The World Health Organization released a new data summary late on October 29. A few highlights:
The growth rate of transmission in West Africa seems to have slowed, especially in hardest hit Liberia. This has surprised most close observers who suggest it is either the result of unrecognized and under reported transmissions or is a temporary trough in what can be a wave-like pattern on the part of the virus.
The region’s anti-Ebola capacity is much stronger now than at the beginning of October. Several new diagnostic labs and treatment facilities are now in place (see map below). Clinical personnel are more numerous and better equipped. Some have suggested the reduced transmission rate is the outcome of interventions — educational, clinical, and logistical — put in place over September and October.
Despite this good news — or pause in worse news — a new scientific analysis published on Thursday concludes, “Under status quo intervention, our projections indicate that the Ebola outbreak will continue to spread, generating a predicted 224 (95% CI: 134 – 358) cases daily in Liberia alone by December…” For the week ending October 25 fewer than 50 probable cases were reported in Liberia.
The key factor may be “status quo intervention”; how much effort, targeted where, will have the most effect? It is widely recognized that the West African outbreak is the result of a failure to intervene early and effectively, before the virus was able to spread in dense urban environments. The best evidence for this analysis being what has happened with an unrelated, but parallel, cluster of Ebola cases in the Democratic Republic of the Congo.
The first Ebola death in the DRC was on August 11. The role of Ebola was identified before the end of August. Aggressive public health measures were taken to isolate and treat those with the virus. (Other factors probably helped.) There have been a total of sixty-six cases and forty-nine deaths. It has now been eighteen days since the last new case was identified. The transmission cycle was contained and has apparently been stopped.
Public education and community involvement are, many emphasize, fundamental to this sort of success. The same analysis projecting potential exponential growth in the number of West African Ebola victims found that four behavioral adjustments could produce a rapid decline in transmission (see chart below). Of particular importance is a change in burial practices. The “status quo” being studied was the situation in mid-September. Several of the practices have been increasingly adopted since. Already enough to produce the recent declines?
Since the West African Ebola cases first emerged, many at HLSWatch have suggested that for the United States this is mostly an opportunity to “run the traps” for a much more easily transmitted, much less treatable infectious disease. Important issues have surfaced related to early identification and treatment, clinical protocols, clinical training, and quarantine policy, strategy, and practice.
Some potentially less obvious lessons:
Isolation matters: The economic isolation of eastern Guinea produced a level of poverty that resulted in hunting bats for food. When a child and then his family members died of bat-borne Ebola they did not receive medical attention. The virus was given time to multiply. In urban Monrovia the poverty-stricken West Point slum has been the epicenter of transmission. The population’s lack of connectedness with wider society has impeded the application of effective public health strategies.
Culture matters: Washing, caressing and otherwise honoring the body of dead family members has been a particularly virulent vector for transmission of the disease. Working respectfully within the culture it has been possible — with remarkable speed — to adjust cultural behaviors.
Community matters: Connecting those who were disconnected and building trust where there was little or none has been a precondition to adjusting population behaviors and bending the transmission curve. Facilitating and supporting community self-organization has again and again been a big part of the public health approach.
Media matters: Mass media and social media can significantly influence the velocity of public attitudes for both good and bad. How to influence the velocity of media attention is, I suggest, quite similar to how we effectively engage the virus itself. Think about it.
Reasoning matters: Chris’ Tuesday post — and Haidt’s claim — have clearly been on my mind all week. For what it’s worth, I perceive Haidt was mostly critiquing a tendency by some to perceive reason as self-evident and to dismiss those too stupid to recognize the obvious. In this regard I agree with Bellavita and Haidt. The noun can be pretentious. But the verb — reasoning — when undertaken in a way that embraces culture, community, and respectful communication is the best tool we’ve got.
Maybe this is an opportunity to run the traps on more than the next infectious disease.