Sep 24, 2014

Ebola... it's not all about the organism

The most salient mistake made by the contemporary infectious disease (ID) professional community in recent decades is overemphasis on organisms verses understanding and addressing other factors in disease transmission.

Here is a brief excerpt from The New England Journal of Medicine article published yesterday -NEJM Sept 2014
We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 (the end of week 44 of the epidemic) will be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 cases in total (Figure 4 and Table S8 in Supplementary Appendix 2). The true case load, including suspected cases and undetected cases, will be higher still.

Although the current epidemic of EVD in West Africa is unprecedented in scale, the clinical course of infection and the transmissibility of the virus are similar to those in previous EVD outbreaks. The incubation period, duration of illness, case fatality rate, and R0 are all within the ranges reported for previous EVD epidemics.7,13-18 Our estimates of R0 are similar to other recent estimates for this West Africa epidemic.19-23 The combination of signs and symptoms recorded between symptom onset and clinical presentation is also similar to that in other reports

"We infer that the present epidemic is exceptionally large, not principally because of the biologic characteristics of the virus, but rather because of the attributes of the affected populations and because control efforts have been insufficient to halt the spread of infection" - NEJM Sept 2014

"...control efforts have been insufficient to halt the spread..."

Understatement of the day.