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DRC Ebola Outbreak 2019 Blog 13 Lessons from the 2014 CDC Ebola Epidemic Model and 1918 Influenza Pandemic
Comparing this 2019 Ebola virus outbreak with previous viral epidemics can help us understand where we are and guide our response. During the 2014 West African Ebola virus epidemic, a CDC report released in October of that year advised that if international efforts did not quickly slow down the epidemic, by mid-January 2015, within 4 months of the October report, there would be over half a million Ebola virus cases. Unlike this 2019 DRC outbreak a more robust global response was already in place and assisting the WHO coalition for months during the Ebola virus epidemic by October 2014. Had there been a lack of international support, the 2014 Ebola epidemic would have grown into an Ebola virus pandemic (87-88).
In the 2014 Ebola epidemic, the requirements for global intervention were met in part through the WHO’s PHEIC declaration back in August of 2014 resulting in significant international mobilization. Some experts doubt that the 2014 CDC model is accurate. Yet, could these experts guarantee that at 50,000 or even 25,000 active Ebola virus cases, the 2014 Ebola epidemic would have been effectively managed? Prior statistical algorithms reached similar conclusions using influenza virus pandemics as their test cases. These older models show that once EID epidemics achieve unchallenged exponential growth, they are uncontrollable (89-91). Epidemics spread exponentially under the right conditions. The complex environment of the 2019 DRC Ebola epidemic has met and now exceeds such conditions (79, 92).
These 3 models ask a similar question. During an epidemic, if all the supplies, personnel, capacity and infrastructure are available at the sites of greatest need, what is the maximal number of active infectious Ebola virus or EID cases that a coordinated and well-funded coalition can treat? While they don’t give a specific number, one point this information highlights is that very strong early intervention is the safest, most cost effective and lifesaving, if not the only sure pathway to controlling EID outbreaks.
The 1918 influenza pandemic history gives us a measure of how many lives will be lost during an unchecked pandemic in the 21st century. About a hundred years ago, between 50 to 100 million people died across the world during the 1918 influenza pandemic. This 3 year-long influenza pandemic, with its secondary infections and mass starvation by neglect, killed only 2% of that globally infected population (93). There are 4 times as many people today as in 1918, and the EID Ebola virus kills between 60% to 90% of people whom it infects. Today, with over 400 cities with populations between 1 and 5 million and with modern rapid transportation readily available to the public, the conditions for EID and Ebola virus dissemination are far more favorable (29, 31, 94). Once in the veins of a global transportation system, any acutely lethal EID will trigger a catastrophic pandemic.
Renowned legislative bodies sometimes make mistakes. The US Congress delayed funding efforts to stop the entrance of the Zika virus into the USA for 8 months because it was a disease of ‘foreigners.’ As discussed above, research into the identity of which populations carried Zika virus into the USA dismissed this foreigner fallacy, while the 8 month Congressional funding delay itself permitted a more rapid entrance of Zika virus into the USA (35, 39). We cannot make such mistakes with the many highly infectious and lethally unforgiving EIDs of which Ebola virus is only one example. If national and international legislative bodies agree that EIDs, and this DRC Ebola virus outbreak in particular, is an immediate global security threat they should coordinate with the WHO and move quickly within hours to days not weeks to months to resolve the issues highlighted in this work.
Copyright © 2019 Na’eem A. Abdullah All Rights Reserved
Morning fog on the African river Sangha. Congo. Sergey Uryadnikov Photographer/ Shutterstock Photos.
Many emerging infectious diseases originate in tropical ecosystems. See About Page - Sangha River.
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