Fighting Ebola in Western Africa

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Well, I'm concerned a lot for the west African nations and the adjacent nations to the involved countries because what we're seeing now is a very rapid, almost uncontrollable escalation of spread and disease. If we don't have an effective response soon, and I'm very pleased that the President's decision to get the military involved to help with logistics, transportation, commanding control, communication, etc, but I hope it happens really quickly and gets implemented quickly, because if you look at the growth of the spread of the number of infections, particularly now that we're in cities like Monrovia and Free Town, that the growth of the scope of the epidemic is almost reaching an exponential phase, and if you, exponential meaning that the increases are not linear, they go up like that, that you'll reach a point that even an accelerated intervention is not going to be able to control it. So it's a very difficult time we're in now where it's getting more and more out of control and it really requires a global effort, multiple countries, multiple organization.

The United States, the European countries, the African Union, the World Bank, WHO, everybody's got to be chipping into this now because it can reek, not only physical pain, suffering and death, but instability in countries, economic, and political and other instabilities which is no good for anybody.

If you just have this region of West Africa and you get into difficulties with countries perhaps a country as populated as Nigeria or surrounding countries in Mali and Senegal and places like that, that can really turn out to be a real problem. So I'm not concerned about an outbreak in the United State because one of the, I mean, there maybe cases in the United States, people get infected over in West African country are asymptomatic, get on a plane without any symptoms, land some where New York, Washington, London, Paris, get sick, go to an emergency room and maybe even unfortunately infect a nurse or a doctor, but once you realize it's Ebola, then you put the infection control, isolation, contact tracing, and a country with a good health care infrastructure and good resources would make it very difficult for there to be an outbreak the likes which we're seen in West Africa right now.

So that isn't a major concern right now for me, my concern is for West African countries because this can devastate them. In the other outbreaks, we had an outbreak in places that were geographically, relatively restricted and isolated, small village where people weren't crossing borders and going into one country or another, or going into the city, and that made it relatively less difficult to isolate, contact trace and protect the health workers who were taking care of them.

This was the perfect stone because you had it introduced into a country that was abutted by countries with porous borders because of the tribal nature, someone who lives on this side of the border is related to somebody who is on the other side, so there's constant going back and forth between three countries or more countries, that's the first thing.

The second thing, is that you had countries whose health care system was, if not dysfunctional, bordering on dysfunctional. And in fact, when I wrote an article in the New England Journal of Medicine, just recently I entitled it as an example of that disparity of health resources is one of the reasons why this exploded, then you take the poorest borders, the dysfunctional health care system, and then it gets into the cities like Monrovia, and Freetown and other cities, and all of a sudden, you have a perfect storm of an explosion, where something that could have been put out right in the beginning if it was good contact tracing and good realization, and all of a sudden that explodes.