June Ebola Update

6/1/2019 - Per the latest WHO weekly outbreak bulletin, the 10 month Ebola outbreak continues unabated in DRC. It's up by almost exactly 30% in the last 21 days.

UPDATE: June 3 WHO Ebola Update:

'the new measures introduced in the past week, along with continued strong reinforcing of community messages, and intense application of proven public health measures, should confine the outbreak to the two provinces currently affected, and bring the outbreak to a close."

 

This happy gas from the UN, despite 118 known new Ebola cases, and an additional 61 deaths, in just the last week. I'd love to be wrong, but it sounds like someone is whistling past the graveyard here. Those new cases alone would be a significant outbreak. That many amidst all possible medical efforts, and nearly 130,000 vaccinations, points to them losing this battle rather decisively. Time will tell.

UPDATE II: London UK Guardian, June 4th:

"Aid agencies, infectious disease experts and the WHO say it will be very hard to bring this outbreak under control, even though they have had vaccines and experimental drugs from the outset.

There is almost no functioning state in much of eastern DRC and an almost total lack of basic services such as power, education, roads or healthcare. The authority of the government only extends to the edges of urban areas."

{This is 2014 redux.
WHO is saying in their published reports "We've got this", everyone else is saying "This sh*t's an out of control inferno!"

90 days later we had Ebola in Dallas.

This is also the first official acknowledgement that officially published numbers no longer reflect reality. You can now apply a Fudge Factor of 50% to all published numbers, until further notice.

That's admitting that things are a full-blown disaster.

Best start getting your sh*t together, people.
This one's going to blow containment. -A.}


The Good
They've vaccinated nearly 125K people, with an experimental vaccine that appears to confer >99% effectiveness against Ebola. (For the 1K or less people who contracted it anyways, don't worry, most of them are dead now.)

The Bad

1) Despite vaccinations, progressing at some 1000 per day, for a non-zero number of cases (currently it's something like 5% of all new cases), they have no effing clue where a given case originated, and thus no wild idea whom to vaccinate, or how to throw up a suitable containment ring around them, or how the virus got past them.

2) They are tracing contacts in 17 health zones. The problem with that is there are 22 health zones (think of counties) with active Ebola cases in the last couple of weeks. Imagine being missed by 17 out of 22 cars as you cross in a crosswalk, and you begin to appreciate why this is a problem.

In the five other zones (23%) where there is zero contact tracing, they have no idea what the disease is doing.

The Ugly

In this current outbreak, in 50% of cases, fever as a presenting sign is completely absent.
(Fever, we remind you, is how grade-school dropout customs screeners in 126 countries check people at the airports for Ebola before letting them in. Including our TSA wizards here in the U.S. It's really the only thing they can check that can be mastered by 80 IQ government employees worldwide. Sleep tight.)
Short of laboratory testing everyone (which they aren't and cannot do in nearly 1/4 of the Hot Zone in DRC), and a 40-day quarantine, cases will continue to multiply.
And they are.

Let's look at that over time, since we're at the 10-month anniversary of this outbreak today:

Index case      Aug 1
2 cases           Aug 1
4                      Aug 1
8                      Aug 1
16                    Aug 1
32                    Aug 3
64                    Aug 3
128                  Aug 31
256                  Oct 15
512                  Dec 3
1K                    Feb 24 
2K                    May 12
4K                    probably about Aug 1

That would be an 11 on the 34-point Scale Of Whether It's Time To Panic, with 34 being Global Extinction Event. And headed to 12 at about 100 new cases/wk, give or take.

And we repeat, as the virus doesn't kill overnight, the correct  death ratio number, we pound home, is not the WHO/Wikistupidia math-retarded posted lie of 65% of dead vs. infected, it's those dead now vs. number infected 21 days ago, which gives a consistent and far more reliable lethality percentage around 75%. Because it takes about that long to get it, and then die from it, on a rough average.

USAMRIID and CDC refer to that level of lethality as a "slate-wiper"; it erases populations.

And bear well in mind "surviving" Ebola means you now have it functionally forever, and get to suffer the sequellae of Post-Ebola virus syndrome. {TL;DR: You're still screwed, and life, as you knew it, is over. You aren't going back to your old life ever again. Short answer: don't catch it to begin with.}

Note that by the time it was confirmed as an outbreak this time, it had already doubled 4 times, meaning it probably started two to four weeks earlier, at minimum, but no one noticed until literally 20 people dropped dead with blood shooting out of all orifices. Nominally, on Day One. Proof of this is that it doubled two more times in the next 48 hours.
Growth slowed notably, mainly because the vaccine and ring vaccination slowed the brushfire down. At first.

And then the local superstition and ignorance kicked in, they started stealing bodies from morgues, burning Ebola treatment centers, and chasing the health teams out at gunpoint, and all hell has broken loose, probably never to be contained, because we don't have the 82nd Airborne in hazmat suits available to shoot idiots at gunpoint to get this back in the bottle.

You know this because it keeps escaping to neighboring health zones and provinces, having now moved some 100 miles outward.
It has surged notably since March of this year, both in terms of numbers, and affected areas. That is an ominous sign.

