Talk:WikiJournal Preprints/Western African Ebola virus epidemic
Anis, O; et al..
Pass. WMF copyvio tool using TurnItIn. Similarities are either attributed quotations or common phrases such as "...more than 80% of registered contacts associated with known cases of Ebola virus disease..." which where were not regarded as plagiarism. T.Shafee(Evo﹠Evo)talk 02:06, 4 November 2018 (UTC)
Although Ozzie would be the corresponding author, I would insist on caring to leave a message on the talk pages of the 47 other editors (excluding 2 IPs) who have made more than 20 edits to the page. The objective of this message is to invite the contributors to collaboratively submit the article for review through Wiki.J.Med, and if possible, to help in further betterment of the article in accordance to the suggestions of the reviewers. Wikipedia articles are collaboratively authored. So, it is very important to make the authors aware of such a process that the article is currently undergoing. Diptanshu 💬 12:31, 3 November 2018 (UTC)
- this may help--Ozzie10aaaa (discuss • contribs) 12:41, 3 November 2018 (UTC)
- @Ozzie10aaaa:: Check the link that I have already provided. It possibly makes things easier. Whichever link you use, the choice is yours. But, I would insist you to take the trouble of informing the other contributors. It is possibly an act of common courtesy for a collaborative project like this. Diptanshu 💬 12:45, 3 November 2018 (UTC)
While copyediting this version of the Wikipedia article, I noticed that the image captions are signed by users such as Chris55. That wouldn't be allowed at English Wikipedia (see W:WP:SIGNATURE) but perhaps the rules are different here. Art LaPella (discuss • contribs) 05:28, 4 November 2018 (UTC)
- Thank you for your copyedits and checking on formatting here. In the case of the journals, we try to include the creative commons attribution information under the caption to ensure that even if printed off, attribution is maintained. T.Shafee(Evo﹠Evo)talk 06:34, 4 November 2018 (UTC)
First peer review
anonymous peer reviewer Prof. Medicine. Published on West African and Democratic Republic of Congo Ebola outbreaks.
This review was submitted on 26 November 2018, and refers to this previous version of the article
The article is extremely long and tedious to read. Because of its length and extensive content it is useful mainly for someone intensively researching the one specific outbreak.
I cannot attest to the accuracy of the dates or the numbers as that would require an enormous expenditure of time. Some that I remember are accurate. It does capture the evolution of the epidemic in what seems to me in an accurate fashion. The organization covers the outbreak well and then has a few sections which cover vaccines and treatment and some other subjects which either should be clearly restricted to the history of what was done then, or more usefully and perhaps in another article, to what is available now. The relevance is that there is a major epidemic of ebola virus disease now in the Democratic Republic of the Congo and there are likely to be many more. It is best to have current information on things like treatment, prevention, etc.
My problem is understanding exactly what is the purpose of this article and its presumed readership.
Also I may have missed it, but there are aspects of ebola virus disease that are very important to consider in terms of infectivity. When people get sick, they tend to stop moving about and therefore only expose family and care givers. As they get sicker, the viral titers in secretions and blood rise (and therefore danger to others rises) and are very high at death. That is why funerals where bodies are washed and otherwise handled by many are so dangerous. The person is of little danger early in the disease.
This is a valuable review and will answer accordingly:
1.In terms of prevention if you look at the 'Vaccine' section, last paragraph (last 3 lines) that is addressed, in terms of treatment even today the North Kivu Ebola outbreak has no specific (approved) treatment and any given is via Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI). As for altering how the article is presented I would direct your attention to the #2 answer below.
2.Prior to this outbreak the largest total case count was 425 (Uganda 2000) clearly the impact of this outbreak at almost 30,000 total cases (and probably more) is beyond a viral outbreak. The West Africa Ebola virus epidemic affected countries such as Sierra Leone, Guinea and Liberia economically for years. The outbreak also revealed for the first time Post Ebola virus syndrome which has been indicated in several articles since. Put more clearly this is a historical view of how one massive outbreak of a virus with a high CFR affected so many countries and lives.
3.If you look at subsection 'Human to human transmission' in the 'Transmission' section, you'll see the first paragraph (more specifically, first 3 lines) cover your last point. Additionally, the 'Virology' section, third paragraph indicates 'funeral' transmission more than once.
