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No, We Aren’t All Going to Die Because Ebola Patients Are Coming to US for Treatment

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Scary, color-enhanced electron micrograph of Ebola virus particles. Creative Commons license courtesy of Thomas W. Geisbert, Boston University School of Medicine.

With the death toll now over 700 in an Ebola outbreak that has been building since February, Americans are suddenly up in arms about the virus, but only because it was announced yesterday that up to two Americans infected with the virus may be transported to Atlanta for treatment. Yes, the virus is especially deadly, with a death rate of 70-90% of infected patients, but the virus does not spread particularly efficiently and is not airborne. Writing at CNN.com, biologist Laurie Garrett points out a disaster scenario for the virus. Rather than an outbreak in the US, which seems extremely unlikely, Garrett outlines how the virus could spread in the much more densely populated Nigeria rather than the more remote areas of Guinea, Sierra Leone and Liberia where it is now concentrated.

Before getting into the details of the current outbreak and its possible spread to Nigeria, a little background on the virus. From the World Health Organization, we have this information on how the virus spreads:

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Of particular relevance to the two patients who may be transported to Atlanta for treatment (they work for Samaritan’s Purse, an aid organization) and the tragic death of Sheik Umar Khan, Sierra Leone’s top Ebola doctor, the information from WHO continues:

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

The fact that these health care givers become infected because standard infection control precautions are not strictly practiced in no way should suggest that they are uninformed or careless. Instead, Garrett points out in her article the stark realities facing health care providers in the three countries where the outbreak rages:

To show how ill-equipped these nations are to battle disease, per capita spending on health care, combining personal and governmental, amounts to only $171 a year in Sierra Leone, $88 a year in Liberia and $67 a year in Guinea, according to the Kaiser Foundation.

For those who want more detail on the virus, this succinct summary of the structure of the Filovirus family of viruses and their mode of operation is very informative.

For the panic-motivated hypochondriacs among us, initial symptoms of this virus mimic the onset of most other viral infections.

The most recent update from WHO on the outbreak can be read here. The update summarizes the assistance that is being provided to the countries where the outbreak is ongoing. Significantly, WHO is not advocating travel restrictions at this time.

Returning to Garrett’s article, she points out the factors that would lead to chaos should Ebola spread in Nigeria:

Were Ebola to take hold in that country [Nigeria], spreading from person-to-person in a densely populated, chaotic city such as Lagos, the worldwide response would swiftly spin into uncharted political and global health territory.

Consider the following: Nigerian physicians are on strike nationwide; hundreds of girls have been kidnapped from their schools and villages over the past six months by Boko Haram Islamist militants — and none has been successfully freed from their captors by the Abuja government.

Nigeria is in the midst of national election campaigning. President Goodluck Jonathan’s government is, at best, weak. The nation is torn apart by religious tension, pitting the Muslim north against the Christian south. Islamists in the north have long distrusted Western medicine. They have opposed polio vaccination and have kidnapped and assaulted central government health providers.

Garrett’s plea is for an already-planned African summit on Monday to be used to develop a coordinated plan for dealing with the virus:

One way or another, Obama must take advantage of Monday’s Africa summit to press the case for calm and appropriate responses. These would include specific post-Ebola financial commitments to Liberia, Sierra Leone and Guinea.

The possibility that the epidemic might take hold in Nigeria must be confronted, and plans of action must be considered. The world cannot afford to make decisions in the heat of panic about such things as international airport closures, withdrawal of foreign oil workers, negotiations for outbreak responses with northern imams, hospital and clinic infection control training across thousands of Nigerian health facilities, deployment of international assistance teams for rapid diagnostics and lab assistance and countless other contingencies.

Sadly, Garrett points out important information on the damage that has already been done in this outbreak:

When this Ebola epidemic eventually ends, the health budgets of these nations [Liberia, Sierra Leone and Guinea] will have been bankrupted, and many of their most skilled and courageous physicians, nurses, Red Cross volunteers and hospital workers will have perished.

