Ebola: Too little, too late, lost lessons from the recent past, too much too late . . . We’re reading chronicles and updates from West Africa

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NewWWRDuring a talk last week at the Kaiser Family Foundation in Washington, DC, U.S. Centers for Disease Control and Prevention Director Dr. Tom Frieden contrasted the scenes of horror and futility he saw during a tour of West Africa health facilities overwhelmed by the region’s Ebola crisis in late August, with the promising and even proactive efforts he saw on his return to the region in December. Having just ended his own 21-day medical monitoring for signs of the virus, he emphasized “we’re not out of the woods,”  and described how new outbreaks  and deaths continue and, in some areas, continue to overwhelm care capacities. He reiterated the confidence he had voiced that morning at a U.S. House Africa subcommittee event  that the goal of “getting to zero” Ebola cases in the region would eventually be reached, and repeated that any result short of that will represent the failure of belated efforts that have begun to yield progress. In spite of that confidence, he also elaborated at both events on an alternate scenario he termed “unacceptable,” in which the disease goes into hiding in remote areas, remaining endemic — and endless. The challenge, he said, is the speed with which Ebola moves, outstripping the guesswork and anticipation even of those who have learned to respond with urgency. In a World Health Organization report on a year of the epidemic , in a New Yorker  “Letter from West Africa,” and in a slightly surreal Washington Post update from an empty Ebola treatment center in Liberia, we’re reading about the shifting shapes of responses to an epidemic.

When the fever breaks – Writer Luke Mogelson spent November in Liberia and Sierra Leone, and in this New Yorker article describes settings devastated by both Ebola and responses to it, and the impetus and successes of homegrown efforts.

One year into the Ebola epidemic – The Ebola epidemic was eight months on, and in the preceding several months had spread across three countries with skeletal health systems and porous borders before the World Health Organization declared the crisis an international health emergency and issued a “roadmap” of strategies to respond to the epidemic last August. This WHO-published report doesn’t include the introspection that such a chronology would seem to call for, but with a methodical telling of how the virus spread, unrecognized, from a child in Guinea, to his family, and then across West Africa, and including a chapter on “Key events in the WHO response,” (as well as a look back at the 2009 H1N1 flu pandemic and “Warnings the world did not heed”) it is a page-turner all the same.

U.S.-built Ebola treatment centers in Liberia nearly empty – First there were Ebola patients with no where to go. Now there are Ebola treatment centers with no patients. This update from Liberia in the weekend Washington Post tells why in public health crisis responses, timing is everything.

One thought on “Ebola: Too little, too late, lost lessons from the recent past, too much too late . . . We’re reading chronicles and updates from West Africa

  1. David Fedson

    In July, 2014, officials at WHO were notified that it might be possible to treat the host response to Ebola virus infection (not go after the virus itself) and that doing so might save lives. This suggestion was ignored by WHO and also by Ebola scientists and health officials who have defined the international Ebola response. Now, six months later and after thousands have died, we know that at least 100 Ebola patients were treated by local physicians in Sierra Leone with a combination of an inexpensive generic statin (atorvastatin) and a generic angiotensin receptor blocker (irbesartan). All but two of the patients survived. These results were not obtained in a carefully monitored clinical trial, and therefore they need to be rigorously validated. Moreover, for reasons unknown, physicians in Sierra Leone have been reluctant to release information on their treatment experience. Nonetheless, it’s hard not to believe that some benefit was achieved with this treatment. Which leads to a question: will anyone pay attention to what has happened?

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