Second peer review
Jesús Olivero Universidad de Málaga
This review was submitted on 08 December 2018, and refers to this previous version of the article
I have checked carefully the paragraphs of this manuscript to which I can contribute from my expertise area (i.e. zoogeography). I find that the information on animal to human transmission, provided in the “Transmission” section, is quite accurate. It makes emphasis on the possible implication of bats as reservoir hosts, but importantly, indicates that the virus has been never recovered from them.
So, I have nothing to change of the manuscript. If something relevant can be added, it could be a reference to recent studies suggesting that forest loss could contribute to the occurrence of new outbreaks, including that one in Guinea, as already mentioned in w:Ebola_virus_disease#Transmission (see original sources in https://www.nature.com/articles/s41598-017-14727-9 and https://www.nature.com/articles/srep41613).
This is a valuable review and have gone about the recommended changes:
- Agree that deforestation should be mentioned in the articleWikiJournal Preprints/West African Ebola virus epidemic#Animal to human transmission and WikiJournal Preprints/West African Ebola virus epidemic#Projections of future cases. Therefore have included both-
- D’Odorico, Paolo; Hayman, David T. S.; Santini, Monia; Rulli, Maria Cristina (14 February 2017). "The nexus between forest fragmentation in Africa and Ebola virus disease outbreaks" (in en). Scientific Reports 7: 41613. doi:10.1038/srep41613. ISSN 2045-2322. https://www.nature.com/articles/srep41613. Retrieved 8 December 2018.
- Nasi, Robert; Sheil, Douglas; Leendertz, Siv Aina; King, Shona; Suter, Jamison; Park, Douglas; Salim, Mohammad A.; Gaveau, David et al. (30 October 2017). "Recent loss of closed forests is associated with Ebola virus disease outbreaks" (in en). Scientific Reports 7 (1): 14291. doi:10.1038/s41598-017-14727-9. ISSN 2045-2322. https://www.nature.com/articles/s41598-017-14727-9. Retrieved 8 December 2018.
Third peer review
anonymous peer reviewer MD, PhD, PhD, MS with ~20 years experience in the Ebola field
This review was submitted on 13 January 2019, and refers to this previous version of the article
“West African Ebola virus epidemic” is an overall very nicely written and highly informative summary on the 2013-2016 Ebola virus disease epidemic. However, some more and some less significant edits should be made to increase accuracy and to avoid misconceptions among the readership:
- Since the article is a source on health care information for a very large audience, it is crucial that the writing adheres to international nomenclature standards and does not slide into colloquialisms:
- a) Please use the UN Geoscheme ISO standard for geographic designations (w:United_Nations_geoscheme; reference 1): the outbreak happened in Western Africa, not West Africa (the latter is colloquial). Please fix throughout. Likewise, please do not use the phrase “Central Africa” – the UN Geoscheme defines Central Africa, and importantly Gabon, which experienced many EVD outbreaks, does not belong to Central Africa. Either use the correct “Middle Africa” or, if you must, the ubiquitous “Equatorial Africa”
- b) Filovirus disease names are also standardized by the UN/WHO in the International Classification of Diseases (ICD). The latest version of the ICD adhered to by most UN member states is the ICD-10 (w:ICD-10; https://icd.who.int/browse10/2016/en). The ICD-10 recognizes two filoviruses diseases: Ebola virus disease (EVD) and Marburg virus disease (MVD). EVD can be caused by several viruses, Ebola virus (EBOV) being one of them (the other ones being Bundibugyo virus (BDBV), Sudan virus (SUDV), and Taï Forest virus (TAFV)). Consequently, please
- change the title to Western African Ebola virus disease epidemic
- introduce at the beginning that this article addresses an Ebola virus disease (EVD) epidemic caused by Ebola virus (EBOV)
- and from then on use the abbreviation EVD whenever you refer to the disease (not the colloquial “Ebola”) or EBOV whenever you refer to the virus (not the colloquial “Ebola”)
- c) The term “strain” has been defined in filovirology (PMID: 23001720) and currently only applies to laboratory-adapted viruses. Please delete throughout. Instead, use the word “variant” if your refer to the lineage of virus (“Makona”) that caused the 2013-2016 EVD outbreak.
- d) Replace “Tai Forest ebolavirus” with “Taï Forest virus”. Tai Forest ebolavirus is the species to which Taï Forest virus belongs and it is the virus that makes you sick, not the species.
