A slow and inadequate response to a disease in Africa

Google would not index this article in a timely manner under its original title, “The catastrophic international response to the looming Ebola pandemic,” The Trenchant Observer, October 27, 2014.

This is not the first time Google has neglected to index an article of obvious importance where timely access was of critical importance.

See the following article and those cited within it.

Not indexed by Google: Trenchant Observer article with text of Security Council Resolution 2118; the unregulated power of a totalitarian instrument of thought control (updated November 27, 2013), September 28th, 2014

There is mounting evidence to indicate government authorities, including the United States and the World Health Organization, are acting to manage the news and narrative about the risks of the exponential spread of the Ebola cases in West Africa, and the slow and inadequate responses of the international community to halt its advance.

Today on Al Jazeera America or CNNi, a WHO spokesperson, with carefully chosen and clever words that did not contradict the known scientific facts, sought strenously to downplay the truly frightening dimensions of the Ebola pandemic in West Africa. She stated, misleadingly, that the (best scientific estimates) of the progression of the disease were “not predictions” but only “calculations”.

The overall impact of these clever people is to downplay the disastrous nature of the current situation, in efforts to avoid alarm (which is needed) and cries for accountability for the failure to respond more effectively (which is also needed).

In not speaking frankly and openly to the public about the scientific evidence and the facts, this WHO spokesperson (and the U.N. representative quoted below), and President Obama who recently issued similar assurances, do us all a great disservice. President Obama’s statements, like his recent appointment of a domestically-oriented “Ebola Czar”, also appear to serve more immediate electoral purposes.

The situation is alarming, and alarm should be spread throught the land, and the entire world.

The original article follows.

“The catastrophic international response to the looming Ebola pandemic,” The Trenchant Observer, October 27, 2014.

Sadly, the United States and other developed countries have been focusing their attention on the few cases which have reached their shores, instead of the fact that the Ebola epidemic in Liberia, Sierra Leone, and Guinea is spiraling exponentially out of control.

Delays in implementing adequate isolation and containment measures have resulted in an ever-greater spiral of needs–particularly Ebola treatment Centers and teams of highly-trained medical personnel from abroad to staff them–that are not being met.

Experts using sophisticated models estimate that 70% of new cases need to be isolated in Ebola Treatment Centers to stop the exponential rise in new cases. Progress toward reaching the target number of hospital beds and medical personnel has been falling behind the time markers for effective interventions.

The costs of delay have been catastrophic, including tens of thousands of lives that might have been saved but now will not be. Each week the international response falls further behind the curve.

In fact, the lumbering response of the international community–despite the heroic efforts of thousands of doctors and other medical personnel and supporting staff to meet an extraordinary challenge–means that the window of opportunity for bringing the epidemic under control any time soon, say by early next year, is rapidly closing. There is then the possibility that interventions will not be able to catch up with the spread of the disease, which has the potential to become a pandemic reaching well beyond West Africa.

Most of the news coverage is now almost beside the point. What needs to be reported, every day, is the following:

1. Number of Ebola Treatment Centers in place and functioning as percentage of those required under different scenarios;

2. Number of hospital beds available in such centers as percentage of those required under different scenarios;

3. Number of Ebola medical teams in place and functioning as percentage of number required under different scenarios; and

4. Estimated number of cases not avoided and lives not saved due to delays in implementation, under different scenarios.

See the latest statistics in the following TIME article, the report on which it is based, and the (Sixth) Morbity and Mortality (MMWR) Special Report, dated September 26, 2014 (cited further below):

(1) Alexandra Sifferlin, “Study: Current Aid Promises Won’t Contain Liberia’s Ebola Outbreak,” TIME, October 25, 2014.

(2) Joseph A Lewnard BA a b †, Martial L Ndeffo Mbah PhD a b †, Jorge A Alfaro-Murillo PhD a b, Prof Frederick L Altice MD a c, Luke Bawo MPH d, Tolbert G Nyenswah MPH d, Prof Alison P Galvani PhD a b, “Dynamics and control of Ebola virus transmission in Montserrado, Liberia: a mathematical modelling analysis,”
THE LANCET -Infectious Diseases, Early On-line publication, October 24, 2014.

(3) Rachael Rettner, “‘Catastrophic’ Ebola Toll in Liberia Is Predicted Unless Aid Scales Up, LiveScience.com (Yahoo News), October 24, 2014 (12:24 PM).

For references to an authoritative model of the spread of the Ebola virus disease, under various intervention scenarios including timing, see

“Three imperious challenges for U.S. foreign policy: Ukraine, ISIS and Ebola, The Trenchant Observer, October 13, 2014.

The portions of that article dealing with the Ebola crisis follow:

The Ebola Epidemic

With respect to the Ebola epidemic, currently out of control in West Africa in Liberia, Sierra Leone and possibly Guinea, which potentially threatens the entire world, the U.S. Centers for Disease Control (CDC) have played a superb role in leading the response to he crisis on a technical, medical level. They have laid out the case that if 70% of new cases are not confined to Ebola treatment centers by November 20, the exponential growth in the number of infected individuals may reach 1.4 million in Liberia and Sierra Leone by January 20.

Obama has pledged to send 3,000 military personnel, but they will not be on the ground before November. Meanwhile the contagion of the disease continues to explode. Resources and above all the coordination of efforts have been slow to materialize on the ground. This is a situation which calls for massive and extraordinarily urgent action, but the U.S. has only said what it is going to do, and that’s it.

