Competence, and incompetence.

Lifted directly from the WHO website. My tuppence worth at the bottom.

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.
Background

The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.

A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.

The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species.

Transmission

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Symptoms of Ebola virus disease

The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

Diagnosis

It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:

antibody-capture enzyme-linked immunosorbent assay (ELISA)
antigen-capture detection tests
serum neutralization test
reverse transcriptase polymerase chain reaction (RT-PCR) assay
electron microscopy
virus isolation by cell culture.
Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.

Treatment and vaccines

Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated. No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing.

Prevention and control

Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors:

Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
Outbreak containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.
Controlling infection in health-care settings:

Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.

WHO response

WHO aims to prevent Ebola outbreaks by maintaining surveillance for Ebola virus disease and supporting at-risk countries to developed preparedness plans. The document provides overall guidance for control of Ebola and Marburg virus outbreaks:

Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation
When an outbreak is detected WHO responds by supporting surveillance, community engagement, case management, laboratory services, contact tracing, infection control, logistical support and training and assistance with safe burial practices.

WHO has developed detailed advice on Ebola infection prevention and control:

Infection prevention and control guidance for care of patients with suspected or confirmed Filovirus haemorrhagic fever in health-care settings, with focus on Ebola
Table: Chronology of previous Ebola virus disease outbreaks

Year Country Ebolavirus species Cases Deaths Case fatality
2012 Democratic Republic of Congo Bundibugyo 57 29 51%
2012 Uganda Sudan 7 4 57%
2012 Uganda Sudan 24 17 71%
2011 Uganda Sudan 1 1 100%
2008 Democratic Republic of Congo Zaire 32 14 44%
2007 Uganda Bundibugyo 149 37 25%
2007 Democratic Republic of Congo Zaire 264 187 71%
2005 Congo Zaire 12 10 83%
2004 Sudan Sudan 17 7 41%
2003 (Nov-Dec) Congo Zaire 35 29 83%
2003 (Jan-Apr) Congo Zaire 143 128 90%
2001-2002 Congo Zaire 59 44 75%
2001-2002 Gabon Zaire 65 53 82%
2000 Uganda Sudan 425 224 53%
1996 South Africa (ex-Gabon) Zaire 1 1 100%
1996 (Jul-Dec) Gabon Zaire 60 45 75%
1996 (Jan-Apr) Gabon Zaire 31 21 68%
1995 Democratic Republic of Congo Zaire 315 254 81%
1994 Cote d’Ivoire Taï Forest 1 0 0%
1994 Gabon Zaire 52 31 60%
1979 Sudan Sudan 34 22 65%
1977 Democratic Republic of Congo Zaire 1 1 100%
1976 Sudan Sudan 284 151 53%
1976 Democratic Republic of Congo Zaire 318 280 88%

============================================

My tuppence worth.

Those are the bare facts. What they hide is perhaps the most vicious display of racism we’ve seen since WWII. Six countries in West Africa had outbreaks of the virus since March this year. But it wasn’t until it became a very real danger to the countries of the West that anything useful occurred on the ground in Africa.
All the countries involved, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone have shit health services. There really is no other way to convey the absence of doctors and nurses. For the few local medics they educate and train move to Europe, Canada and the US as soon as they are trained leaving the population to the mercies of charities like MSF and good-hearted people with medical training who know and understood the dangers.
That table at the bottom explains one of the reasons why the those charged with protecting the herd health in the west weren’t all that worried for the first few months when a concerted effort could’ve nipped this in the bud. The death rate is huge. It is relatively rapid once the infectious onset occurs. So it tends to burn itself out where it usually occurs due to poor transport links and poor medical services.
But why weren’t the military medics in making war upon the disease by the end of April once it became clear it wasn’t burning itself out. Well, here’s where I believe we’re seeing racism at it’s most basic. You see once it occurred in a population that has part of the trappings of a high population society it was bound to spread. Cousin Charles living and working 500 miles from where his uncle will travel by bus/car/train/plane to attend his deathbed once he hears on his phone, will touch his uncle like any other caring human being and therefore will be infected. Thence to return to his home area and spread the infection. The question is if he was informed of the risks early on would he have traveled. I believe he wouldn’t. He would’ve stayed put and perhaps have visited the grave months later.
We could argue incompetence and not active racism. Well we could, if the bet made by the West wasn’t informed by the disease burning itself out. And that the analysis was predicated upon crass ill-informed assumptions about the west Africans living in isolated stone age villages.
As to what occurred when real humans returned to home after helping their fellow-man. That was just disgusting.

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10 Responses to Competence, and incompetence.