- e) “(formerly and often still called the Zaire virus) is the most dangerous and is the species responsible for the epidemic in West Africa”
- EBOV was never called “Zaire virus”. It was called “Zaire Ebola virus”, “Zaire ebolavirus”, and “Ebola virus Zaire” after it was named “Ebola virus” for many years (and hence the community returned to it). Please delete
- “is the most dangerous” cannot be upheld. The average lethalities over all recorded cases are 33.65% (BDBV), 41.81% (EBOV), 52.89% (SUDV), and 0% (TAFV). Statistically, one cannot make any statement here; but if one takes absolute values, then SUDV “is the most dangerous one” (and all of them pale in comparison to Marburg virus disease (80.5%))…
- Species are concepts, not real things. Viruses are assigned to species. Hence here it should say “the virus responsible”. The word “species” should not appear anywhere in the article except to point out to which species a particular virus belongs
- “for the Sudan or other strains of the virus rather than only the Zaire strain, which is responsible for the West Africa outbreak” – Sudan is not strain, but a virus (Sudan virus); and there is no “Zaire strain”, it’s called EBOV
- Please carefully differentiate mortality and lethality/case-fatality rate. Mortality is defined as the number of dead per number of healthy per time frame whereas lethality is defined as number of dead per number of infected/sick. Hence mortality during the epidemic was still very very low, whereas lethality/case-fatality rate was high (please also note that mortality is a rate by definition, hence “mortality rate” is redundant)
- Please adjust the CFR statements throughout to facts. The end of the outbreak was declared by WHO many months ago and WHO stated official case numbers and deaths. These numbers amount to a CFR of 39.5% (11,310 deaths divided by 28,616). It is perfectly okay to state that WHO suspects these numbers to be too low – but in absence of any concrete other data this number stands. Overstating CFR has direct consequences in the field in terms of patient behavior and hence accuracy is important. Thus, please delete the 70% sentence in the first paragraph. Likewise, the paragraph: “Ebola virus disease has a high case fatality rate (CFR), which in past outbreaks varied between 25% and 90%, with an average of about 50%. However, it is known that the Zaire species, which was responsible for the West African outbreak, carries a higher death rate; the epidemic caused significant mortality, with reported CFRs of up to 70%.”:
- In the past, CFR for EVD due to EBOV varied between 39.5% (Western African outbreak, the lowest CFR of all) and 100% (single laboratory infections in Russia). Thus, the range is meaningless or misleading as it doesn’t take case numbers into account. The average of all EVD/EBOV outbreaks is 41.8%, not 50%
- CFR of EVD due to any ebolavirus varied between 0% (RESTV, SUDV laboratory infection) to 100% with an average over all outbreaks of 42%
- Delete second and third sentence
- Please carefully differentiate between symptoms and clinical signs. Symptoms are subjective reports (headache, nausea, abdominal pain) whereas clinical signs are objectively measurable (fever, increased bleeding time etc.).
- My biggest concern about the article are the references. While I do think that press articles are appropriate for Wikipedia articles, I strongly feel they should be accompanied by primary scientific and medical references to counter any suspicions of “fake news” or partisan bias based on the news sources cited. The authors should take a very close look at the scientific literature and better back up most statements.
- Please delete the sentences “Ebola had been discovered to be endemic to West Africa decades prior to the 2013–2016 outbreak, but this was not well understood in West Africa or by the international health community ” and “prior to the outbreak Ebola was mistakenly thought by the international community to not be endemic to West Africa.”. This statement refers to antibody serosurveys that were performed with highly error-prone methodologies (mostly IFA). The same methodologies “demonstrated” Ebola virus antibodies all over Africa, in Alaska, in Ukraine, in dogs etc. These are certainly false positive to a large degree.
- “Unrelated outbreak in the Democratic Republic of the Congo” – please delete this entire section. As the header already states, this outbreak has nothing to do with the article and Wikipedia has a separate page on it.
