“It is vexingly hard to determine what made this Ebola epidemic so much worse than previous episodes: Biology, economics, culture, politics, and chance all play a part in the trajectory of an emerging infection. Previous outbreaks had devastated communities, but those episodes had also been self-limiting and geographically contained within a single or small group of villages.”
That is paragraph three in an article, Breached Ecological Barriers and the Ebola Outbreak by Robert L. Dorit in the American Scientist, Volume 103, page 256. The article goes on to mildly flame the authorities for not getting more deeply involved sooner than they did, but the fact is that the local authorities had sent teams to Meliandou, Guinea, in the first weeks of the outbreak. The problem was that the symptoms of Ebola disease were similar to many of the other tropical diseases, and because they didn’t have the sophisticated laboratory equipment to test for a disease that was never before present in the local area, they simply misdiagnosed it. Once there was a blood sample available and sent to a sophisticated lab in France for examination, it was quickly recognized as Ebola. That was on March 20, 2014, which was only 79 days after the first victim died, and by that time only about 40 others had been infected. That may seem like a lot of sick people, but they were immersed in remote communities in a vast population of 340 million West Africans where there had never been a single recorded case of Ebola.
If on March 21st the critically important information could have been given to the local people telling them exactly what to do with potential Ebola victims the disease would have quickly terminated, because it has a low infection rate. Basically avoid the effluvia of sick and dead people, because those fluids are highly infectious. Contact infectiousness was a serious problem there because the African funeral goodbye ceremonies included touching the dead body. The outbreak might have ended in the village of Meliandou, with the death of 2-year-old Emile on December 28, 2013, or his sister Philomena on January 5, or their mother Sia on January 11, or a friend Fanta on January 11. Unfortunately, Emile’s grandmother Koumba, having seen her two grandchildren and her daughter die, immediately set out from the village to get help for herself, and traveled around to different cities to various hospitals seeking help. She thus became a super spreader, and not just in a single location but in several.
The first cases of Ebola are in the village of Meliandou
WHO – 1st Chain of Transmission of Ebola: MELIANDOU chart showing Emile’s death as December, 28, 2013
In the WHO chart above the bottom two rows of people died in April and that is after the discovery that the disease was Ebola. Thus, if an accurate information campaign had been launched instantly, even these early victims might not have caught the disease and spread it. Also, if the information had been given to hospitals immediately they could have treated the possible Ebola victims with isolation and super cautious treatment. Note that Koumba’s nephew died in Conakry on February 5th, only five weeks after the index case Emile, but that’s a city of a million people and a nine-hour bus ride from Gueckedou.
Among the first dozen people there were several spreaders who had they stayed home and treated their symptoms with basic hydration therapy they might have survived, and not started an epidemic. Here is a link to a post on, A distribution plan for an Ebola home treatment kit and posters. It states that water can pass from the intestine into the body best when the drinking water has a balance of 1 level teaspoon of salt, to 8 level teaspoons of sugar, to a 1 liter of water. The survival rate at home is poor if the person is untreated, but with this simple hydration treatment their survival rate is greatly improved.
What can be done now in preparation for the coming outbreaks of disease is to prepare individual plans for each specific disease, and other problems. These computer-based information packets could be made up as complete and detailed as possible including treatment procedures, email, phone numbers, titles of who needs to be contacted, and the potential radio, TV, web, broadcast statements with commentary and who to best make the commentaries. These information packs could be created in English by the CDC or WHO, but the information should be available on their sites computers and translated into the local languages where the outbreaks of a specific disease might occur. Once done, these ready to print information packets could be sent to the local authorities in seconds, or even long beforehand. If specific information packets, of this type, had been in available when the Ebola outbreak was first identified it might have ended within a month.
What bothered me about the opening statement quoted above, “Biology, economics, culture, politics, and chance all play a part in the trajectory of an emerging infection,” was that those generalizations might be true, but they don’t help solve any problems. My goal is to see problems clearly, and discover effective solutions.
It takes years to create specific vaccines for a new disease and during that time the public should be informed as to what they should do. Creating specific information packets for potential outbreaks of disease, before they happen, would solve predictable problems. The packets could be pre-vetted for accuracy and applicability so they could be instantly available, and immediately published in all appropriate media and languages.
Broadcast specific information on how to prevent a viral disease from spreading by demonstrating how to separate the virus sources from people.