The business of medicine – and the band played on…

Its official, I am starting to be concerned about the spread of Ebola to the developed world.  Now, let me make this clear, I doubt we would have a major epidemic in a country like the US.  But with the sheer number of cases reported and the fact that the epidemic is gaining steam makes the possibility of cases developing in the developed  world more likely.  The WHO just released a very grim prognosis regarding the course of the epidemic in Africa and given the way things are going, I see why they are concerned.

Ebola outbreak spreading and showing no signs of peaking…

Yesterday, I  read an article in The Washington Post article about Ebola spreading to Senegal the following points were particularly worrying:

  • The spread to Senegal itself is of great concern because  Senegal is a major transportation hub for the entire region.  Once Ebola establishes itself in a region where travel is easily accessible, it is going to be more difficult to contain.  In the 21st century, diseases from remote areas are generally just a plane ride away.
  • Another particularly alarming piece of information buried in the article was the fact that 40% of the total reported cases have occurred in the past three weeks.  That indicates that this Ebola outbreak is a long way from peaking.
  • The virus has mutated during the course of the epidemic which could complicate diagnosis and could (perhaps) be creating a situation where the number of actual cases is being underestimated.  Underreporting is already an issue as Africans, understandably suspicious of the care offered in hospitals, are attempting to care for their loved ones themselves. The latter also helps spread Ebola since direct contact with bodily fluids is how its transmitted.

A few weeks ago, I posted in a New York Times comment section that it was not a question of if, but when Ebola would come to the developed world.  At that time I was thinking that this was an unlikely scenario in the current situation and was more concerned about future outbreaks.  But with the numbers in Africa increasing, it would be foolish not to consider the possibility of  cases appearing in the US or europe.

I will modify what I say about my concern here.  There are many factors that are involved in transmission.  One thing working against the virus and for us, is that direct contact is necessary for transmission.  It certainly is far less transmissible than  – say – smallpox which required only casual contact for transmission to occur.   In the case of smallpox one person would  infect 5-7 other people (don’t hold me to this number).  I’m not sure what that number is for Ebola.  Maybe 2-3?  The rate of spread in Africa is alarming, but that may be in part due to the fact that people are trying to take care of their loved ones themselves and are not taking the proper precautions.  Many probably don’t understand that handling bodily fluids is how this virus is spread and are not taking appropriate precautions.  I’m surmising, but its an educated assumption.

Full disclosure, I haven’t worked as a scientist (save for teaching) for about 9 years.  Also I was never an epidemiologist. But you don’t need to be a rocket scientist to see the obvious.

Once again – where was the WHO and the CDC on vaccine production?

Anything with this kind of mortality rate, whether easily transmissible or not should be the active subject for vaccine production. The current epidemic has an over 50% mortality rate.  Other outbreaks have recorded mortality rates of close to 90%.   Why no vaccine?

Public health officials have not been out to lunch, but they have been underfunded.  The supply-side, deficit-hawk, privatization cartel have been firmly in charge of the funding agenda in Europe and the US since the market collapse (which their ideology probably caused).   They have cut the NIH, CDC, and WHO budgets to the bone.  If nothing else, Ebola is proof that the private sector does not have all the answers and should never be a substitute for a vigorous public health system.  As I said in my previous blog on the private/public sector partnership in biomedical research, all the supply-side has managed to produce for Ebola  is an experimental and massively expensive cocktail of monoclonal antibodies that that probably costs about five-figures/dose.

Once again, the private sector is no substitute for a public health system.

© 2014 – RGHicks – – All rights reserved.


Tags: , , , , ,