[rwallace]

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epide...

In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while, it even looked as though it had worked.

Unfortunately, it didn't, by a long shot. Now WHO and MSF want to repeat that strategy on a much larger scale.

My opinion is that this is a very bad idea. The epidemic in West Africa not going to be stopped. That window of opportunity closed months ago, if it was ever open. If we send in thousands of doctors now, a large percentage of them will end up dead, and the epidemic still won't be stopped. It will be a waste of life, and at that, of the lives of trained doctors and nurses who will be all too soon and badly needed if the epidemic does start hitting other regions where the outcome would still be in doubt.

And no, sending in the military is not the answer. Not only does "it's for your own good" not morally justify aggression, but by further eroding the trust of the local population for authority in general and foreigners in particular, it would make matters worse, not better.

The affected area needs to be sealed off so the disease can't spread to the rest of Africa and the rest of the world. By all means airdrop medical supplies to Liberia, but don't for heaven's sake start sending hordes of doctors, soldiers and camp followers there to create more fodder for the virus.

[ghshephard]

Your recommendations are exactly contrary to the guidance from those who have spent their entire careers studying the best way of responding to these types of epidemics.

Attempting use "force" to seal off the area, is perhaps the single most effective way to lose all control of this disease, and see it spread to hundreds of thousands, if not millions of people who (quite reasonably) decide to fight back against such an activity.

Careful Training, use of locals who have developed immunity, massive injections of beds, medicine, and supplies, can have a huge impact, and keep this current epidemic under control

[rwallace]

Your argument is from authority, but authority is trumped by empirical fact. The kind of strategy you advocate was, yes, the right thing to try back in spring, when there was reasonable hope that it could work. It conclusively failed, at a time when the outbreak was far smaller and more tractable than it is now. It cannot possibly keep the current epidemic under control, because the current epidemic is already not under control, hasn't been for months. Meanwhile, hundreds of healthcare workers have, despite training, been among the dead. No amount of training can compensate for the fact that with a caseload of this magnitude you get overworked to the point of exhaustion and start making mistakes.

By contrast, the strategy I advocate has thus far been working.

Nigeria? Cut travel to the affected area. One idiot had slipped through, causing an outbreak. Because it was only one small outbreak, it was possible to contain it.

Senegal? Same. Tougher problem because it has a land border with the affected area. In response, citizen groups have been supplementing the security forces, patrolling the border and turning back people trying to enter the country, thus far successfully.

Ivory Coast? Cut off travel from the affected area. Thus far, no Ebola detected.

Do you believe in results? I advocate abandoning the strategy that has been proven not to work and focusing on the strategy that has been proven to work.

[gbrown]

You have no idea what you're talking about. Sealing off the area wouldn't just be a crime against humanity, but it isn't possible. This is a region with little infrastructure and extremely porous borders.

The reason things got out of control is that the world relied on charitable organizations to fix things, but the wonderful folks at the MSF were quickly outgunned.

[rwallace]

I would suggest actually reading about the facts of the case before commenting with such unfounded confidence. Empirically, sealing off the area has been working so far. The wonderful folks at the MSF were not outgunned - they had resources that seemed adequate to the task - if you read the article I linked, it explains the actual reason things got out of control. And this disease has the potential to rack up a nine digit death toll if we fail to contain it. Allowing that to happen would be the crime against humanity.

[gbrown]

If you'd followed the outbreak as you seem to claim, you will have seen that they succeeded to a large extent in Guinea, but the subsequent spread to other areas overwhelmed their capacity quickly, and that efforts to contain the spread were complicated by having to work with three (unprepared and weak) governments. Oh, did I mention that Guinea did try closing the borders and was unable to?

I'm writing a dissertation on infectious disease spread, and your comments strike me as uninformed and harmful. The time for massive action is now, and pipe dreams of impossible (and downright inhuman) international quarantine cordons only confuse the issue.

[JulianMorrison]

A cordon sanitaire won't work. You're betting against the ingenuity of every single person trapped behind it, and the inevitable infected refugees are very motivated to confound efforts to find them.

[rwallace]

No, I'm betting the world's medical resources can contain the occasional small outbreak created by the occasional individual who gets past the cordon, particularly since such containment doesn't have to last forever. You can't put out an inferno, but you can put out scattered sparks.

[gbrown]

We're talking about a region with more than 20 million people, and recent research indicates that the disease may become endemic rather than burning itself out. Cordons would just hamper our ability to get aid in and try to keep infected patients isolated. What's needed is immediate and large scale increases in the number of isolation beds available in field hospitals, tons of PPE, and trained personnel. Or perhaps we should ignore the consensus of the entire infectious disease and medical communities.

Or perhaps we should ignore the best advice of both the medical and epidemiological communities and throw our effort behind an impossible and inhuman military containment scheme...