Vivien010

In a recent article entitled Estimating the reproduction number of Ebola virus (EBOV) during the 2014 outbreak in West Africa, Christian L. Althaus, a post-doctoral research fellow at Institute of Social and Preventive Medicine at the University of Bern, provides an optimistic and unrealistic assessment of the Ebola outbreak in West Africa. In the abstract, Althaus implies that the Ebola outbreaks in Guinea and Sierra Leone were under control by the end of May and July 2014, respectively. Elsewhere in the text he contradicts the abstract and states:

"This results in a different decrease of the effective reproduction number, Re, after the outbreaks started in each country [Guinea. Liberia, Sierra Leone]. While Re dropped below unity in Guinea and Sierra Leone by end-August 2014, the model suggests that control interventions were not successful in reducing Re in Liberia."

Based on the World Health Organization (WHO) comments that the number of Ebola cases are grossly underestimated (WHO link, WHO link), there is no evidence to suggest that as of September 1, 2014 the effective reproductive rate has dropped below 1 in either Guinea or Liberia nor is there evidence of a concomitant decrease in new cases.

Althaus also states:

"In particular, I assumed that the transmission rate decays exponentially due to control measures after the appearance of the first infectious case."

With more than 240 health care workers infected during this outbreak (WHO link) and health care facilities overwhelmed, there is no reason to assume that adequate control measures are in place. Without adequate control measures, transmission rates will not decrease exponentially in these countries in the near future and the current data do not suggest that the reproductive number in any of these countries is less than 1. At this time, the Ebola outbreak in West Africa is continuing to grow and is not yet under control.

Presently, only four countries, Guinea, Liberia, Nigeria, and Sierra Leone (as depicted in red on the map below) have confirmed cases of Ebola. But the outbreak is rapidly becoming out of control with more than 2400 cases reported. Several weeks ago, on August 3, the director of the Center for Disease Control in the United States, was quoted as saying that Ebola is “out of control” (link) at that time. Today, the World Health Organization (WHO) acknowledged that they have underestimated the extent of this Ebola outbreak in Africa in a situation assessment identifying the many reasons why the current cases are underestimated. (link) The inability of the international health community to understand this outbreak is precisely because it is out of control in the West African nations.

However this outbreak is more than an African problem. There is worldwide concern for this infectious disease. So far, no cases have yet been reported beyond the four African nations. The FluTrackers crew (www.FluTrackers.com) has been reporting and tracking suspected Ebola cases from media reports around the world since the outbreak began. To date, at least 36 countries (as highlighted in yellow on the map below) have had suspected cases of Ebola. Unless this outbreak is controlled in Africa, it is a certain to spread to other parts the world. It will only be a matter of time before one of the suspected cases becomes a confirmed case outside of Africa.

In a meeting in early August with the presidents of Guinea, Liberia, and Sierra Leone, Margaret Chan, the Director-General of WHO, stated “this meeting must mark a turning point in the outbreak response.” (link) That didn’t happen. It is now time for Chan and the rest of the international community to provide the much-needed assistance for these countries to combat Ebola locally before it truly becomes an international problem.