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Lancet Infect Dis 2014; 14: 1163

Fisman D, Tuite AR et al. Lancet Infect Dis 2014; 14: 1164–1165

This balanced Editorial, puts into perspective the impact of Ebola with that of other health burdens in west Africa. As of 31st October, 13,540 people have been diagnosed with Ebola, a third of whom have died. When comparing this with malaria, in 2012 alone, there were over twenty thousand deaths in Sierra Leone, Liberia and Guinea. The initial signs and symptoms of Ebola are the same as those for malaria. As a consequence, Médecins Sans Frontières have begun to distribute artesunate/amodiaquine (to treat uncomplicated malaria) in order to reduce the numbers of those with malarial-related fever, seeking care for possible Ebola, in Ebola treatment centres.

This Editorial also urges US states to adopt an evidential approach when implementing procedures to prevent transmission. These states should not be panicked into specious actions driven by the media. For example, healthcare workers returning from west Africa are not thought to be infective as long as they are symptom-free. It is only 3-4 days after the fever onset, and as shown by a positive reverse polymerase chain reaction, can they infect others. In addition, such is the severity of Ebola, once these symptoms develop, those afflicted would be too sick to function normally and thereby transmit the disease to those carrying out their everyday business. It is reiterated that 'Transmission occurs only through contact with the body fluids...'

These commentators cite others that have shown the present spread in EBOLA follows well-established mathematical epidemiological modelling that seems 'torn from the pages of a textbook'. This is based on R0 (basic reproductive number); 'the number of cases one case generates...over the course of its infectious period...' Simply, an R0 <1 and the infection will disappear, but with an R0 >1, it will spread into populations. The present R0 for this outbreak is 2.5. This would result in an increase in 150% in each successive generation. There is an imperative to reduce the total number of cases now. It has been calculated, that if 1) construction of treatment centres, 2) accelerated case assessment, and 3) distribution of protective kits for home care, could have started 2 weeks earlier (15th October instead of 31st October), 137,432 new cases could have been prevented compared with 97,940 cases. The present Ebola epidemic 'is proceeding at virus time, with a response on bureaucrat time'.