Friday, October 10, 2014

Blind Hog. Acorns. Assembly Required.


While I would normally hold most of the stuff written in the WaPo with an understandable amount of disregard given their editorial perversion, if they keep this sort of thing up, they may actually stumble back onto real journalism, provided the shock of the pure strain doesn't kill them outright.

When the experts describe the Ebola disaster, they do so with numbers.
Right now, the math still favors the virus.
 The number of Ebola cases in West Africa has been doubling about every three weeks. There is little evidence so far that the epidemic is losing momentum.
“The speed at which things are moving on the ground, it’s hard for people to get their minds around. People don’t understand the concept of exponential growth,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. “Exponential growth in the context of three weeks means: ‘If I know that X needs to be done, and I work my butt off and get it done in three weeks, it’s now half as good as it needs to be.’ ”

Thanks, Tom. Only 15 doubles out of 33 possible* along this road, it's rather nice of y'all at CDC to notice everyone's a tad bit behind the curve.

 The virus is still outpacing the efforts to contain it.“The situation is worse than it was 12 days ago. It’s entrenched in the capitals. Seventy percent of the people [who become infected] are definitely dying from this disease, and it is accelerating in almost all settings,” Bruce Aylward, assistant director general of the World Health Organization, told the group.
Aylward had come from West Africa only hours earlier. He offered three numbers: 70, 70 and 60. To bring the epidemic under control, officials should ensure that at least 70 percent of Ebola-victim burials are conducted safely, and that at least 70 percent of infected people are in treatment, within 60 days, he said.

For reference, they're at maybe half of the burials being conducted safely, 20% of the victims are in treatment, within any number of days, until they become a problem for the burial teams.

More numbers came from Ernest Bai Koroma, president of Sierra Leone: The country desperately needs 750 doctors, 3,000 nurses, 1,500 hygienists, counselors and nutritionists.

For some perspective on that, Sierra Leone had a total of 115 doctors total in their entire country before the Ebola outbreak hit. So all their president is asking for is six and a half times more doctors amidst an epidemic that's killed thousands than the total number they could muster when things were relatively peachy and stable.
And while you're up, we'd like world peace, the winning Powerball ticket, and a Shetland pony.

The numbers in this crisis are notoriously squishy, however. Epidemiological data is sketchy at best. No one really knows exactly how big the epidemic is, in part because there are areas in Liberia, Sierra Leone and Guinea where disease detectives cannot venture because of safety concerns.
The current assumption is that for every four known Ebola cases, about six more go unreported.
Put another way, the reported number of case and death totals are only 40% of the actual ones, we're therefore at more than 16 doubles out of 33 possible before the number of cases exceeds the world population , and thus Sierra Leone really needs 2,250 doctors, 7500 nurses, and 4500 hygeinists, counselors, and nutritionists. (And just to be fair, I'd also like to add the home phone number of this month's Playmate, and a Ferrari to my wish list.)

The U.S. military is building 17 treatment centers that can hold 100 people each, but the top military commander in Africa said Tuesday that they won’t be ready until mid-November. Liberia and Sierra Leone have a particularly keen need for more hospital beds. The two countries currently have 924 beds between them, but they need 4,078, according to the WHO.
But as Mssr. CDC Director Frieden pointed out, by mid-November, six weeks hence and two more doublings along, they'll be needing 16,312 beds. Less the 5709 patients that have died, and now need burial (8156 x 70% death rate) by the teams that can't keep up already with only a quarter of the work now that they'll have by then. So the 1700 new beds are going to come up juuuuuuuuuuuuuust a little short. 

In case I lost anyone with that math, imagine you start running as fast as you can now. In thirty seconds, I'll fly by you in an F-22 on supercruise. You keep running as fast as you can to catch me, while I fly along in a straight line at about 900MPH. Then, in 5 minutes' time, we'll see how much closer you are to catching me. Then we'll check again in 5 minutes after that. And so on. That's how exponential virus outbreak works in real life. Like now.