Let’s hope that Monday sees the beginning of stronger coordination to put more resources where they are needed to halt the spread of this ongoing disaster.

Oops! Bribing Nigeria for Cheney’s Freedom Not Legal

A lawyer in Nigeria has reminded the country’s anti-corruption watchdog that the recent deal buying Cheney’s freedom for $35 million is not legal.

In a letter to Nigeria’s anti-corruption watchdog, Osuagwu Ugochukwu, a prominent lawyer in Abuja, said the withdrawal of charges against Cheney was a breach of the law.

“We know as a point of law that once a criminal charge has been filed in a competent court, issue of penalty of fine is for the courts to impose and not parties,” he wrote. “Hence, we are shocked to hear that EFCC imposed a fine on an accused person. We also know as a point of law that criminal matters cannot be settled out of court as in civil matters in Nigeria.”

And a newspaper editorial makes the fairly obvious point that if corporations can keep buying the freedom of its executives, then those executives will never have an incentive to follow the law.

The risk of solving one criminal act through the plea bargain option amounts to a mere slap on the wrist and subtly telling the guilty firm and its personnel to “go and sin no more”. It does not paint a good image for Nigeria, especially in the world’s corrupt nations index where we are currently featuring notoriously.

We therefore condemn in strong terms this kind of under the table settlement. The same thing happened in the Siemens bribery scam, and this is making Nigeria look like a country where money can buy justice. More importantly, the Halliburton case questions the seriousness of government in holding corrupt foreign firms and their officials accountable for their action, while on the other hand encouraging and patronizing companies that have not only confessed corrupt practices, but are not known to respect wholesome business ethics.

Only a painstaking trial and possible conviction, if found guilty, would have forced Halliburton to change its corrupt ways of doing business in Nigeria.

But Nigeria’s anti-corruption watchdog, in response to Ugochukwu, pointed out that such plea bargains are standard in countries like the UK and US.

And, without addressing the move’s legality, the head of the anti-corruption watchdog agency defended the move, saying that it is a “best world practice” used in more developed countries.

“The US and the UK governments are practicing it. Where you cannot successfully sustain a charge in court and you want to recover, then instead of losing the case, losing the money, then you opt for plea bargaining,” Farida Waziri, head of the watchdog agency, said,

Of course, the US got an even bigger bribe from KBR — $402 million — to dismiss these charges, without even having to threaten Cheney with jail time. So I guess Nigeria is left only to aspire to the “best world practice” of getting bigger bribes from corporations guarding the freedom of their executives.

Halliburton Tries to Get Half Off Its Bribe for Cheney’s Freedom

As I noted last week, Halliburton is in negotiations to reach a plea deal with Nigeria to drop its bribery charges against Dick Cheney. At that point, Nigeria was demanding $500 million for such a deal, which led Gregg to quip, “So, Cheney Halliburton is bribing Nigeria to drop bribery charges?”

As Reuters reports, Halliburton and Nigeria are getting closer to a deal. Over the course of negotiations, though, it appears Halliburton has asked for half off of Nigeria’s original demand, or a total fine of $250 million.

The Economic and Financial Crimes Commission (EFCC) said it met with officials representing Cheney and Halliburton in London last week after filing 16-count charges at a federal high court in Abuja in a case dating back to the mid-1990s.

Halliburton, which has said the Nigerian charges have no legal basis, could not immediately be reached to comment on the outcome of the meeting. But EFCC spokesman Femi Babafemi said an offer had been made to pay fines totalling up to $250 million.

“They have made offers of fines to be paid in penalties. They offered to pay $120 million in addition to the repatriation of $130 million trapped in Switzerland,” Babafemi said.

“It will need to be ratified by the government and we expect a decision by the end of the week,” he said.

It seems like the value of Cheney’s freedom, like all other goods, declines the closer you get to Christmas. Cheney better hope that Nigeria ratifies this deal soon though, because you never know what happens to goods left on the shelf after the holidays.