- “endemic” and “indigenous”: please avoid these terms. As long as the natural host reservoir of EBOV has not been identified unequivocally, one cannot make a statement towards endemicity. Molecular studies have demonstrated without a doubt that the entire 2013-2016 EVD outbreak was based on a single introduction of EBOV from the unknown reservoir followed by human-to-human transmission. To state that EBOV is endemic in Western Africa based on a single infection from a host is highly misleading (theoretically, an overlooked person from far away could have travelled to Méliandou and infected that alleged index case…)
- Please delete Figure 12 as it will mislead the reader (although this figure is everywhere and so every reader is already misled). The figure is purely speculation with almost no data backing up any individual step. Live EBOV or complete EBOV genomes have not yet been detected in any bat, any duiker, or any ape, let alone is there any proof for bat-duiker, bat-ape or duiker-ape transmissions. Likewise, there is no proof of bat-human or ape-human transmission. For the same reason I am highly concerned about the two paragraphs following this figure. I would say one can make a case based on evidence that bats are somehow involved in the ecology of EBOV but there certainly aren’t any data that strongly implicates them as the reservoir host (and which particular bat anyway)? You make a good case about primates not being infected in the area and no fruit bats living in the index case area – jumping from these discouraging data to simply saying, oh, must be insectivorous bats then is a bit desperate in particular because the data that were used to “strongly implicate” bats in EBOV transmission almost exclusively came from fruit bats. The deforestation sentence (also elsewhere in article) also cannot stand. Aerial satellite imagery has shown that the forest around Méliandou has not changed in decades…
- Please clarify to the reader that persistence of EBOV RNA in semen does not mean the same thing as persistence of EBOV in semen and then carefully go over every statement and specify virus versus virus RNA.
- Please add to the fluid replacement section that while maintaining proper hydration status in patients is intuitively the right thing to do, there is no published evidence that fluid replacement actually influences patient outcome (at least not to my knowledge).
- Please qualify the post-Ebola virus syndrome section by pointing out that the syndrome is undefined, largely based on subjective reports from patients, and thus far not backed up by objective scientific measurements or observations in animal models. There is little doubt that survivors indeed have sometimes severe sequelae, but which ones, how often, and how severe is subject of hot debates.
- Please be consistent in listings. In the first paragraph, if you list countries Nigeria, Mali, Senekal, UK, then you should also list Italy (not Sardinia, which is a part of Italy).
- Second paragraph: please state here when the Emergency of International Concern was initiated before you state when it was terminated (you state that much later in the text, so please move it up)
- Please avoid hyperboles: “the vaccine” is not “considered to be so effective that 300,000 doses have already been stockpiled”. Instead, the vaccine is the only prophylactic that is thought to offer at least some protection and because it’s the only thing we have got, it is being used. Likewise, please remove the sentence “While the vaccine had shown 100% efficacy in individuals” – such a statement (also elsewhere in article) cannot be made as it would require to vaccinate an individual and then attempt to infect the vaccinee with virus known to be infectious. This is, of course, unethical and hence such experiments have not been performed. From the paper, one can only deduce that individuals were probably protected because based on statistics they were likely exposed to virus in some way but did not get sick.
- Please qualify the statement “Previous outbreaks had been brought under control within a few weeks”. This is not true – it took months in several cases.
- “children had been orphaned, losing one or both parents to Ebola”: is one considered an orphan when one still has one parent?
- “Méliandou”, not “Meliandou”
- “Scientists believe…” – scientists do not believe, they deduce from or interpret data
- “The Ebola virus was, however, not found in any of the bats that were captured and tested” – no bats were tested in Méliandou as the tree was burnt down before the scientists arrived
- “Ivory Coast” is considered derogatory by many. The official name of the country is “Côte d'Ivoire” [note that Côte d'Ivoire is the only current country that does not have an official English name]
- “the Ebola virus” – virus names are mass/class nouns (similar to “water”) because viruses are, ultimately, populations and hence virus names are not to be preceded by articles.
- “Sudan and the Democratic Republic of Congo (then called Zaire)” – please pick a format: it’s either “Sudan (now South Sudan) and Zaire (now Democratic Republic of the Congo)” OR “South Sudan (then Sudan) and Democratic Republic of the Congo (then Zaire)”
- “was sparked by at least two distinct viruses introduced from Guinea” – this is highly misleading. Only one distinct virus caused the entire outbreak: EBOV. What you mean are “distinct lineages” or clades of this virus
- “Also, while extremely unlikely, researchers remained concerned that, given the time, the virus could morph into an airborne pathogen.” – please delete this sentence. You correctly identify it as nonsense and there is no need to give nonsense any credence.
