CORDS

Week of Monday, 27 October 2014

This week was the CORDS network meeting! CORDS is the network that unites other Disease Networks. A little confusing I know, but it lets groups like SACIDS (South African Centre for Disease Surveillance) and MBDS (Mekong Basin Disease Surveillance) met and exchange information and develop ideas on Disease prevention/preparation world-wide.  It was wonderful getting the chance to see a group like this in action. They discussed current projects and projects they wanted to implement. Of course Ebola was a huge topic, and I was surprised to learn that CORDS had proposed the creation of an Ebola Surveillance Network in West africa back in 2012 that would monitor for any cases and take immediate action when they arose but couldn’t get the funding. They wanted to mimic how Uganda treats Ebola but over all West africa. Uganda has had several outbreaks over the last few years, however they are prepared, with a laboratory in country that is dedicated to Ebola. During a Glews meeting, a vet on loan from the CDC told me that in Uganda when they have a suspected Ebola patient they immediately quarantined, their contacts are traced, and the results are at the lab within a few hours. Uganda rarely has more than a few cases in their outbreaks (How Uganda Stopped Previous Ebola Outbreaks). One of the representatives at the CORDS meeting who wanted to start the West africa Network back in 2012 seemed to see the current outbreak as a personal failure. He just kept shaking his head and said “this would never have happened.” It was very sobering.

I also had the honor of meeting the governmental official in charge of Ebola in Guinea. He gave a presentation on whats been going on in country and what they still needed to do. It was incredibly fascinating. One thing he talked about was the cultural impact of this disease. Their culture used to be very, for lack of a better word, touchy. You hugged people, kissed the cheeks when greeting (remember they have lot of french influence), and all in all often touched each other. Now, he says, people are afraid to come close to one another, afraid to go to crowded places like markets which hurts the economy. Even though it was in French and it was hard to follow along with the translator it was a really interesting to hear of it from his perspective.

Over this week I made several great contacts and was asked to keep in touch with several people, particularly for when I finished grad school.When they heard my plans, I was told over and over how much they need more medical entomologists and there are too few out there. Several told me to contact them when I was looking for jobs after grad school! Truly this was an incredible and eye-opening experience!

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For more information on the CORDS network you can visit them on their webpage at http://www.cordsnetwork.org/

Should You be Worried about Ebola?

I have been seeing Ebola all over Facebook lately, and what worries me is the reaction of my friends and family back in Texas. I have seen a lot of fear, angry, and even hate. So here is my stance on Ebola. You can choose to ignore me, or not. But I am surrounded by these cases at work and spend time on the crisis every day. I am not doctor, but I am educated and privy to the thoughts of veterinarians and other officials who have been to the actual crisis in Africa. So here is what I think you should know.

What happened to Thomas Duncan is tragic. A Liberian national, he met his girlfriend when they both fled to a refugee camp during the civil war. She became pregnant, but moved to America when she got a visa. Duncan’s brother and mother were also some of the lucky ones, but sadly he wasn’t. It took 19 years, his son is about to start college, but he finally got his visa. His girlfriend, who he had reconnected with over the last year, was ecstatic to see him and they planned to marry when he arrived.

Reports vary on how Duncan became infected. The only fact known is four days before his flight Duncan helped his landlord take his pregnant daughter to a hospital. Duncan’s brother said Duncan thought she was having a miscarriage; however it is known she died the next day of Ebola. He may have lied about being exposed to an Ebola victim when he got the airport or he may not have realized. That fact died with him. No matter what happened we should mourn the death of a man who just wanted the American Dream.

I have read comments on articles saying that Duncan was a terrorist in disguise, that he should never have been allowed in the US, and at the worse, that Africans somehow ‘deserved’ this, that Ebola is a cleanse, and or even that the severely infected should be ‘culled.’ In the internet, anonymous with their usernames, these people spread hate and encourage murder. These terrible words fill me with so much grief that anyone would be ok with the pain and suffering Ebola patients and their families and friends are going through.

What really hurts though are the comments I have heard from people back home. Smart and educated people, people who I know are good at heart. People who are upset about the deployment of American troops to build more treatment centers and to train local providers because they worried these soldiers will bring Ebola back home (US Troops to Give Help). People who think all flights should be canceled from West Africa and no nationals from the three most infected countries should be allowed on our shores. People who think West Africa should be isolated to prevent further spread.

Although the words are prettier, you are still condemning people to die.

Liberia, Sierra Leone, and Guinea are developing countries. They don’t have access to a population with a majority being well educated. They have struggled every day against other issues like malaria, starvation, political unrest, literacy, and countless others issues. But they have been winning. Over the last decade the conditions of these countries have been improving. Slowly yes, but still improving. They should be admired, how hard they have struggled and fought.

