Evening Ebola Update, Thurs, 11/13: Liberia out of state of emergency-bad move/Paul Farmer in JAMA   Leave a comment

11/13/14

Dear Colleagues:

1.  JAMA (Journal of the Amer. Medical Assn.) published today on line an article from the Harvard School of Public Health discussing what needs to be done specifically in West Africa to end this EBOV epidemic and prevent another epidemic.  The authors include Paul Farmer, MD, PhD, who is working now in West Africa.  The article reports that Staff is needed; the Staff should be communal health care workers trained to care for EBOV patients because physicians are very rare in West Africa and West Africans distrust strangers.  Local workers would build trust in EBOV treatment centers among the population.  Health Care Resources are also needed; these resources are basic supplies such as gloves, gowns, and IV fluids, not the experimental drugs being tested.  Finally, Systems are needed to coordinate care among the countries affected, to trace contacts, to fill in data gaps, e.g., why no cases from Liberia this week, and to set in place a rapid response team for any new outbreak.  See the complete article at: http://jama.jamanetwork.com/article.aspx?articleid=1915433

2.  PLoS Neglected Tropical Diseases today provides a partial answer to the JAMA article on missing Systems in West Africa.  Gebreyes, et. al. from the Ohio State University College of Veterinary Medicine discusses One Health, a congress initially held in Ethiopia in 2011 to provide more knowledge of zoonotic infectious disease throughout the world.  See the entire article at: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003257

3.  PLoS Current Outbreaks published on line today an article by Kiskowski from the Department of Mathematics at University of South Alabama an article which states the EBOV epidemic can be stopped if community mixing is stopped in West Africa.  The article is a mathematical approach to the problem of community mixing.  In my opinion, prevention of community mixing is a tall order because human mobility is 7X greater in West Africa than the rest of the world (Alexander, et. al. in last night’s blog).  Tribes are always on the move, from base village to specific neighboring villages.  See: http://currents.plos.org/outbreaks/article/a-three-scale-network-model-for-the-early-growth-dynamics-of-2014-west-africa-ebola-epidemic/ for this article.

4.   USA Today reports that U.S. will reduce its trooper deployment in West Africa from 4,000 to 3,000 troopers because of improvement of EBOV situation in Liberia.  I believe this is a premature action, and I believe the Liberian President’s ending of the state of emergency is also premature.  The NY TImes reports 539 cases in Liberia for the week ending November 4th.  This case number is 2X the case number reported in Sierra Leone and 5X the case number reported in Guinea for the same week.  Epidemics don’t suddenly stop in 7 days after 539 cases reported.  See second graphic at NY Times site: http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?ref=health

RGL, MD

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Posted November 14, 2014 by levittrg in Ebola

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