The Ebola Thread

[Beet]

Discuss the ongoing ebola outbreak here.

Summary:Previous ebola outbreaks were confined to central Africa, to isolated villages where each case could be traced back to a single source. The villages could then be easily quarantined until the virus was contained.

Here we have it suddenly appear in west Africa, and it has already touched three metropolitan areas - Conakry, Freetown, and Monrovia. "The situation is serious, you can't say it is under control as cases are continuing and it is spreading geographically," Dr Pierre Formenty, a WHO expert who recently returned from Guinea, told a news briefing in Geneva on Wednesday.

Sierra Leone suspended cross-border trade fairs with Guinea and Liberia on Wednesday and closed schools, cinemas and nightclubs in a frontier region in a bid to halt the spread of the Ebola virus.

June 20, 2014: Doctors without Border: Outbreak Out of Control

Ellen Johnson Sirleaf: National Emergency

July 22, 2014: Number of cases top 1,000

July 30, 2014: Public Health England (PHE) issued an alert to GPs, A&E departments, Critical Care Units as well as all NHS trusts across the UK, warning doctors and medical staff to be vigilant to the disease.

August 7, 2014: The U.S. Centers for Disease Control declares a Level 1 Public Health Emergency, previously applicable only to the Swine Flu Outbreak (H1N1) and Hurricane Katrina.

August 9, 2014: Number of fatalities tops 1,000.

September 30, 2014: First case identified outside of West Africa, in Dallas, Texas.

October 6, 2014: First confirmed case of transmission outside of West Africa, in Spain.

October 8, 2014: First Ebola death outside of West Africa from a case identified outside of West Africa (Thomas Duncan).

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On July 27 2014 there were 1323 cases, which was more than double the 599 cases of June 24.  That in turn was about double the cases of 309 on May 27. Thus the virus at that point had been doubling in reported cases each month since at least late May.

The official number is almost certainly a significant under-count as many cases are not being reported due to massive resistance to health workers. At the current rate (doubling every 24 27 days increasing in a linear fashion at about 150/day), here are the projections of the number of infected from Sep 23.

Sept. 23 2014 : 6,600
Oct. 19 2014 : 9,936
Nov. 1 2014: 11,736
Dec. 1 2014: 16k
Jan. 1 2015: 21k
Feb. 1 2015: 25.5k
Mar. 1 2015: 30k
Apr. 1 2015: 34.5k
Jun. 1 2015: 39k
Jul. 1 2015: 43.5k
Aug. 1 2015: 48.2k
Sep. 1 2015: 52.8k
Oct. 1 2015: 57.3k
Nov. 1 2015: 62k

As a result of the degradation of the exponential model, the Zero Hour projection no longer makes sense.

[Beet]

Now officially the deadliest outbreak, ever. And hand sanitizer doesn't do anything to viruses.

[Beet]

Indeed. I'm surprised at how little coverage this is getting, especially compared to developments in the Middle East. What's the worst that can happen there? ISIS takes over? Who cares? They can always be bombed into oblivion just like the Taliban were.

On the other hand, if ebola goes unchecked in west Africa, who says it can't reach the West? And how, exactly, is it going to be stopped now? We can't rely on overworked, underfunded Medicines Sans Frontieres volunteers to fix this for the world. I'm convinced slow mobilization of Western resources now to fight ebola could be seen as a historic mistake by future generations. I urge everyone to spread awareness of this issue as far and wide as possible, and in the meantime, make a donation to Medicines Sans Frontiers in lieu of a political campaign contribution.

[Beet]

Daily Kos gets with the program:

http://www.dailykos.com/story/2014/06/25/1309531/-Ebola-out-of-control-we-have-reached-the-limits-of-what-we-can-do-says-Doctors-Without-Borders

[Beet]

Indeed. I'm surprised at how little coverage this is getting, especially compared to developments in the Middle East.

Well, it get's little coverage because it affects poor, black people in African countries that nobody cares about.

If there were an Ebola outbreak in the White House, it would certainly get more media coverage.

But they live in the same world we do. Viruses don't know whether somebody is white or black or yellow or brown or red, or how much money is in your bank account. Viruses don't know borders either, those man-made invisible lines. Viruses have only dynamics, and the current trajectory of human response is not sufficient. This is one area where for the developed world to look beyond our own myopia would be an act of supreme self interest.

Also,

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http://www.npr.org/blogs/health/2014/06/27/326159053/for-a-9-year-old-with-ebola-a-sliver-of-hope-isnt-enough

Think of this story the next time you are feeling sorry for yourself.

