The chance of being exposed once was so insanely low until about a year ago that it’s extremely unlikely that someone was exposed more twice with more than a year in between.
Interestingly and reassuringly, this is very close to the estimate given to me by my friend (an author the NEJM piece I linked to in my post above).
Having recently returned after spending several months in Guinea (with MSF) delivering frontline care to Ebola patients , he* said “80 percent”.
*FWIW, I doubt there are many/any physician on the planet who have more experience than he in dealing with Ebola.
Good info direct form the source. Awesome.
Did he happen to mention anything about the long term damage prospects for the survivors? i.e. would most survivors be mostly OK, or would we see lots of long term disability, shortened lifespan, etc.?
First world hospital medicine has come a long way in nearly 40 years.
Speaking as someone who’s visited Presbyterian’s ER twice in the past few years, I’d guess it wasn’t so much Duncan being black, as Presby being utterly unprepared to deal with exotic and fatal communicable diseases like Ebola.
The place is geared primarily toward 3 things- baby birthing, orthopedic surgery, and neurosurgery.
Their ER is most likely geared toward urgent care for the local area, which is predominantly white and suburban, with one low-income area literally down Greenville Avenue, which is where Duncan was staying. I suspect that critical care situations are stabilized at Presby and shipped to Parkland or Baylor, since they’re the local level 1 trauma centers, and I also suspect that the vast majority of uninsured non-ambulance ER people go to Parkland, since it’s the public hospital.
So Presby just flat out doesn’t see those things. They did a stellar job with my knee injury and subsequent surgery and with my wife’s pregnancy bleeding, for what that’s worth.
I seriously doubt there’s any consideration of color going on; more than likely it was just some perfect storm of incompetence, unpreparedness and Duncan having a high viral load, and being much farther along the disease timeline before he showed up than the nurses who were already being watched closely.
This is a ridiculous extrapolation…
Duncan had a huge viral load by the time he got fancy treatment.
Now if you are saying he got the short shrift the first time he presented to the ED b/c he was black, you may know something I don’t. His diagnosis was definitely missed, but I have heard nothing that makes me think it was missed because he was black.
Well, but this is what’s kind of bugging me about the death rate in africa, KG.
Remember cholera (you may be too young).
Anyway, cholera years ago was felt to be pretty deadly, especially for kids. Then we figured out hydration and electrolytes–even oral, b/c it’s mainly a secretory toxin that doesn’t inhibit absorption–could markedly lower the death rate.
Now Ebola is obviously more sinister than a secretory diarrhea, but I can’t figure out why the death rate in african countries is so high if supportive care (especially fluids, electrolytes and maybe blood products for anemia/hypocoagulable states/etc) should be fairly available.
I am inclined to think that the fatality rate in capable hands is going to end up being substantially under 50%, and perhaps closer to 10%. Yet africa has had multiple outbreaks with various strains over the decades, and their fatality rate still sucks.
Any idea if the MSF Docs in africa think the fatality rate is due to inadequate health delivery much more than it is the pathogenicity of the virus? Are they experimenting with plasma from recovered patients? Is their supportive care just sipping on gatorade and swatting flies away? Surely they’ve tried convalescent serum empirically?
My sense is that more Westerners, especially americans perhaps, would take a chill powder if they didn’t see Ebola as a death sentence.
Unfortunately convalescent serum was not shown to be effective in animal studies.
And here is a pretty good write up from a virologist who is doing BSL-4 work but not with Ebola. She trained with C.J. Peters who is one of the foremost researcher in the Ebola field. She has access to some of his unpublished data - and to the man himself.
But they are not, that is not consistently.
Africa is not a country.
If you look to the Senegal, it is 100% (but of course it is one case).
There there is the Nigeria, which had 20 cases and 8 deaths, so 40% fatality. But I believe the information shows that the deaths are weighted to the first cases before it was realized that it was the Ebola virus and not the malaria etc…
In the Nigeria case, it was only the oral rehydration, this article describes it: I'll (Gag) Drink To That: Oral Rehydration Key For Ebola Patients : Goats and Soda : NPR - and once this began, it seems the recovery rate was 100%.
So if one stops looking at Africa as a single unit and looks at the history for each, then the information becomes more clear, and the case of the Nigeria (or the Senegal) would suggest that even under basic circumstances, very early intervention with the full rehydration obliged, the Ebola disease is much less deadly.
It appears that is Americans for some strange reason who are the most panicked. In Europe it is not like this. Perhaps it is your news media or your politics.
One-two months ago or so, I read an article about a MSF camp in Liberia. They were completely understaffed, and didn’t even have IV lines/ fluids for rehydratation. So, they had some people in recovery rehydrating ill people by hand, which wasn’t even done properly because it was very time consuming and those tasked people were weak, and there weren’t enough of them anyway.
I wondered at the time exactly what medical care was provided there.
Noticed that too. It seems that Ebola is making the headlines in the USA, while it doesn’t here. I wonder why. During the last medical scare (flu) the coverage (and public concern) seemed roughly similar. So, maybe it’s indeed the politics rather than the medias that started the hysteria (I remember threads about Obama not doing enough).
It is more strange as in Europe - France, UK, etc. there are many many many more exchanges with Africa and by any logical analysis, it is more a risk - but only a small risk. But if you watch the BBC, they are sober and not panicky. When I watched the CNN or the Fox, you could have an impression of some great global crisis.
I think it is both the politics and an American media culture that seems to adore hysteria. I find I can not watch the American news, it is not news, it some other creature.
It is needed that there is some detailed comparison between what is actually done; a clear timeline analysis of the Nigeria for example. And it is necessary to note that the historical outbreaks in the Central Africa are mostly in the DRC (ex-Zaire) and in the extreme rural areas. It can be said the DRC has almost no health system, so to have the 90% mortality there is no surprise.
