Ebola Bundibugyo: Friday Night Numbers

Two weeks and one day since the diagnosis of Ebola was made public.  Two weeks since the MSF preparation team came, 12 days since the first real medical staff, and 10 days since the overall organized response took shape.  In that time it is good to think about what has NOT happened.  Ebola has NOT been confirmed anywhere outside of Bundibugyo.  Hundreds of new cases have NOT materialized.  Health centers in addition to the two primary foci have NOT been swamped with cases.  It has been a stressful and uncertain two weeks, and a time of great loss and sorrow.  There were many points at which it seemed we might be reaching the potential beginning of the end of life as we know it, with diffuse spread of the infection and overwhelming fatalities.   Thankfully that has not happened, but now the weariness of grief is beginning to catch up with us, the change in pace to the long-haul.  And with that shift comes the district and ministry wrangling over money, power, and control.  Scott spoke up in tonight’s meeting on behalf of compensation for health workers who were infected and recovered, as well as the families of those who died, concerned that these people were getting lost in the scramble for the money flowing in.  He was immediately attacked by at least three people who sensed a threat or challenge to the proposal of huge allowances for all numbers of people, some of whom are quite peripherally involved. Sigh.  I think it is a small reflection of the kind of pressure Jonah faced.  If we aren’t a threat to the way things are, we shouldn’t be here.  And so it goes.

• Cumulative Cases:  120.
• Cumulative Deaths:  34 (CFR 28.4%)
• Admitted:  Bundibgugyo 8, 1 new admission, 1 discharge, 0 deaths.  Kikyo 10, 1 new admission (a health worker sadly), 0 discharges, 0 deaths.
• Confirmed cases by lab:  32 still, but now we got the information that 11 have died, 7 are still admitted, and 14 have recovered.  If those 11 are the only ones to die then the CFR among laboratory confirmed cases will be slightly higher than the overall, at 34%.  The numbers are small, and this CFR could be falsely lowered by the fact that the sickest patients did not survive to get their labs drawn, or falsely elevated if we go back and test lots of people for antibodies since we’ll only find the survivors.  Still it is the best number we have, and would suggest this strain is less lethal than other strains of Ebola.
• Contacts:  345 (17 were removed from the list for reaching their 21 day limit, a milestone we look forward to next week!).  Over 90% were followed up today.  
• Interesting stories:  the two biggest clusters of related cases  have been mapped out.  There do not appear to be multiple sources of this infection crossing from the supposed animal reservoir to humans.  This is excellent news, since it was certainly possible that Bundibugyo might have had lots of little mini-epidemics all cropping up in this time period.  Most cases seem to be directly related to each other.   However not all are testing positive, which may mean that we are looking at not just another strain of Ebola but something else as well.  We continue to be thankful for the excellent and inquisitive minds who are focusing their energies on this.
• Sad news:  there was a massive turn over in staff today, especially WHO, including three of the men whom we have grown to really trust and respect over the last ten days.  They will be missed.  Dr. Yoti promised to come back.  Other sad news was that a mission house was broken into, the thieves dragging a safe a long distance and then sledgehammering it to pieces.  They were probably disappointed to find it was pretty much empty.  Sad for all of us that people would use this time to take advantage of others.
• Happy news:  The UPDF nurse Fred, whom we met in the Bundibugyo isolation unit the first time we went to investigate patients, recovered.  
  

Some men that Scott lived with in college, 25 years ago, let us know that they are coming together to pray for us.  A dear friend whom I have known since I was born, and almost never had an email from, wrote today.  We continue to be humbled by the outpouring of love and concern from the amazing network of friends God has blessed us with.  We even had a call today from the National Forestry Authority official who nearly arrested us last Christmas when we cut down a pine tree (with permission, but it turned out that the permission was not from the people who had authority to give it . . . ).  He wanted to be sure we are OK, and asked us if we had our Christmas tree yet for this year!  For the first time in my memory I have not done any preparations for Christmas at all beyond packing a hurried trunk of things for my children when we sent them off.  But the team in Kampala had tree and decoration plans for tonight, so we politely declined the NFA friend, though we appreciated the thought!