Wednesday, May 17, 2017

Here It Goes Again

Another Ebola outbreak. (Not that the 2014 one has really gone away, but I digress.)

From comments:

Off topic... but here is an update from WHO on Ebola:
WHO dashboard report 2017 Congo Ebola outbreak 15 May 2017
I am curious to hear your take on this - last week it was 3 and this week it is 19.

And depending on the location, next week could be 50, or 300. Or still 19.

They're following an additional 129 people, according to the report.
(BTW, both dead victims #2 and #3 were the ones who helped transport and treat #1, and the next 16 are people they infected. Stop me if you've heard this one...).

The saving grace this time is that this outbreak is in outer BFCongo, rather than in downtown Kinshasa (pop. 10,000,000)

The incubation period for Ebola virus was formerly considered 2-21 days, IIRC. A 2014 WHO report suggests it may be latent for over 42 days.) That means reports of infected persons now are always  at least 3-6 weeks behind reality, and the pool of infectees is always 21-42 days' worth of contacts higher than you think, and estimates are always behind the curve.

Think about how many people you come into close (like hand-shaking close) contact with in 3 weeks' time, and then imagine you had Ebola, and you get the idea.

Until they throw a quarantine line outside the virus' ability to spread among those infected, it keeps going outward inexorably like ripples in a pond.

Now imagine one of that potential infected pool gets on a 767, passes through two airports, and goes to a conference, before showing clear symptoms.
Then go back and re-read what I wrote on Ebola from 2014-2015.

My take is that every time a country has an outbreak, and isn't immediately declared an international catastrophe with a major international health care response, with all persons departing that country put on mandatory seven-week isolation quarantine until two months after the last case in that country, we've already fucked up by the numbers.

This was settled science before there was any science, because the Black Death was a thing 600 years before Pasteur figured out the details, and quarantine works. ("quarantine:n. 1. a 40-day period of observation of potentially infected victims to discern whether or not they are, in fact, diseased. From Italian quarentena quarantine {of a ship}, from Latin quaranta forty")

In 2014, we were two patients away from the US becoming Sierra Leone.

And to this day, no one knows where the last outbreak came from, or why it went away, because not one of the multiple requirements WHO laid out to control the epidemic was ever reached in any of the three affected countries in 2014.

Ebola is a guy juggling hand grenades with the pins pulled during a fire in a live nuclear missile silo kind of bad, and we can't keep staying stupid and getting lucky indefinitely.

Math refresher (rounded):

 1                      1             Initial case: Patient 0.
 2                      2
 3                      4             Where we were last week.
 4                      8
 5                    16
 6                    32             Where we are now, officially.
 7                    64
 8                  128             Where we probably are now, in reality.
 9                  256
10                 512             Where we might be now, worst case.
11               1024
12               2000
13               4000
14               8000
15            16,000
16            32,000              Official tally of Ebola cases in 2014.
17            64,000
18          128,000              Probable actual tally of cases in 2014.
19          256,000
20          500,000
21       1,000,000
22       2,000,000
23       4,000,000
24       8,000,000               Kinshasa, DRCongo approx. population.
25     16,000,000
26     32,000,000
27     64,000,000
28   128,000,000
29   250,000,000
30   500,000,000
31 1,000,000,000
32 2,000,000,000              Africa's population, more or less.
33 4,000,000,000
34 8,000,000,000              All human life on Earth.

So, you get 34 doubles to go from no one, to everyone (with the caveat that some will never get it, and some who do get Ebola will survive nonetheless, whether it's 7 people or 7 billion people we're talking about).

IOW, nothing to worry about.

Preparation for it would be get yourself able to hang at home (or wherever) hunkered down and shuttered in for the course of any pandemic.
Proper treatment of it in others is get the hell away, or settle your affairs.
If an epidemic becomes a pandemic, neither you nor your sentiments will be respected by a virus, especially if someone dear to you contracts the disease. It will kill you deader than canned tuna, and it won't care that you were making a noble sacrifice.
Get. The. Fuck. Away. And. Stay. There.

As Commander Zero and Remus have exhorted on other things like riots and general unpleasantness:

Avoid crowds.
Be somewhere else.

That means you, unless you have the entire Emory University Hospital BL-IV Serious Communicable Diseases Unit handy to pull right out of your @$$, at a moment's notice.
Nothing less will suffice.
If not, the one and only plan to cope is to stay the hell away from this.
Ebola is a m*****f*****, and you're the mother in that word.

Maybe keep a pin in the story, but at the moment, it's a typhoon in Sumatra: there are many other far more pressing things about which to be concerning yourself.


LFMayor said...

Boss, what saved us a few years ago? Was it just the general level of cleanliness in the population? I know that seems funny with all the pj pants and crocs walking around wal mart, but as a whole we are much cleaner than the equatorial places. at the same time ease and speed of travel here definitely work against us. What saved us?

Aesop said...

Having two more beds at the four BL-IV treatment facilities than we had active Ebola patients.

To see how trying to cobble regular US hospitals into Ebola treatment facilities (still the current plan from the CDC) works in practice, Google Dallas Presbyterian Hospital and the 2014 Ebola outbreak in Dallas.
cf.:Luftzeppelin Hindenburg

Bill Robbins said...

First, we have to find Hillary's missing shoe and figure out which Russian spy put sugar in the White House salt shaker. Then, there's the whole impeachment thing to deal with, and finding something else for Comey to do, once he gets too tiresome (he's getting there). Plus, a full-blown investigation of Maxine Water's wig.

Only then can we turn our attention to flesh-eating viruses and global epidemics.

Anonymous said...

Sigh. I'm 30-40 miles from Emory. Not sure if that's a good thing or a bad thing. Maybe I'll move to Minnesota for some measles. Diversity is our strength ya know. Ugh.

Aesop said...

As a refresher, Emory (and the other 3 BL-IV treatment centers) aren't a problem.
The local international airport is.

I'm not worried about the people we get shipped here inside a sealed bio-bubble.
It's the ones who come with nothing but a hot towel before landing to wash up with that you need to worry about.

LSWCHP said...

The problem isn't the infected guy flying on a jet to the US. There's a good chance of recovering from that, albeit with a bunch of casualties.

The problem is the infected guy flying on a jet to one of the giant third world shitholes with relatively poor hygiene like New Delhi, or Bangkok or Mexico City. Then within a few days you might have tens of thousands infected who get on jets to the US and elsewhere, which would simply overwhelm even the best western health services.

This little bug is gonna escape West Africa one day and make it to the rest of the world on a large scale, and we'll all really be in the hurt locker.

Aesop said...

Yes, but.
Look how well (NOT!) U.S. healthcare fared when it came to dealing with Ebola in Dallas.
If there hadn't been two BL-IV beds for the two American ICU nurses infected, it would have gone on and on here, just like it was doing in West Africa.
Worse, actually, because we don't build our hospitals out of tarps so we can burn them to the ground when the pandemic is over.

The other thing is the point TPTB were toying with every day they let potential infected people fly out of W. Africa last time, and in nearly every instance, it cost them.

All that prevented worldwide disaster, at the end of the day, was the poverty of most Africans, and their inability to afford a plane ticket.

As noted, that won't be the case in any number of other metropolii.
And the virus only has to get lucky once.