Of course it is clear for anyone who was worked in Africa that if you have to wear the full gear for protection and without any air conditioning, you can not be operational for too long. So even with good equipment, if not with air conditioning it is sure that tent hospitals in the Liberia without the air conditioning would be less effective than a good facility.
I found on the same NPR (it is the US state radio-TV yes?) site this article which describes what I see, and it is the great difference: Ivory Cost [Côte d’Ivoire] response, organised; although they make the point that the Guinea Conakry is one of the three countries badly hit, but it is first less badly hit than the two anglophone countries which had their government systems destroyed in their decades long civil wars and itself has the weakest government culture of all the francophone countries in the region and went through its own revolution only a few years ago.
They also have this article, which is on the Liberia and the organized response of the American company Firestone. This matches what I hear, that in the places where there are strong and organized systems, and where the patient can get quick and early treatments, the Ebola is not the death sentence Zombie Plague disease that my watching in the hotel the fox news gave the impression.
What comes from reading this Board and from the American TV I have seen - the American panic is unique - and it would help if there was more mediatization of the successes of the Nigerians and the Senegalese to make it clearer. From the French and the UK media I can see this more often discussed, it seems to me.
I don’t think it’s politics[sup]1[/sup] so much as the 24-hour news cycle. TV news in the US really likes to whip up the hysteria because it makes for better ratings. For a local example of this, you should see the local TV channels whenever there’s even the hint of snow in the weather forecast. We only get snow once or twice a year and often not at all, so people don’t really know how to handle it well. But if you watch the local news, they make it sound like the Apocalypse is on its way. Which makes it worse and gives the reporters more fuel to dump on the situation. Positive feedback at its {worst|best}.
[sup]1[/sup] If it were politics, Fox News would be blaming the whole thing on Obamacare, and I don’t think they’re doing that. But I don’t watch that channel, so could be wrong.
I agree completely with this.
Ramira writes:
> . . . NPR (it is the US state radio-TV yes?) . . .
Yes and no:
It’s the only radio network that receives funds from the federal government, and there is a separate equivalent television network, PBS, which is similar:
They both receive some funds from the federal government. Mostly they are funded by charitable contributions from individual listeners. They also get funds from corporations and from state and local governments. Just like commercial networks, each network consists of hundreds of stations. Each station, public or commercial, chooses what it wishes to broadcast and can reject any particular program the network offers it and can add programs they create on their own or that are created by other show producers. PBS and NPR are each run by self-sustaining boards. They are not official spokesmen for the U.S. government in any sense. Sometimes they both are criticized by American politicians for running programs which the politicians find offensive to their political tastes.
MOST survivors apparently make a full recovery, but some do not. Long term effects include chronic inflammation and pain in muscles, joints, and testicles; peeling skin; hair loss; and chronic eye problems like light sensitivity, excess tearing, various types of inflammation, and in some cases blindness.
So some people do suffer long term disability from it.
Immunity seems to last for at least several years based on research on survivors.
Unfortunately, at least in Africa, long term psychological trauma and effects are common in survivors. They are frequently shunned and feared, sometimes driven from their homes, their possessions destroyed, abandoned by their families, and so forth. This is unfortunate, as these people, being immune, could be assets in combating the disease and providing care for those infected.
There’s the problem - you assume administering fluids would be fairly available.
Ebola tends to hit rural areas where getting clean water is hit or miss, much less clean IV’s and the ability to monitor the patient’s fluids and electrolytes. Given that vomiting is a feature of late stage Ebola, oral re-hydration may be inadequate. If you haven’t got clean needles, or any needles, tubing, IV bags/bottles, and sufficiently pure water to mix up a saline solution giving fluids to vomiting patients is going to be quite a trick.
From what limited information I’ve read, MSF has a major issue with the availability of we First World types consider basic medical supplies, like gloves, clean needles, and pure water. So I think the answer there is yes.
I’ve heard a bit about use of plasma from survivors, but, again, in the locations in Africa where this is a real outbreak there are issues with getting the needed supplies to perform safe transfusions. There are also concerns with blood-borne diseases in the locations affected.
It’s not that it can’t be done but the infrastructure concerns in the affected areas are great. Local ignorance and superstition is probably not helping, either.
It would also help if the media wasn’t so inflammatory.
Cholera is a perfectly good comparison - a once-murderous disease now eliminated from the first world and *mostly *controllable in the third world, through sanitation and simple therapy. Global fatality rate 1.63% according to the WHO. But look at the interactive map or the data.
Sierra Leone 8.49% fatal
Guinea - 10.3%
Congo - 13.61%
Even for a nowadays ‘simple’ disease like cholera you are 8-10 times more likely to die of it in one of these countries than in somewhere like India (even though India has its own issues with healthcare delivery). There is no reason to suppose that Ebola would turn out any different.
Why? Because often times the total ‘medical supplies’ available are a bar of soap, a bottle of bleach, and maybe a couple tins of condensed milk. Sometimes less than that, to the point where even sipping clean tap water and swatting flies away would be an improvement. And virtually no trained medical personnel available. Hence the huge focus on getting people with a medical background out there, along with supplies.
IMO Americans would benefit hugely from a bit more travel so that they have an idea of the unbridgeable chasm that exists between western healthcare/sanitation and what people in these countries are having to cope with.
I think this is important, but also it is important to understand the difference between the countries in the medical care systems, where some poorer countries perform better because they are better organized despite poverty, and then within these countries it is a big difference between the economic capitals and the rural areas.
It is missing a lot to talk of AFrica.