  1. Kelly says:

    A great deal of interesting information here. (remains in semen for up to 7 weeks following recovery?!)

    Okay….just taking the stance of “devil’s advocate” for a moment, but don’t you think developed countries would have reacted the same way if this had occurred in poor areas of Asia or South America? Of course “racism” isn’t limited to black/white, but don’t you think fear and ignorance played a big part in this? For that matter, trying to armor those in third-world countries with information and knowledge is often met with fear and distrust, as well.

    I’m not stating an opinion or offering solutions, but I will say I feel there was a lot of incompetence in the way many things were handled, both here and there, over the past few months.

    • V.H says:

      To some extent they would. Only I believe the impact would be less in Asia than South America for the Stares are stronger than Africa where the agencies of State are weak.
      My point is that it is very well known the precise lifespan of the virus by the medical community. But the west chose to ignore it’s own analysis about the States in West Africa and their capacity to deal with such or any real crisis.

      You see I think there should be a quasi-military fast reaction force with the capacity to enter and solve such issues. We saw more or less the same in Ceylon and Banda Achi. Nevermind the utter chaos of Haiti.

  2. Kimberly says:

    Our track record is less than spotless when it comes to aid to Africa, isn’t it. This is just another one of many examples where some small amount of help from us would have made a world of difference. I am unsure if it’s because of racism. Maybe it is, maybe it’s classism. I am sure that our response to it arriving here was from fear and ignorance (and the media capitalizing on that).
    The way the “officials” handled the health workers returning from helping in Africa was just as appalling. I’m far more concerned with their ability to virtually imprison someone, who is showing no signs of infection, against their will than I am with ebola.

    • V.H says:

      Have a read of this http://www.theatlantic.com/education/archive/2014/11/modern-day-segregation-in-public-schools/382846/ it goes some way to explain why I think thinking about Africa in general and in this case in precisely is informed by racism.
      We know that ‘all’ States in Africa have profound limitations. They’ve done what they can, but they are continually being stymied in their development. Yes, they have medical schools but most of their grad’s end up in the west. Their tax base is undermined every-which-way-to-Sunday all which leaves them in the condition of council estates in Europe and projects in the US. They have a tiny wealthy class wholly dedicated to keeping labour cheap and are hand in glove with the military and political class that we keep in place.

      • Kimberly says:

        My “I don’t know if” wasn’t disagreeing with you, but rather not knowing enough about it to say it is or isn’t. I think a lot of “our” policies may have an underlying layer of racism and some are in-your-face. This certainly might be one.
        However, as an educator who has 10 students, out of 24, who are anywhere from one to three years below grade level (which is something since they have only been in school for 3 years) and 8 who are reading above grade level, I truly don’t see tracking as racism. NO ONE in my room is getting the very best of me because there is only one of me and 24 of them all needing something completely different. I see tracking as a way to meet the needs of all students. And I’ve got kids who will never, no matter how hard they or I try, become proficient academically in the current model of education. I wish there was a place in the system where they would get what they need to live a productive life. They may not become an engineer or a doctor, but they may make a great mechanic or electrician or some other respectable tradesperson who doesn’t need to be on the track to college. We have nothing like that here. They’re either on the track to college or forced through that track hating every minute of it, not learning a thing, and maybe even dropping out. That’s the true atrocity of our system.
        Now, I’m not saying that race/social class do not factor into this. They definitely do. In most white middle-to-upper class families kids come to school ready to learn – clothed, full bellies, cultured (exposed to vocabulary), 2 or more supportive adults as caregivers, loved. And, sadly, that’s not the case for a lot of our kids at schools. They need more support and more help and more pretty much everything to be successful in school. The school system itself may be rigged so “the man” is keeping the minorities down. But, I truly believe the schools and teachers do what they can in a broken system that doesn’t have policies (good ones anyways – NCLB was a joke) to make sure that all of our kids leave school ready for adulthood, regardless of what that may be. I guess my point (Darn it! I climbed up on my soapbox again ☺ sorry) is that these policies may have been put in place out of hate and that’s why they limit the schools. But I tend to think it’s utter lack of understanding and incompetence that has made and keeps the status quo of our system. They never ask us how to make it better. What do we know anyways?
        But I can see where the microcosm of our schools in the urban areas making your point about Africa. A place where policies and backroom deals are keeping the people from becoming self-sufficient and brought into the modern times the rest of us get to live in. It’s hard for me to wrap my mind around that being the case. It’s almost like the more we delve into understanding the “why”, the more suspect our leaders become. How, in 2014 (almost ’15, gasp!), do we keep uncovering these hateful motives.