[Beet]

Lancet warns many cases of ebola may be going undetected, particularly in Sierra Leone:

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Link

[Beet]

So what do you think the end game is here Beet, should us non-poors in non-tropical places be worried?

No one knows what the end game is but the top experts in the field have says that it spreading outside of Africa is a very real possibility. With a symptom free incubation period of 21 days and thousands of people crossing borders every day I don't see what there is to stop it.

The EU has provisioned 500,000 euros and this alone will allow Medicines Sans Frontiers, the Red Cross and the Red Crescent a significant expansion of resources. 500,000 euros! Obama has asked for 500 million for Syria alone, and 3.7 billion for some kids on the border. This is a rounding error we're talking about. Yet it will make a huge difference at this point in time to stop this outbreak. Have you seen pictures of JFK hospital in Liberia? The largest hospital in the country... Google it. This is what we are dealing with here. Last Thursday a pregnant woman died if ebola there and now all the staff are running around like headless chickens, and without protective gear, according to one reporter. $1 million is going to make a huge difference. Six months from now, $1 billion might not be enough. Yet it's like spitting in the wind here...

[Beet]

Part of the problem is the incentives are all Fuked up. 80-90 percent of people die, so people see the sick going into these treatment centers relatively healthy and not come out. So if you're sick, there's no incentive for you to go to these treatment centers. But for the rest of us, we need then to go there to be isolated. That's why if there are experimental treatments they should start trying them now. The downside is pretty low. But these big pharmaceutical companies won't give it a high priority because there's no money in it. Some if the main research on ebola right now is being funded by the Canadian government and the DoD. Because the government knows that this is a national security issue.

[Beet]

WHO can't fully deal with Ebola outbreak, WHO warns

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[Beet]

Everything is going to be okay, dude. This isn't going to be like Contagion.

Well not the people who get it.

[Beet]

Ha ha guys, keep laughing.

Meanwhile, last week a guy was left outside Liberia's largest hospital puking blood for half an hour while a crowd of onlookers gathered in because health workers were too panicked to figure out what do with him.

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http://allafrica.com/stories/201407170961.html

The kicker is the guy took the taxi to the hospital, potentially leaving his bodily fluids all over it and infecting however is the next person to take that taxi. There was no mention in the article that the taxi was tracked down and de-fumigated. One can easily imagine a person taking a taxi to the airport and getting infected.

[Beet]

The introduction of chikungunya (non-fatal, dengue fever like disease) into the western hemisphere is a bigger immediate concern.

While the symptoms of chikungunya may be similar to ebola for 1 or 2 weeks, ultimately it is not a fatal disease.

~

"The articles I read in the English-language press decry the absence of functioning healthcare infrastructures in the African nations hit by the Ebola virus. But I am not convinced that the United States would do much better. There are a great many things that western medical institutions and personnel do extraordinarily well. We have sophisticated surgical technology and an advanced pharmacopeia of medicines to treat hundreds of diseases. But the bulk of our medical resources go towards curing rather than prevention. What we do dedicate to prevention tends to be limited to proximate factors such as germs and personal behaviors such as smoking that make individuals sick. We also divert resources into campaigns for procedures such as mammograms which detect but do not prevent disease. We pay less attention to poverty, inequality, environmental degradation and, yes, globalization, as root causes of sickness.

...

We need to learn about public health emergencies around the world not only because they might become our emergencies, but also because those emergencies could be better contained and managed if we were to invest our expertise, our attention and our resources into community, national and international health preservation. For a fraction of the money that Western countries have poured into military campaigns in Africa, it would have been possible to support local governments in building functioning public health infrastructures. "

America’s shameful ebola ignorance: The troubling truth about our attitude toward the virus

[Beet]

Ebola reported in the Democratic Rep. of the Congo

Four Nurses have contracted ebola at hospital in north-central Liberia; the hospital had received a donation from Gus and Hope, a US-based Lutheran Church, as recently as March. In February, patients and nurses had abandoned the hospital due to ebola fears.

Precautions professionals take around ebola; which include full body suits that are burned afterwards (cost of $80 each), two fences six feet apart; a decontamination chamber from which nothing ever comes out except people.

Ebola is rated at a higher biohazard level than anthrax, HIV, SARS and tuberculosis. There are only a few labs around the world rated high enough biohazard level to deal with ebola.

