The Ebola Update, Halloween/November Edition

Two months ago I posted the original "Ebola Post" to capture my thoughts on the West Africa EVD plague, with the intention of revisiting the topic once a month. Here's what happened since last time.

THE NUMBERS

On October 1st, WHO reported 7,157 cases with 3,330 dead. Today, WHO reported 13,567 cases with 4951 dead. The overwhelming majority of these cases are in the West African nations of Liberia and Sierra Leone. Cases are still doubling roughly every month. If the rate of increase doesn't change, we'll exceed 50,000 reported cases by December 31st, a million cases by next May, and a billion cases by Jan 1 2016.

THE GOOD NEWS

• A month ago I predicted that we would exceed 15,000 cases by November 1st. Today's report indicates that we'll fall short of that mark. This is a big deal --- previous estimates had cases doubling every 21-25 days, and the new period appears to be longer than 30 days. The rate is still geometric, but there's indications that it's slowing (for now).


• Senegal and Nigeria are officially EVD-free.


• Several experimental vaccines are now in the pipeline.


• Ebola flare-up in Texas appears to have been contained. While a couple of nurses in Dallas came down with Ebola, both of them recovered; no other cases have been reported.


• The world is making plans to produce a million doses of vaccine a month by the end of 2015 --- assuming that an effective vaccine is found.

THE BAD NEWS

• WHO believes that cases may be vastly under-reported, by about a factor of two or three.


• Ebola has spread to Mali (to the tune of one case)


• Ebola has also spread to Spain (to the tune of one case). Fortunately, all 83 of the contacts from that one case have passed the 21-day maximum incubation period without symptoms, so that outbreak is probably over.


• Two weeks ago, a New York doctor who worked in West Africa and felt perfectly healthy, came down with a fever, went into isolation, and tested positive for Ebola, making him the fourth case in the United States. As of three days ago he's still in serious condition. It's also come out that he lied to the authorities about his travels, which means that they have to start contact tracing all over again. The implication is, there's a small but nonzero chance that someone outside the original contact trace might have EVD and not know it. This has led to states favoring mandatory quarantine, which has Constitutional issues.


• The Dallas incident demonstrates that not all US hospitals are prepared to deal with Ebola. In particular, hospital staff were not trained on handling of Ebola patients, which led to two persons coming down with the virus, and hundreds of more exposed.


• The resulting panic over Ebola is likely to lead to undue curtails of civil liberties (e.g. Maine Governor LePage trying to quarantine a nurse who poses no danger to the community). Of course, this is also going to affect November's elections somewhat.

ANALYSIS

The geometric rate of transmission is slowing, but it's still geometric. We still need more time to tell whether the measures we're taking will slow the rate further. Our best bet is still to find a vaccine.

PREDICTIONS

By November 30th, EVD cases will exceed 25,000 with 14,000 deaths. Almost all of these will be in West Africa. There might be a few more cases of EVD in the United States, but no flare-up, in part due to the containment measures being enacted in various states and Canada. The estimated cost to contain the epidemic will exceed $10 billion; world response will continue to be anemic at best.