The Ebola Thread

[Beet]

But getting back on track regarding ebola, Mr. Moderate summed it up quite well

Africa has a major problem with distrust of medical workers, disobedience of quarantine, and a failure to understand the mechanism by which disease spreads. We're separated by the disease by a huge ocean (both literally and culturally).

Let's be realistic about the numbers. Since the outbreak began, there have been 932 deaths due to Ebola. In the same time frame, 300,000 Africans were lost to Malaria and 600,000 were lost to Tuberculosis. And, of course, we'll likely see another 1,000,000+ Africans die to HIV this year.

It's a scary-sounding disease, but it's not a real threat. If there's any contagious disease to be concerned with in the U.S., it's the flu. It'll kill thousands of Americans this year.

The difference is that those are all known diseases that have more or less had the same pattern for decades. AIDS was terrifying in the early 1980s, as it should have been, and it eventually became a gigantic catastrophe. George W. Bush deserves credit, both personally and as a president, for not writing off Africa as a lost cause and putting American money into a cause which did a lot of good for very little personal or national benefit.

Ebola is worrying precisely because the pattern of infection is totally new and unknown. It is unknown what the ultimate consequences of the current outbreak are going to be. There is no precedent. All we have is the current exponential growth rates and the lack of any particular reason that I can think of as to how the disease might be controlled; even if it says in the three countries at the epicenter currently; still quite a catastrophe. If we had an Ebola outbreak of this size every year, as with Malaria and Tuberculosis, it certainly would be less worrying.

[Beet]

Africa has a major problem with distrust of medical workers, disobedience of quarantine, and a failure to understand the mechanism by which disease spreads. We're separated by the disease by a huge ocean (both literally and culturally).

Let's be realistic about the numbers. Since the outbreak began, there have been 932 deaths due to Ebola. In the same time frame, 300,000 Africans were lost to Malaria and 600,000 were lost to Tuberculosis. And, of course, we'll likely see another 1,000,000+ Africans die to HIV this year.

It's a scary-sounding disease, but it's not a real threat. If there's any contagious disease to be concerned with in the U.S., it's the flu. It'll kill thousands of Americans this year.

Also, some other stuff that may have been too obvious to mention before. The fatality rate for Ebola is orders of magnitude higher than than these other diseases. In 2012, there were 200 million cases of malaria and only 627,000 deaths, a 0.6% fatality rate. And most of those people probably died because they didn't receive the proper treatment. One third of the world population is thought to be infected with Tuberculosis bacteria. 90% are asymptomatic. Of those "incident cases" that do occur, among the HIV-negative population about 1 in 9 resulted in a fatality. AIDS was highly fatal in the 1980s until the mid-1990s, but is now treatable. Survival time increases to up to a decade and with proper, early treatment the death rate falls by 80%.

In contrast, Ebola's death rate in the current outbreak is between 65%-75% within a very short amount of time. The official Case Fatality Rate (CFR) is currently about 50%-55%, but that is diluted by the inclusion of newly reported cases that have not yet had time to resolve. If Ebola ever became as common as Malaria, for instance, it would likely kill more people than World War I, the Spanish Flu, the Holocaust and World War II combined. The gruesomeness of Ebola cannot be denied either. Bleeding everywhere, vomiting out your internals, and melting organs are not things anyone likes to contemplate.

It's ironic that the article Mr. Moderate links concludes by blaming the "hysterical" media for people's fear of Ebola, but I have made my disdain for the mainstream media clear throughout this thread. If I followed the media, 80% of my posting here would have been about the few cases of Ebola patients brought to the U.S. for treatment (or the constant reports of "suspected cases" here and there), since that is mostly what the U.S. media covers. Heck, if I followed the media 80% of my posting here would be on ISIS and not Ebola. I am not concerned about Ebola because of the mainstream media. What I follow & have followed from the beginning are available throughout this thread to see: (1) Medicins Sans Frontiers / Doctors Without Borders (2) The governments of Liberia and Sierra Leone (3) The World Health Organization (4) The Centers for Disease Control (5) Direct eyewitness accounts of events happening in the ground. If you listen to these people and groups, which have more knowledge about this situation than any in the world, you will see that they are worried, and have been for some time.

