To wonder why there isn't more resource being thrown at Ebola?

[Roonerspism]

There are now reports this outbreak could kill a million people in West Africa. It could mutate. Countries like Spain cannot contain it properly.

I don't understand why countries have been so slow to react. It could have been controlled so much easier had we responded sooner. Now we seem to be dealing with a catastrophe for Africa. What if it spreads to India? It seems likely to hit most countries, even if contained.

It seems unbelievable we have slept walk into this.

Not sure what we can do about it anyway given that we can't cure it. What are the countries it originated in doing about it and could they have done more in advance? It's not just our job after all.

Even medically trained professionals have children.
They must have proper training and equipment to be deployed.

This is an unusual outbreak, there have been a few so far and with never more than a few hundred cases. The exponential rise did take people by surprise.
And it takes a lot longer to prepare than sending food to a natural disaster.

Still, it is true that the WHO has had a somewhat slower response and its director will be having a lot to explain.

Would you personally want to go and work with people that could potentially give you a fatal disease? No?

That's probably why.

It's great you want something done at someone else's expense/life though.

I was asking because if there were things that should/could be done by the government individuals here (and I expect there could be many I couldn't possibly predict) then I'd like to know. So I could either do them, or campaign for them.

Examination of what should/could have happened earlier can wait, can't it? Right now the priority is (I hope) getting the right help to the right places as soon as possible, isn't it?

I can scratch my head as well.

But seriously, just what do you really expect?

An unprecedented outbreak of disease and you think someone should have responded sooner/differently?

Armchair warriors eh.

Not sure what we can do about it anyway given that we can't cure it. What are the countries it originated in doing about it and could they have done more in advance? It's not just our job after all.

Since they already had weak and massively underfunded healthcare systems that were struggling to cope with the health issue their populations already had, I'm guessing there's not much they could have done in advance. Ebola was probably not high on their list of things to plan for given that we've not had an outbreak in West Africa before.

Currently they're short of equipment, appropriately trained staff and basic infrastructure, including specific Ebola treatment centres. Newly opened ones are filling within minutes. There really isn't a lot they can do without significant support from charities and the international community.

I'm sure lots of us would happily campaign for other people to go over there and risk death to help, if indeed anything can be done to help other than just contain the existing outbreaks?

The he most stupid decision was made by the Spaniards in bringing their two priests with Ebola back to Spain in the misplaced and arrogant belief that they could contain this virus.

Some of us will remember the smallpox outbreak in Birmingham when the virus escaped from a lab and infected the scientist and a man working in the floor below the lab.

If you bring deadly viruses into densely populated countries things are almost certainly likely to go wrong.

We are so stupid

How is that stupid? The Americans, French and UK have all taken infected citizens home for treatment, all without any starting an outbreak so far. The first infected Spanish priest doesn't seem to have started an outbreak.

Clearly something has gone wrong with the second Spanish case, but it wasn't 'almost certainly likely'.

it's worth remembering though that while the outbreak has been higher this time the death rate has been significantly lower down from approx. 90% to about 50%, so this particular strain of the virus is not as deadly as previous strains.

And realistically I'm not sure what it is our government should be doing? We already have aid workers out there helping and at least one of those has become infected with the virus. Should we be sending out more people and putting them at risk only to refuse them entry back into the country in case they bring it back with them?

Saying we should have responded to this in the same way as the tsunami is an ott and hysterical response to a virus which thus far has only claimed a few thousand lives.

HIV/aids is a far bigger problem in Africa with approx. 25% of the population believed to be infected in some areas, and in that instance we are in a position to do something about that and should be. Ebola is tragic for those affected but let's put it into perspective in the context of the population/infrastructure of Africa....

The Spanish are rightly worried. Major transit systems used by millions daily and the like in the west, especially london and other capitals mean we should all be very very worried about ease of transmission

wannabe presumably that's the proportion of fatal cases (and not case fatality rate)?

