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The Ebola flag

By Clem Sunter

Flag-watching is the foxy way to capture game-changing phenomena in the world around you and to decide what your wisest response should be. Flags, like those of countries, come in all shapes, sizes and colours. The same is true of company logos where each has its own distinctive identity.

The flags which foxes watch are the events and trends that can change the future in a material way. Some flags have fairly definite consequences, while others have a wide variety of possible futures flowing from them. They can stay up for a long time or suddenly come down. Obviously, the more a flag can affect you personally or your family or your business, the keener your sight must be to pick up movements in the flag and the more attention you must pay to the best means at your disposal to handle the flag. The impact and probability of the potential outcomes associated with the flag, together with your ability to alter those outcomes for better or maybe for worse, have to be constantly monitored. That is what risk evaluation is all about.

Such is the case with the latest outbreak of Ebola. Although the number of reported Ebola deaths still has to reach 5 000 in its latest appearance (compared to 40 million people who have died so far of AIDS-related causes and the millions who die every year of Malaria), the disease has consumed the world's attention more than any other item of news over the last month. The reason is that once a patient shows any symptoms of the disease which can occur within 21 days of catching it, he or she becomes super-contagious. That is why the doctors and other personnel who so bravely treat Ebola patients look like astronauts and have to cover themselves up completely. It is also why the teams who collect the bodies of the victims have to do the same. The fatality rate among those catching Ebola is currently estimated to be 70%.

The epicentre of the epidemic at the moment is Guinea, Liberia and Sierra Leone in West Africa. The few cases occurring elsewhere in the world have been medical personnel who have volunteered to work in the region, carers who have come into contact with those medical personnel in the home base hospitals to which they have been evacuated and one or two citizens of the affected countries who have travelled overseas. We have not yet seen a case of transmission in America or Europe caused by contact between an infected person and the public in some congested street or train. Nevertheless, people who have come into close contact with infected individuals have been either quarantined or asked to monitor their temperatures for 21 days.

Best and worst case scenarios

So where can the Ebola flag lead us? The best case scenario is that the interventions currently being made in the three affected countries - to educate the community, test all potential Ebola cases and treat those infected in isolated wards - work and the epidemic peters out. Experimental drugs like ZMapp which are at present being rolled out turn out to be effective and a vaccine is successfully tested and made available. This stops any further outbreaks. President Obama receives accolades for his timely provision of American soldiers to fight the epidemic in Africa and the world moves on to other things.

The worst case scenario is that the interventions are too little, too late and the epidemic spreads to other African countries and possibly jumps across the ocean. International travel becomes severely curtailed as entry visas are refused for anybody travelling from an affected country, as Australia has already done this week. Meanwhile, Peter Piot, the Belgian scientist credited with the discovery of Ebola in 1976 (it was named after a river in Zaire), has made the following statement: "A mutation that would allow Ebola patients to live a couple of weeks longer is certainly possible and would be advantageous to the virus." In other words, the worst case scenario is where Louis Pasteur's words ring true: "It is the microbes who will have the last word."

Interestingly, two of the worst epidemics of all time are considered to be the Black Death which killed somewhere between 75 and 200 million people between 1346 and 1353 and reduced the population in Europe by 30%; and the Spanish Flu which killed 50 to 100 million people between January 1918 and December 1920 and reduced the world's population by 3 to 5%. In the latter case, the virus mutated during the course of the epidemic into a much deadlier form.

Of course, there are intermediate scenarios where Ebola does not go away but never goes beyond a limited outbreak. All we can do in South Africa is watch how the flag plays out and take the necessary precautions as a country. We have already had two cases of Ebola here, but they occurred in 1996. A doctor treating patients in Gabon travelled to South Africa. He fell ill but recovered. However the nurse treating him died.

Lest we forget the human dimension of this epidemic, I have to mention a heart-rending picture I saw in the newspaper the other day of a small Liberian boy of about 10 sitting cross-legged on the floor of a bare room. He was staring vacantly into space. He was infected and had been isolated from his parents and friends. The shadow of Ebola is very dark indeed.

By Clem Sunter

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