Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

[Gert van der Hoek]

sept 12 2014

Ebola outbreak worst ever

Mark Colvin reported this story on Friday, September 12, 2014

Interview with Dr Ian Norton, chief of foreign medical teams with the World Health Organisation.

- snip -

MARK COLVIN: When you look at the graphs of ebola's spread in recent weeks, the projection looks exponential. In other words, it's rising to a degree where it would be pretty much uncontrollable, and that would mean probably spread over a much, much wider geographical area. How possible is it to stop that happening?

IAN NORTON: We have to. We have to stop it spreading beyond the point of no return in this exponential graph. And so we have a window of opportunity now but if we ignore that window then you're right: we're into a situation where it will be much more difficult to control and certainly infection rates within the countries affected can escalate and escalate.

To put no fine point on it: we have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground in the way that we normally would and already the WHO and the ministries of health of the three most affected countries are thinking of other ways to contain and manage the large numbers.

You've already seen it in the way we've designed the field hospitals. These are not field hospitals for 20 or 30; they're field hospitals for hundreds. And that adaption will have to continue as long as we're struggling to get the resources in to manage.

Read the interview @ ABC Net

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[MHSC]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

New mortality rate or did he misspeak?

IAN NORTON: There will definitely be survivors. We have, at the moment, without care, we know the mortality rate of ebola: it's about 90 per cent in this outbreak. A devastating disease but not universally fatal, even with minimum care.

With better care, and certainly with the new ebola treatment centres and with the right number of staff treating them, we can gradually escalate care. And I'll give you examples that are coming out of Guinea for several months now. With good supportive care they can bring the mortality rate down to 30 to 50 per cent at most.

 

[sharon sanders]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

I have seen 90% before in reference to people who are not treated at all - which is about as high a rate possible.

 

[Gemineye]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

Before we get carried away by apocolyptic thinking, it's important to keep a few facts in mind:

1. Only 6 countries are involved, Giunea, Liberia, Nigeria, Sierra Leone, Senegal and the DRC.

2. In Senegal, there has been 1 case and 0 deaths.The only region affected is Dakar. There has not been a new infection since 29 Aug 2014.

3. In Nigeria, the most populous of the affected counties there have been 21 cases and 8 deaths. The only areas affected are Lagos and Port Harcourt. On 11 September 2014, Nigeria announced that it no longer has an active case of Ebola.

4. There have been no cases in countries bordering the afore-mentioned affected countries: Guinea-Bissau, Mali, Ivory Coast. The outbreak in the DRC was unrelated to the west African outbreak.

5. Since the oubreak began, despite many false alarms, there have been no locally tranmitted cases outside the affected countries.

6. The WHO has stated that the risk of catching Ebola on an airplane is very low.

7. Despite much speculation, the EBV has not mutated to become transmissable through the air. It can be quite easily contained by well-known practices of wearing PPEs by HCWs, isolation of active cases, and contact tracing and quarantine of close contacts.

I'm not saying that this outbreak is not serious, just that it's important to keep things in perspective.

 

[JimO]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

The combined population of Guinea, Liberia, and Sierra Leone is about 16.5 million. The attack rate is highly dependent on what controls are put in place, but even if it's 25%, with a 70% CFR, we are still facing a potential of 2 to 3 million deaths, even if it doesn't spread to other countries. That's a big number and it could happen by next summer given the current rates of spread. I am pretty certain that if it gets that out of control, millions of people will try to escape, many into neighboring countries, with associated consequences.

Also, given the primary outbreak, not a lot of attention has been given to the outbreak in the DRC. Under normal circumstances, 35 deaths, including HCWs, would cause great concern. There is no indication that this outbreak has been brought under control and fewer resources are available to help them. I hope that outbreak isn't neglected and allowed to spread.

 

[AnnaLisa]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

Would I be incorrect to say up to now, this has been a disease of the very poor and the people that care for them, (in general)? The ones responsible for distant spread have generally been people with the means to acquire transportation, AKA Sawyer to Lagos and his associate to Port Harcourt and thankfully a non-case in the student who travelled to yet a third city, ill, but not with Ebola. These are middle class people. As the disease crosses socio-economic borders (due to sheer numbers of cases), I expect we will see it cross geographical borders as well.

