Wednesday, October 29, 2014

If residents of Ebola-infected areas are allowed to leave with only a fever check, the virus will spread

A woman traveling from Guinea into Mali has her temperature
checked at the border in an effort to screen for Ebola.
    I read with some concern recently about the young girl who was carried into Mali while infected with the Ebola virus. One hundred eleven Malians who had exposure to the girl are now being tracked by the World Health Organization.
    As a practical matter the actual number of people actually at risk from developing Ebola from contact with the girl is probably fewer than 30 and perhaps only a dozen. But that's still a lot of people.
    The two-year-old girl apparently never had her temperature checked when entering Mali as she was being carried in a sling on her grandmother's back. She was already ill with Ebola symptoms at the time, and a screening would have detected it.
    What concerns me is that Mali is letting in streams of people from Guinea with only a temperature check to screen for Ebola. The virus has a typical incubation period of 4-21 days (and up to 45 days), so a temperature check is of little use in keeping out those infected with the disease but still asymptomatic.
    My guess is that Mali may already have an Ebola outbreak, authorities just don't know it yet. The nature of Ebola is that there is one death from an unexplained cause, often thought to be malaria or some other malady; three weeks later two or three additional people die; in three more weeks that total might jump to six. It can take two or three months for authorities to even become aware of an outbreak.
    Even when villages might suspect Ebola they might be afraid to alert authorities for fear of being quarantined with no food or having their loved ones carted away. So an initial, isolated outbreak often goes undetected by authorities until a village is completely decimated, perhaps even abandoned.
    Most people have all been indoctrinated with the notion that people should have the right to go wherever they want whenever they want. But no one should be allowed to leave an area with an uncontrolled Ebola outbreak without a mandatory quarantine. Nobody has a right to infect the world.
    The world needs to create a cordon sanitaire around those areas with uncontrolled Ebola outbreaks; nobody leaves without a quarantine. If it requires massive numbers of troops standing shoulder-to-shoulder to enforce, then troops we should send. If the only way to stop people from leaving is to shoot them, then shoot.
    Make no mistake, the developed world should send far more aid to areas affected by the Ebola outbreak. We should send medical help. We should immediately step up and start paying all of the health care workers a risk bonus. We should do far more than we are doing. But we should not allow any potentially infected person to leave the area without a quarantine, period.
    Sadly, the world isn't willing to commit the resources or make the hard choices necessary to control contagion, so Ebola will, in all likelihood, continue to slowly spread. At some point it is likely to spread into rebel-controlled areas of Mali or Nigeria where even Doctors Without Borders has been able to operate with only the greatest of difficulty. Eventually Ebola is likely transform from an epidemic to a pandemic affecting all of the undeveloped world.
    I should note, as I always do, that my views are perhaps overly gloomy. There is evidence that new cases are dropping in Liberia, although some say they are merely going into hiding to avoid cremation. As I have pointed out many times, viruses often burn out of their own accord. Many Africans have developed antibodies to Ebola despite never having been infected, perhaps through exposure to bat saliva on gathered fruit. And the virus tends to spread so slowly that there may still be time to implement a mass-vaccination program.
    I have high hopes for both vaccination and medicines that will be effective against Ebola. As for containment, I fear the battle is either already lost or being lost. Should Ebola become a true worldwide scourge, it won't be from a lack of resources, but rather a lack of will.

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