There’s an interesting BBC article with some decent graphics in it here:
The basic problem is in the graph of the growth of Ebola over time. They have it by country, and in total. THE major issue is a simple one. All the curves continue to be upward sloping. The exponential continues. Until one of them (preferably the total as well) rolls over to flatten and then downward, we have a completely out of control and expanding plague. Quarantine is NOT a ‘dirty word’. It is a crude but effective tool to stop planting new weed patches and new sources of trouble in areas that are healthy refuges. Places from which a response can be raised. First, wall off the ‘bad thing’ (be it a virus, chemical contamination, nuclear contamination, whatever), then from your secure and clean base, provide a load of corrective / curative effort into the (now limited) area of involvement.
Continuing to haul thousands of folks all over the planet from infected areas is insanity. Yes, IMHO, that includes Dallas now too.
In the article they point out two very important things:
1) The counts are likely to be low. Perhaps as much as 50% low.
2) That sudden turn up at the end for Sierra Leone was due to a review of hospital records.
That curve is what we are ‘up against’. It will get a lot worse before it gets better.
In earlier postings I’d pointed to some positive news.
A CNN report on a retro-viral that looked to be curative. Other folks posted links that also pointed to potential “good things”. One was to an article on using massive intravenous Vitamin C (as the sodium salt) that had very good antiviral impact. Another was about Selenium, and that showed a very interesting thing. The symptoms of severe selenium deficiency include things, like hemorrhage, that are signatures of Ebola. And… The Ebola genome codes for sequences that would use a lot of the host selenium. The virus may be sucking up your selenium as a way of making you weak / sick. Large doses of Selenium would prevent that sequence. There was also some evidence for using nano particle silver as a virus killer. There was also a link to a Chinese drug with promise.
So, as a bare minimum, I’d propose the following:
1) Land a mobile CBW hospital with complete hazmat gear in Africa. Use THAT as the place to treat, and quarantine, any health care workers and missionaries and such that get Ebola while working there. Do not take them off the continent until 30 days after recovery from infection, or 30 days after last exposure to infection in others.
2) Put the quarantine outer border outside the known exposed areas. (At present, cases are known from outside the presently closed boarders. See the map in the article at BBC.) Folks can go in, but nobody comes out. Set up a 30 day quarantine facility at the border. Folks can enter it from the sick area, and if healthy 30 days later, can exit to the healthy side. IF that facility has a case of Ebola, everybody has a reset on their quarantine time. Yes, it’s a ‘lock box’ for limiting who gets out and that they have proven to not have the disease (i.e. incubation has passed).
3) Start trials of each proposed treatment. There are plenty of desperate patients who would benefit from anything, even just a bit of hope. Also try combinations. (So selenium with anti-virals for example). As soon as something is shown to work, use it in a whole country (if enough drug is available). As soon as something is shown to work really really well, use it everywhere.
4) Since a load of the cases are health care workers, drop the hubris that we have a clue just what this virus can, and can not, do. At least one variation (Reston) has evidence for limited airborne spread. With 10,000 to 20,000 infected, the mutation rate will be creating new sub-types right now. What it was, is not what it now is, and what it will be. Expect to be surprised. So health care workers ought to be assigned to the treatment of Ebola cases in the smallest number possible. Those folks get a room in the hospital and stay 24 x 7 (also pay them 24 x 7 for the duration). They leave when the outbreak ends, and go into 30 day quarantine then. Paid. Nobody who works an Ebola ward travels. (Use video conferencing if you need to ‘attend’ a meeting…)
Until those growth curves flatten, we are demonstrably clueless and doing the wrong things.
Now, with one case in Dallas leading to 2 nurses sick, and with a couple of weeks left in the incubation period for the other healthcare workers, and with unknown 100s of folks exposed to the nurses; the USA is also on that exponential growth curve. Yes, we are down at the toe of it, but on it we are. It will be 20 days before we know how far on it we go. That’s about November 6 or so. We can make no statement at all about how many Ebola cases are in the USA until then. Only if we get no more at all can we then say how many there are… Until that time, we must assume we are on that exponential curve and act accordingly.
We know the ‘protective measures’ didn’t work for those nurses. We know that exposures have happened. We know that cases have doubled. We know that we don’t know how to stop it. Yet.
So the right thing to do is to act as aggressively as possible. Assume the worst and assume you do not know how to prevent spread nor treat the disease. So far that looks to be accurate.