BBC Ebola World - Outbreak, The Truth About Ebola

  • September 2014 - possible person with Ebola escaped from hospital, crowd wanted to kill him

  • xmas day 2013 was day 1, kids killed and ate bats (animal populations are sources of infectious diseases), started with Etienne’s family - spread by direct contact with bodily fluids

  • healer collected objects saying they caused the curse, got the healthy & sick together

  • they thought it was cholera at first

  • West Africa did not know of Ebola

  • WHO underestimated Ebola, thought it was severe but manageable

  • there were disagreements between Guinea Ministry of Health, WHO, MSF

  • govt tried to hide true extent of outbreak, only counting those who were laboratory confirmed cases

  • rumors were going around that the foreign doctors were killing people - one girl ran away back to her own village Sierra Leon, and Ebola spread there

  • WHO was aware & let Sierra Leon, but Sierra Leon govt reported that she was not there & has said that they were not made aware that she was sick

  • metabiota from America joined but had no experience dealing with ebola outbreaks

  • govt decided to have infected people to go to the state hospital, but it was quickly overrun and it helped spread Ebola rather than prevent it from spreading

  • there was no system to see who the infected had been in contact with

  • WHO chose not to declare an outbreak

  • interesting the woman who was a nurse said ebola wasn’t real, many nurses recently didn’t believe in covid or at least the scope of covid

  • dr. kahn who had been working to educate the people on stopping the spread got ebola and died

  • Ebola spread to London 8 months into the outbreak

  • No places were prepared or knowledgeable for Ebola

    • some looted places where ebola victims were, taking mattresses and such with their bare hands

  • they tried using police to get people to stop looting and such but also didn’t want them to run to other communities

    • people were brutalized, shot

  • later spread around the world - spain, britain, us

  • numbers started going down - people started staying home, burying dead safely, not caring for ill people

  • officially 10,000 people died, but the number is actually much higher

Class Discussion:

  • lots of MSF workers were European, those that worked on construction or cleaning were locals - if MSF workers got ill, they were sent back to recover

  • MSF focused on contain, do not treat

  • “William Osler once said: “The greater the ignorance, the greater the dogmatism”. During one of the training sessions in Europe, one MSF medical doctor reacted to the announcement that MSF does not use iv hydration. She asked: “So, what are we doing when a dehydrated patient cannot take ORS anymore?” The answer was: “We give them Coca-Cola; that’s what they like”. At a minimum, the dogma of not administering iv hydration totally undermined the principles of medical care. At worst, it demonstrated a patronizing attitude bereft of any medical ambition.”

    • lots of places outside of US consume Coca Cola - helps with dehydration (but not in long run) and is pathogen-free compared to local water that is not, but leads to diabetes mellitus

  • MSF workers felt no satisfaction from their work

  • theres not really an international board to keep organizations like MSF in check

  • using soldiers to quarantine crowds, mistake because soldiers too aggressive & not trained in de-escalation

  • soldiers used to stop people from running and spreading disease to other, more wealthy communities

  • our k-12 education system came from Germany - prepare us for factory settings

  • emphasis on cultural practices - burying the dead, religious leaders/elders were told to let communities know that people will be buried without the traditional practices of touching them on the face, etc.

  • nigeria most densely populated area in africa - lots of worry when ebola spread there

  • liberia - space set aside in africa by america for liberated slaves because some people didn’t want them to stay in america

    • leader of liberia trained in america to go back and lead, not representative of the people

  • question of when we should declare an outbreak

Class Discussion 1/28 & 1/30

  • US intervened in Oct 2014, waited that long because

    • politics - midterm elections for Obama

    • economics - who would miss Guinea, Liberia, Sierra Leone if they shut down for a few months

Definitions

  • Health - absence of disease, complete state of wellbeing

    • physical, social, mental

  • Public Health - actions, policy, research to promote health at the population level

    • community specific

    • what we as a society do collectively to assure the conditions in which people can be healthy (National Academy of Medicine, 1988)

    • the science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private communities, and individuals (C.E.A Winslow, 1920)

  • Global Health - addressing health inequities among countries and within countries

    • improving health for all people in all nations by promoting wellness and eliminating avoidable disease, disabilities, and deaths

Global Health Agenda

  • access to healthcare

  • environment safe to work/live in

  • healthy lifestyles

  • responding to health emergencies

  • safety - air, food, clean water, shelter, sleep, reproductive health

  • nation-specific needs

  • education

  • know your rights

  • sanitization

Medications made for maintenance rather than eliminating the problem so people have to keep coming back for medicine

When making a drug…

  1. efficacy/effectiveness - has to be better than the other drugs already made first and then trials for efficacy and effectiveness

  2. safety - get high & low dose levels and then middle

100-day pledge

  • within 100 days of a pandemic being declared, high income countries pledge to have a vaccine created

Covid-19 → “warp speed” vaccine

  • there was already an ebola vaccine in the works since 2014 outbreak, based on mRna (encoding protein) which helped set the basis for the covid vaccine (they didn’t have to start from scratch in terms of regulations)

LMICs

  • don’t have R&D capacities

first vaccine discovered - smallpox

posteur had a vaccine for rabies, wasn’t ready for it to be used on humans but did because a kid was mauled by rabid dog and mother begged him to try it on the boy - the boy lived

during covid-19, incentive for pharmaceutical companies to release vaccine was higher income economies (germany, u.s.) guaranteeing they’ll buy a set number of vaccines (competing with each other to get it first by offering more money), but this leaves out the LMICs that can’t compete

Vietnam hit badly in 2003 SARS - defeated without vaccine

  • immediately shut down during covid to act similarly during the 2003 SARS - cases stayed low but then drastically increased

5 dimensions of health - interdependent (changing one can change the others); but achieving well-being does not require a perfect balance in all dimensions

  • physical

  • spiritual

  • social

  • emotion

  • mental

Reproductive Health

  • Roe v Wade (1973)

Americans are not guaranteed a right to health legally

  • but, if you go to a hospital with no insurance, they are obligated to keep you stable before sending you on your way

  • OECD - u.s., turkey, mexico, south korea

rfk jr - fluoride in water, vaccine safety, primary aspect of health concerned with - food (obesity & diabetes mellitus type II) & cancer

  • makes it seem like diabetes is a u.s. problem, but it is everywhere! per capita, we are not even close to being the top of the list

epigenetics - changes in gene expression from experiences of parents or early life