Grim's Hall: Curves bending the wrong way

For a week or more recently, I hunted for new statistics on the Ebola outbreak, but the official death toll was stuck in the 800 range, despite hints that the reporting system had broken down. It now looks as though the infections and deaths were indeed piling up silently. Reported deaths are now over 1,400. WHO now admits that the outbreak has spread to the Congo, after initial denials. The Ivory Coast has closed its borders.

Ebola remains a relatively difficult disease to transmit, or we wouldn't be seeing deaths in the 2,000 range six months into an epidemic in countries with almost no institutions capable of slowing its spread: we'd be seeing millions. The 1918 influenza spread worldwide in a few months and killed something like 50 or 100 million people (the world was in such a mess, and reporting systems so rudimentary, that it's hard to be sure). Now, the flu: there's a virus that knows how to spread. It's contagious before symptoms occur, for instance, which is not the rule with Ebola.

Ebola kills just over half of the people who contract it, in horrific conditions. We have no information to speak of on what percentage of people it kills in a modern hospital capable of delivering good supportive care while the body mounts its own immune response. As infected Europeans come home for decent treatment, though, we may be about to find out.

Like many of the diseases that have intruded themselves on human attention, including HIV, influenza, West Nile virus, bubonic plague, Lyme disease, and salmonella, Ebola is an example of zoonosis, meaning that it has an animal reservoir and occasionally spills over into the human race. The current thinking appears to be that Ebola, like rabies, Chunkunguya, influenza A, SARS, Hendra virus, and Nipah virus, may have its reservoir in bats. Bats make a good reservoir for human disease. They resemble humans in several important respects: they're long-lived mammals, they cover long distances on the wing, and they live in huge communities capable of sustaining an infectious disease. Bats are lovely creatures that serve their neighbors well by eating lots of insects, but it's a really terrible idea to go into a bat-cave, especially in Africa.

Lately it's a bad idea to go anywhere in Africa. Ebola is the least of their worries.

3 comments:

Ymar Sakar1:22 PM
Is this what people are worried about now.
james6:06 PM
The fear is partly the worst-case progression of the disease, and partly the "no cure" and partly how harsh it is on doctors and nurses and the burial team--nobody left to help.

Is the Congo strain the same one, or one of the older ones paying a new visit?

I'm pretty sure the latest numbers are still too low, though at some point every death will be attributed to ebola because there's no way to tell a non-dramatic ebola death from a malaria death without investigating--and there's no time or money for that.
Texan9911:51 PM
At first WHO claimed the Congo disease was something different--I think they were calling it Congo Hemorrhagic Fever--but as of today they're saying it's Ebola. Or at least some of the cases tested positive for Ebola.

While it's true there's no cure as such, it's also true that there are effective treatments. Most people's immune systems will eventually clear the virus if they can be supported through the symptoms for a week or two, with fluid support and careful attention to over-clotting and under-clotting. The problem is that treatment on this level is likely to occur only in a first-rate, relatively unstressed hospital, and that's not much comfort in a collapsing health system in Africa.

Of course, in Africa, a thousand things are more likely to kill you than Ebola, just from the medical point of view, without even getting into the prospect for mass murder.