23 September:

"A new paper from the WHO Ebola Reponse Team in New England Journal of Medicineprovides the first proper estimate of the CFR from a large sample of cases with known outcomes.Itestimates the CFR to be 0.71 (95% CIs 0.69 to 0.73) based on a sample of 1737 patients with definitive outcomes recorded and the estimates are extremely consistent amongst the 3 countries most affected. From the paper:

"Our estimates of case fatality are consistent in Guinea (70.7%), Liberia (72.3%), and Sierra Leone (69.0%) when estimates are derived with data only for patients with recorded definitive clinical outcomes (1737 patients). Estimates for hospitalized patients with recorded definitive clinical outcomes are also consistent across countries but are lower than those for all patients with definitive clinical outcomes. In contrast, simply taking the ratio of reported deaths to reported cases gives estimates that differ among countries (Table 2). These discrepancies perhaps reflect the challenges of clinical follow-up and data capture."

"This is extremely similar to the estimate from 77 patients in the Gire et al paper and is consistent with the estimate from Guinea when the number of cases per day was low."

(CFRs can really only be established after an outbreak, when all outcomes are known. This estimate is restricted to known outcome. PFCs tend to be lower as they include all cases, including those where outcome is not yet known).

You need to stop worrying about a disease that is highly unlikely to mutate, is not airborne and can be contained.

For example - Measles kills over 100,000 people a year, especially in Africa But increasingly in Eurpope. It is airborne and it is hard to contain. The average Ebola sufferer may infect 1 or two other people, the average measles sufferer may infect 10 or 11.

I'm more scared of measles than Ebola.

I think we can all reasonably be angry with the WHO's sluggish response to ebola, can we not? We're not exactly armchair warriors, we're also paid up members of the WHO.

I sat in a lecture yesterday in front of a newly arrived young man from Sierra Leone.

He then proceeded to cough all over the back of my neck for two hours glad to hear it's not airborne!

Plus, you're dealing with countries that are not only suffering with a serious lack of medical infrastructure, they are also having to cope with a population that is highly suspicious, superstitious, and, in many villages, isolated. The estimated number of cases can never be accurate whilst you struggle with the situation where entire villages are barracking themselves in, and refusing to allow access to medical personnel. You're going against their customs with regard to caring for the sick, and dealing with the dead. You're dealing with people who are attacking clinics, and 'liberating' their sick. At best, the figures are a guesstimate. We will never really know how many have caught ebola in these outlying places.

One thing I would like to see over here, is more emphasis placed on the dangers of bushmeat. There's a thriving black market for it, and an educational push to make the purchasing population aware that it is highly dangerous would seem to be a good idea to me.

If it comes here, we will cope. Nigeria contained it, Senegal contained it; it is a crisis in Liberia and Sierra Leone because they simply don't have the infrastructure in place to deal with an urban outbreak like this. Their healthcare systems, if they can be called that, are run by overseas charities, and are, for the most part,very basic health clinics.

you aren't going to catch it on the tube! it's not airborne - unless you enjoy sharing bodily fluids with sick strangers it's unlikely you will get it on your way to work

It's being contained - no need to panic

*barracking - barricading

When should they have acted then?

I've been looking into the timelines a little more. The number of cases passed the previous largest outbreak some time in July.

WHO started issuing the highest level warnings on 8 August. Should that have been earlier? (Based on evidence then, not hindsight). And before characterising them as "sluggish", is it going to be possible to separate out what they have actually been doing for most of the year (which is a lot) from what the media have chosen to report and when?

The British Government offered the clinic in August, work started to build it in September, open for business October.

Major transit systems used by millions daily and the like in the west, especially london and other capitals mean we should all be very very worried about ease of transmission

It is not easily transmitted and it's not likely that it will become more easily transmitted. You need closer contact than just transit.

But if someone coughs in your face and you get particles of saliva in your mouth or nose is that risking infection?

What does airbornne mean exactly?

Closer contact like what? What counts as closer?

Sneezing/coughing on you?

Daughter that's what I want to know!

And if it is transmitted by the handling of dead bodies does that mean it can linger, why doesn't it die when its host dies.

Grim conversation for breakfast time...