Science
21 November 2014 vol 346, issue 6212, pages 885-1028
http://www.sciencemag.org/current.dtl

Feature
Saving lives without new drugs
Jon Cohen
Many people treated for Ebola in West Africa have received bare-bones care in overwhelmed facilities that had few resources, contributing to a case fatality rate (CFR) of about 70%. Of the 20 patients treated in the United States and Europe, only five have died, a CRF of 25%, and the ones who did not recover tended to begin their care at the latest stages of disease. Now, a push is on for what’s dubbed Maximum Use of Supportive Care (MUST), which would offer Ebola patients in West Africa the basic life-saving interventions common in wealthier countries. MUST includes intravenous fluids to combat dehydration; balancing of electrolytes; nasogastric tubes for feedings; and medicines to counter diarrhea, vomiting, and secondary infections like bacterial sepsis and malaria. Estimates suggest that MUST would cost no more than $600 per patient.

Report
Strategies for containing Ebola in West Africa
Abhishek Pandey1,*, Katherine E. Atkins1,2,*, Jan Medlock3, Natasha Wenzel1, Jeffrey P. Townsend4, James E. Childs5, Tolbert G. Nyenswah6, Martial L. Ndeffo-Mbah1, Alison P. Galvani1,5,
Author Affiliations
1Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
2Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
3Department of Biomedical Sciences, Oregon State University, Corvallis, OR, USA.
4Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
5Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
6Ministry of Health and Social Welfare, Monrovia, Liberia.
Abstract
The ongoing Ebola outbreak poses an alarming risk to the countries of West Africa and beyond. To assess the effectiveness of containment strategies, we developed a stochastic model of Ebola transmission between and within the general community, hospitals, and funerals, calibrated to incidence data from Liberia. We find that a combined approach of case isolation, contact-tracing with quarantine, and sanitary funeral practices must be implemented with utmost urgency in order to reverse the growth of the outbreak. As of 19 September, under status quo, our model predicts that the epidemic will continue to spread, generating a predicted 224 (134 to 358) daily cases by 1 December, 280 (184 to 441) by 15 December, and 348 (249 to 545) by 30 December.