Ebola – don’t panic yet

First a disclaimer. Although in a previous life I was fairly proficient in nuclear, chemical and biological warfare I am not an Ebola expert, not a public health one.

But I am increasingly concerned that measures are not being taken with sufficient urgency to contain Ebola. Nor am I convinced that the implications of uncontained Ebola have been thought through and the necessary actions planned.

First the facts:

  • Ebola kills 70% to 90% of its victims.
  • There is no cure.
  • There is no inoculation.
  • Ebola is transmitted via contact with infected bodily fluids, and the nature of the disease is that it produces lots of such fluids from each victim.
  • It is highly infectious – one droplet is enough.

For more technical details see http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

There is an outbreak in West Africa, and some victims have become infected in US and Europe. The problem is that in its early stages Ebola’s symptoms are like flu, but the droplets are of course lethal, even through the skin. There is therefore a very high probability that one person with Ebola will infect another. If more than one person is infected then an epidemic has the potential to kick off.

As there is no treatment for Ebola, the object of the medical profession is to support the victim in isolation while his body fights it off. If it doesn’t, then it’s a case of palliative care until the victim dies. Death can take up to a week, so on this regime every victim requires an isolation bed for a week. If infection rates are higher than one per isolation bed per week (as seems probable) then health facilities will be swamped. If alternative isolation facilities are not found quickly infection rates will accelerate as the volume of bodily fluids leaking increase, and thus the infection rate rises further and the disease infects more people over a wider area. Unchecked, at some point civic order will fail.

There is little good news. While Ebola may not be airborne, as the link makes clear, that is not certain. Also a droplet from a cough can travel a fair distance. The incubation time is from 2 to 20 days, so there could already be tens, if not hundreds of cases in Madrid. And elsewhere.

In the absence of a cure, prevention is the only sure option. The only way to not get Ebola is to not encounter any victim, but they can’t be identified. While at the moment the balance of probability is that you have not met a victim, that probability decreases alarmingly as the number of victims rise, particularly in modern cities. If you work in London, how many people do you pass within a metre of in a day? At some stage avoiding meeting others becomes prudent. A bit later it will become vital.

But we are not yet at that apocalyptic state yet. The best option is to contain the disease in West Africa. That means that their medical facilities need support and order needs to be imposed. With 70% mortality properly run mortuaries are crematoriums are probably more important that actual medical care. Disinfection and isolation regimes must be enforced. If the local governments can’t do it then others must step in. The simple fact is that Ebola poses a far clearer and more potent threat than the ISIL lunatics. And yet our government is focused on the latter.

If it was up to me I would cease all flights to and from the infected area. Now, and until at least one month after the last reported outbreak. I would also encourage other countries to do the same, and reserve the right to cease flights to and from countries that do not impose a similar ban. We did it because of a volcano that might have damaged jet engines so we can certainly do it for Ebola.

I would also get the armed forces ready to move. Not just medics, all of them. As was shown in the foot and mount epidemic here (which is an alarmingly similar problem), their ability to impose order onto a situation that might otherwise become chaotic is well established. They are all trained and equipped for chemical and biological warfare too. I would urge the infected countries to invite them in to help. If necessary, I would seek a UN mandate. The only other alternative is to seal the infected countries borders until the outbreak has run its course. That course could include 70% of the population dying.

We must be clear about what we are seeking to achieve. It is not to cure the afflicted, but to save the as yet uninfected.

Finally I would start to educate the UK public about what might be necessary, and why. I assume (and hope) that contingency plans exist and are being reviewed urgently and in secret. The government needs to get ahead of the game on this – last night’s revelation that there were only 4 isolation beds in the country was not prudent. While precipitate action might cause some panic the consequences of delay are far worse.

As an individual I am fortunate to live in the countryside. We were spared Foot and Mouth on our farm, although we were in the quarantine zone. I hope the rest of the country is as lucky as our cows.