Ebola demands our full attention

The cheery and intelligent man who operates our local dry cleaning agency and I often chat. He has a son doing medicine, and last week, he was worried about Ebola.

He feared that casual contact in his shop or, in the case of his son, on the wards might lead to the disease.  

It made me realise that it is easy to overestimate community understanding of the basic facts about Ebola.

Not that as health professionals we know all there is to know about it - even the precise details of its transmission are uncertain - but sharing what we do know can help the public manage its anxiety.

And quality vigilance depends on good intelligence. So what do we know? The first good thing - and there are not many - is that over half the people who contract it recover.

It is less certain how recovery occurs and whether classic principles of immunity apply, but a 50% recovery rate is a lot better than we saw with HIV in the early years.

Medical care also helps. Fluid replacement and intensive care make a difference to survival chances.

Second, the disease thus far appears to spread through blood, sweat and other body fluids, especially the excreta of infected people, to those who touch them during life or death.  Airborne transmission has not been documented.

In theory, this means that enhanced infection control procedures can protect family and health professionals.

However, as of the end of October, about 500 healthcare workers had contracted Ebola and half of them had died, so protection as practised at present is far from perfect.

Third, we live in an age of brilliant technological possibility, so the search for a drug to treat Ebola or a vaccine to prevent it is likely to yield dividends quickly.

The most likely limits, with so few cases, will be political and economic, as the cost of developing a drug or vaccine may not be a good commercial deal. But the accolades that would come to the inventor of a drug or vaccine would be great.

Furthermore, technological fixes are not always expensive. As reported in the 27 October issue of the New Yorker, a recent competition run by Columbia University yielded several inexpensive innovations designed to assist in managing Ebola.

The competition, auspiced by the schools of public health, and engineering and applied sciences, was open to all students and faculty. Among them was an inexpensive hose that sprayed bleach foam rather than a solution, because unlike a bleach solution, with foam you can see where it has been sprayed. 

But there are significant endemic barriers to combating the virus in West Africa.

The impoverishment of the countries where Ebola has become an epidemic is a major limitation, both in the treatment of those with the disease and the control of its spread. 

Poverty means fewer healthcare facilities and medical supplies, which is why the military support offered by the US, with its sophisticated logistic capability, will make a huge contribution.

Last month, 4000 US troops with cargo planes stuffed with all necessary equipment and transport were deployed to Monrovia in Liberia as part of Operation United Assistance.

With that as a background, groups such as Médecins Sans Frontières and other NGOs' efforts will be enhanced by field hospitals and supply lines for IV fluids and material needed to care for Ebola patients.

Medical volunteers from Australia are also contributing to the Ebola effort ­- including supporting diagnostic laboratories that are hard-pressed to keep up in the affected countries, and are working with MSF and the Red Cross on the front line. 

This month, the Federal Government pledged $20 million in funds for the private healthcare company Aspen Medical to operate a 100-bed hospital in Sierra Leone that will be run by 240 healthcare staff, some of whom will be Australian.

The move came after weeks of public accusations by the AMA and NGOs that the government was not doing enough. 

However, until effective treatment and infection control measures are more widely implemented in Africa, the course of the epidemic is hard to predict.

I understand that the mutagenic potential of the Ebola virus is no match for influenza, but if its mode of transmission does expand to include airborne routes, the challenge of the epidemic would grow enormously.  

Figures published by the US Centers for Disease Control and Prevention say almost 5000 people in West Africa have died from the virus, with the number of cases in Sierra Leone and Liberia said to be doubling every 20 days, which means that by year's end, those affected will be approaching 1.4 million.

It is clear Ebola deserves our serious attention: just as we view the extremist Islamic State as a distant threat to Australian security, so too we should view Ebola.  

As for my friend the dry cleaner, when he asked if he should wash his hands after handling unfamiliar garments, my cautious (but not entirely rational) answer was, yes.

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 17 November, 2014 http://bit.ly/16p4FTz