My previous post discussed three factors that could increase the global Ebola pandemic. Today I am going to outline three key factors that could decrease it.
A faster, more coordinated, and more significant international response brings the outbreak under control in West Africa
Money, supplies, and workers are needed to aid the efforts currently ongoing in West Africa. According to the World Bank, current levels of aid are falling short. While monetary contributions are very helpful, the current limiting factor to stopping the outbreak is a lack of healthcare workers, including doctors, nurses, sanitation workers, and burial teams. The longer it takes to mobilize and begin implementing pledged aid, the more will be required to get ahead of the outbreak. Recent moves by some governors in the U.S. to quarantine returning healthcare workers could discourage workers from volunteering.
More rapid diagnostics are developed
Current testing takes about 24-48 hours to receive results, and tests are typically administered only after symptoms appear. Getting results more quickly would allow for quicker identification and isolation of cases. This would be especially helpful in the early stages of Ebola when people often present to the ER or doctor's office with non-specific symptoms. Recognizing the importance of faster diagnostics, the U.S. Food and Drug Administration (FDA) has just granted emergency authorization for two newly-developed rapid tests, where waiting time could be reduced to 1-2 hours instead of days. If the test equipment can be more widely deployed, it could be very helpful in the fight against the outbreak. Even more helpful is that the diagnostic test could identify cases while they are still incubating and allow patients to be isolated before they develop symptoms, rather than having to wait the full 21-day maximum incubation period for someone with a known exposure to see if they develop symptoms.
Vaccines and cures are developed
Current treatments can help to alleviate symptoms and reduce the death rate. There are currently no vaccines or cures for Ebola that are of proven efficacy and available for widespread use. These are under development, and testing is underway. However, it will still be many months before enough will be available for general use on a large scale. Based on a World Health Organization meeting on October 24, it is anticipated that healthcare workers in the three worst-affected countries (Guinea, Sierra Leone, and Liberia) could be vaccinated by the first quarter of 2015. In addition, hundreds of thousands of doses could be available for general use in West Africa by the middle of next year. The main actors are attempting to achieve in 6 months what more typically takes as many as 4 years.
The assessment of a low risk of widespread and sustained transmission assumes that preparedness and response will be up to the task ahead. Containing the outbreak requires action. All previous large outbreaks were stopped with active containment measures. For Ebola to become a pandemic (barring a change to the virus itself), a truly catastrophic "perfect storm" of shortcomings in the response and containment would be required. We must work aggressively to ensure that such a scenario is avoided.
By the way, if you would like to donate to the ongoing Ebola-fighting effort, Doctors Without Borders (MSF) is accepting donations, along with other organizations listed at the USAID website.