How should we respond to the Ebola virus threat?

We Australians live in an exceptionally safe country compared with many others today (and compared with our own in times gone by) when it comes to serious infectious diseases.

Our immunisation programs have succeeded brilliantly against whooping cough, polio and the other diseases of childhood.

The basics of public health -- clean water and waste disposal -- are secure in urban and much of rural Australia. Huge gains in life expectancy have followed.

We no longer need the rituals and beliefs to comfort us as did families in Victorian England when the death of children from infections was commonplace. We are not a society facing the loss of 16 million deaths of combatants and civilians as happened in World War I, followed by about 50 million more who lost their lives from the larger scourge of H1N1 influenza in 1918.

Being unaccustomed to catastrophe, especially those due to infections, it is understandable that we are shocked and frightened by the current outbreak of Ebola virus in West Africa.

Well, even if we aren't ourselves, then at least a friend of mine is. This man, a retired, successful and highly intelligent businessman living in the north-east of the US, recently cancelled his summer holiday in the south of France.

You can read about the fascinating history and virology of Ebola on Wikipedia. The virus was named after the river in the Democratic Republic of the Congo (then Zaire) where it was first isolated in 1976. The current outbreak in West Africa is the first recorded for that area.

On 8 August, the WHO declared the outbreak to be an international public health emergency.

As of 21 August, the WHO reported there had been 2473 cases of Ebola virus in places such as Guinea, Liberia, Nigeria, and Sierra Leone, and 1350 people had died from the disease.

Infectious agents can kill in epidemics by being highly lethal and highly contagious. Highly lethal infections that are not contagious do not create epidemics.

Viruses that spread by airborne droplets such as influenza are highly contagious, but many forms of flu are benign because their pathogenicity is low.

It is only when a strain of influenza that has high lethality and is highly contagious -- such as the H1N1 influenza that followed World War I -- is circulating abroad that serious flu epidemics occur.

In the case of Ebola, there is high lethality associated with human infection. About half of the reported cases see the patient die due to massive cytokine disruptions to the vascular tree. But bodily contact, or contact with bodily fluids, is necessary for infection.

The Ebola virus does not mutate rapidly -- it's 100 times slower than influenza A and about the same as hepatitis B. If we could develop a vaccine, it would not be quickly out-of-date.

So what should we, in Australia, do? First, we need to ensure our surveillance strategies are sound and in place, concentrating especially on plane arrivals of people from West Africa.

Second, we need quarantined treatment facilities available to effectively manage cases.

Two US medical attendants, Kent Brantly and Nancy Writebol, who were exposed to Ebola while treating patients in Liberia were repatriated by air on 2 August to a special facility at Emory Hospital in Atlanta, built with the Centers for Disease Control. The US is thus taking seriously the possibility of treating patients with Ebola on its shores. So should we.

Third, we should, as a nation, contribute what we can to the advancement of scientific understanding of this threat, with an eye on antiviral therapy and vaccine development.

Australia's response has been appropriate to date, but we still do not have a national centre for disease control.

The surveillance networks that we have are generally adequate, but relatively informal and for a nation of our wealth, aspiring to international leadership, 'adequate' is not the word that comes to mind as an expression of appropriate ambition or responsiveness.

Professor Leeder is a member of the Menzies Centre for Health Policy at the University of Sydney, chair of the Western Sydney Local Health District Board, and editor-in-chief of the Medical Journal of Australia.

Published in Australian Doctor 26 July 2014 http://bit.ly/ZEx5FW