        • V.H says:

          I think if you take tracking as a good thing and I believe it is. But if one then don’t invest in the kids in the lower track way more that the higher ones the net result is to accept that they are 2nd class and because it’s education, that they always will be. This holds true here in Ireland as well as the UK where kids of lower ability who cannot fund private tutors simply will not advance. This is not true in most of the rest of Northern Europe. There the best available education is provided.
          This is where I’m equating the thinking. If one accepts that Ebola would run rife in States that haven’t the wherewithal and to help themselves survive I believe the choice has been made, and actively so, not to help.
          Today, both Ireland and the UK are officially sending health service nurses to West Africa. On the exchequer’s dime. Prior to this it was left to MSF and other charities.

          And no, I wasn’t incoherent with rage, or even slightly annoyed. Somehow the last comment was butchered and retained edits and rewrites when I Ctrl-Ced it into the box.

          • Kimberly says:

            I know that pigeon-holing the kids can be a byproduct of the tracking. And since I’m in primary school I don’t know what things are in place (or not) in those schools that do track that keep/should keep that from happening. And from that article it sounds like they were having that exact problem. And I don’t have an answer to that. In a perfect system, all kids would get a program tailored to their needs and learning styles. In a standardized system that is simply not the case.
            I had heard that small sanitary changes like burying those who died from ebola right away rather than keeping them out and exposed have been making a difference in those countries in Africa. But then just this morning, an article I read accused the CDC of making up those claims. It gets awfully hard to make heads or tails our of it all when our media sensationalizes everything and our policy makers are less than truthful.

            • V.H says:

              Yes, the point was being made that even those kids from middle class homes were tracked to the lower form if black.

              And yes we’re getting information from many different sources, some of which are contradicting each other..

  3. Ed says:

    My perspective from living in the United States is that you are confusing racism with a host of other factors. I’ve read lots of people around the world who feel we should have done more than we have in Africa and that what we did was essentially “saving our own butts”. I disagree. We are coming off the worst depression in 80 years and our economy is weakly growing again at best. We’ve been mired in wars for nearly 15 years that have cost untold trillions of dollars and thousands of lives. The appetite of the U.S. to send out the ‘troops’ to help those who can’t help themselves is weak at best. I don’t think it has anything to do with it being Africa or Argentina. It is simply anywhere. Had we had a robust economy and not been mired in wars in the Middle East, I would fully expect that we would have sent in the troops much like we did with the Tsunami a few years back, the Haiti earthquake, and numerous others we have been involved in.

    I also don’t have any statistics to back this up but I’m guessing if someone tracks foreign help involved, the U.S. is one of the top nations providing support in the Ebola stricken nations right now.

    I also think allowing doctors and nurses to freely roam around upon their return is a horrible mistake. While I don’t think we need to keep them in solitary confinement, I do think they need to be home quarantined. First, the two patients that got infected here in the United States did roam and cost the general society millions of dollars tracking down and monitoring all the people that perhaps had contact with them. A third doctor in New York who got infected in Africa and then went bar hopping with a fever also caused another huge response involving lots of money. So when the one nurse refused to be quarantined, she was risking lots of other peoples time and money, not just health. Second, what your articles don’t say, it the long term effects of surviving ebola. Many studies think that there is a strong possibility that the ebola virus lives in brain tissues for years after the patient has been ‘cured’. My wife just did a presentation among the medical community on this subject and their number one worry are the survivors who present weird and life threatening symptoms years later. Because we don’t know if being cured is truly being cured at this point, I think all due diligence should be done to prevent people from spreading it to others for selfish reasons like the nurse in Maine. 21 days of home confinement to ensure the safety of potentially thousands of others is a small price to pay.

    • V.H says:

      On the racism, no, I don’t think I am confusing it with other factors. Nor do I think Hanlon’s razor applies here either.
      If we found out about this last week and we had the response to date I would say we were doing very good indeed. But this has been going on since last March, eight months. During which only volunteers went to help.
      This is not something that should be left to volunteerism, no matter how effective or well meaning. This was and is something that requires discipline. And it doesn’t have to be the US providing it. In fact given the proportion of Muslim’s in those countries it would be better if the US confined itself to transport.
      But what got to me Sunday morning was on the BBC they were telling us they were sending the first NHS staff. I thought this had been done in June. I thought there was a clear idea about what was going on, with whom was to be doing what. But no, that isn’t the case, leastwise it wasn’t. There was a free for all with the same charities that mucked up the aftermath of the Tsunami were causing mayhem for the people who were ill didn’t know what to do, and nor did those tasking care of them.

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