The apathy and resistance to caring about Ebola, on the other hand, is driven IMHO by a quadrifecta of human follies that progressives should abhor the most: (1) traditional, religious superstition and ignorance. It is because of ignorance and being mislead by traditions, pastors, witch doctors, etc. that is the most damaging problem causing Ebola to spread. All the doctors and supplies in the world will not fix it unless people get educated, and begin believing in the existence of Ebola relying on scientifically-backed methods to control Ebola (2) classism. Rich people and those of us in rich countries do not care as much about Ebola precisely because we think our better equipped hospitals and medical systems will protect us. The subtext of this is that it is ok if the poorest people in the world die of Ebola for lack of good health care systems, as long as the rich are protected. (3) racism. Let's face it, if this was happening in Europe or Japan there would be a lot more attention to it. We have a fatalistic view of Africa that the place is a giant garbage dump and perpetually hopeless. This couldn't be farther from the truth as the continent is finally starting to pull itself up. But that would be cut short by Ebola. (4) nationalism. I am always amused at how the panic over Ebola starts to jump as soon as it is reported in another "country." As far as I am concerned, countries do not matter when it comes to natural phenomena, such as global warming, or Ebola. Well at least, they do not matter except to the extent that they influence human behaviors. But there is nothing magical about Ebola crossing borders. Unlike with wars or economics, being on one side of the border or the other won't protect you.

Here is quote from the Liberian Minister of Defence, addressing the U.N. Security Council:

You must be logged in to read this quote.

I assure you, CNN did not put him up to this.

[Beet]

U.S. Plans Worker ‘Surge’ to Aid Ebola Effort in Africa

The U.S. is planning a “surge” of federal workers into West African countries hit by Ebola, and has hired the air-ambulance company that evacuated two infected U.S. citizens in July to support them.

About 1,400 U.S. government employees are in the region now, and more are on the way, the State Department said in a contract document posted today. As workers for global aid groups have fled, “the vacuum is increasingly being filled” by U.S. aid providers, the document said.

http://www.bloomberg.com/news/2014-09-10/u-s-plans-worker-surge-to-aid-ebola-effort-in-africa.html

That's a lot more than I'd thought... previously we had reports of up to 100 C.D.C. workers. This feels a lot more significant. A lot more of them are also being repatriated after being exposed to Ebola than is being reported. We only hear about the confirmed cases.

In the worst case scenario here, Africa may be partially recolonized. The governments here have no operational capacity.

[Beet]

U.S. State Department orders 160,000 hazmat suits for Ebola

The best article written about the current outbreak thus far:
http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment#

[Beet]

Me on July 26:

I think one thing we've learned from the West Africa situation is that, when there's an ebola outbreak, sending people to the hospital is not the best place to go. Hospitals are needed for normal patients of normal ailments; a critical mass of ebola patients at a hospital, and pretty soon other patients will not be willing to go anymore. Ebola isolation units are special facilities that ideally should be set up away from population centers, and well defended.

Samaritan's Purse today:

You must be logged in to read this quote.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/are-hospitals-part-ebola-problem-charity-wants-new-strategy-n202486

[Beet]

Beet, do you have any particular feelings on Samaritan's Purse as an organization? I've donated to them recently cause it seemed like they've been doing good work in northwestern Africa (among other places) in the midst of this epidemic.

But if there are other NGOs you think are doing a better job or are more worthy of donations I'd definitely like to know.

I donated to them when Brantly and Writebol got sick. What I liked what was unlike M.S.F. (who have their own reasons), Samaritan's Purse allows you to earmark your donation for your cause of choice. I have a high opinion of any relief agency that has been active in responding to Ebola in West Africa, given that few of them are, or at least very few of them were until recently.

[Beet]

Well, there it is. The billion mark is finally being mentioned.

It looks like a major announcement is coming tomorrow.

[Beet]

8 Ebola health care workers / journalists were found hacked to death in a gruesome manner and their bodies dumped in a septic tank in or near Wome village in N'zérékoré prefecture, Guinea.

"According to our source, the eight bodies found include: the sub-prefect of Wome, the prefectural health director of the regional hospital N'zérékoré, deputy director of the regional hospital center head Health Womé, an evangelist pastor of the health center Zao, two trainee technicians rural radio journalist and a private radio Zali Fm."

http://guineenews.org/violences-a-womey-huit-corps-exhumes-six-interpellations-et-une-declaration-du-pm-attendue/

"This is likely the greatest peacetime challenge that the United Nations and its agencies have ever faced," - U.N. health chief Dr. Margaret Chan

"If the international community does not stand up, we will be wiped out," - Jackson Naimah, a team leader for Doctors Without Borders at a treatment center in the Liberian capital Monrovia

http://abcnews.go.com/US/wireStory/chief-calls-billion-fight-ebola-25603216

[Beet]

Thought this might be interesting to a forum full of map enthusiasts

http://www.sun-sentinel.com/health/sns-rt-us-foundation-ebola-maps-20140917,0,6565204.story

[Beet]

My estimate from Sept. 4, when as of Aug. 30 there had been 3,700 cases, would be about 7,400 cases by Sept. 24. As of Sept. 23, there are 6,554/6,574 cases. That puts me over by about 700-800. Accordingly, I am revising my projections. Per my calculations, the doubling time has increased from 24 to 27 days.

[Beet]

CDC is using a factor of ~2.5 to account for underreported cases, and this is how they reach 1.4 million. I am only looking at confirmed, probable and suspected cases. Their 550k remains a worst case scenario and CDC director Tom Friedan has said he does not think it will come about. Let's hope.