- “male’s testes” – there are no female testes 😊
- “past epidemics had occurred in remote regions” – Kikwit was/is not a remote region
- “that includes massive bleeding” – please qualify as this is very rare
- “Ebola survivor studies”. Please delete first paragraph as it refers to BDBV, not EBOV (let alone EBOV in Western Africa)
- Figure 20: USAMRIID, not USAMRILID
- “Ebola vaccine was used to stop an outbreak for the first time” – the outbreak is still ongoing…
- “polio” should be “poliomyelitis”
This is a valuable review and have gone about some of the recommended changes:
1.a.Done as suggested
1.b.I.Done as suggested
1.b.II.Done as suggested (with reference)
1.b.III.Per World Health Organization both terms are used interchangeably with 'Ebola'as can be noted in the given reference (in it WHO refers only to the term 'Ebola' at least a dozen times)
1.c.Done as suggested
1.d.Done as suggested
1.e.(I - IV) Done as suggested
2.Done as suggested
3.a.Done as suggested, dropped the 70% (reworded to... It caused significant mortality, with the case fatality rate reported which was initially considerable)
3.b.'Ebola virus disease has a high case fatality rate (CFR)' while I did alter/drop some wording, the general sentence in terms of CFR stands per WHO ..."Ebola virus disease". www.who.int. Retrieved 13 January 2019.
3.c.Delete second and third sentence - it is not entirely clear to which sentences you're referring to
4.Done as suggested
5.This is not the case of a paper on Hepatitis E or Dyslexia (for example), this was an event (a tragic event) that is going to need news articles as the events unfold. In some cases news articles were necessary, much like the current 2018 Kivu Ebola outbreak, one finds that day to day events cant be looked up in PubMed, having said that if there is any particular reference(s) that needs to be reviewed/replaced I would certainly do so, as I have "done as suggested" many times
6.Done as suggested
7.'Unrelated outbreak in the Democratic Republic of the Congo' it was included in the article as the DRC outbreak was occurring (within the same time) on the African continent, I am of the opinion it should stay for the aforementioned reason
8.Done as suggested
9.a.The figure you ask to 'delete' ...is from the Centers for Disease Control they are a very reliable US.gov organization? (The text that is in the same section as the CDC image is therefore a reflection of what the image depicts,in its majority, though not all)
9.b. The deforestation text was added per peer reviewer 2
10.Done as suggested (added several references)
11.Per CDC... When used early, basic interventions can significantly improve the chances of survival..."Treatment | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 22 May 2018. Retrieved 13 January 2019.
12.Please qualify the post-Ebola virus syndrome section by pointing out that the syndrome is undefined, largely based on subjective reports from patients, and thus far not backed up by objective scientific measurements....with all due respect this statement is at odds with -
- Shantha, Jessica G.; Crozier, Ian; Yeh, Steven (November 2017). "An update on ocular complications of Ebola virus disease". Current Opinion in Ophthalmology 28 (6): 600–606. doi:10.1097/ICU.0000000000000426. ISSN 1531-7021. https://www.ncbi.nlm.nih.gov/pubmed/28872492. Retrieved 13 January 2019. review
1.Done as suggested
2.Done as suggested
3.Done as suggested
5.Done as suggested
6.Done as suggested
7.Done as suggested
8.Done as suggested, though may/could add ' In the ash surrounding the tree, the researchers found DNA fragments that match the Angolan free-tailed bat Mops condylurus, an insect-eating species that is widespread across Central and West Africa and that fits the villagers' description. Other studies have found that the species can survive experimental infections with Ebola.'
9.Done as suggested
10.In terms of 'grammar',I dont see this as cogent
11.Done as suggested
13.Done as suggested
14.Done as suggested
17.'Ebola survivor studies'...you're correct,however at that time there was very little information in terms of Ebola survivors, and there were thousands of survivors and eventual Post Ebola virus syndrome
18.Done as suggested
20.Done as suggested
I believe I have addressed the specific comments,however if 3c, 7 or 17m needs to be further reviewed/responded I would be more than happy to, I would like to thank you for your valuable time and recommendation--Ozzie10aaaa (discuss • contribs) 01:32, 14 January 2019 (UTC)
- "Ebola virus disease". www.who.int. Retrieved 13 January 2019.
- Prevention, Centers for Disease Control and (2 August 2014). "English: Life cycles of the Ebolavirus". CDC. Retrieved 13 January 2019.
- VogelDec. 30, Gretchen (30 December 2014). "Bat-filled tree may have been ground zero for the Ebola epidemic" (in en). Science | AAAS. https://www.sciencemag.org/news/2014/12/bat-filled-tree-may-have-been-ground-zero-ebola-epidemic. Retrieved 13 January 2019.
