Is It Out of Control?

In Liberia, the Ebola situation appears to be easing, while in Sierra Leone things seem to be getting worse. It is not clear why the numbers should be diverging in these two closely-related countries. 

Many factors contribute to Ebola statistics. We must assume, first off, that those publishing the numbers are beyond the temptation of massaging them. That said, there are many other ways in which figures can be subject to error. For example, those who enumerate may not be able to do so accurately because humans are tricky creatures with minds of their own: they may hide, dissemble or otherwise make life difficult for the canvasser. Thus, final numbers must always be regarded as tentative, even when conditions are normal.

When things are as chaotic as they tend to be in the hothouse atmosphere that is Ebola, counting can be even less reliable. Besides, Ebola, in itself, is rather tricky. First off, we know very little about it in spite of the noisy declarations of “experts” and amateurs alike concerning its origin, infectivity, clinical manifestations and natural history. As for individuals afflicted by the disease, they find themselves in totally uncharted territory. They have no idea what is happening to them or what their eventual fate would be. They are petrified and their behaviour tends to the unpredictable. Some drift around and others may even cross borders without respect for immigration formalities.

Those who treat Ebola patients are also quite stressed and, sometimes, are confused too. Whether in America, Spain or in the disease’s epicentre there is lack of cogency. Rules are made up on the trot, and at the height of the confusion everything is likely to be slapped into quarantine on sight. Even unsuspecting dogs may be put down, a fate to which humans appear at some risk on return to their home country, judging by the shrillness among some sections of the media.

It is easy enough to mock these antics. But in countries where Ebola disease does exist, it is no laughing matter. The outlook is grim. Pundits worry that not enough is being done and dread the possibility of a pandemic. Why this anxiety? Is it because there is incompetence? Or malfeasance? Many are convinced that the latter is the case. They could see no reason why the problem should be so intractable when so much money is being thrown at it. It should have gone away by now, shouldn’t it? But it hasn’t. So there has to be some dodgy doings. “Follow the money,” they say. Money, in this case, is not an enabler, but rather a spoiler, a temptation too strong for the moral resolve of those in charge.

So Ebola remains wrapped up in all manner of theories and speculations. Money disappearing into the wrong channels is just part of that mix. However, as for the case of the origin of the epidemic, I remain, for the present, sceptical.

Eleven months down the line, we are beyond the shock and surprise that the epidemic chose West Africa to descend on in 2014 (2013, if you like). Also, for now, let us suspend recrimination over who or what did or did not do what when Ebola first struck. What is needed now is a ramping up of resources, human and non-human, local and international, for full engagement with a foe that gives no quarter.

Once the emergency is over, there will be time enough for an accounting.

Tell Fren Tru

Americans. Don’t you just love them.

America is a peculiar place. 

         Its land is vast with a population of over 300 million, enjoying the highest GDP on earth. The average American has an annual income of over $66,000. (We need not bother our heads over how this income is distributed). Suffice it to say that this is a per capita income that is exceeded by only a handful of tiny sheikdoms producing lots of oil, plus a few small European countries skilled in the management of secret money owned by extremely wealthy individuals. 

         Forty-two percent of Americans have a college education, bettered only by Canada (Number 1) and a few other OECD countries. America’s dominance in educating its people is underscored by the fact that 7 of their universities are among the 10 best in the world. It is well to note too that, in America, there are about 25 doctors for every 10,000 population; put in another way, every doctor registered to practice medicine in America has, on average, only 400 individuals to look after.  

          You may already be wondering where all this is leading. Well, the conclusion that any reasonable person would draw from this snapshot of Americana is that the land flows with milk and money. Sorry, honey. Enough honey to, at least, sweeten the temperament and lubricate neural circuits responsible for clear thinking. But most disappointingly, the country seems to fall down every time it is called upon to lead the world in rational thinking. Every time, before and since one of their greatest ever presidents asserted that the only thing that they have to fear is fear itself, Americans have consistently shown a fearfulness that is almost primal. They have been afraid to escape from the bonds of slavery; they have feared Japanese-Americans during World War II; they have dreaded communist bogeymen under the bed during the Cold War; they went wild with fear during the early stages of the HIV/AIDS epidemic; Al Qaida petrified them to the point of incoherence (but that, you might say was a GW thing); and in 2014, Al Qaida’s progeny, ISIL leaves America quivering. And this year also, America is gripped by fear just because of a single case of Ebola entering their pristine realm. 

        Why, you may ask, is America not using all its valuable assets to inform public debate and policy about Ebola? Instead, what we see is a shambolic media and political show concerning the remote possibility of Ebola threatening the American way of life.

To be honest with you, I feel totally let down by these antics because I had believed that Ebola's spread in West Africa was due partly to a lack of public literacy in a region where factors of well-being are orders of magnitude lower than in America.

          There is no upside to this type of paranoia. But downsides are many. Not the least of these is the prevailing view that Americans going to West Africa to help control Ebola there may not be allowed to integrate back into their community when they return home. It should be clear to all that if Americans are prevented from returning to the bosom of their loved ones there is no way they would want to go to the region where help is most needed. Is this what America really wants? 
      Please tell me it is not so.

 Tell Fren Tru

Surrending to Ebola is not an option

It’s all about Ebola. And beheadings too. Both virulent and both shocking and horrific. But while the former evokes our finest feelings, the latter arouses nothing but revulsion and contempt for the perpetrators who, seemingly, have nothing of value to contribute to the human condition.