The latest data from the WHO show hints of progress in bringing Ebola under control in certain rural areas stricken by the disease earlier this year. Seven provinces in Guinea that previously reported Ebola cases saw no new infections in the most recent three-week period covered in Wednesday’s WHO update. Two districts in Sierra Leone and one in Liberia showed a decline in infections.
But experts caution against reading too much into small fluctuations that may simply reflect an increase or decrease in surveillance or a reappraisal of older data. This cautious attitude toward lower numbers particularly applies to a reported drop in new cases in Liberia in the past three weeks, which the WHO said is “unlikely to be genuine” and more likely reflects “a deterioration in the ability of overwhelmed responders to record accurate epidemiological data.”

That's the "squishy numbers" they mentioned earlier. It's a bitch to try and gauge how well you're doing when people inconveniently die faster than your team can tally them, even using their fingers and toes to count. Welcome to West Africa.

But the best news:
As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.
“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”
In case you missed that, that was the head of the CDC admitting out loud that we're going to have any number of additional Duncans, in multiple countries, doing the exact screenings we're doing now. Assuming no changes in any variable, 10 more at least on a straight extrapolation. Some (but not all) of whom will come to the US. the rest of whom will head for London, Paris, Rome, India, China, Pakistan, Indonesia, etc. And it could just as easily be 50 as 10; we simply don't know. We just hope.

And we're betting all the marbles there are that in every export case, we'll spot them immediately, isolate the infectious people flawlessly, and track down all their contracts swiftly. (Just not in the pooch-screwed manner it worked out in Dallas. And Madrid. And what looks to be the UK case(s) loose in Macedonia.) No one else will screw it all up every way possible, unlike what's happened every single time so far, because Magic Beans and Fairy Dust.




*(For those unclear:
Exponential Growth 101
1 patient "double" becomes 2, 2 becomes 4, 4 becomes 8, etc.
It takes 10 such doubles to get from 1 to 1,000, ten more to get from 1000 to 1,000,000, and ten more to get from 1,000,000 to 1,000,000,000. Three more doubles to get to 8,000,000,000. In a planet with only 7.7B people, 33 doubles from Patient Zero gets you to "Game Over". When you get to 16M, in about 15-18 weeks (each double is now taking about 21 days), you've reached the point where everyone in the three primary affected countries has Ebola, or died from it (because about 20M people live there). Long before then, governments there break down, people go every which way, and the process continues spreading outward like ripples in a pond. So you either stop it cold early, slow it way down, or become functionally extinct. We're at the halfway point, give or take, on that 33-step process, today. And losing. This is why Frieden and WaPo describe the math as "ominous".)

17 comments:

Anonymous said...

Thanks for your hard work

A Texan said...

And yet...Frieden does not have either the good sense or the integrity to walk into Obama's office and say, "Mr. President, I'm here to tell you that this disease is an extinction event unless YOU ban air travel from West Africa and order the quarantine of everyone who has been there within the last 3 weeks before arriving on our shores. Either you do that, today, or I will resign and hold a press conference and explain both the gravity of the situation and your refusal to do the right thing."

That would bring this to a head, at least here. I strongly suspect that if President Obola did this, other countries that haven't yet had the good sense to do so would follow (that's what leadership is, you know).

Oh, and we need to lean HARD on the Saudis to cancel the Hadj. I simply cannot imagine what 20 million people from all over the world, including from West Africa, will do for this situation - well, I can imagine, every time I watch The Walking Dead. IOW, civilization gone, no food production, no medical care, every person for themselves, etc. (the dead rising...uh, not so much).

As you've been stating, we are at a critical juncture. The longer we wait, the less probable is any effort to contain this likely to be successful. Given our present government, we're likely to be at a world population of 700 million (or less, given the collapse of civilization) before too long.

Anonymous said...

Ok, I was trying to figure out a way to monetize this idea, but now I realize that I don't have time.

I propose that someone should do this immediately, first in Africa, then in the western world:

Health care leaders need to acknowledge publicly that they CAN'T help all the people that need help, and therefore people will need to help themselves. (I know this is anathema to the field, and I watched it happen on TV in Africa -- a family arrives at a care station with a sick person, AND THEY ARE TURNED AWAY because the aid center is full --to wander around and infect others. This is NOT the way to contain this.