- "2018 Kivu Ebola outbreak". Wikipedia. Wikimedia.org. Retrieved 13 January 2019.
- "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Samedi 12 janvier 2019". us13.campaign-archive.com. Retrieved 12 January 2019.
- "Ebola outbreak in DRC ends: WHO calls for international efforts to stop other deadly outbreaks in the country". www.who.int. Retrieved 13 January 2019.
anonymous peer reviewer
This review was submitted on 23 January 2019, and refers to this previous version of the article
3.b. Point in case, vis-à-vis the comment above. The final tally of the outbreak is published by WHO via the WHO Situation reports. And those clearly state that the CRF is around 40% as far as could actually be measured.
3.c. Unfortunately, I don’t know either any more ☹
5. This is an issue for the editor to decide. If citing news reports is okay for Wikipedia in an article that is allegedly consumed by many people for health information, then so be it. Personally, I am uncomfortable about it, because news articles often get things wrong and they are often partisan.
9.a. Please see my point above about WHO. If the authors can provide scientific, peer-reviewed articles, that report the isolation in culture or the determination of full-length EBOV genomes in either duikers, nonhuman primates, or bats; and if they can further provide scientific literature that provides evidence (not hypotheses) of EBOV transmission between these animals and humans, then the figure can stand (I am not aware of any such literature). Otherwise, the figure implies an understanding of the ecology of EBOV that actually does not exist, no matter from where the figure originates. Does this make sense?
9.b. Ok – please cite scientific literature showing deforestation data in EVD outbreak areas over time. For sure, deforestation did not play a role in Meliandou as satellite imagery shows clearly.
11. Ditto here: please provide a peer-reviewed manuscript in which fluid replacement was compared to non-fluid replacement in a human patient cohort, resulting in statistically significant different CFR. In the absence of such data, this statement cannot stand and at the very least would have to be modified to “physicians speculate based on personal observations that…”.
12. I apologize for not being clearer. The authors are right that there are individual cases of EVD survivors who have sequelae that more or less without doubt stem from EBOV infection (for instance, isolation of virus from the eye or the brain in the presence of inflammation [uveitis/meningoencephalitis). However, one can count those cases on one hand and it is not clear whether one can/should extrapolate from them. There is not scientific evidence that EBOV indeed causes arthralgia yet, for instance, although it may very well do that; likewise, while there is EBOV RNA in semen, EBOV isolation has actually been achieved only a couple of times and the number of sexually transmitted EVD cases is incredible low in comparison to the RNA semen prevalence numbers. This is a classical case of correlation versus causation. Just because somebody reports a particular symptom after event x does not mean event x caused that symptom. One should of course not discredit patients on the basis that a patient “just” reports something that cannot be measured; but at the same time one can also not simply assume that what was reported actually occurred and has the causation one assumes. Hence my recommendation was/is to qualify this section by being clearer on what is actually known and what is speculated on. Please also not that “post-Ebola syndrome” is not an WHO ICD-accredited term, even in the newest edition, for exactly that reason.
m19. The authors are right, this was my mistake by mixing up Kivu and Equateur. My apologies.
Have responded per the following reference(s):
- reiterating original answer...Per World Health Organization both terms are used interchangeably with 'Ebola' as can be noted in the given reference (in it WHO refers only to the term 'Ebola' at least a dozen times)
3.b.Have found....the rate among hospitalized patients was 57–59% ...and... Ebola virus disease has a high case fatality rate (CFR), which in past outbreaks varied between 25% and 90%, with an average of about 50%
As I have looked for anything that resembles 40% CFR for West Africa Ebola referenced by WHO and have not been able to find, I suggest/appreciate should you know the reference/source in question I would be happy to add it, otherwise...
- Wappes, Jim. "US health worker monitored as DRC Ebola nears 600 cases". CIDRAP. Retrieved 23 January 2019....did offer the 40% reference
3.c.It happens ... however should the reviewer recollect what the question was, Ill certainly answer
5. (see Dr. Shafee note)
9.a.In the absence of the CDC having a retraction/disclaimer...
- reiterating original answer...The figure you ask to 'delete' ...is from the Centers for Disease Control they are a very reliable US.gov organization (The text that is in the same section as the CDC image is therefore a reflection of what the image depicts,in its majority, though not all)
- BTW ..January 24, 2019..."Scientists Discover Ebola Virus in West African Bat | Columbia University Mailman School of Public Health". www.mailman.columbia.edu. Columbia University. Retrieved 25 January 2019.