Unfortunately, the U.N. special representative for the Ebola crisis, Dr. David Nabarro, has been putting the credibility of the United Nations Ebola response on the line with optimistic statements that appear not to have a solid basis in scientific fact, or which are at least highly misleading. He has stated, for example,

The UN special envoy on Ebola says he hopes that the outbreak can be brought under control within three months.

David Nabarro told the BBC the number of Ebola cases was currently increasing exponentially, but greater community awareness would help contain the virus.

People were becoming aware that isolating those infected was the best way to prevent transmission, he added.

So far, there have been more than 8,300 confirmed and suspected cases of Ebola, and at least 4,033 deaths.

Mr Nabarro said that the number of new cases was “quite frightening”, as the spread of the disease was currently accelerating.

At the beginning, many west African communities did not understand that the outbreak was an infectious disease, he said.

“I think we’ve got much better community involvement [now] which leads me to believe that getting it under control within the next three months is a reasonable target,” he said.

–“UN: Ebola outbreak could be controlled in three months,” BBC, October 11, 2014 (23:52 ET).

His assertions stand in sharp contrast to the scientific analysis contained in the last (sixth) Morbity and Mortality Weekly Report (MMWR) Special Report, dated September 26, 2014, which explained that under a worst case scenario the total number of Ebola cases in Liberia and Sierra Leone would be likely to reach 1,400,000 by January 20, 2015.

If trends continue without additional interventions, the model estimates that Liberia and Sierra Leone will have approximately 8,000 total Ebola cases (21,000 total cases when corrected for underreporting) by September 30, 2014 (Figure 1). Liberia will account for approximately 6,000 cases (16,000 corrected for underreporting) (Appendix [Figure 1]). Total cases in the two countries combined are doubling approximately every 20 days (Figure 1). Cases in Liberia are doubling every 15–20 days, and those in Sierra Leone are doubling every 30–40 days (Appendix [Figure 1]).

By September 30, 2014, without additional interventions and using the described likelihood of going to an ETU, approximately 670 daily beds in use (1,700 corrected for underreporting) will be needed in Liberia and Sierra Leone (Figure 2). Extrapolating trends to January 20, 2015, without additional interventions or changes in community behavior (e.g., notable reductions in unsafe burial practices), the model also estimates that Liberia and Sierra Leone will have approximately 550,000 Ebola cases (1.4 million when corrected for underreporting) (Appendix [Figure 2]). The uncorrected estimates of cases for Liberia on September 9, 2014, were 2,618, and the actual reported cases
were 2,407 (i.e., model overestimated cases by +8.8%). The uncorrected estimates of cases for Sierra Leone on September 13, 2014, were 1,505 and the actual reported cases were 1,620 (i.e., model underestimated cases by -7.6%).

See

“CDC projects huge increase in number of Ebola cases in West Africa until 70% of new cases confined to Ebola treatment centers or equivalent, The Trenchant Observer, October 6, 2014.

Adam Nossiter, “Officials Admit a ‘Defeat’ by Ebola in Sierra Leone,” New York Times, October 10, 2014.

Whether the 70% level of Ebola treatment centers or equivalent isolation can be achieved in time to break the momentum of the epidemic by December is an open question. Significantly, the critical factor is isolation not community understanding of the disease and its transmission, though the latter factor is obviously critically important in order to reach the 70% isolation target.

The Trenchant Observer

About the Author

The Observer
"The Trenchant Observer" is edited and published by The Observer, an international lawyer who has taught International Law, Human Rights, and Comparative Law at major U.S. universities, including Harvard, Brandeis, the University of Pittsburgh, and the University of Kansas. He is a former staff attorney at the Inter-American Commission on Human Rights of the Organization of American States (IACHR), where he was in charge of Brazil, Haiti, Mexico and the United States, and also worked on complaints from and reports on other countries including Argentina, Chile, Uruguay, El Salvador, Nicaragua, and Guatemala. As an international development expert, he has worked on Rule of Law, Human Rights, and Judicial Reform in a number of countries in Latin America, the Caribbean, Africa, the Middle East, South Asia, and the Russian Federation. In the private sector, The Observer has worked as an international attorney for a leading national law firm and major global companies, on joint ventures and other matters in a number of countries in Europe (including Russia and the Ukraine), throughout Latin America and the Caribbean, and in Australia, Indonesia, Vietnam, China and Japan. The Trenchant Observer blog provides an unfiltered international perspective for news and opinion on current events, in their historical context, drawing on a daily review of leading German, French, Spanish and English newspapers as well as the New York Times, the Wall Street Journal, the Washington Post, and other American newspapers, and on sources in other countries relevant to issues being analyzed. The Observer speaks fluent English, French, German, Portuguese and Spanish, and also knows other languages. He holds an S.J.D. or Doctor of Juridical Science in International Law from Harvard University, and a Doctor of Law (J.D.) and a Master of the Science of Law (J.S.M.), from Stanford University. As an undergraduate, he received a Bachelor of Arts degree, also from Stanford, where he graduated “With Great Distinction” (summa cum laude) and received the James Birdsall Weter Prize for the best Senior Honors Thesis in History. In addition to having taught as a Lecturer on Law at Harvard Law School, The Observer has been a Visiting Scholar at Harvard University's Center for International Affairs (CFIA). His fellowships include a Stanford Postdoctoral Fellowship in Law and Development, the Rómulo Gallegos Fellowship in International Human Rights awarded by the Inter-American Commission on Human Rights, and a Harvard MacArthur Fellowship in International Peace and Security. Beyond his articles in The Trenchant Observer, he is the author of two books and numerous scholarly articles on subjects of international and comparative law. Currently he is working on a manuscript drawing on the best articles that have appeared in the blog.