(4) Let’s put aside the Ebola-as-weapon scenario—some things are too depressing to contemplate at length—and look at the range of scenarios for what we have in front of us, from best-case to worst-case. The epidemiological protocols for containing Ebola rest on four pillars: contact tracing, case isolation, safe burial, and effective public information. On October 14, the New York Times reported that in Liberia, with “only” 4,000 cases, “Schools have shut down, elections have been postponed, mining and logging companies have withdrawn, farmers have abandoned their fields.” Which means that the baseline for “best-case” is already awful.
In September, the CDC ran a series of models on the spread of the virus and came up with a best-case scenario in which, by January 2015, Liberia alone would have a cumulative 11,000 to 27,000 cases. That’s in a world where all of the aid and personnel gets where it needs to be, the resident population behaves rationally, and everything breaks their way. The worst-case scenario envisioned by the model is anywhere from 537,000 to 1,367,000 cases by January. Just in Liberia. With the fever still raging out of control.
By which point, all might well be lost. Anthony Banbury is coordinating the response from the United Nations, which, whatever its many shortcomings, is probably the ideal organization to take the lead on Ebola. Banbury’s view is chilling: “The WHO advises within 60 days we must ensure 70 percent of infected people are in a care facility and 70 percent of burials are done without causing further infection. . . . We either stop Ebola now or we face an entirely unprecedented situation for which we do not have a plan [emphasis added]”.
What’s terrifying about the worst-case scenario isn’t just the scale of human devastation and misery. It’s that the various state actors and the official health establishment have already been overwhelmed with infections in only the four-digit range. And if the four pillars—contact tracing, case isolation, safe burial, and effective public information—fail, no one seems to have even a theoretical plan for what to do.
(5) And by the way, things could get worse. All of those worst-case projections assume that the virus stays contained in a relatively small area of West Africa, which, with a million people infected, would be highly unlikely. What happens if and when the virus starts leaking out to other parts of the world?
I think the President's plan to try to contain it in Africa is laudable, even though we have to acknowledge that some of the thousands we are sending are going to die.
However, the way the government has addressed the virus since it arrived on our shores is beyond incompetent.