How bad is Ebola, really?

Yesterday’s Congo outbreak has suddenly gotten much worse and much better:

At least 70 people have died in northern Democratic Republic of Congo from an outbreak of hemorrhagic gastroenteritis, the World Health Organization said on Thursday, denying that the illness was Ebola.

A WHO report dated Thursday and seen by Reuters said that 592 people had contracted the disease, of whom 70 died. Five health care workers, including one doctor, are among the dead.

“This is not Ebola,” a WHO spokesman said in an email to Reuters on Thursday.

Let’s hope so, the WHO is still conducting tests. In Ireland a man has died of maybe Ebola:

In a statement, the HSE said it was currently assessing a suspected case of Ebola virus disease (EVD) in Donegal.“The public health department was made aware earlier today of the remains of an individual, discovered early this morning, who had recently travelled to the one of the areas in Africa affected by the current Ebola virus disease outbreak,” it said.

The US NPR is asking the prickly question:

The latest numbers on the Ebola outbreak are grim: 2,473 people infected and 1,350 deaths.

That’s the World Health Organization’s official tally of confirmed, probable and suspect cases across Guinea, Liberia, Sierra Leone and Nigeria. But the WHO has previously warned that its official figures may “vastly underestimate the magnitude of the outbreak.”

So how bad is it really?

That’s the question NPR put to several people who have been carefully watching the outbreak.

There’s no scientific way of knowing exactly how wrong the official numbers are, says Joseph Fair, an infectious disease doctor who has been acting as a special adviser to the health minister of Sierra Leone. “At a bare minimum, I would guess they’re probably off by 20 percent,” he says.

Once public health workers identify someone with this disease, Fair says, they have to find everyone else who might have gotten exposed through contact with that person. And that hasn’t been easy.

Even if someone tests positive for Ebola, he says, public health workers may return and find that the person has simply disappeared.

“They’re traveling, usually by public transport, and coming into contact with a lot more people,” Fair says.

The health agencies of these poverty-stricken countries don’t have the staff they need to track down all these people who may have been exposed. Unlike previous Ebola outbreaks that hit isolated, rural areas, this one is affecting many more people in a more urban environment.

Adding to the difficulty is a climate of distrust created by years of war and conflict.

“Because people are so afraid, in some instances, if a relative dies in a home, all the others run away instead of going toward the clinic to report themselves,” says Roseda Marshall, a Liberian pediatrician who is president of the Liberia College of Physicians and Surgeons. She’s currently in the U.S., trying to raise funds and support to help fight Ebola.

“Obviously, the statistics we’re getting is just scratching the surface,” Marshall says. “When we say we have so many suspected cases, so many probable cases, so many confirmed cases, that’s just the ones who are coming in for testing.”

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, agrees that people running away from hospitals and quarantines are a real problem, making him fear that this outbreak will get worse before it gets better.

“A considerable number of people are going to die before we get it under control,” Fauci says. “Obviously, as a physician and as a health person, that bothers me.”

“This is the biggest Ebola epidemic of modern times … (but) no one has somehow gained control,” said Liu in a phone interview from Montreal. “The ministries of health and governments of each country have a responsibility, but the other thing is that somehow the WHO needs to step up.

“They keep telling me, ‘We’re not an emergency response organization.’ I’m sorry but you’re the World Health Organization; you need to step up to that role because you have the legitimacy and the authority to do that.”

Liu’s comments echo a recent New York Times editorial, which criticized the WHO for being “shamefully slow” in supporting Guinea, Liberia and Sierra Leone, the three countries that have been hardest hit by the outbreak and which are “among the poorest and most war-racked in the world.”

…But for Liu, the most urgent need is for “people who will roll up their sleeves and do some legwork in the field” — everyone from doctors and nurses to “social mobilization” teams who can help spread education and awareness.

“People need to go and walk around and talk to the elders, talk to the villagers, and explain to them what’s going on,” she said. “If we don’t act rapidly … fear will be changed into panic and then irrational behaviour. We need to stop that vicious cycle.”