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At the time of writing, October 8th 2014, there are still less than 5000 reported cases of Ebola, although actual cases may be far higher.  For example, Save the Children are reporting that they are seeing 5 new cases every hour, and it is likely that most cases in worst affected nations are not being reported.

Experts are already warning that numbers of people infected may rise to more than 20,000 in the next 4 weeks, and to a million by early 2015 unless urgent action is taken.  But what happens by mid 2015 or 2016?

Ebola is therefore at present out of control.  What is more, it is spreading in parts of the world with only a single doctor for every 100,000 people, in countries that are very, very poor indeed, without any hope whatsoever of containing Ebola on their own.  In places where hospitals rapidly run out of rubber gloves or face masks, where there are no goggles available, where every bed is already filled with Ebola cases, with many patients lying on the ground outside, who are waiting for patients inside to die so they can get a bed inside.

For many years, I have warned about the risks of a new viral pandemic, accelerated by global travel, densely packed megacities, and weak health systems in many of the poorest nations.  As a trends analyst, physician and founder of an international AIDS agency, I have been particularly concerned about what would happen if a new virus jumped from animals into humans and spread widely.  HIV did just that, and has already killed over 45 million people, continuing to infect over 1.5 million new people every year.  

Roughly every 12 months, a new type of viral disease appears in humans, usually first in Asia, and usually such mutants die out rapidly.  Ocaisionally we have a wider scare, as was the case with Sars and Bird Flu.  With Sars we had a lucky escape.  Out of 8600 cases, around 860 died.  Most infections were in China and countries like Canada - and contacts were rapidly followed up with strict quarantine.  1% of cases were highly infectious super-spreaders - capable of infecting someone who entered a lift they had used the previous day for example. If a single super spreader had travelled to - say - Kinshasa or Kigali, it is very likely that Sars would still be infecting many people today.

As a result of Sars, governments around the world are on the whole better prepared for viral outbreaks than they were a decade ago.

Ebola is not a new illness, and in many ways is easier to manage than HIV since people become sick very rapidly - in less than 22 days - compared to HIV where they may remain infectious for over a decade before showing any signs of illness.  However, Ebola is a major threat:

* Very high mortality - 50-70%.

* No effective treatment or vaccine.

* Very infectious - hence around 10% of all deaths amongst the first 3500 have been among health workers.  And hence the rapidly growing number of cases. Such death rates amongst professional carers are very rare indeed. A spanish nurse became infected in a Spanish hospital in late September 2014 despite wearing gloves, goggles, a face mask and two sets of disposable head to toe clothing.  A single splash into the eye can be enough.  While experts remain confident that the virus does not spread through coughing or sneezing, it is clear that people with Ebola excrete very large amounts of virus in diarrhoea, vomiting and bleeding as they become very ill and (in most cases) die.

If that is the case for a well-trained nurse in a European hospital, then it is obvious that the risks are considerable to family members who may be caring for relatives in mud huts in remote rural areas, or in the slums of megacities.  To illustrate the seriousness of the situation: advice on one official website is to use gloves if you are caring for a relative; if you have no gloves, use soap and water; if you have no soap, use water alone; if you have no water available, wash your hands with earth.  But that is the reality across large parts of Africa.  

To compound the problem, there is the growing risk of further outbreaks of Ebola - not from human to human contact, but from contact with infected animals. Research suggests that fruit bats are natural reservoirs of the virus, but there are growing worries that a wide range of wild animals may also be carrying the virus, hence the warnings about not eating bush meat.

A further indication of how dangerous this virus really is, is that fact that the NHS in the UK says that there are only two hospital beds across the whole of Britain that are fully equipped to deal with Ebola cases.

So what do we expect to happen?  Unless there is very rapid mobilisation of resources globally to help hard-hit nations in West Africa, it is in my view quite likely that Ebola will escape control, and will become a part of the health risks that people have to learn to live with. We can hope that as with other viruses, Ebola mutates to a milder form as it spreads from person to person, but we cannot assume this.  We must also hope that vaccine and treatments are developed very rapidly, bearing in mind that scientists have been studying this virus for several decades.

We are starting to see mobilisation of doctors, nurses, army, non-profit agencies and so on from developed nations, but at a snail-like speed compared to the growth in cases.  At every step, containment is being overwhelmed.  Much of the effort is being focussed on treatment centres for health workers who become ill, which is vital to encourage health care workers to volunteer, following the courageous example of hundreds in the UK.

Expect to see much larger and more rapid mobilisation towards the end of 2014, as cases start to hit Europe and other regions, and as the world in general finally wakes up to the fact that Ebola is not a West African problem, but could rapidly become a danger to the whole of humankind.  

Expect vaccines to become available for health care workers in the New Year, with larger scale vaccination programmes by the middle of 2015, but such vaccines are at present experimental and the degree of protection is as yet unknown.

Let us hope that Ebola is rapidly contained by rigorous contact tracing and strict quarantine, and full precautions by properly equipped professional carers. But even if it is, it will only be a matter of time before the next viral threat emerges.

Best site for regular updates on Ebola news is the BBC - http://www.bbc.com/news/world-africa-28754546


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