According to the Centers for Disease Control (CDC):

"In addition to BSL-3 considerations, BSL-4 laboratories have the following containment requirements:

Laboratory practices

Change clothing before entering.
Shower upon exiting.
Decontaminate all materials before exiting.
Safety equipment

All work with the microbe must be performed within an appropriate Class III BSC , or by wearing a full body, air-supplied, positive pressure A suit.
Facility construction

The laboratory is in a separate building or in an isolated and restricted zone of the building.
The laboratory has dedicated supply and exhaust air, as well as vacuum lines and decontamination systems."

http://www.cdc.gov/training/quicklearns/biosafety/

[Beet]

A reminder of why ebola is treated as a biohazard level 4:

The head doctor fighting an outbreak of the deadly Ebola virus in Sierra Leone has himself caught the disease

"It was not immediately clear how Khan had caught the virus. His colleagues told Reuters that he was always meticulous with protection, wearing overalls, mask, gloves and special footwear. Three days ago, three nurses working in the same Ebola treatment center alongside Khan died from the disease."

The high risk to health workers is one of the most insidious aspects of this disease.

Also...

"In a sign of the growing frustrations with the failure of region's governments to tackle the outbreak, a Liberian whose brother died from the disease set fire to the Health Ministry in protest on Wednesday."

Also...

* Dozens of nurses at a government hospital in eastern Sierra Leone town of Kenema went on an indefinite strike on Monday following the death of three of their colleagues on Sunday. They demand " "immediate relocation to an isolated area of the Ebola ward and its takeover by the French medical agency, MSF".

As we know, MSF is already stretched beyond its limits. This is the only hospital in the country with an ebola testing center.

* Dozens of laboratory technicians at Sierra Leone's only Ebola-testing facility went on strike last week over a $20 monthly risk premium which they were promised but never paid.

Link: http://www.reuters.com/article/2014/07/21/us-health-ebola-africa-idUSKBN0FQ0XO20140721

The problem is, you have to pay these health workers huge premiums to work under these conditions. And then the worse the outbreak gets, the more tourism and investment falls, the less able the society is to deal with the disease. So it's a vicious cycle of economic collapse, which makes dealing with the outbreak harder, which leads to further economic collapse.

* According to reports in local media, the doctor mentioned mentioned above, Dr. Khan, is one of two "prominent" doctors showing ebola-like symptoms.

* "a national broadcaster last evening reported that following the deaths of eight ( 8 ) nurses within one month, ostensibly from Ebola infection, the Kenema city Ebola Unit is now abandoned by nurses who accuse the Health Ministry of being “incapable” of protecting health workers."

http://news.sl/drwebsite/publish/article_200525829.shtml

[Beet]

A doctor at the Phebe Hospital in Bong County has been tested positive of the deadly Ebola Virus Disease, barely a month after a head doctor at the Redemption Hospital in the Borough of New Kru Town died of the disease at the John F. Kennedy Memorial Hospital in Monrovia.

In Monrovia, several hospitals have shut their doors to the public, including Redemption Hospital and the James Davies Memorial Hospital in Nee-Zoe community, Paynesville after nurses and doctors refused to report for work.

http://allafrica.com/stories/201407241076.html

[Beet]

It's now spread to Nigeria.

[Beet]

Authorities are now considering shutting down the John F. Kennedy Memorial Hospital in Monrovia for 21 days, after senior medical practitioner, Dr, Samuel Brisbane died of ebola yesterday. JFK is one of the biggest state run referral hospitals (referenced in my posts above). Nurses are not working or getting paid anymore and could be seen standing around the hallways in fear. The OPD Wall, the Operation Room, the pharmacy and other important segments of the hospital were all closed to the public.

The meagre health system in Liberia is being absolutely eviscerated. Pretty soon it will completely cease to function.

[Beet]

Jeez.

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http://crofsblogs.typepad.com/h5n1/2014/07/sierra-leone-police-use-tear-gas-to-curb-ebola-related-riot.html

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.

[Beet]

Holy sh*t, a woman in Charlotte, NC has contracted it. 'Hoping she ends up ok.

She is from Charlottle, not in Charlotte.  She is in Liberia where she has been helping out with a medical aid mission.  By all appearances, she is a woman who should end up at the right hand of Christ, though hopefully not soon.

My heart skipped a beat. But yeah, Charlotte is the headquarters of Samaritan's Purse, the organization the Ft. Worth doctor who contracted it is from. Dr. Kent Brantly is only 33 years old; with a wife and kids in Texas. Last I checked his blogspots from 2009 were still up. God bless him. You can donate directly to the organization's West African ebola response here. I donated $50.

Nancy Writebol worked in the decontamination unit, basically she was one of those who you see helping the doctors suit up and take off their suits afterwards. The fact that she was infected, and doctors are infected, shows that there are multiple failures in the current operational procedures which must be corrected. For a supposedly "hard to catch" disease it certainly is hard to defend against. Which is going to be an issue going forward because, BSL-4 is not replicable on the ground.