Self care kits need to be put together and distributed to anyone seeking care. Kit to contain 12 days of IV fluid, box of gloves, trash bags, AD, fever, and pain meds (if effective) and masks. Add one box of MRE's for each accompanying family member.

Care station inserts the lock or port or whatever it's called in the patients arm and hands the kit and instructions to the family. Family is instructed to go home and care for afflicted.

EVERYONE that presents at the care station with the patient gets an IV lock and a kit as they are now doomed too. This will keep them from traveling to the aid station when they inevitably get sick.

Once the kits are in the pipeline and pallets of them start arriving in Africa, then they can be distributed and stored in the US.

I know the medical folks will have all sorts of reasons why this can't be done. At the base of them all will be "because WE aren't doing the care." Face facts, there aren't enough trained caregivers. And really, what are the caregivers in Africa actually doing? Any infection or bad outcomes from the family not following instructions, or from the miss-application of the IV etc DOESN'T MATTER. These infected only have a 1 in 10 chance of living anyway.

Current strategies aren't working and CAN'T work. As you've pointed out, the numbers outpace the availability of beds. You cannot GET 20,000 cots (from where?) to Africa, let alone build what amounts to a small city, before you need 40,0000. There aren't enough health workers in the world to meet the demand, and TURNING AWAY known infected to continue roaming the city looking for care is INSANE.

So, anyone reading this with contacts in manufacturing and healthcare-- get busy. You can make a lot of money and save lives if you can act quickly.

nick

Anonymous said...

Regarding providing medical kits, food, etc. to families:

1) That is a good idea - at least some help is provided, which is better than none. You are right that the resources simply aren't there. Having AD and IV fluids (with electrolites) will give a few percent of the people infected a chance to beat this thing by outlasting it.

2) However, as you noted, it won't stop people from wandering (including "wandering" to a different part of the world and spreading the infection even further and faster. Sooooo, I propose the very humane (from the standpoint of the entire species) policy of setting up perimeters at certain critical points and, just like in World War Z, just killing people who are infected so as to contain this thing as much as possible. Yes, it is very harsh, but this could literally be a worldwide pandemic before too many more months, and compassion also includes making sure that a preventable spread to millions (or billions) simply DOES NOT OCCUR.

The irony is that, ultimately, something along those lines will happen anyway. But is it better to have it happen relatively early on, when there's a chance to save untold millions from incredible misery and death, or wait until "we don't have a choice any more" when it won't do a lick of good? I know what my choice is.

By the way, I think that the uninfected world ought to begin to stockpile food and other critical resources to prepare for long-term quarantines. If people have food, plus their water and electricity works so that they can have a shower and watch TV, then they are much more likely to actually follow directions and stay home for a few weeks. If we don't do it, then the same "wandering" will end up happening here, defeating any attempt to contain the outbreak.

I never thought that I'd be living in a sci-fi movie...but we apparently are about to begin.

Anonymous said...

1) Most, if not all, of those infected in West Africa, at this very moment, are going to die from the virus.
2) There is, realistically, no possible way to save them without needlessly risking health care workers that potentially will be desperately needed at home.
3) It is tremendously sad to be born on the wrong continent, and then end up in the sum of an arithmetic equation that simply does not work out any other way but factually.
I am sorry for all of the above, and I pray for their lives and for forgiveness, but the real need here is body bags, and before the entire world is sacrificed in the name of... kindness? Humanity? Altruism? You-name-it...
The fact is, we are not far from the death rate exceeding the burial rate. At that point, someone will have to find the courage to use fire.
I'm sorry. The truth is, after all, the truth. As Ayn Rand said, "You can avoid reality, but you cannot avoid the consequences of avoiding reality."

Anonymous said...

http://www.nature.com/srep/2012/121115/srep00811/full/srep00811.html

Anonymous said...

To Anonymous 12:08

I agree with your assessment. Sadly, tragically, we as a species will have to, at a certain point, take extraordinary measures to try to contain this outbreak before it becomes an out-of-control pandemic.

1) ALL air travel out of these countries MUST stop, ASAP. The only ones getting out are to be in military transports controlled by a reliable nation's military, and all of them ONLY after having been in quarantine for 3 weeks.

