ETA, and everyone who was exposed is past the incubation period without becoming sick.

In the past, outbreaks have died out pretty quickly in a big part because of the isolation of the areas where it occurred. This epidemic is spreading because it happened where it had not been so was unknown, people could easily travel to other places, and more populated places.

As far as the virus, it remains present in the animals it lives in, monkeys and bats. Eating "bushmeat", monkeys and bats, even hunting and gathering them, is how people get exposed to the virus. As far as I have recall.

There are probably other vectors and means of starting an outbreak, but as far as I recall, that is how it starts. 1 person handles an infected animal, gets sick, others get exposed caring, onward.

The virus itself continues to survive in the wild animals, monkeys and bats, even after all the people are cured or dead.

efforts to fight it in Africa

So is it pretty much a given in that everyone in Liberia and the two other countries whose names escape me is going to get it and either survive or die? That is really heartbreaking.

Those who have gotten it tend to be family members and friends who came into close contact by either tending their ill at home or doing the cultural norm of washing, patting, kissing their dead before burying them, or caregivers of other sorts.

Like here, there are many people who have not been exposed. I was meaning the virus will never go away since there are vectors in the wild, animals it can live in.

An outbreak is over when no one has it and incubation period for all exposed is over. But the virus will still be in those wild animals, leading to another outbreak at some time. Vaccines will be needed to protect over time. For now, facilities, equipment, supplies, caregivers are needed to care for the ill, and educators are needed to educate the populace, along with people to search out cases and isolate them and quarantine those exposed.

Unfortunately there is a lot of fear and misunderstandings of what ebola is, how it is transmitted, and the necessity of quarantining the ill and the exposed. Educators have been murdered, riots have happened out of fear that this is a made up thing, meant to kill everyone there.

But no, everyone in those 3 countries need not get it.

get it from the very act of tendering care. Elsewhere in this thread, Warpy has mentioned the urgent need for a vaccine and I heartily concur.

My wife tells me that scientists in Canada have developed an experimental vaccine and I hope it is effective and deployed forthwith.

Thanks for taking the time to clarify; I had misread your original reply and was really depressed by my misreading.

Endemic: (of a disease or condition) regularly found among particular people or in a certain area.
"areas where malaria is endemic"

Here is the article
http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=articleDiscussion
a snip
Notwithstanding the geographic variation in case incidence within and among Guinea, Liberia, and Sierra Leone, the current epidemiologic outlook is bleak. Forward projections suggest that unless control measures — including improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement, and support from international partners — improve quickly, these three countries will soon be reporting thousands of cases and deaths each week, projections that are similar to those of the Centers for Disease Control and Prevention.

Experimental therapeutics and vaccines offer promise for the future but are unlikely to be available in the quantities needed to make a substantial difference in control efforts for many months, even if they are proved to be safe and effective. Furthermore, careful assessment of the most effective means of utilizing such interventions (e.g., vaccination or treatment of contacts versus health care workers) will be required while stocks remain limited.

For the medium term, at least, we must therefore face the possibility that EVD will become endemic among the human population of West Africa, a prospect that has never previously been contemplated. The risk of continued epidemic expansion and the prospect of endemic EVD in West Africa call for the most forceful implementation of present control measures and for the rapid development and deployment of new drugs and vaccines.

"......It ends when there are no new cases and everyone who had it has survived or died......"

It ends when the percentage of susceptables in the herd drops below, IIRC, 30%. Because of herd health (the vaccination effect), if we get the percentage of vulnerable individuals down below a certain level, the virus can no longer propagate through the population effectively. This number varies from virus to virus due to quirks in epidemiology and I don't even remember its exact name, but I do remember the basic principle.

Point being, it need not drop to zero.

It will burn out BEFORE it reaches the point of everyone infected and either dead or recovered. Herd immunity.

This is why some of us are doctors and some of us are not.

Have you ever gotten one of those papers after a clinic visit, This Is Your Condition? Good chance I wrote that after researching med/scientific journals. You are welcome though writing to "5th grade reading level" was a bit to do at first.

aim for in my client education materials. But then I do a lot of face-to-face verbal explaining, too.

Too bad you were so patronizing about it.

It's generally a sign of low self-esteem when someone has to build themselves up on an anonymous website, by putting others down.

simply because it got to a city.

In the villages out in the bush, it runs its course through one extended family and then goes away. Travel to neighboring villages is often too expensive and laborious and infected people who try to flee die before they get there.

