Nerd Alert - Ebola Fever

In a possibly futile attempt to keep this post light,
here's a pretty picture of the sky at Issia

When I arrived in Côte d'Ivoire in June the West African Ebola epidemic was already in full swing, but I was hardly aware of it.  Ebola Fever - the media circus and madness triggered by the disease - had not really caught on.  My friend Bastian, returning from work on a project in Liberia a month later, mentioned the disease to me a few days before it spread by plane to Nigeria and became the new huge threat all over the global media.

I'm not sure if Ebola Fever is still raging in the news now that it's clearly unlikely to cause a major public health problem in developed countries.  Here, though, the tension is building.  It has not been identified in Côte d'Ivoire, but we border Liberia and Guinea, so we're getting prepared.  We have regular bulletins on the progress of the disease by email, as well as public service text messages (there are 95 cell phones / 100 people here, so it's a good way to keep people informed).  People joke about it, but a lot have stopped shaking hands, too.  At work we are building an isolation unit at the ONUCI medical center, just in case.  The World Food Programme, meanwhile, is preparing for the humanitarian crisis that looks set to unfold when the rest of the world completely cuts off the already impossibly poor affected countries.

I'm a nerd.  When upsetting things happen, I try to make sense of them with numbers.  That may be irrational (tee hee - irrational numbers, get it? Nerd humor) but it helps me keep things in perspective.  So here's my numerical perspective on Ebola:

• December 6, 2013 (262 days ago) a 2 year-old boy in Guéckédou, Guinea (near the border with Liberia and Sierra Leone), became the first known victim in this outbreak of Ebola Virus Disease (EVD), which later also killed his mother, 3-year-old sister, and grandmother.  
• March 23, 2014 (155 days ago) the virus was positively identified in Guinea as EVD, at which time there were 49 cases including 29 deaths.
• July 20, 2014 (36 days ago) the virus arrived in Nigeria, on a plane via a man who had been caring for his sick sister in Liberia.  When he died on July 28, the virus was suddenly worthy of global news coverage.  It isn't just killing remote African villagers any more.  It takes airplanes.
• As of August 22, 2014 (2 days ago), there have been 1,427 EVD deaths (confirmed or suspected).
• Of those almost 130 have been health workers (9%)
• Since the disease is transmitted through direct contact with bodily fluids, and it took over 100 days to figure out it was Ebola (so they may not have thought to wear all the protective gear), why aren't more health workers affected?  According to the CIA factbook:



Ladies selling roast plantains which they wrap
in the leaves shown instead of plastic bags


• Liberia has 1 physician for every 100,000 people.  
• That would be like having 84 doctors for the 8.4 million inhabitants of New York City, spread out over an area the size of Tennessee or Cuba.
• New York actually has 1 doctor/1000 inhabitants, 100 times as many as Liberia.
• Sierra Leone has twice as many doctors per capita as Liberia, or 1 doctor/50,000 people, in an area the size of Ireland (Ireland has 1 doctor/310 people).
• Guinea has 10 times as many doctors per capita as Liberia, or 1 doctor/10,000 people, in an area the size of the UK (The UK has 1 doctor/360 people).
• Nigeria has 40 times as many doctors per capita as Liberia or 1 doctor/2,500 people, in an area twice the size of California (California has 1 doctor/381 people).
• In the absence of healthcare workers, women, like the mother and grandmother of the little boy in Guéckédou, are the primary caregivers and, also like in Guéckédou (with the sister), make up 75% of the victims.
• Complicating the diagnosis, and making it easier for an affected family to cling to denial, according to the WHO fact sheet:
• "Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers."
• Malaria on its own kills 1 child/minute in Africa, or 1,440 African children per day. 
• Compare:
• 1,427 deaths due to Ebola in 8 months,
• 1,440 deaths due to malaria every day.
• The total population of Africa is 1.033 billion, with 21.3 million in Sierra Leone, Liberia and Guinea combined.  Ignoring any regional variation (and I believe West Africa has a particularly high malaria mortality rate), that works out to over 7,500 children killed by malaria in just those three countries in the 262 days since the Ebola crisis began.
• If we include Nigeria (population 177 million), the number of malaria deaths in that period is over 72,000.

I am at very low risk of catching Ebola, even if it were to come here.  I don't work in healthcare and my loved ones are all very far away.  I know I say I clean up poo for a living, but I don't do the actual shoveling.  It's easy for me to be flippant.  My heart goes out to all those in the region who aren't so insulated.  The idea that your child could get sick and you would be afraid to hold her because of the risk of passing on the disease that's killing her to the rest of your family - it's too awful to imagine.

Still, the malaria numbers are what stay with me.  1,440 deaths every day.  Until we fix the public health problems that make that number possible, we don't have a prayer of quickly catching and controlling something like Ebola.  But maybe Ebola will inspire us to address the underlying problems the malaria numbers relentlessly flag up - poverty, insecurity, lack of education, and lack of access to safe drinking water and (my favorite!) sanitation.

They're complicated, interrelated problems, and they're a long way from being solved.  I hope we have the perseverance to make some progress before the next epidemic.

African pygmy kingfisher (I think) shamelessly promoting Coke

Note: much of this is my math, so let me know if you see anything that doesn't add up.  There are links to all the sources.  The best article I have read about the human impact of the Ebola epidemic is from Buzzfeed, also linked to above under women accounting for 75% of victims but worth flagging up again, in my opinion.  Some slightly different numbers for doctors/population are given in an interesting global healthcare article in the Guardian, too.