2) If the 3 nations involved don't wish to cooperate, then (again, sadly and tragically) there is a simple and cheap solution: crater every airport, save 1 in each country, that is capable of handling aircraft. That will only take a single B-1 armed with about 40 1,000-lb. bombs, with about a dozen dropped at various points on the runway(s). The one remaining airport in each nation would then be seized by a reliable military and used to bring in relief supplies (and plentiful amounts - this isn't about punishment, it is about survival, so we don't have to be needlessly cruel and shouldn't be - quite the contrary). NO ONE who hasn't been specifically cleared as free from Ebola may enter the airport grounds, on pain of being shot.

3) Perimeters need to be set up to prevent people from exiting these nations by sea or on foot. The population simply needs to be bottled up so as to let the disease burn out. This means clearing jungle for a hundred yards or so and setting up free fire zones. Cruel to those involved, but merciful for the rest of humanity.

4) We also need to begin some kind of program to either: a) eliminate the local habit of eating bats and monkeys; or b) find a way to eradicate as many bats and monkeys as possible. The bats will be relatively easy - dump DDT all over the place and kill off their food supply, plus sealing off caves know to harbor them. No, you'll never get them all, maybe not more than half, but this will help to reduce the natural reservoir of the disease.

Sooner or later (hopefully sooner) the outbreak will burn out and we can begin to rebuild these countries. It isn't their fault (well, mostly) that they were born there and that Ebola started there. (I say mostly because SOME people there are eating these animals and thereby getting the disease). Meanwhile, governments around the world MUST begin a crash program to find a cure and/or a vaccine for Ebola (in all of its known variants) and Marburg and the rest of the hemmorrhagic fevers. This should never have to happen again.

Our survival as a species is literally at stake here - not to mention untold misery. It is hard to think, say and write these things, but these are steps that MUST be taken to prevent the 99.9% of the world that is not infected from becoming infected. Once we go more than another couple of months, even these measures will be too little, too late, as there will be spread elsewhere. That CANNOT be allowed to happen.

Anonymous said...

ok, so that means two of us are realistic enough, and courageous enough, to speak the truth. And neither one of us works for the government, so I guess we can stock up on what we'll need to get through the upcoming quarantine in our homes... I feel like Noah... 'no, seriously, it's going to rain...' 'no it won't, it never has before...' argh.

Ex-Dissident said...

I just want to say something reassuring here because people believe that we will all die of this virus and that is simply not true. About 50-90% of us will die and the rest will survive. However, governments will collapse and the survivors will need to learn how to survive on their own. That is, without government assistance. I hope you all feel reassured now and can go about your day with happy smiles.

Anonymous said...

MEMORANDUM
TO: Vladimir Putin, President, the Russian Republic
FROM: Sane people everywhere
DATE: As soon as you read this
RE: The spread of Ebola
FACTS:
1. Ebola is a communicable disease that, in its current variant, is fatal approximately 70% of the time, and causes immense suffering.
2. There is no cure (or at least none available to more than a few dozen people), and no vaccine. Additionally, the disease mutates very rapidly, so even if scientists are able to develop a cure or a vaccine, the disease may by then have already mutated to a more easily communicable form. Actually, the more people who are infected, the greater chance of such a mutation.
3. Additionally, the more people that are infected outside of West Africa, the greater chance that a second or third “natural reservoir” of the disease will become established, making it virtually impossible to control future outbreaks.
4. People from the 3 nations where this nascent pandemic originated are traveling to various places around the globe, and cases have occurred in a variety of places around the world including the United States and Europe.
5. The President of the United States, Barack Obama, has repeatedly refused to take any action to stop people who may be infected with Ebola from traveling via air.
ISSUE:
What can be done to stop the spread of this disease before it becomes incapable of being managed?
ANALYSIS:
1. Since the disease is effectively incurable, and since there is no vaccine, the best hope of minimizing the harm created by this disease and minimizing the chance that it will become a pandemic that could literally kill half or more of the human race, lies in containing the disease to its points of origin in Liberia, Sierra Leone and Guinea.
2. Since President Obama is, apparently, unwilling to do anything of substance to halt air traffic originating from the host nations of this Ebola outbreak, something else must be done by some other nation that is capable of effectively stopping the above-mentioned air travel.
3. The Russian Republic is a nation of vast resources, including vast military resources.
4. You are in charge of the armed forces of the Russian Republic.
CONCLUSION/RECCOMENDATION:
1. Since Ebola is a communicable, highly-lethal and effectively incurable disease, the spread of this disease must be stopped as soon as is practical in order to spare the world a pandemic that could literally kill hundreds of millions or billions of people.
2. Since the United States has abdicated responsibility or initiative in attempting to accomplish the halt of the spread of this disease, some other nation must do so to avoid an unspeakable tragedy.
3. Since the Russian Republic possesses enormous military resources, and since you are in charge of those resources, and since you have displayed tremendous decisiveness over the years of your leadership, it is the conclusion of all sane people everywhere that you may be our only hope. Therefore, and with great humility and respect, we hereby ask you to order the armed forces of the Russian Republic to destroy every airport in the nations of Liberia, Sierra Leone and Guinea, and to do so without delay.

