Does Chicken Little have Ebola?

This is my second post about Ebola, in which I continue to pontificate about things I don’t really know anything about. Yesterday I suggested Ebola is the Kardashian of diseases and we ought to be a little less worried about Ebola and talk more about HIV, malaria, and TB.

There are some excellent graphs and discussion from Kim Yi Dionne and Stéphane Helleringer, who do know what they are talking about.

Africa is a continent – not a country. If a health problem is only prevalent and problematic in one country rather than in many of Africa’s 54 countries, does that make it as irrelevant as a Kardashian? Continent-wide metrics can mask dramatic impacts of disease outbreaks in countries or even sub-regions. If we consider Ebola in the context where it’s unfolding, it matters a great deal. By the end of 2014, it may matter even more in these countries than the other infectious diseases mentioned by Blattman.

…So, how many deaths from Ebola can we expect by year’s end under these conditions? To try and answer this question, we did some simple arithmetic: at a rate of 18 deaths per day (i.e., the average number reported for August so far in Liberia), it will only be 10 days until Ebola has killed as many people as road-traffic accidents usually kill in the country in an entire year. It will be 20 days until Ebola reaches the yearly level of maternal deaths; 70 days until it reaches the number of deaths from HIV/AIDS deaths and 125 days (i.e., before the end of 2014) until it reaches the estimated annual number of malaria deaths in the country. And of course, these “projections” rest on the very optimistic assumption that the public health response will be able to maintain the number of deaths due to Ebola at 18 per day. In recent days however, the daily number of deaths seems to have been rising quite sharply over time.

This is a good response. The full post is worth reading. A few thoughts.

  1. I care unusually about Liberia, having worked there for the past six years and seeing the toll this disease is taking on the country. But it seems to me the fearful and overblown coverage will do more damage in the long run as businesses and NGOs pull out, or deals in the future never get done. I’d venture a guess that shaving a percentage point off GDP for the next few years will lead to more preventable deaths than the disease will in the end. This is disastrous for the country and it doesn’t help when organizations like MSF say it is “spiraling out of control“.
  2. Unless it is actually spiraling out of control. Donne and Helleringer tell us what happens if they project a linear trend. But diseases also expand exponentially. I think the discussion ought focus mainly on the realistic potential for a linear or exponential increase for a long period of time. If agencies can get this under control in a month, the hype will have done much more lasting damage than the actual disease.
  3. I’m conflicted as to whether history suggests the disease has this potential. If this blog is correct, there have been less than about 3000 confirmed deaths from Ebola in human history in every country in the world. This does not sound like a world ravaging killer.
  4. At the same time, the 2014 outbreak probably accounts for about half those deaths. So maybe this time is different. 99% of the time “this time is different” is wrong. Until it is not.
  5. I am waiting for science to weigh in on the trend. Anyone?