         Ebola is a biological agent that recognizes no frontier. It threatens most of its victims with an impartial, squalid death. Unfortunately, the world’s response has, so far, been relatively limp. This lack of resolve in tackling the threat has been difficult to understand, especially since the epidemic has been knocking at doors all around the world.

It is a hundred years since the first recognizably viral epidemic became pandemic, killing some 20 million. Then, as now, the spin doctors fell over each other to create as much confusion as possible, while real doctors had their work cut out trying to contain it. Eventually, the spin doctors satisfied their appetite for mischief by settling on Spain as the source of the epidemic. Thus “Spanish Flu” was born and, for better or worse became the name by which the first influenza pandemic became known.

Around that time, too another game was in progress. In the score card of that one, some say, lie the seeds of the unending chaos in the Middle East that continue to germinate one horror after another. But that was then.

Now is now and we have, in the intervening decades, learned a lot about viruses and the diseases they cause. We know precisely how most of them transmit from person to person and from which animal species some of them migrate. But there is a lot we still don’t know and that has left space for the range of crack-pot notions such as those pervading the internet. They certainly do not need my help for their propagation so I will not mention them. I will also for now, forgo the pleasure of listing the Nobel laureates who, by their work on viruses and virus-related disease have made life safer and better for billions.  Too bad the messages contained in their acts of valor are drowned by foolish utterances of conspiracy theorists who have nothing useful to say.

But perhaps we would not be where we are today with this epidemic and soon-to-be pandemic, Ebola, if others, responsible for keeping the world safe, had taken their job seriously. We are told, for example, that unusual sickness and deaths began to be observed in Guinea in December 2013. http://www.nejm.org/doi/full/10.1056/NEJMp1409858. Yet, astonishingly, neither the Guinean authorities, nor the WHO reported the looming threat until March 23, 2014. We were in Sierra Leone in January/February and, at that time news began to emerge of an outbreak of a hemorrhagic fever in Guinea that was already spreading to Liberia and eastern Sierra Leone. What were the authorities doing? Why did they have to wait till March before sounding the alarm?

Now, today, there are over 8000 Ebola cases in the region, with an overall mortality of more than 50%. And today WHO, perhaps compensating for its earlier dereliction, is pumping up projections of new cases for the next two months. However, one might take comfort in the fact that in Sierra Leone the incidence figures and death statistics are not as dire as the overall picture in the region might suggest, although the slope of the graph describing total cases is getting steeper as the weeks go by.

Sierra Leone Ebola Stats to  12 October 2014

Also, death rate is still being maintained at a steady 30-40%. Grim enough, but not as devastating as for untreated Ebola. Trouble is, can we rely on the quality of the data that the Sierra Leone Ministry of Health put out in their daily briefings? Further, we are now hearing that cases are being turned away from treatment centres. So it is likely that there is under-reporting anyway. Indeed, one online paper is suggesting that the government of Sierra Leone is tacitly surrendering to the virus because it is now encouraging home treatment of patients: http://www.americanthinker.com/blog/2014/10/ebola_patients_in_sierra_leone_to_be_treated_at_home.html.

Surrender? Probably not. At least not just yet. Just another way of fighting a relentless foe, against which all available tactics must be deployed.

Tell Fren Tru

Asymmetric Warfare

We are headed for Armageddon, it seems.  Exercises modelling where Ebola is heading are terrifying. We are told that there will be from between 20,000 to 200,000 cases in the medium to long term and also, that the disease will likely spread to other continents. What is even scarier is that the virus, reportedly, is mutating at a high rate, raising the possibility that new, more dangerous isolates could arise and that these could infect--wait for it--not just by contagion but through the air also, a prospect that is mind-bendingly awful. 

Ebola Cases In Sierra Leone

   This is asymmetric warfare in which, so far, West Africa does not appear to have an answer.

Meanwhile, we blame ignorance as one of the factors fuelling the disease’s spread. We say, lack of education makes it near-impossible to engage minds with concepts such as viruses and bacteria that kill people by the dozen. To those minds, such notions are about as confounding as things that go bump in the night... This is a difficulty we can understand.

But what I don’t get is the response of those who have had more than just basic education, but who have shown the most perplexing response when they realize that they may have contracted Ebola. They too, run. And when they run they do so to places where they are most likely to cause maximum chaos. Take the case of Patrick Sawyer, the Liberian-American consultant at the Liberian Ministry of Finance and who absconded from Ebola surveillance there, boarded a flight to Lagos, Nigeria and introduced the infection into that country. And take also one of the persons Sawyer infected in Lagos. This man, Ibukun Koye is the Head of the ECOWAS Liaison Office in Lagos and was one of Mr Sawyer’s primary contacts. Koye himself, realizing he had become symptomatic, absconded from quarantine in Lagos. He ran to the city of Port Harcourt in south-east Nigeria and, somehow, persuaded a doctor there to treat him in a hotel, of all places. This doctor has since died from Ebola, whilst Mr Koye survives. Then, there is the Guinean, so far unnamed, but identified as a third-year student at the University of Conakry, who left his village near the Sierra Leone border in south west Guinea, evading Guinean quarantine to end up in Dakar, the capital of Senegal. His was a 1000 km road trip that left a trail of contacts wherever he went, ending up in a compound in Dakar where 33 residents are now quarantined. No one knows why he did it but the potential consequences of his odyssey now hang over Senegal’s head.

In a few days, Sierra Leone will be clamped under curfew in which everyone, apart from those involved in essential services will be required to stay at home for a 72-hour period. 
Will this make a difference? 

Tell Fren Tru