Ex-Dissident said...

Anonymous, why not just drop nuclear bombs all over Sub-Saharan Africa and rid this world of Ebola, most of the AIDS carriers, Mahrburg, biggest reservoir of Malaria, and a whole host of other nasties. BTW, where did you get the idea that Putin is sane?

In case you are seriously considering the appropriateness of such a response, I am being facetious in this comment as well as my comment above. I do think that quarantine of the affected population is right and that we should allow mercy flights into the area to bring badly needed supplies and personnel.

Anonymous said...

The "badly needed supplies and personnel" will be needed here. When or if we can protect and support our own, we can discuss going overseas to help. I feel no great obligation to be the world's policeman or physician. Or coroner/funeral director.

Anonymous said...

Putin is sane, just exceptionally brutal (by today's standards - he is a teddy bear next to Hitler, Stalin and Mao). Most importantly, he is a very protective nationalist who will do damned near anything to protect Mother Russia.

Yes, I was being a bit facetious. But a serious quarantine of the primary Ebola countries is absolutely necessary, the sooner the better. I think that it is possible that the very existence of the human race may depend on stopping this thing from spreading in the next few weeks. Continuing to allow walking, talking disease vectors for the most virulent disease seen by Mankind to travel all over the world infecting people is insane...and the fact that they are human beings just like us with families, hopes, dreams, etc. A is heartbreaking and tragic. I seek to reduce the number of people being infected to reduce misery and further such tragedies.

Legal Alien said...

Sooooo, by the maff, to get to 33 doublings and get to the 'magical' 8billion number, we have only 20 doublings remaining. At a rate of 3weeks per doubling, that leaves us with only about 60 weeks MAX, before the whole world population is infected.
With current mortality rates (assuming WHO figures are accurate - HUGE assumption I guess), we will be facing at least a 48% mortality of the human race come end 2015 . . . . . Have fun y'all

Aesop said...

More like 16.
The current number of cases is pushing 9K "officially, and the actual number could be closer to 20K+. (The informed assumptions are that things are 2-2.5 times worse than the official numbers).

Just to make it more fun, the doubles as recently as late summer were every 4 weeks, Now they're every 3, on average. In Liberia, they're about every 2.

Total bad juju: multiple disseminated simultaneous outbreaks (thanks, international air travel) in major population centers.

So Total Horror Story worst case: maybe only 18 doublings left, at 2 weeks per. 36 weeks from now.

Cancel Christmas.

If we keep it contained in W. Arica, that doesn't happen. it just wipes out 18M out of 20M people in the three countries in question.

But Duncan in Dallas shows how well that fond hope works out in the real world.

Anonymous said...

Key words: "keep it contained in west Africa". I am no genius, but I do have a tremendous grasp of the obvious. See, govt. stooges? Problem solved. Now handle the implementation, that's what WE pay you for..
KEEP IT CONTAINED IN WEST AFRICA.

Fiftycal said...

But, but, but obamacare.