And now we have Ebola. These developing countries don’t have the infrastructure to deal with this disease. They do not have high tech hospitals with isolation wards and a plethora of doctors. Most of the time they don’t even have electricity. The capital of Liberia only has 15 ambulance teams for the entire city according to Times. I encourage you to watch this short video about Ambulance work in Liberia and a brave teams that risks infection every minute to save a few.

If there is any positive to be had from the Texas case is that it made America step up in its response to Ebola. Ebola has been out of control for months. The hospitals are overwhelmed and overcrowded. I really suggest watching this short video from 11 September. Times: Dying of Ebola at the Hospital. This was released over month ago. And this is still happening. All of my Texan friends and family. You don’t need to worry about Ebola. Unless you had direct contact with Thomas Duncan, YOU ARE FINE. Please calm down. Even if another infected person makes it to America, the CDC has upped its game. You will never see what is happening to Africans happen to Americans. We have the money and infrastructure to prevent anything like this happen. We should be worried about the infected countries neighbors, not the US (WHO: We must focus Ebola fight on 15 high-risk nations)

How did Ebola even get so bad? In its early stages Ebola is less contagious then the flu (which by the way kills 3,000 to 40,000 people in the US every year according to the CDC). However as the patient becomes more ill and starts to show some of the more severe symptoms. Vomit, diarrhea, blood, and other bodily fluids are the best way to spread this disease. And what makes Ebola truly dangerous is that even after a person dies the virus stays alive for quite a while. Ebola is most contagious right before/after death. The problem is, burial for Liberians is a very important culture affair. Family and/or friends will often wash the body and even kiss the forehead of a deceased person. The funeral of the first victim, a young boy bear the border of Guinea right where the three countries touch, is where the outbreak began. Those friends and family members, including a prominent healer, went home after the funeral unknowing carrying home a deadly virus. When they became ill their families carried for them not knowing they were signing their own death warrants. And slowly the disease spread. Keep in mind these people are poor. Many of them lacked a basic education. Coupled with a distrust of authorities breed from civil war, the government had no idea there was an outbreak until several months after the first case. By that time the disease had reached urban areas, where people lived close together, often in poor sanitation. Denial and Disconnect Add to Toll of Ebola in Sierra Leone. The slums have been the hardest hit. Many people still don’t believe Ebola is real, and refuse to tell people about sick relatives. And sometimes when people die and officials come to remove bodies there is protest and even violence. They are afraid, and don’t want to see their loved ones burned.

But guys, we can stop this! Senegal and Nigeria have contained their outbreaks and have been officially Declared Ebola Free. There is no reason this can’t happen in the rest of Africa! They just need help.

In the big picture there might be a few more cases of Ebola in the US before the outbreak is curbed, but from what I have been told if it does happen it will be rare and quickly contained. By the time a patient has become contagious (e.g. violent vomiting, severe diarrhea, and extreme fever) they would already be in hospital in the US. Due to the unpreparedness in the Texas case, the CDC is doing everything to become over prepared now. But you know, until the Outbreak in Africa is contained there will always be a risk for Ebola cases in other countries. Why? Because disease don’t respect borders or quarantines. They don’t resect soldiers with guns. Diseases want to infect, it is how they are successful as a species. Travel bands just make it near impossible for medical supplies and volunteers to arrive to these countries, exacerbating the issue. If this outbreak isn’t contained it could end up becoming endemic, like malaria. Instead of crying out in fear, let’s call out for aid and goodwill. These people are dying because unlike Americans their countries don’t have money to build and man good hospitals, where the symptoms can be treated.

I think Bob Geldof on Ebola summarizes it best. If you haven’t watched or read any of my other sources, please watch this one.

So please. You don’t have to worry about Ebola becoming out of control in Texas or the US. But you should be worried about the 10,000 people the WHO estimates could become infected PER WEEK in Africa (10,000 a week). You should be worried about them, their families, and their friends. The orphans that are left behind, the empty streets and bellies. Be smart, learn about what is going on (Ebola separating Fact from Fiction). Look around, there are plenty of charities that are sending people to help. Donate a few dollars and help build a bed for a sick child. Support our troops building hospitals. Anything. But please.

Don’t turn this African Pandemic into an American Panic.

COAG & Ebola in Texas

Monday the 29th to Friday the 3 

Ok, I’m a little behind but they have been keeping me really busy at work! The week of 29 September to 3 October week was the 24th session of the Committee on Agriculture (COAG). I was able to listen as the delegates discussed to pass or not pass several reports. The most important to my department was the report concerning Peste des Petits Ruminants. For those of you unfamiliar with the UN process it would have seem really tedious, but it was really interesting listening to the different county representatives taking about how they saw the report impacting the world and themselves. One really cool thing was that this meeting is held in several different languages- the chair in fact spoke Spanish the entire time! There are 6 official languages of the UN; Arabic, Russian Chinese, English, French, and Spanish. Every delegate spoke in the language they were most comfortable in. That mean that everyone in the hall wore earpieces, and we selected our language of preference on the translator. The UN has many professional translators whose jobs are to translate the speeches while they are given. That sounds like an incredible tough job considering how long-winded some speeches get!

