Guest Editorial

By Lawrence Sellin, PhD  |  OCTOBER 29, 2014

Ebola: a politically incorrect approach

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lawrence sellinBottom line up front:

The Ebola threat to the United States is mostly dependent on the extent of the epidemic in West Africa and it is growing.

Travel restrictions from nations with high Ebola infection rates can help stem the spread of the disease and will be needed.

Airport screening will not necessarily prevent Ebola-infected individuals from entering the United States, an expensive and mostly ineffective solution.

American military personnel can be highly effective in delivering short-term humanitarian assistance and may be needed to help contain the spread of the epidemic.

The first cases of the current West African epidemic of Ebola were reported on March 22, 2014 with 49 patients in Guinea.

Up to October 14, 2014, the total number of reported cases is in excess of 9,216 and 4,555 people have died from the disease in five countries; Liberia, Guinea, Sierra Leone, Nigeria and the United States, about a 50 percent fatality rate.

The current epidemic sweeping across West Africa has rapidly become the deadliest occurrence of the disease since its discovery in 1976 and has now killed more than all other known Ebola outbreaks combined.

The World Health Organization (WHO) admits the official figures are underestimated and warns there could be as many as 20,000 cases by November.

In agreement with the WHO claims, a Center for Disease Control and Prevention computer simulation estimated a potential underreporting correction factor of 2.5, which predicted an actual number of 21,000 cases in Liberia and Sierra Leone by September 30, 2014. More ominously, reported cases in Liberia are doubling every 15-20 days, and those in Sierra Leone are doubling every 30-40 days.

In a CDC hypothetical scenario, every 30-day delay in increasing the percentage of patients in Ebola Treatment Units to 70 percent was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic.

That is, if efforts to tackle the outbreak are not stepped up, the WHO has estimated that, by early December, there could be as many as 10,000 new cases a week in West Africa.

There has been much debate in the United States whether to implement a travel ban affecting airline flights originating in Liberia, Sierra Leone and Guinea. Health experts have argued against a travel ban, maintaining that it won't necessarily stop the spread of the virus and will inhibit the flow of aid and health workers to a region that needs it most.

As shown in a new study and witnessed by the imported cases of Ebola virus into Nigeria and the U.S., the potential for further international spread via air travel remains present. Based on current epidemic and international travel conditions, their model projects up to 3 passengers infected with Ebola virus will successfully depart from Liberia, Sierra Leone and Guinea every month.

The authors contend that airport screenings don't change their conclusion because such measures can miss travelers who don't yet show signs of Ebola. A person can incubate the virus for up to 21 days without exhibiting signs of the disease.

Of additional concern is that the anticipated destinations of more than 60 percent of travelers departing those three countries are to low-income or lower-middle income countries, where inadequately resourced medical and public health systems might be unable to detect and adequately manage an imported case of Ebola, including possible subsequent community spread via commercial flights, like the situation which occurred in Nigeria.

The risk of spread by commercial air or other types of travel beyond 3 persons per month will likely increase as the total number of infected individuals increases. The spread of Ebola beyond its current boundaries could expose additional Americans to the disease and potentially present a national security threat to the United States.

Finally, there is ample evidence of the Defense Department's capability to provide effective humanitarian assistance. As an Army Reservist, I participated in a successful delivery of healthcare services to West Africa in 2007. With the proper protection and procedures, U.S. military personnel could help stop the epidemic at its source, especially by deploying the needed Ebola Treatment Units and prevent possible further appearance of the disease on the U.S. mainland.

Lawrence Sellin, Ph.D. is a retired colonel with 29 years of service in the US Army Reserve and a veteran of Afghanistan and Iraq. Colonel Sellin is the author of "Restoring the Republic: Arguments for a Second American Revolution." He receives email at lawrence.sellin@gmail.com