City life is a bit different. There are more people around than in the villages and neighbors can join in the funeral rites that provide maximum contact with infected corpses. In addition, in men who have survived it, it is an STD for the next three months as the virus hides in semen. Women who survive carry it in breast milk for several weeks.

I'm afraid the persistence of live virus in semen is going to make this outbreak especially hard to contain unless they want to lock men up for 3 months until no virus is detected in their semen.

We need vaccines and treatments. Those are the only things that will stop this one in Africa. Stop it there and you'll stop it here.

focus efforts on fighting this in Africa as well as here. A worldwide crash course to develop a vaccine and administer it widely would seem to be the first order of business.

The first recipient was a nurse from the UK (it was on the BBC webpage). It's far too early to tell if it will work, how long it will work, and how many boosters it will take.

My best guess says that if medical workers don't croak from the vaccine, they'll start doing larger trials on high risk people in the same villages where they've found people sick with Ebola.

Still, we're months away from hearing anything, years away from definitive proof it works.

can't get to another susceptible humans.

But there is suspicion that this virus occurs in animals in the wild, with fruit bats high on the list...but also other mammals.
So the disease may continue as an endemic infection among them, only going away if somehow, infective virus from the last infected animal doesn't get to another susceptible host.

"Well, duh!" moment while reading the first paragraph. As Warpy noted above, getting a vaccine is really the only way to fight this in humans and I hope one is developed soon.

lives until something else comes along (human, perhaps even dog), is thought to be a species or three of fruit bats.

IOW, Ebola is enzootic in fruit bats in Africa the same way plague is enzootic in ground squirrels/gophers in the SW US. Sometimes that spills over into humans.

If Ebola keeps this thing up in West Africa, though, it could mutate just enough to be really successful long term in humans and become an endemic HUMAN disease in the region.

We. Need. That. Vaccine. Now.

I suppose that's not clear enough language.

Wait, wait! I think I got YOU, who didn't say there is also suspicion of an arthropod vector in those bats




http://virus.stanford.edu/filo/bats.html

".....But there is suspicion that this virus occurs in animals in the wild....."

And i responded by CORRECTING you. It's not a suspicion. It's a fact.

So then you go off on the arbovirus tangent, which virologists have pretty much pooh poohed. The web page you cite is from 1999. Last I looked it was 2014.

and you can't recognize someone pulling your leg.

it and Onionesque humor.

http://www.twiv.tv/tag/ebola/

http://www.who.int/mediacentre/factsheets/fs103/en/

http://en.wikipedia.org/wiki/Ebola_virus_disease

http://www.ecohealthalliance.org/press/84-recent_study_suggests_bats_are_reservoir_for_ebola_virus_in_bangladesh

http://www.ncbi.nlm.nih.gov/pubmed/17848072

I mean really. That web page looks like dates back to the 70s.

since March and found The Economist article "Much Worse to Come" dated today 10/18/2014 one of the most informational and well-researched I've seen.
Covers the history and forecast of what might come but also tells us just which countries, public health agencies, governments, NGOs and medical companies are supporting and actually working in West Africa. It's long and not easy because it took the world so long to come around to the severity of the epidemic but it's well worth your time.
Another good way to learn what's happening is to listen to people returning from working in Africa if you have an opportunity. The CDC people, missionaries, research students, medical personnel, such as Doctors without Borders are helpful when they come home.

I only wish Obama had appointed a "czar" someone like Paul Farmer who is working in Africa now and has long experience in planning, setting up and coordinating services around the world.

of government with all of the dishonesty and BS that comes with it

try to find it tomorrow and give it a read.

I'm having to undergo something of a crash course in epidemiology and public health for the layperson (as I suspect several others on this board are) so every tip helps.

to arise and strike us as we come into contact with them. It must also be recognized that as these lands are de forested the land becomes inhabited and exposure goes up exponentially.

It might only end when they develop a vaccine.

Hopes that it will "burn itself out" seem futile at this point. Here's the page with WHO updates which show the progression. It's very detailed, and certainly quite disturbing.
http://www.who.int/csr/disease/ebola/situation-reports/en/

Look at the last two reports. On the 15th they reported 8,997 cases with 4,493 deaths, and on the 17th they reported 9,216 cases with 4,555 deaths. The update for the 17th is an annex. The full report for the 15th has a lot of information. In particular, the wave formations in the week-by-week maps have not stopped and are very frightening.

It's much more likely to show up in neighboring countries than it is to die out, and when you look at the maps, it's hard to believe it hasn't jumped the border.