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Here is the link to the official COAG website if you want to know more. You can even see some webcasts of the meeting itself. If you are interested in what COAG is doing I would suggest clicking this link to read COAG: Driving FAO’s agricultural agenda. This is a recent publication which talks about COAGs impact and accomplishments since its creation in 1971. The overview contains examples of how COAG guided FAO to give more emphasis to among other things: food standards, the seed sector and sustainable agriculture including livestock. It also covers COAG’s impact on the Organization’s strategic direction. All in all it is a very interesting read, and I was given a paper copy at the beginning of the meeting to help get me through some of the more redundant long-winded speeches. 🙂

Although I came here with just the most basic Italian, I feel that I am picking it up around the office some. Surprisingly my Spanish has been improving, as sometimes I can get away with using Spanish instead of Italian. I am really trying to make time to work on both!

My favorite thing this week however was being able to attend the Ebola Outbreak: Impact on Agriculture and Food Security in West Africa side meeting where the FAO representatives from Senegal and Liberia spoke along with the Minister of Agriculture from Sierra Leone. It was webcasted, however I do not know where you could find it if it is still up. The only information I can find right now on public domain is the agenda. It was a really interesting meeting because we were able to hear about the Ebola crisis from people who lived there and have been a part of it from day one.

So, on that note, the whole Ebola case in Texas… I am from Texas and have several friends and family who still live there so of course I have heard all about it. Part of my research does entail work with Ebola, as it has become a threat to food security in West Africa for the farmers have been badly hit and people are unable to work due to the quarantine. If you are interested on the impact of Ebola on the W African economy (I suggest being interested!!) this is a good video to watch, Ebola crisis: Toll on regional economies, and this is a good article to read, Ebola could wreck W Africa economies, warns World Bank. I even spent an entire day this week researching Ebola trends. If you yourself don’t know too much about this disease I would suggest watching this short video from BBC, In 60 seconds: What is Ebola?

Ebola is a crisis in W Africa, and the WHO estimates the number of cases may hit 40,000 before it is contained. This is horrible. There is no other way to describe it. Ebola has a 40-90% mortality rate depending on the strain and care and the death toll has been staggering. The heath care system in these developing counties just cannot handle the amount of patients they receive and have to send many home with their families, which increases the risk of infecting others, adding to the problem (See this video Ebola: UK medic on ‘mind-blowing’ deaths for more information). One of the reasons this disease has had such a hard impact is the amount of healthcare workers affected. According to the most recent WHO Situation Reports published on 3 October there have been a total of 382 health care workers infected in Sierra Leone, Guinea, and Liberia and 216 of them have died so far (for more information read this article, Health Care workers face Ebola Risks). The impact on the health care workers is neatly summarized in this Time magazine article, Ebola Healthcare Workers Are Dying Faster Than Their Patients. This people though are risking their lives every day. But still they fight on. These are our Heroes

Figure 1: Distribution of Ebola virus disease cases in countries with intense transmission from the 3 October 2014 Ebola WHO Situation Report.

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“Data are based on official information reported by Ministries of Health up to the end of 1 October 2014 for Guinea and Sierra Leone, and 30 September 2014 for Liberia. The boundaries and names shown and the designations used on this map do   not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of  any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and   dashed lines on maps represent approximate border lines for which there may not yet be full agreement” 3 October 2014 Ebola WHO Situation Report.

At least while I was still in the US this was not treated as seriously as it should be by Americans. However, it is my personal option, and that of the CDC, that Americans really do not need to worry about a real Ebola outbreak in the US. Unlike Africa we are coming into this situation aware (before Ebola was diagnosed no safely precautions were being taken, which quickly spread the disease) and we have the infrastructure to handle this situation. Although there were several mistakes in the initial handling of this case, everything is under control. There were bound to be mistakes because it is the first time dealing with a case like this. All of the patients close contacts are under a 21 day quarantine and we can only hope for their sake that none of them come down with the disease (although it is highly likely at least his family members will). I would personally say that it is unlikely that this disease, due to the quickness and efficiently of the CDC and Texas Department of State Health Services, will spread past those initial contacts. I would however recommend that you regularly check the CDC Ebola website and the Texas Department of State Health Services websites for updates.

For the interested:

A new book is being published about ebola— Ebola & Poverty