[Beet]

Fascinating comment on reddit from someone who works on micro-finance:



It is said that an element as simple as Clorox bleach can kill ebola, so maybe I was wrong to disagree with Simfan early in this thread. The problem is it must be applied consistently. I wonder if it could help health workers to have their suits completely soaked in bleach?

Also, again what we have learned here is that ebola isolation cannot be confused with "normal" medical institutions; if at all possible these isolation centers should be built from scratch and it should not be assumed that a normal hospital is equipped to deal with it.

[Beet]

Sorry if this seems like a lot of posts, but a major speech today by Liberian president Ellen Johnson Sirleaf is pertinent

http://allafrica.com/stories/201407270112.html?aa_source=acrdn-f0

It looks like full mobilization of gov't resources, including the armed forces to enforce local quarantines. should have been done a month ago

[Beet]

So apparently the guy's family only traveled back to the U.S. a few days ago. And now it's already reported he's under quarantine? I hope the guy's family is being tested/monitored, if not under quarantine for the requisite 21 day period.

[Beet]

Well, according to Samaritan's Purse, Nancy Writebol had never even had contact with patients, and they are "investigating how [infection] might have occurred." That puts a damper on all the pollyanas saying "oh don't worry, it only transmits through blood or feces, durrr hurr hurr" I'm pretty sure this woman would have known if she had touched the blood or feces of a patient.

Meanwhile, Patrick Sawyer, the Liberian Finance Ministry consultant who died in Nigeria, had been on three flights... one to Togo, one to Ghana, and one to Lagos. And apparently they don't have all the flight lists yet still.

[Beet]

http://www.cdc.gov/media/releases/2014/t0728-ebola.html

CDC on risk to U.S. population:

'I want to underscore that Ebola poses little risk to the U.S. general population.  Transmission is through direct contact of bodily fluids of an infected person or exposure objects like needles that have been contaminated with infected secretions.  Individuals who are not symptomatic are not contagious. The mortality rate in some outbreaks can be as high as 90 percent, but in this outbreak, it is currently around 60 percent, indicating that some of our early treatment efforts may be having an impact.'

The 60 percent figure being thrown around seems too low. In Guinea, the disease has a fatality rate of about 75 percent. In Sierra Leone and Liberia it is much lower, but that is because new suspected cases are piling up very fast in those countries. Many of those cases will die.

CDC on response strategy:

'Fundamentally we need to work together to do three things.  These things are 100 percent in line with the global health security agenda.  First we need to build systems to find cases quickly.  And when health care can make a difference between life and death.  This means traditional healers, supporting primary care and accurate laboratory testing.  Secondly we need to respond by isolating cases, and managing the response through emergency operation centers which every country should have.  Third, we need to prevent future cases through infection control, safe burial practices, prompt diagnosis and isolation of new cases.'

'I think what I can say is that what we're trying to do is to approach this as a two-faze response here.  Perhaps three because we already had phase one.  In this phase, we want to, as quickly as possible, surge as many resources as we can into the area to try to get things going in all of these different areas where there is ongoing transmission.  There is five or six districts that have cases.  Once we do that surge, we have to maintain the effort.  So we're developing rosters of people with appropriate skilling, a new class of epidemic emergency service offices and we're looking to engage them in the outbreak response as well.'

They are still going for the isolate and contain route. Getting cooperation from the local population is going to be the number one issue.

[Beet]

Meanwhile, Patrick Sawyer, the Liberian Finance Ministry consultant who died in Nigeria, had been on three flights... one to Togo, one to Ghana, and one to Lagos. And apparently they don't have all the flight lists yet still.

So apparently this guy was a U.S. citizen. He lived in Minnesota for a decade and his wife and kids are still there. (A little awkward that his Americanness was erased, when the two Samaritan's purse workers were reported as the 1st and 2nd cases). Apparently he was also some big shot with the Liberian government, who had spoken for the Finance Minister before, and the Nigerians were under a lot of pressure to release him. Even now the Liberians are supposedly displeased with his treatment, although the Nigerians certainly made the right choice.

Sheik Umar Khan, the top Sierra Leone doctor, has died in Kailahun. Yesterday it was reported that the president of Sierra Leone, Ernest Bai Koroma, flew up to Kenema, a large market town near Kailahun, to visit the epicenter of the outbreak in that country and an ebola treatment center for the first time. He was tipped to visit Dr. Khan in Kailahun, but his helicopter was reported to not be able to make up due to lack of fuel, and he was to return the following day. I wonder now if they said "Don't bother coming, he's about to die." Or "He's already dead, but we're not ready to announce it."