary admission from the W.H.O. that these numbers are merely the tip of the iceberg.
Is it not clear by now the local governments and even the W.H.O. and noble Doctors Without Borders do not have anywhere near the necessary resources to contain this tragic disease, which we can predict is going to become significantly worse before it gets better?
I have taken great care to avoid irresponsible alarmist exclamations in my previous reports. If anything, in retrospect, many of us have been too restrained and need to put an exclamation point on the need for greater global attention, resources, and sense of urgency in confronting what is already the largest, and longest Ebola epidemic in our known history.
And in this case, these Ebola viruses are just "warming up." This is one of those rare cases where if we say this is "literally an evolving situation" we would not be misusing the word literally.
As always, I hope I can speak for our whole community in offering our prayers, and best wishes to those afflicted and their loved ones. Unless we all do something more than say kind words, however, more of these words alone will offer little comfort to the terrified people of Western Africa who see no signs of sufficient resources and help on its way to provide much hope that this epidemic will not very soon become greatly more tragic than most appear to imagine.
The current already vast containment perimeters are clearly grossly inadequate. Again, I am not a doctor, nor epidemiologist, but even as just as average citizens where do we imagine the next "fall back" perimeters are going to be? The W.H.O. again comforts us that the danger of international spread is small.
How much longer can these rates of expansion continue before the world is demanding a quarantine border be drawn around all of Liberia, Sierra Leone, and Guinea? We've only seen 10 cases so far in Nigeria, Africa's largest economy.
The economic tragedy for Liberia, Sierra Leone, and Guinea may soon be of greater consequence than the health disaster if the entire countries are cordoned off. The economies of all three of these desperately poor countries rely heavily on tourism, game meat exports already banned, and mining. International staffs of most mining operations I've read about long ago shut down and expats fled to their home countries.
And the emergency resources need to include not only health supplies, but now also food, water, and means of basic survival for increasingly vast population cordoned off from the outside world, without the trade that supplied them with food imports and simultaneously ordered not to eat, or even touch game and bush meats which have been a major food source, for populations already impoverished and without enough. Four of the ten poorest countries in the world are in Western Africa, an include both Liberia and Sierra Leone, I believe.
We need to deploy vastly more emergency resources to this crisis immediately, like as of yesterday, if we do not want to see this terrifying tragedy greatly expanded. Yes, we need to keep our perspectives balanced by the recognition that diseases like Malaria, and Lassa Fever kill millions more throughout Africa every year without most of us even noticing, however, the rates of spread of these diseases is not growing exponentially.
We should also deploy greatly more resources to these diseases as well - I do not which to engage in "disease bigotry," but wish only to call international attention to yet another brewing potential disaster we may still have an opportunity to contain while it is still "only smoldering." Once the spreading flames reach the stage of a roaring inferno, our options will be no where near as many, nor as humane.
Here is a test case for the extent of our human compassion for people desperate, terrified, and in panic but well used to indifference from the rest of the world. Please, let us find room in our hearts to help our fellow human beings in this time of their greatest need when we have so much, and relatively so little would make a world of difference - the difference between life and agonizingly painful deaths.
Who was it who observed we can judge our own capacity as spiritual beings by how we treat the lest among us? So far I'm sad to report our capacity for human compassion would appear to leave much room for easy improvement if we judge by our actions so far in this desperate and exponentially growing Ebola epidemic crisis.
