Ebola, the day after

Ebola, the day after A total of 28,616 cases (confirmed, probable, and suspected) and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone from March 2014 to June 2016. At first, the clinical picture dominated by severe gastroenteritis baffled clinicians trained to diagnose viral hæmorrhagic fever based on bleeding. And there was another problem: samples had to be sent abroad for laboratory confirmation of the diagnosis. From the start, the outbreak elicited strong reactions in the different social strata and within public and private institutions, their scope extending far beyond the mere biological dimension of the phenomenon. By the summer of 2014, the winds of panic were blowing. Public health recommendations were issued, in authoritarian fashion, to the population, in some cases prompting a violent response. Accustomed to locally-confined Ebola outbreaks causing a few dozen deaths in several months, the world discovered forecast models that, in one case, suggested the possibility of a million cases with half a million deaths. Though it did not get to that point, by the late 2015 there were over 215,000 people needing to be monitored due to contact with a patient. Clinicians had no rapid diagnostic test that could be used in their consultations to deal with the situation. No antiviral drugs had proven effective, and symptomatic and palliative treatments were limited by the care providers' fear of infection. There are no data proving that such treatments reduced the death rate. The impact of public health measures on the course of the outbreak at the population level is also unclear. Despite this rather bleak picture, early trials of a vaccine against the Zaire strain suggest that the response to such outbreaks will soon be more effective.