Ebola - the threat, the heroes, the politics

On Friday of last week, the World Health Organization raised the number of confirmed or suspected deaths from the 2014 Ebola virus outbreak to 4,033 - greater than the death toll from all previous outbreaks.  And unlike previous outbreaks, generally confined to the villages where the disease appeared, the 2014 outbreak has spread to cities and countries outside the epicenter.  As reported by AP and carried by Huffington's World Post: "David Nabarro, the U.N. special envoy for Ebola, said the number of Ebola cases is probably doubling every three-to-four weeks and the response needs to be 20 times greater than it was at the beginning of October. He warned the U.N. General Assembly that without the mass mobilization of the world to support the affected countries in West Africa, 'it will be impossible to get this disease quickly under control, and the world will have to live with the Ebola virus forever.' "  Mathematical models performed by numerous researchers suggest that anywhere from 20,000 to 100,000 people globally could contract the virus by December of this year.  With the virus' 50% fatality rate, 10,000 to 50,000 could be killed by the epidemic. Hopefully, the world's governments will respond to this plea for mass mobilization and the worst case scenarios will be prevented.

There is no cure for the disease and no vaccine against the virus. Prevention and containment are the best defense.  Basic interventions, when provided early enough, can increase an infected patient's chances of survival,  From the CDC website:  Symptoms of Ebola are treated as they appear. The following basic interventions, when used early, can significantly improve the chances of survival:

• Providing intravenous fluids (IV)and balancing electrolytes (body salts)
• Maintaining oxygen status and blood pressure
• Treating other infections if they occur

Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. 

The heroes of this battle are the men and women fighting every day to save Ebola patients.  They are the ones putting themselves at risk to keep the epidemic in check.  The slightest imperfection in protective equipment or procedure can lead to infection and death.  Even when procedures are followed and protective equipment is used, it's possible to become infected as happened with one of the nurses treating the Dallas Ebola patient.  Whether they be part of the local response or the UN or Doctors Without Borders medical staff or the medical teams sent by countries like Cuba, they put their lives on the line every day.  The US is sending at least 4,000 troops to West Africa improving the infrastructure, helping with logistics and building treatment units.  The 101st Airborne is currently undergoing intensive safety training before joining the 350 troops already on the ground in West Africa.

Screening procedures are being put in place in many international airports - London's Heathrow, New York's JFK, Chicago’s O’Hare International, Atlanta’s Hartsfield-Jackson International and Newark Liberty International - to help stop the spread of the disease from countries with the highest level of infection.  The Economist notes that "African and Asian countries have been screening air passengers for months, with some using infrared cameras to detect fevers. This is in addition to the screening of all departing air travellers in the affected countries."  While these measures may help calm people, they will not completely stop the spread of the disease.   The article concludes "...the best way to stop Ebola from spreading, say health experts, is to drain the reservoir of the disease, which means tackling it in west Africa. Doing that presents an entirely different set of challenges. When it comes to stopping Ebola, the rich world's self-interest aligns neatly with the needs of the developing world. But countries in a position to help have been slow to act."

Here in the US, politics has raised its ugly head. Most recently, a key Republican Senator was blocking the transfer of $750 million (of the $1 billion requested by Obama) in Department of Defense funds to fight the disease because, among other things, the Defense budget was "thin". After realizing how ridiculous his position was, he dropped his objections.  Reuters reported Friday : "The U.S. Defense Department won permission to shift $750 million in war funds to fight Ebola in West Africa as a Republican senator on Friday lifted his remaining objections to the transfer.  The action by Senator James Inhofe of Oklahoma will give the Pentagon enough funding for about six months of operations in West Africa, including the deployment of up to 4,000 troops and the establishment some 17 Ebola treatment facilities with 100 beds each."  The bad news is that Republicans are still holding up $250 million of the original $1 billion request for transfer.

Inhofe says that "it will be difficult to support any further last-minute funding requests using military resources,"  Really? With 40% of the world's total military expenditures, we can surely find something we don't need in that bloated budget.  Inhofe asks for a "more appropriate" source of funding while we are still feeling the impact of the domestic program budget cuts that Republicans love so much.

The main agencies tasked with this aid work say they're "hamstrung by budget cuts from the 2013 sequester."  Sequestration caused budget cuts in the National Institute of Health's budget affecting every area of medical research.  Cuts to international aid budgets and to USAID totaling $700 million affected the detection and containment of the disease.  Dr. Beth Bell of the CDC testifying before a Senate committee, "argued that the epidemic could have been stopped if more had been done sooner to build global health security... 'If even modest investments had been made to build a public health infrastructure in West Africa previously, the current Ebola epidemic could have been detected earlier, and it could have been identified and contained.'" [Mother Jones, October 1]

The head of the National Institutes of Health, Dr. Francis Collins, pointed out the impact of a decade of stagnant funding for the agency (down 23% in current dollars).  "has 'slowed down' research on all items, including vaccinations for infectious diseases. As a result, he said, the international community has been left playing catch-up on a potentially avoidable humanitarian catastrophe.  'NIH has been working on Ebola vaccines since 2001. It's not like we suddenly woke up and thought, 'Oh my gosh, we should have something ready here,' Collins told The Huffington Post on Friday. 'Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would've gone through clinical trials and would have been ready.' " [Huffington Post, October 12]

The US media have done a pretty good job of stirring up fears of a devastating outbreak of the virus here in the US despite statements from medical experts that there is little reason for that fear. Normally, the Surgeon General of the United States would be advising Americans and addressing the health concerns of the nation - what's real, what's not, what can be done, what precautions to take. But here too politics has had an impact.  Thanks to the NRA, we are without a Surgeon General overseeing the Ebola threat. "Last November 14th, the President nominated Dr. Vivek H. Murthy, an extremely qualified candidate to replace ‘acting’ Surgeon General Dr. Regina Benjamin. It took three months, but the Senate finally got around to holding a confirmation hearing for Dr. Murthy’s appointment. However, the National Rifle Association exerted its very substantial legislative prerogative and blocked Murthy’s confirmation because he...called for sane gun restrictions to prevent more Americans from dying unnecessarily from the gun violence epidemic. It is exactly what a real medical professional, and highly-qualified potential Surgeon General of the United States, is supposed to do; help prevent a deadly epidemic from spreading to save American lives." [PoliticsUSA, October 14]  More than 30,000 people are killed by gun violence each year.  The devastation caused by gun violence is order of magnitudes more devastating than the Ebola virus will ever be in this country.