In its Talks@Google series, Google has brought hundreds of authors, musicians, artists, innovators, and other speakers to the company’s Mountain View, California, campus for discussions that, the company writes on its website, “capture the popular and intellectual zeitgeist of the day.”
This month the zeitgeist has been Ebola, and on Oct. 3, the expert talking at Google was medical anthropologist and infectious disease expert, Dr. Paul Farmer, chair of Harvard University’s Department of Global Health & Social Medicine and a founder of Partners in Health, which is working in Sierra Leone and Liberia to treat the sick and stop the spread of the disease.
Farmer was interviewed by Jacqueline Fuller, director of Google.org, the company’s philanthropic arm. The talk was broadcast to 42 Google offices around the world and posted to the Talks@Google channel on YouTube on Oct. 10.
Should we be worried in the U.S.?
Fuller first asked Farmer the question on everyone’s minds: “Should we be worried in the U.S. or other developed nations? Do you see this spreading in Europe?”
“I see it coming to Europe, but not spreading. I see it coming to the United States,” said Farmer. “But I agree with the CDC director Tom Frieden … It’s not going to spread here, because we have the ability to do what’s needed, which is isolate the infectious patient while actually giving him good care, and then doing contact tracing, which is, as [Freiden] said, bread and butter of public health.
“To do it, it requires a lot of resources. … And I think that would happen in the European countries I’ve been to. It’ll happen here. So I think we’ve got a very good chance of seeing cases, but not of seeing much in the way of person-to-person spread.”
‘People are dying of the virus. It doesn’t mean that people should die.’
Farmer shifted attention away from the U.S. to West Africa, questioning the inevitability of the disease’s reported 90 percent fatality rate in Sierra Leone, Guinea, and Liberia. “You hear that the case fatality rate is really high, but what does that mean?” he asked. ” It means that a lot of people who get the virus are dying. But doesn’t mean that they should die.”
“I think the message of 90 percent case fatality is damaging,” he added. “I think we should believe that we can flip those numbers on their head. This is a failure of delivery of basic supportive care.” In the most affected countries, the disease “has already made the health system fall apart — that is a done deal,” he said. “It already took down the health system in Sierra Leone and in Liberia.” In those countries, and in Guinea, “there’s not a lot of T in the ETUs — Ebola treatment units.”
For the sake of argument, Farmer asked the audience, “what if the 90 percent was not the fatality rate, but the survival rate? And if the goal or plan is ‘Let’s make sure everybody survives’ — then we have to work really hard to make sure that people are diagnosed early, that they’re given proper care.”
The kinds of symptoms that Ebola causes in the early stages are first abdominal pain and fever, and then vomiting and diarrhea. “And just as with any other cause of those symptoms, you’re losing electrolytes, you’re losing fluids, and the treatment is fluid resuscitation. And any American emergency room can do that,” he said.
‘We should assume we can save the great majority of people sick with Ebola.’
“This is just me saying live to the planet, wherever this stuff goes,” Farmer said: “I think that we should assume that we are able to save the great majority of people already sick with Ebola. What if we assume that 95 percent of people could be saved, and we — pardon me, but bust our asses to try and get them diagnosed and cared for early on and do everything we can.
“What’s the risk in saying, [there should be a] 95 percent survival rate? A risk that I’ll look like a fool? I don’t care, right? I could care less if that sounds foolish to any of my colleagues.
“One little happy thing,” Farmer said, “is that when I was leaving Monrovia, they were just opening up a new Ebola treatment unit. And the ‘they’ was the Liberians, working with colleagues mostly from Uganda. And it was the day before the grand opening and there was a huge crowd in front of the Ebola treatment unit, and they were volunteers. And it was all Liberians.
“People want to help. And we’ve got to help them help, right?”