• Sunday, May 19, 2024
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Ebola – A tale of two cities…


A new 21st century disease has spread to 5 countries and within 6 months may affect another 30 countries. The disease has jumped from animals eaten by humans … into humans … and spread. After 8000 deaths, global panic has set in. The UK and US say citizens should not travel to the most affected areas unless it is absolutely necessary. The World Health Organisation (WHO) has intervened.

The story above is 12 years old …. And the disease was the 2002 Severe Acquired Respiratory Syndrome (SARs) outbreak in Asia.

In 2004 a seminal paper entitled ‘Learning from SARs – Preparing for the next disease outbreak’ said “Despite the low transmission rate … and the relatively low number of SARS deaths compared to other infectious diseases, SARS had a remarkably powerful and negative psychological impact on many populations worldwide.”

That paper estimated the cost of SARs pandemic at over $40billion.

With this 2014 Ebola Virus Disease (EVD) outbreak, we don’t yet know the full costs.

Identified in Congo in the mid-1970s, EVD isn’t new. It had a mortality rate of 90 percent and no known cure. However the current West African outbreak has about a 50 percent mortality rate … even so about 2400 people have died so far… The outbreak epicentre is in Sierra Leone, Guinea and Liberia. All three are currently blaming each other for its spread.

In our tale of two cities – The game changer for epidemiologists is the transmission of EVD from Freetown in Sierra Leone to Lagos a megacity in Nigeria – Africa’s most populous country.

Nigeria is 2000km and 4 countries away, and its most populous city Lagos is bigger, much bigger than Freetown (population circa 1.2m).

Lagos’ population of circa 21 million equals the populations of all the towns and villages in Liberia (4 million), Sierra Leone (6 million) and Guinea (11 million) combined.

At $45 billion Lagos’ (2014 forecast) is Africa’s 13th biggest economy.

The combined size of the economies of Guinea ($11.9bn), Sierra Leona ($8.5bn) and Liberia ($2.9bn) is $23bn and approximately half that of Lagos. Travel, Health, Retail, Wholesale, Trading and Agricultural production (the bulk of the local economies) have seen marked slowdowns.

If 10 percent is lost to EVD, it will cost $2.3bn.

The study also said “Evidence indicates that a modern approach to quarantine encompassing a range of options designed to reduce the frequency of social contact can significantly reduce the spread of infectious disease.”

The options chosen by some leaders have not worked.

In August 2014 President Alpha Conde of Guinea ordered the closure of its borders with Liberia and Sierra Leone. By 22nd August, Senegal also closed its borders. Ghana, Togo, Cameroon, Ivory Coast, Kenya and South Africa have also imposed varying travel restrictions. Not to be outdone, in Sept 2014 President Helen Sirleaf-Johnson closed Liberia’s boarder and ordered that people crossing the broader illegally should be – shot on sight. Just in case they are infected with EVD.

Sierra Leone’s President Koromaeven authorised a national curfew between the 18th and 21stSeptember. The result is that these economies have crashed.

Fears of crowded markets and places, even schools, is rife. EVDs spread has caused the health system to collapse as patients and health staff stayed away.  In Sierra Leone unprecedented powers allow the police to detain anyone suspected of having EVD. They can enter and search any property. And have powers to quarantine whole neighbourhoods. Riots have followed in some places and in Liberia the US has agreed to send troops and doctors.

While Obama’s support for Liberia is welcome. We must remember that in global terms EVD in West Africa is currently small fry.

Across the world other diseases like sepsis are more significant. This antibiotic resistant bacterial infection that poisons the victim’s blood came to prominence in the 1970s like EVD. It affected about 100,000 and killed 37,000 people last year in the UK …but globally it kills millions annually.

Effectively Sepsis in the UK will easily kill 10 times more people this year than EVD has so far. But UK GDP growth won’t change even if Sepsis cases double next year… and kills 72,000 people. No one is calling on the UK to quarantine hospitals and towns with its patients.

In Nigeria the Minister of health Prof Onyebuchi Chukwu has reacted differently to EVD. He focused on creating quarantine centres and communicating the number and locations of new infections weekly. Guidance of no contact with bodily fluid and no more eating of wild animals is widely circulated – Lagosians now joke about not shaking hands or hugging. WHO has praised his efforts.

This policy focuses on preventing EVD spread, not curing it.

Nigeria’s Oil and Gas Industry is largely a trading and service economy that sits away from its crowded cities in industrial complexes in the south east. It is unlikely to be substantially hit.

Even so, if EVD spreads in Nigeria, and costs the equivalent 10 percent of Nigeria’s $540bn economy, an additional $54bn could be lost.

Hence the total cost of the West African outbreak could reach $57bn and exceed those of SARs.

This week the US Centre for Disease Control implied that if EVD prevention in Nigeria fails, between 500,000 and 1.4 million people could die.

This tale of two cities and two approaches is hence very important.