If you look at those maps, it's easier to understand why they didn't freak earlier than they did. Another wave kept passing, and then they'd think they were gaining on it. Now no one can believe that.

and it seems researchers in Canada infected some macaques with this particular strain and it is very virulent.

I think that is a more realistic approach.

There is one thing that has been worrying me since the beginning of September - this virus simply must be mutating, because this is the first long-pass chain through humans we've seen. And in the cities, there should be different selection pressures.

I mean, it's a normal technique when working with a virus to create a strain fitted to your study species by just creating a long chain through that species. We KNOW this happens.

The other thing that worries me about that distinct wave formation we see in the stats when we look week by week (pretty consistent across countries), is that it looks like there's a substrate channel forming, and that looks like carriers. It could be that it's passing from humans to rats back to humans, but I think human carriers or "slow" cases are the best fit, although rodent births are the next best fit.

I think all bets are off and that we need to proceed on all fronts, but that we need to be very sensitive to patterns as they emerge, and that over-cautiousness will repay us.

That is very concerning to me.

since one of the suspected reservoirs has been bush meat, IOW monkeys.

He's right that even though this disease has been emerging for 40 years and has been studied, we don't know the whole story.

What we seem to know at present is that body fluids are incredibly infectious. That people in the prodromal stage aren't yet contagious, that it seems to be hit or miss among health care workers with the same exposure to the disease, that people living in close quarters like one room huts with someone who has it don't all get sick, and what we can identify are close contact with blood, body fluids, and a corpse after death as the biggest risk factors.

Of course, all that is open to change, but it's what we have to go on right now, at this moment.

He's right that this is not going to go away until we have a vaccine. One is now undergoing limited trials in moderate risk healthy people. I just hope it's not too late for West Africa.

Of one guy in senegal.

The reason for that is because surrounding countries have taken the "mean, bigoted, unfair and counter-productive" (according to the unnamed "experts&quot steps of closing their borders.

In fact, except for that one guy in Senegal, EVERY exportation of ebola has got out on an airplane- despite the rigorous exit screenings that involve a form and a potentially miscalibrated forehead thermometer.

ours.

They tell us that stopping will make things worse, but they give no examples of where that has been the case and fail to address the fact that a travel ban is part of the program that's worked so far in Nigeria and Senegal.

They're just saying, "trust us," and while I would trust Obama and Freiden over, say, Cheney and Rumsfeld, I'd still like to see a write up of their evidence.

Not producing some back up studies makes me think that there are other considerations that are not being discussed at all.

They've cycled through several arguments against, none of them particularly convincing.

i agree with your last sentence 100%, as well.

I don't feel so weird about questioning this particular authority.

So, I doubt that it hasn't. The "drag and shovel" approach may be operating. I wouldn't trust that theory. Too much land.

in surrounding countries, which one would expect if folks were sneaking across the border and hiding, and infecting others- indicates to me that there has been at least moderate success so far.

One hopes that success holds, of course.

Mind you, I hope it does work.

particularly if our neighbors to the north and south decide to restrict travel from the affected nations as well.

http://news.sciencemag.org/health/2014/10/congressional-ebola-debate-invokes-plos-paper
According to the group’s more recent predictions, the risk of another infected person arriving in United States by 31 October given the current reductions in air traffic is about 25%. The published work simulates how reductions in travel can reduce the spread of the disease—right now, their estimates assume an 80% overall reduction in travel—but Vespignani notes that cutting down on traffic is just “postponing the problem for a finite amount of time.” (The 80% drop amounts to a 3- to 4-week delay in a probable case, he says.) “This debate doesn’t have to divert the discussion from the real issue, which is to win the battle in Africa.”

Ira Longini, a biostatistician at the University of Florida in Gainesville and another author on the PLOS paper, says he thinks “it’s fine” for Congress to make use of the work in a hearing, but laments that “people are notoriously bad about interpreting probability.” The group’s plots show how the probability of new imported cases would drop if the flow of travelers decreased, but it doesn’t wade into the complex costs and benefits of a travel ban. “You can point at that plot and make the argument in either direction,” Longini says. The group plans to publish a new paper next week that looks at the impact of travel restrictions that some airlines and governments have already imposed. “They can point at that one next,” he says.

2 successive 21-day incubation periods with no new infections will mark the official end.

Sadly, a lot of people will suffer horribly and die before that happens. The world is in a race against the virus right now, and because we dilly-dallied around, we are starting out from way behind.

The WHO has determined that we need to isolate 70% of all cases before slowing the spread.

Right now number of cases are on the exponential increase.