Richard Horton tweets the future

/ebola-richard-horton-tweets-the-future.

  • Alors que les États-Unis envoient 3000 militaires en Afrique de l’Ouest, une compilation d’articles sur #Ebola et la réponse internationale

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    What We’re Afraid to Say About Ebola - NYTimes.com
    http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-to-say-about-ebola.html

    The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done. (...)

    There are two possible future chapters to this story that should keep us up at night.

    The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. (...) What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu — or even Karachi, Jakarta, Mexico City or Dhaka?

    The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air.

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    The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It | WIRED
    http://www.wired.com/2014/09/r0-ebola

    I’ve spent enough time around public health people, in the US and in the field, to understand that they prefer to express themselves conservatively. So when they indulge in apocalyptic language, it is unusual, and notable.

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    BBC News - Ebola outbreak ’threatens Liberia’s national existence’
    http://www.bbc.com/news/world-africa-29136594

    [Defence minister] Brownie Samukai Samukai warned on Tuesday that the disease was “devouring everything in its path” in Liberia.

    The country’s weak health system was already overwhelmed by the number of cases, he said.

    Mr Samukai told UN Security Council members that Liberia lacked “infrastructure, logistical capacity, professional expertise and financial resources to effectively address this disease”.

    “Liberia is facing a serious threat to its national existence. The deadly Ebola virus has caused a disruption of the normal functioning of our state,” he said.

    Separately on Tuesday, the UN’s envoy in Liberia said that at least 160 Liberian health workers had contracted the disease and half of them had died.❞

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    ‘Ebola’ Draining Economy - Min. Konneh - The New Dawn Liberia | Truly Independent
    http://www.thenewdawnliberia.com/index.php?option=com_content&view=article&id=12673:ebola-draining

    According to him, some concession companies have already scaled down operations, as expatriates depart the country for fear of contracting the Ebola virus. He said productivity in the various sectors of the economy was adversely affected, resulting in lower revenue performance, and increased expenditure demands, threatening the post- conflict recovery process of sustainable, inclusive and proper growth.

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    Poor will die of hunger, not just Ebola, say Sierra Leoneans
    http://www.trust.org/item/20140915104032-w7rs4?

    FREETOWN: Supplies of food are running so low in Sierra Leone that residents fear many could die of hunger if the Ebola virus is not contained soon, reports humanitarian organisation Plan International.

    Freetown residents say food prices are soaring out of control due to the lack of cross-border trade.

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    Ebola’s Hard Lessons | The CSIS Global Health Policy Center
    http://www.smartglobalhealth.org/blog/entry/Ebolas-Hard-Lessons

    In the acid words of one observer, Ebola is to WHO what Katrina was to FEMA in 2005. MSF is at its limits and cannot possibly continue to shoulder the lion’s share of responsibilities. In the meantime, staff on the ground are becoming steadily more vulnerable – to infection and to violence – requiring greater investments to ensure their protection.

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    The Ebola War
    http://haicontroversies.blogspot.ca/2014/09/the-ebola-war.html

    Although there are clearly downsides, experts from Peter Piot to MSF leaders to Mike Osterholm are calling for military involvement. 

    The need for such involvement is based simply on the scale of this disaster—WHO, CDC, non-governmental groups like MSF, no group has anything close to the logistical capability of the military to quickly deploy personnel and supplies almost anywhere in the world. If, as MSF suggests, military assets are “not…used for quarantine, containment, or crowd control measures”, which have backfired (particularly in Liberia), such a response could help bring essential capacity where it is needed most. The chart below provides a comparison of the total budgets for the US military, CDC, WHO and MSF.

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    Ebola outbreak an avoidable tragedy, say UK MPs | Global development | theguardian.com
    http://www.theguardian.com/global-development/2014/sep/12/ebola-outbreak-avoidable-tragedy-uk-ministers-mps

    “The devastating ongoing Ebola epidemic in west Africa has served to emphasise the importance of establishing strong health systems,” it said. “The apparent hesitancy and lack of coordination in the international response suggest that the global health system and emergency plans have failed.”