[Beet]

There is some chatter that the current suspected ebola case in Dallas County may be more than what you usually get with this story. Supposedly the CDC is sending teams, and that's unusual.

[Beet]

If Africa's largest economy could not have contained a single case that was identified almost as soon as he stepped out of the airport, the implications would have been too horrid to contemplate. But a win is a win, so a tentative congratulations (against the outside chance there's still any unidentified patients) to Nigeria then.

The below comment has no wider political implications whatsoever.

"MAKENI, Sierra Leone — “Where’s the corpse?” the burial-team worker shouted, kicking open the door of the isolation ward at the government hospital here. The body was right in front of him, a solidly built young man sprawled out on the floor all night, his right hand twisted in an awkward clench.

The other patients, normally padlocked inside, were too sick to look up as the body was hauled away. Nurses, some not wearing gloves and others in street clothes, clustered by the door as pools of the patients’ bodily fluids spread to the threshold. A worker kicked another man on the floor to see if he was still alive. The man’s foot moved and the team kept going. It was 1:30 in the afternoon.

In the next ward, a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open. A corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood in a cot watching as the team took the body away, stepping around a little boy lying immobile next to black buckets of vomit. They sprayed the body, and the little girl on the floor, with chlorine as they left."

http://www.nytimes.com/2014/10/02/world/africa/ebola-spreading-in-west-africa.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=2

[Beet]

I never understand why these stories are so popular. Some people are sick. It's bad. I hope we don't get sick here. That's literally the whole story.

Some people are killing each other in the Middle East. It's far away from us. I hope gas prices don't go up.

[Beet]

A Spanish nurse has been confirmed to have contracted ebola, after treating a Spanish priest at the end of September. She was working in a facility especially designed by Spain to handle ebola patients and (the facility) had treated another Spanish priest back in August. They are not sure how the nurse contracted ebola. She had entered the patient's room twice: once while he was still alive, and once after his death. After his death, the nurse went on vacation. She had a fever for several days while on vacation before being isolated. She is 44 years old and married with no children. There is no confirmation of how many people she had contact with.

[Beet]

This is far bigger news than the Dallas case. Dallas... I mean come on, it was just a matter of time. You have 10,000 people from the affected region that were coming in by commercial airplane every 3 months. The experts conceded as much.

This... is a genuine surprise. Otherwise, the authorities would never have let this woman go on vacation. Look at the precautions they were taking:

[Beet]

"El Mundo reported that it was the nurse who asked to be tested for Ebola, having to insist repeatedly on being tested before it was done on Monday"

http://www.theguardian.com/world/2014/oct/07/ebola-crisis-substandard-equipment-nurse-positive-spain

Once again, proactive people = win, bureaucracy = fail.

[Beet]

So, the world is finally waking up to the severity of the Ebola problem. The problem now is that there is no coordinated response. If we had a single world government, this would be easy. But instead we have all these different organizations each "contributing". In an environment such as this, with such a scary disease, it's easy for individual organizations like the US govt, WHO, MSF, to get caught up in a hero complex, the idea that we're already doing more than 99% of people out there, so let's pat ourselves on the back. Because it's true. They are heroes.

But a problem needs more than just a series of contributions, it needs a solution. Particularly, as we've seen, since the world is not prepared for a large scale response to this. Any large scale response will take months to get into gear. This is akin to a military mobilization for a type of war we've never fought before. There needs to be one comprehensive plan of how to defeat this ebola epidemic from start to finish. There needs to be a single, centralized command structure, international in nature, that will take control and implement this plan. It must have authority to coordinate all actors, including governments, NGOs, and international bodies. And it must be competently and efficiently run. One would think the genesis of such a headquarters would be in the United Nations, but WHO seems out of its depth and not in charge. The U.S. has contributed a lot. Russia, China, Japan, India, etc. have contributed far less. The response seems ad-hoc, almost as if the former colonial masters are being asked into each country to handle each one separately. No one is in charge, so ships full of supplies sit in dock for weeks.

This is all going to have to change. The sooner the better.

[Beet]

Thomas Duncan has died.

[Beet]

Meanwhile, some Ebola patients in Liberia are coming back to life, after having died of Ebola.

[Beet]

Fascinating difference between Figure 2 and Figure 3

There appears to be some sort of serious degradation of reporting capabilities in Liberia; WHO has said case numbers will likely be revised up.

In comparison, reporting capabilities in Sierra Leone are stellar. Unfortunately, they show the situation is starting to really take off there.

[Beet]

The growth rate of the official count has slowed dramatically since September and exponential growth, at least in Liberia has come to an end for now. As a result, there were fewer than 10,000 cases on October 20, instead of the over 13,000 in my projection. As a result, I am revising my model from exponential to linear.