Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections

New England Journal of Medicine ^ | September 23, 2014 | WHO Ebola Response Team

[Raebie]

As of September 14, 2014, a total of 4507 confirmed and probable cases of Ebola virus disease (EVD), as well as 2296 deaths from the virus, had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. In terms of reported morbidity and mortality, the current epidemic of EVD is far larger than all previous epidemics combined. The true numbers of cases and deaths are certainly higher. There are numerous reports of symptomatic persons evading diagnosis and treatment, of laboratory diagnoses that have not been included in national databases, and of persons with suspected EVD who were buried without a diagnosis having been made.1

The epidemic began in Guinea during December 2013,2 and the World Health Organization (WHO) was officially notified of the rapidly evolving EVD outbreak on March 23, 2014. On August 8, the WHO declared the epidemic to be a “public health emergency of international concern.”3 By mid-September, 9 months after the first case occurred, the numbers of reported cases and deaths were still growing from week to week despite multinational and multisectoral efforts to control the spread of infection.1 The epidemic has now become so large that the three most-affected countries — Guinea, Liberia, and Sierra Leone — face enormous challenges in implementing control measures at the scale required to stop transmission and to provide clinical care for all persons with EVD.

[Raebie]

From the paper:

On the death rate:

"Case fatality is among the most important topics for further investigation. Our estimates of case fatality are consistent in Guinea (70.7%), Liberia (72.3%), and Sierra Leone (69.0%) when estimates are derived with data only for patients with recorded definitive clinical outcomes (1737 patients)."

On the doubling time:

"As of September 14, the doubling time of the epidemic was 15.7 days in Guinea, 23.6 days in Liberia, and 30.2 days in Sierra Leone (Table 2). 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 4FIGURE 4 , and Table S8 in Supplementary Appendix 2). The true case load, including suspected cases and undetected cases, will be higher still."

[Raebie]

Ping

[driftdiver]

Is it time to worry yet?

[ClearCase_guy]

I have my prediction on my wall at work — 30,000 dead by Jan 1 2015. And that is extremely optimistic.

[null and void]

The game of Ebola Roulette continues...

*click* spin *click* spin *click* spin…

Eeeee-bolllll-aaaaaa ping!

Bring Out Your Dead

We’re gonna need

a bigger cart!

Post to me or FReep mail to be on/off the Bring Out Your Dead ping list.

The purpose of the “Bring Out Your Dead” ping list (formerly the “Ebola” ping list) is very early warning of emerging pandemics, as such it has a high false positive rate.

So far the false positive rate is 100%.

At some point we may well have a high mortality pandemic, and likely as not the “Bring Out Your Dead” threads will miss the beginning entirely.

*sigh* Such is life, and death...

[Black Agnes]

Given the estimated rate of unreported deaths, you may already be there.

[RayChuang88]

I think we may soon see essentially much of sub-Saharan central Africa essentially isolated from the rest of the world. I would not be surprised if the death toll could reach one million by 2017 by the time a truly effective vaccine is finally developed.

[Prospero]

Interesting note from the Summary "Conclusions," the epidemic course includes patients among whom 49.5 percent are male.

I note they do not feel the need to list the self-evident percentage of females.

It's only a rich or especially degenerate social order that perceives the luxury of bogging down under, so-called, "gender bias" that would worry about unnecessary silliness respecting how many patients are are among all the self-styled and subjective gender categories.

Under the stresses of genuine warfare, where survival is the issue, people come out from under their adopted "perceptions" and get down quickly to some reality, or they simply don't survive the crisis.

[Smokin' Joe]

Ping…

A link to this thread has been posted on the Ebola Surveillance Thread

[ElenaM]

That 49.5% number is interesting. In these cultures the women are responsible for caring for the ill, so you expect to see more women infected than men simply due to greater exposure to infectious fluids. That it’s now evenly distributed between males and females says something about the nature of this outbreak but I’m not sure precisely what.

Thanks for the heads-up.

[Tolerance Sucks Rocks]

I like your new Eeeee-bolllll-aaaaa picture. It looks like Terragen artwork.

[Tolerance Sucks Rocks]

PING!

[DouglasKC]

That 49.5% number is interesting. In these cultures the women are responsible for caring for the ill, so you expect to see more women infected than men simply due to greater exposure to infectious fluids. That it’s now evenly distributed between males and females says something about the nature of this outbreak but I’m not sure precisely what.

Maybe that it's much easier to catch then they're letting on....

[Alamo-Girl]

Thanks for the ping!

[Smokin' Joe]

You’re Welcome, Alamo-Girl!

[ElenaM]

Perhaps. Little is known about this virus, though much is assumed based on epidemiological surveys. It’s hard to say with any degree of certainty at this point but I’m leaning toward your thought, that Ebola is far more contagious than current dogma permits.