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The Toll of a Tragedy

The Economist   in 
October 23, 2014

The first reported case in the Ebola outbreak ravaging west Africa dates back to December 2013, in Guéckédou, a forested area of Guinea near the border with Liberia and Sierra Leone. Travellers took it across the border: by late March, Liberia had reported eight suspected cases and Sierra Leone six. By the end of June 759 people had been infected and 467 people had died from the disease, making this the worst ever Ebola outbreak. The numbers do not just keep climbing, they are accelerating. As of October 19th, 9,936 cases and 4,877 deaths had been reported worldwide, the vast majority of them in these same three countries. Many suspect these estimates are badly undercooked.

The rate at which cases give rise to subsequent cases, which epidemiologists call R0, is the key variable in the spread of Ebola. For easily transmitted diseases R0 can be high; for measles it is 18. Ebola is much harder to catch: estimates of R0 in different parts of the outbreak range from 1.5 to 2.2. But any R0 above 1 is bad news. And the very high mortality rate of the disease, estimated at 70% in this outbreak, means that, left unchecked, Ebola can quickly claim more lives than other, more established killers.

The inadequacies of the health-care systems in the three most-affected countries help to explain how the Ebola outbreak got this far. Spain, whose first locally transmitted case was confirmed on October 6th, spends over $3,000 per person at purchasing-power parity on health care; for Sierra Leone, the figure is just under $300. The World Health Organisation estimates that Liberia needs just under 3,000 treatment beds for Ebola; its current capacity is 620. The United States, which suffered its first Ebola fatality on October 8th, has 245 doctors per 100,000 people; Guinea has ten. The particular vulnerability of health-care workers to Ebola is therefore doubly tragic: as of October 19th there had been 433 cases among medical staff in the three west African countries, and 244 deaths.

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