Ebola Bundibugyo Wednesday Numbers

Back from the daily Task Force meeting. The group is getting larger every day, as planes fly in, and is both numerically and culturally more complex. I can easily count 8 different countries represented; there are probably more. The Africans and the MSF advance team showed up first, but the bajungu (whites) are increasing in force. It is oddly reassuring to hear those good old American accents from the CDC, and heartening to see four fresh young doctors on the ground. The epidemiologists outnumber the clinicians I’m afraid. There must be a dozen people there with high graduate degrees working on the numbers, the transmission, the pattern . .. . But only three seeing patients. I have such great respect for all of them, but particularly those who are donning the head to toe PPE “Personal Protective Equipment” and caring for patients. OK the numbers:

• Cumulative cases 93 (controversial actually. Now that we have MSF, WHO, something like African Epidemiology Network, Ministry of Health, and CDC all wanting a say in who is a case and who isn’t, they don’t totally agree on this . . .also as wise Dr. Yoti pointed out, if numbers shoot up this week it can be a reflection of good surveillance, of contact tracing, not of a spike in the epidemic.)
• New admissions to isolation units today: 4. Two were in Bundi and two in Kikyo.
• Deaths: 21. But they decided not to include Jonah’s death in that number because he died in Kampala not Bundibugyo. Clearly he got his disease in Bundibugyo, so in my opinion 22 more accurately reflects the toll of the disease to date. Again one must bear in mind that there may have been others that were missed in the community.
• Deaths in the last 24 hours: 3, all medical workers, Dr. Jonah Kule, clinical officer Joshua Kule, and nurse matron Rose.
• Money the task force budget wishes for: 400 millions shillings . . . (about 250,000 dollars, for a major epidemic. Luke told me today that the Virginia DOT has budgeted 80 MILLION dollars to for snow removal this year).
• The government agencies involved don’t seem to have much in the way of funds . . . But UNICEF has already given clearance for the money allocated for this district be reassigned for use to combat this problem, and clearly MSF and CDC are bringing in lots of resources. There were calls for transparency from people whom I personally know to be opaque and slippery. Maybe a bit of scrutiny of spending patterns would be one of the good things to come out of this tragedy.
• Main discussion points: should public gatherings be banned, even weddings? Is it a mixed message to ban public gatherings and then travel in a film van to show an educational film about Ebola, if that attracts hundreds of people? The decision was: yes. Bag the film for now and educate in small groups. Should community educators be paid for their mobilization efforts? I bit my tongue when it was mentioned that would be too expensive, yet the lab plan is to fly samples every other day from Bundibugyo to Entebbe (at $600/flight??).
• Specimens collected for testing and sent today on MAF: 28: the CDC has set up a lab in Entebbe at the Uganda Viral Research Institute. They have a few people in Bundi, not sure what all they do, but the main lab will be off site. They will try to leave behind a sophisticated lab that Uganda can then use to find answers on outbreaks like this much faster. They said that the PCR (test for presence of virus by detecting the genetic material of the virus) has not been fully developed for this new strain, so we’ll have to rely on antigen detection (looking for various proteins the virus makes) which has “very good” sensitivity (read: we think it should work for this strain like it has for others to find all the cases but we don’t know the real numbers yet, so it is hard to feel too secure about a negative test) and 99% specificity (read, if you get a positive test, it really means you have the disease). They will tests all samples for the antigens (presence of the virus) plus antibodies (evidence of a person’s immune response, therefore indirect evidence of the virus). Unfortunately not all the lab equipment arrived, so the first batch won’t be run until Friday.
• Data I wish we had: non-Ebola district death and suffering, as a result of fear, of lack of health center staff, of patients running away. The usually bursting-full maternity unit was EMPTY. Maybe that’s fine, maybe that’s not fine and there will be dozens of dead babies or mothers or both in the wake of this.