Thursday 9 October 2014

Ebola expert speaks


Ebola is a true intelligence test item, a hard problem to solve with real consequences if you get it wrong. I have posted about Ebola several times in the last few months, but I think I covered the basic point on 5 August in “Solving Ebola” where I mentioned an obvious strategy:

If treatment is really unlikely to help victims, then in a big outbreak it might best to avoid attempts at close contact nursing, and rely on quarantine and subsequent disinfection as the best way to save more lives. Perhaps hydration packs distributed to homes under quarantine would be best, but that is for public health specialists to judge.

Your can read the whole post (link below) to check that I really said that, and that I did not immediately contradict myself.

I again mentioned the advantages of quarantine on 12 August, and made a stronger case for quarantine on 3 October:

The following day, 4 October, Prof Peter Piot, the Antwerp researcher who discovered Ebola in 1976 gave an interview to The Guardian/Observer. I had already mentioned him in previous posts. Most of the interview is the very interesting story, re-told many times in the past few months, about his pioneering work tracking down and understanding the new disease. It is a celebration of field work and laboratory science.

At the end of the interview there are some intriguing new bits.

What can really be done in a situation when anyone can become infected on the streets and, like in Monrovia, even the taxis are contaminated?

We urgently need to come up with new strategies. Currently, helpers are no longer able to care for all the patients in treatment centres. So caregivers need to teach family members who are providing care to patients how to protect themselves from infection to the extent possible. This on-site educational work is currently the greatest challenge. Sierra Leone experimented with a three-day curfew in an attempt to at least flatten out the infection curve a bit. At first I thought: "That is totally crazy." But now I wonder, "why not?" At least, as long as these measures aren't imposed with military power.

A three-day curfew sounds a bit desperate.

Yes, it is rather medieval. But what can you do? Even in 2014, we hardly have any way to combat this virus.

Do you think we might be facing the beginnings of a pandemic?

There will certainly be Ebola patients from Africa who come to us in the hopes of receiving treatment. And they might even infect a few people here who may then die. But an outbreak in Europe or North America would quickly be brought under control.

(end of extract from interview)

So, I can say, with some pride, that the tentative suggestion I made on 5th August has received the imprimatur of The Expert on 4 October. Perhaps he reads this blog, or more likely he has just been thinking about it a little: “Yes, it is rather medieval. But what can you do? Even in 2014, we hardly have any way to combat this virus”.

However, in the tradition of the savage scepticism practiced here, I think that Prof Piot still doesn’t understand the situation. Belatedly, he now backs quarantine “as long as these measures aren't imposed with military power.”

How else does this noble bench scientist think that quarantine can be applied effectively? By his supposed education program, given to citizens who still do not accept the contagion model of disease, and who are still denying Ebola? The whole point of quarantine is that it will save the lives of many people, while inconveniencing and even threatening the lives of a smaller number. Some will die in their houses when, without quarantine, they could have rushed to safety outside, and carried the virus with them to infect others. Quarantine is a desperate measure, but dying from Ebola is worse.

Prof Piot is sanguine about African Ebola cases coming to Europe and infecting Europeans, and is sure that an outbreak would quickly be brought under control. As far as I can see, he does not advocate that we put Africa in quarantine as regards travel to Europe. The Spanish experience suggests that Europe is less prepared than we had been assured. As of this morning, 9 October, two Spanish doctors who treated the infected Spanish nurse are now under quarantine.

So, two months late, Prof Piot backs quarantine in Africa so long as it is not compulsory, but he does not want travellers from Africa to be subject to quarantine. Perhaps he does, but he hasn’t said so yet.

The Medieval Ages are much misunderstood.

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