Ebola Case Counts: Who knows? WHO knows.

There has been significant frustration over the availability and accuracy of Ebola case count data as the outbreak in West Africa has escalated. Media reports, often considered timely and ‘on the ground’ sources of information, have seemingly become reluctant to post their own numbers. These sources have been praised for their ability to pick up on outbreaks before more formal surveillance methods and programs. In the New England Journal of Medicine article by Brownstein et al. the growing importance of online media reports is highlighted[i]:

"Over the past 15 years, Internet technology has become integral to public health surveillance. Systems using informal electronic information have been credited with reducing the time to recognition of an outbreak, preventing governments from suppressing outbreak information, and facilitating public health responses to outbreaks and emerging diseases."

So, if these news reports are considered integral to ‘innovative’ surveillance, why are we still collectively holding our breath for sporadic World Health Organization’s Ebola Virus Disease Updates/Press Releases/Situation Reports/Response Roadmap Reports?

We wait because the World Health Organization (WHO) is considered the ‘gold standard’ in global disease surveillance. They are the organizing authority, within the United Nations system, for all things (world) health. Their objectives, as listed on their website, include “providing leadership on matters critical to health and engaging in partnerships where joint action is needed” and “monitoring the health situation and assessing health trends”[ii]. The organization appears, on paper, to have been established and equipped specifically to respond to situations like the Ebola outbreak burning though West Africa. If the WHO is supposed to be so readied for anything, what’s with the lag in case count data?

The WHO does the directing and coordinating, but the affected countries Ministries of Health (with help from outside organizations) are responsible for providing official data. This data is then collated/analyzed and published by the WHO.

For the Ebola outbreak, the WHO has openly acknowledged the possibility of error, or more specifically unintended underestimation, in their data[iii]. Although we would all appreciate the ease of up-to-the-minute data, we cannot ignore the particularly unique difficulties of this outbreak. The WHO and the media have reported patients and communities resistant to medical care[iv], patients fleeing treatment centers[v], bodies in the street[vi], bodies being buried before recording[vii], treatment centers full or closed[viii]. All of these impediments are severely confounded by a mere silhouette of a health care infrastructure in the affected countries.

Bottom line: case counts in this outbreak are messy and complicated. As of August 21^st, there was a backlog in entering cases into the official system, said Barbara Knust, an epidemiologist with the CDC[ix]. Although the WHO has reported that case counts may fluctuate due to reclassifications, we are hoping that at this point the entering system has been streamlined and expedited[x].

If you are still looking for alternate-yet-still-official information, case count data can be obtained from the websites for the Ministries of Health for some of the affected countries. Sierra Leone releases updates on a daily basis[xi], whereas Liberia releases Situation Reports much like the WHO[xii].