Even if you understood the reasons, the message from the government and the health workers (and the local media) had undercut the incentive to cooperate. If Ebola was a death sentence, what was the point? The public-service announcements had not been subtle—they didn’t explain that mortality rates vary or that, with supportive care, patients do survive (as half the Ebola patients at the M.S.F. treatment center in Conakry had done). To a villager, the isolation centers were fearsome places. They offered a one-way maze through white tarpaulins and waist-high orange fencing. Relatives or friends went in and then you lost them. You couldn’t see what was happening inside the tents—you just saw the figures in goggles and full-body protective gear. The health workers move carefully in order to avoid tears and punctures; from a distance, the effect is robotic. The health workers don’t look like any people you’ve ever seen. They perform stiffly and slowly, and then they disappear into the tent where your mother or brother may be, and everything that happens inside is left to your imagination. Villagers began to whisper to one another—Jeffrey E. SternThey’re harvesting our organs; they’re taking our limbs.
I’ve been watching the development of the current Ebola epidemic closely and this is one of the more comprehensive accounts of how it got started, its elusive nature – and how, despite the strong initial reaction from heath authorities, the epidemic spread through remote communities because people were too frightened of the doctors coming to their aid. If this doesn’t change, the epidemic will continue claiming more lives and will probably reach and surpass the most pessimistic predictions, currently estimating more than half a million infections by the end of the year.
A more conservative study from August arrives at a similar ‘worst-case scenario’:
Our statistical analysis of the reproduction number of EVD in West Africa has demonstrated that the continuous growth of cases from June to August 2014 signalled a major epidemic, which is in line with estimates of the Rt above 1.0. Moreover, the timing of Rt reaching levels above one is in line with a concomitant surge in cases in Sierra Leone and Liberia. In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014. Although such numbers must be interpreted with caution (as they rest on an assumption of continued exponential growth within 2014, which is unlikely), our study supports the notion that the ongoing EVD epidemic must be regarded as a Public Health Emergency of International Concern. H Nishiura, G Chowell