1. The Lancet on-line 6 January has an article by Merler, et. al. from the Bruno Kessler Foundation, Italy, and Northeastern University in Boston re: computer modeling of the EBOV epidemic in Liberia. The computer modeling was based on geographic and demographic data from Liberia. Three populations were ‘subjects’: people with EBOV and without EBOV who visited Ebola Treatment Centers; HCW who attended EBOV patients not in Ebola Treatment Centers but at home; people who attended burials of EBOV patients. The authors (senior author is Vespignani) found 33% of EBOV infections acquired in hospitals; 33% of EBOV infections acquired in households with EBOV patients; 8% of EBOV infections acquired by attending funerals of EBOV patients.
2. Merler, et.al. found the EBOV infection rate in Liberia was decreased by isolating suspected or confirmed EBOV patients in hospitals to prevent mixing of these patients with non-EBOV patients; institution of safe burial practices; distribution of household infection prevention kits. See the Merler, et. al. article at: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71074-6/fulltext
3. A Comment (Editorial) by Chowell, et. al. from Georgia State University and the International Epidemiology Division at NIH, emphasizes the impact that Ebola Treatment Centers had on reducing the EBOV infection rate in Liberia. Look at the Figure in the Chowell, et. al. article and you will see that Sierra Leone, which has an increasing EBOV infection rate, has one-half the EBOV beds that Liberia does. See the Chowell, et. al. Comment at: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71086-2/fulltext
4. NEJM 8 January (two days from now) has two Letters re: EBOV in West Africa on pages 188-189. The first Letter reminds readers that the Ivory Coast separates West Africa from Ghana and is a crossing point for travelers from West Africa to Ghana. So everyone is watching out for EBOV transmission across Ivory Coast, but there is another epidemic we should also be on the look-out for. Ghana is having a cholera epidemic, and this epidemic can travel across Ivory Coast to West Africa. The WHO and UN need to stop this cholera epidemic in Ghana before West Africa gets its second epidemic in as many years.
5. The second Letter in the NEJM asks the WHO Ebola Response Team to make available to researchers and clinicians the specific data WHO has collected on the demographics, geographics, and clinical courses of EBOV patients in West Africa. The writers say that previous EBOV epidemics have been in Central Africa so that data may not be applicable to the West African EBOV epidemic. Dr. Dye of the WHO Ebola Response Team responds to this Letter; he says that ‘under specific conditions’ and ‘after discussion with external research groups’ the WHO does share data.
6. The WHO Ebola Response Teams’ statement says to me that WHO data is shared only in special circumstances. In my opinion, EBOV clinical data should be shared with all physicians treating EBOV patients by open sourcing the data sets; patient confidentiality can be protected. All EBOV patients deserve the ‘best’ care, which requires their physicians to know what worked and what didn’t work for EBOV patients who had similar presentations.