 

[franzpick]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

Liberian SitReps #116 and #118 show a 2 day, 9/9-9/10, increase of 231 new cases (or 223 new cases in a different table), which if continued would double the 9/10 new case Liberian total from 2415 to 4830 in just 20 days, by Sep. 30, and then double again to 10,000 total cases by Oct. 20, if the trends persist.

If these statistics are not new case overstatements due to difficulties and errors in data capture, classification and reporting, the 100% increases in the 2 day new Liberian case numbers could be signaling the beginning of an infection rate runaway.

 

[JimO]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

A couple of weeks ago, I put this spreadsheet of predicted deaths assuming an R0 of 1.8 and an exponential period of 21 days. This is not my area of expertise, so it's not a model per se, just a simple exponential spread estimation. Of course, this also assumes that any controls are not effective in limiting the spread. It's pretty frightening what could happen after the first of the year.

 

[Sollydog]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

Before we get carried away by apocolyptic thinking, it's important to keep a few facts in mind:

1. Only 6 countries are involved, Giunea, Liberia, Nigeria, Sierra Leone, Senegal and the DRC.

4. There have been no cases in countries bordering the afore-mentioned affected countries: Guinea-Bissau, Mali, Ivory Coast. The outbreak in the DRC was unrelated to the west African outbreak.

5. Since the oubreak began, despite many false alarms, there have been no locally tranmitted cases outside the affected countries.

I'm not saying that this outbreak is not serious, just that it's important to keep things in perspective.

In another thread I read that nations are required to notify WHO about infectious outbreaks but that they may not allow WHO to make that info public. If there have been a few cases, quickly contained, in other countries might that info not be public or would nations want to allow open reports?

 

[JimO]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

In another thread I read that nations are required to notify WHO about infectious outbreaks but that they may not allow WHO to make that info public. If there have been a few cases, quickly contained, in other countries might that info not be public or would nations want to allow open reports?

I would guess that in such cases other developing nations would tend not to release the information to avoid panic, social instability, and economic impacts.

 

[Laidback Al]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

In another thread I read that nations are required to notify WHO about infectious outbreaks but that they may not allow WHO to make that info public. If there have been a few cases, quickly contained, in other countries might that info not be public or would nations want to allow open reports?

While it is a requirement of IHR to report infectious diseases to WHO within 24 hours, there is circumstantial evidence that some countries will delay reporting of cases of novel infectious diseases to WHO for their own convenience.

 

[JJackson]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

I would guess that in such cases other developing nations would tend not to release the information to avoid panic, social instability, and economic impacts.

Jim if you are interested in States' behaviour and the IHR, and it limitations you may like to look at this post/thread which I wrote at the time of the IHR(2005)'s adoption.
At the bottom of the first post you will find a numbers of links which I have repaired/updated. I would recommend David Sencer's account of his experience as a judge of arbitration in an inter-State dispute (originally posted as a comment in an EffectMeasure discussion).
Also this link which is to a legal analysis of State compliance during the 2009 pandemic (link).

 

[AnnaLisa]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

I'm not the brightest candle in the church when it comes to understanding the duties of the State Dept. but are they involved somehow in patient care? When they say 'hazmat' what kind of suit are they referring to? I am assuming they plan to use these in our humanitarian efforts?

 

[Ray]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

So, given the severe economic consequences for countries which have reported Ebola cases (travel restrictions/border closures etc) why would a developing nation 1) test 2) report pos. case(s) or 3) allow WHO to reveal that information? Or have I inferred incorrectly from the above comments?

 

[sharon sanders]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

So, given the severe economic consequences for countries which have reported Ebola cases (travel restrictions/border closures etc) why would a developing nation 1) test 2) report pos. case(s) or 3) allow WHO to reveal that information? Or have I inferred incorrectly from the above comments?

You have it right. Unfortunately.

And it is not only the developing nations. No one wants to admit to a disease problem until it is so apparent that it can not be concealed.

 

[JJackson]

Re: Ebola, West Africa - "We have a closing window of perhaps weeks now before we won't be able to manage all the cases on the ground" - Ian Norton, WHO

Yesterday, in post #12 of this thread, I linked to an old thread on the IHR and as it has generated a lot of new traffic on that thread I have added a new post trying to simplify the sections of the IHR which are relevant to its application to the current Ebola outbreak. The new posts can be found here.