9.b.Have added "though 100% evidence does not as yet exist" to the sentence in question...I wanted to add that according to  Favorability modeling, centered on 27 EVD outbreak sites and 280 comparable control sites, revealed that outbreaks located along the limits of the rainforest biome were significantly associated with forest losses within the previous 2 years. This association was strongest for closed forests (>83%), both intact and disturbed, of a range of tree heights (5–>19 m). Our results suggest that the increased probability of an EVD outbreak ...though have not inserted this text
11.'peer-reviewed manuscript in which fluid replacement was compared to non-fluid replacement in a human patient cohort, resulting in statistically significant different CFR' …. I found none. I did add the CDC position statement to the review that was already in place...
- West, T. Eoin; von Saint André-von Arnim, Amélie (November 2014). "Clinical presentation and management of severe Ebola virus disease". Annals of the American Thoracic Society 11 (9): 1341–1350. doi:10.1513/AnnalsATS.201410-481PS. ISSN 2325-6621. https://www.ncbi.nlm.nih.gov/pubmed/25369317. Review
- "Treatment | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 22 May 2018. Retrieved 23 January 2019.
12.Have added to the end of the section in question….'In terms of medical literature that are reviews, few articles have been published, such as Shantha, et al which discusses management of panuveitis and iris heterochromia.' 
- "Ebola virus disease". www.who.int. Retrieved 23 January 2019.
- "What is Ebola Virus Disease? | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 20 September 2018. Retrieved 23 January 2019.
- "Ebola Situation Reports | Ebola". apps.who.int. Retrieved 23 January 2019.
- Prevention, Centers for Disease Control and (2 August 2014). "English: Life cycles of the Ebolavirus". CDC. Retrieved 13 January 2019.
- Nasi, Robert; Sheil, Douglas; Leendertz, Siv Aina; King, Shona; Suter, Jamison; Park, Douglas; Gaveau, David; Vargas, J. Mario et al. (30 October 2017). "Recent loss of closed forests is associated with Ebola virus disease outbreaks" (in en). Scientific Reports 7 (1): 14291. doi:10.1038/s41598-017-14727-9. ISSN 2045-2322. https://www.nature.com/articles/s41598-017-14727-9. Retrieved 23 January 2019.
- Shantha, Jessica G.; Crozier, Ian; Yeh, Steven (November 2017). "An update on ocular complications of Ebola virus disease". Current Opinion in Ophthalmology 28 (6): 600–606. doi:10.1097/ICU.0000000000000426. ISSN 1531-7021. https://www.ncbi.nlm.nih.gov/pubmed/28872492. Retrieved 13 January 2019.
Comments by Thomas Shafee
These comments were submitted on 26 January 2019, and refer to this previous version of the article
Referring to point #5 above, the WikiJMed board discussed and came to the consensus:
- Where possible, reliable refereed scientific sources would be preferred by far (similar to WP:MEDRS)
- However, this article is an unusual case - Rapidly evolving out breaks in a setting with limited infrastructure are very challenging. It was noted that other journals have "relaxed" the usual rules when necessary (example)
- If there's absolutely no better source, besides newspapers, to convey a key point/concept, the author could write where relevant in the manuscript e.g. "Media reports state..." to indicate that the source is of a lower level of scrutiny.
- The board consensus is to handle subsequent similar situations on a case by case basis (avoiding blanket policies)
The question to the author is therefore: For the statements currently supported by news media sources, are peer reviewed sources available? If so, it would be useful to include them in addition to the contemporaneous source, if not it would be useful to note in the text.
- In anticipation of this conclusion I had already gone over part of the article. I will therefore insert the media states where such references are used, should any statement exist (that I initially overlooked) that could use MEDRS reference then it will be inserted.
- Have done the following per "Revision history of "WikiJournal Preprints/Western African Ebola virus epidemic" - Wikiversity". en.wikiversity.org. Retrieved 27 January 2019....the edits you will find indicate I. some references added and II. several "Media states/reports" indicated...keeping in mind that a significant percentage of references are WHO, should there be need for additional references or "Media states/reports" indications ... "to convey a key point/concept", I would not hesitate to add more where appropriate
- The section 'Economic effects' and 'Responses' (includes criticism of World Health Organization management/outbreak response) were omitted from the above recommendations since they offer nothing having to do with MEDRS (CDC,NIH,Google books, PubMed indexed reviews)