Too Good to be True?

For months treatment centers in Monrovia have been turning away patients, who are then cared for at home, which places household members at high risk of infection. New treatment facilities have been filled as soon as they become available. Projections showed the need for ever increasing numbers of beds, for at least the next several months.

But suddenly, around the middle of October, reported cases and burials in Monrovia have started to drop. Some Ebola clinics are less than half full! [NYT 10/31/14]  [Economist 11/1/14] Can it be that the epidemic is waning? Or are appearances deceiving? On the same day Yale researchers warn that deaths could skyrocket, consistent with the earlier models of exponential growth. [Yale Daily News 10/31/14]

I don’t have a crystal ball, but I will just throw out a few ideas:

  • Home treatment kits started being distributed around the middle of October. [Reuters 10/20/14] This is a desperate stopgap, since patients become so highly contagious in the last stage of illness that caregivers and others in a household are likely to be infected. But is it possible that many people are using home treatment kits instead of taking patients to clinics? If so, the epidemic could be roaring ahead unnoticed. Except for this: where are the burials? To make sense of this hypothesis you would have to also assume that families were secretly burying their dead members (thus creating more opportunities for infection). While this has been reported it seems implausible that it would occur widely enough to impact statistics, especially in an urban context.
  • More hopefully, the worst Reproduction Rate seen for Ebola in this epidemic was 2.2, which, though ample to fuel exponential growth, is not that much above the steady-state level of 1.0. (See my earlier post for details). Also, transmission of Ebola is a function of human behavior: primarily incautious care-giving and the handling of dead bodies. It’s difficult to change people’s behavior but the crisis in Liberia may just have been sufficiently acute for this to happen. Many individual decisions just may have added up to success: not to touch someone who seems ill; to use a barrier when touch is necessary; to sterilize objects with chlorine bleach; to allow a body to be taken away without traditional cleaning and funeral rites.
  • This report is from Monrovia, the capital of Liberia. We must not lose sight of what’s happening in other parts of Liberia, and in the other countries with active transmission: Guinea, Sierra Leone, and now quite possibly Mali.

Meanwhile, a new 200-bed treatment unit opened on October 31 in Monrovia. This is a big addition to the 500 beds previously available. “The daily management of the treatment centre will be taken care of by the Liberian Ministry of Health and Social Welfare, with support from African Union and Cuban foreign medical teams.” [WHO 10/31/14] I hope it is never needed, and that unused Ebola facilities may perhaps become the nucleus of an improved ongoing healthcare system in these desperately poor countries.

Ebola Resources

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