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    Ebola – the World’s Katrina | Molecules to Medicine, Scientific American Blog Network
    http://blogs.scientificamerican.com/molecules-to-medicine/2014/09/09/ebola-the-worlds-katrina

    the world’s response has been incomprehensibly and seemingly irresponsibly slow. Why is this the case? Likely because of disparities in the power and wealth of people affected by the epidemic.

    The Washington Post has a good backgrounder, “The long and ugly tradition of treating Africa as a dirty, diseased place,⁠” by professors Laura Seay and Kim Yi Dionne. They note the racism of the European colonizers, and how that led to “othering” of Africans, attributing inherent flaws to the people and their societies rather than to cultural differences, without any true basis or understanding. And they cite the “persistent association of immigrants and disease in American society.”

    The impact of such “othering” was first really brought home to me in a provocative lecture by Eileen Stillwaggon in 2006, at a Global Network for Neglected Tropical Diseases⁠ conference. She spoke of the perception that AIDS was more prevalent in Africa because of different sexual mores⁠—hypersexuality⁠ and promiscuity. Then she ripped this apart with eye-opening evidence of the links between helminth (worm) infections, schistosomiasis, malaria, and AIDS, effectively demonstrating that the parasitic infections strongly increase the susceptibility to HIV, explaining the difference in HIV rates between Africa and industrialized countries.

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    Ebola highlights slow progress in war on tropical diseases | Reuters
    http://www.reuters.com/article/2014/09/11/us-health-ebola-neglected-analysis-idUSKBN0H60TA20140911

    [until this crisis] the absence of economic incentives for drugmakers to develop and supply medicines for neglected tropical diseases (NTDs) has long been highlighted by health campaigners, but it rarely gets on to the political radar in the West. (...)

    It is not that scientists don’t have ideas for new drugs and vaccines but, until now, they have lacked the industry buy-in needed to take experimental products through the costly late stages of clinical development.

    BIOWEAPON FEARS IN WEST

    Significantly, much of the funding for Ebola has been driven not by concerns about sporadic outbreaks in Africa but by a biodefence strategy in the United States and other countries fearful of the potential to weaponize the virus.

    • M’enfin, si les États-Unis envoient des militaires quand Cuba envoie des médecins, c’est qu’ils y ont des intérêts précis à défendre ! Comme la présence de firmes américaines par exemple. Pétrole, plantations commerciales... faudrait voir à ne pas faire obstacle au business. C’est du #pur_cynisme

    • réponse à l’article d’Osterholm par Vincent Racaniello (qui au passage cite l’intérêt des expériences de Ron Fouchier) :

      What we are not afraid to say about Ebola virus
      http://www.virology.ws/2014/09/18/what-we-are-not-afraid-to-say-about-ebola-virus

      More problematic is Osterholm’s assumption that mutation of Ebola virus will give rise to viruses that can transmit via the airborne route:

      If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico.

      The key phrase here is ‘certain mutations’. We simply don’t know how many mutations, in which viral genes, would be necessary to enable airborne transmission of Ebola virus, or if such mutations would even be compatible with the ability of the virus to propagate. (...)

      The other important message from the Fouchier-Kawaoka ferret experiments is that the H5N1 virus that could transmit through the air had lost its ability to kill. The message is clear: gain of function (airborne transmission) is accompanied by loss of function (virulence).

    • édito du Guardian :

      The Guardian view on using the American military to contain the Ebola epidemic in Liberia | Editorial | Comment is free | The Guardian
      http://www.theguardian.com/commentisfree/2014/sep/17/guardian-view-american-military-ebola-epidemic-liberia

      President Barack Obama’s decision to despatch a force with a strong military component to contain the Ebola epidemic in Liberia is to be welcomed. This is one of those cases where American boots on the ground will be an unalloyed good.

      (...) But there are lessons – about readiness, about the proper funding and staffing of the World Health Organisation, and about the need to work on cures for diseases ignored in the past because there were no easy profits to be made by the pharmaceutical industry – and they must be learned.