Bear in mind once again that this area is
a) equatorial jungle, literally right on the Equator
b) listed in all maps relevant as "ungoverned"
c) listed in all relevant maps as "armed conflict zone"

The UN and all local organizations are doing their usual Headless Chicken, thrashing about, but to little effect, and the literature continues to try and paint a happy picture, while ill-concealing their ultimate despair that they'll get ahead of this one.

It continues to be a slow roll-out compared to 2014, but is notably picking up steam.

For the record: The current outbreak in DRC is where West Africa was in mid-August 2014.
Six weeks later, Ebola got to the U.S.
{BLUF: You should start thinking that you've got maybe twelve weeks before it gets here. Again. It may take longer, or less time, or it may not make it here at all. But it looks like it's on the same trajectory, and we're all just one passenger flight away from doing this all over again.}

1000 vaccinations a day is great when you have 100 cases.
When you're working on 2200 cases and counting, and nearly 1/4 of the regions you need to be in are untouched by any effort, the horse left the barn, and you're just marking time on three sides while the whole show departs through the gaping holes in containment.

It's going to get much worse, much faster, probably in a week to a month, when cases start popping up farther afield, where there are no resources or testing, let alone contact tracing, and the percentage of cases with no clear infection chain will go from single digit percentages to mid-double digits rapidly.

And now comes unconfirmed word that we have a number of potential infected refugees in custody on the Southern border of the US. Nobody's saying they have Ebola, just getting all flustercated because they might. {Emphasis added for clarity. -A.}

My default answer is to ignore these reports until it's confirmed, because most of them are indeed false reports, so we'll wait and see how it pans out, as you all should.

But if it breaks out here, we have 11 BL-IV beds, max, to adequately contain that outbreak.
For reference, Mexico has zero beds.
I repeat, Mexico has zero beds.

If it breaks out south of the border, one case becomes 100 cases in about a month, tops, (probably more like a week to ten days) and then the flood of refugees coming here becomes a tsunami (actually, we're there now completely without a pandemic to drive it faster, so picture that when it gets turned up to 11). At that point, f**k a wall. The only way you stop that flow is AC-130s doing minigun sweeps of anything moving within 1/4 mile of the international border, which is going to be hard on the millions of people who already live inside that zone on both sides of the line.

So if Mexico gets one active case, you can cancel Christmas.
America (North, and particularly Central and South) becomes Africa at that point.
Ditto if we get more than 10 cases here in the U.S.

We saw what happens when people at the local big hospital tried to be Emory or Nebraska or The Vault at USAMRIID: it fails, and you knock a 1000-bed major tertiary care facility out for months, for the whole community.
And the virus doubles, despite your best efforts.

With EVD, close isn't good enough, and only counts with horseshoes, hand grenades, and nuclear weapons.

I'm working, and have been, in level I and II trauma centers, and major high-volume ERs my entire career. More since 2014 than before, BTW.

And I'm here to tell you, by the numbers:

1) We aren't ready to deal with this, in any meaningful way, any better than in 2014
2) By "we" I mean any hospital in any city anywhere in North America, and
3) when, not if, this breaks out here, it's going to take out health care as you know it in every affected city, starting with the people who work in them, then patients and visitors. Hospitals will become abbatoirs, morgues, then ghost towns.
4) 911 responders (firefighter rigs and EMT units, and to a lesser extent, law enforcement) will become potential carriers to spread the disease back into the community.
5) anybody, anywhere, with whatever certifications, who tells you anything different is either lying out their ass at both ends, or doesn't know what they're talking about, and anything further they say can be completely discounted as utter bullsh*t from someone too stupid to live, or irredeemably evil.

Good times, huh?

That means no ER, no 9-1-1, no 50 other things people come to hospitals or call the police and fire department to handle. Trauma, heart attacks, strokes, diabetic emergencies, appendicitis, and the whole plethora of modern medicine.
Imagine the police not wanting to get within 20 feet of people on a stop or a call.
Car accidents will become morgue calls.

Because Ebola.

The Monster

The little filovirus in the masthead for these updates is magnified tens of thousand times, in pics that have been around since the mid-1970s.
A period at the end of this sentence would be a ball of virus that numbers 100,000,000 of them.
The number necessary to give you full-blown Ebola is one.

We don't know in what species Ebola resides between outbreaks. Anywhere. Ever.
We don't know how it gets transmitted from them to humans.
No idea whatsoever.

Flecks of infected blood from a human victim who has it can be coughed and sneezed 25', and may linger in the air for up to 10 minutes afterwards.
And that's only considered droplet precautions, because those particles are heavier than air, and eventually settle, unlike true airborne precautions, for something like TB, or pneumonic plague.

Your body won't care which it is if you suck in one of those droplets at the movie theater, theme park, supermarket, or mall, whenever you simply breathe it in anytime you walk within 25' of anywhere anyone has coughed in the last 10 minutes.

Have fun at WalMart, Target, the airport, a theme park, a movie multiplex, a ballpark or auditorium, and the supermarket then.

And before someone starts asking (again?!) about how to "deal" with this, by suiting up:
1) You need a 20-piece hazmat ensemble, a spotter to put it on and take it off, a metric fuckton of disinfectant and disposable items, including gloves, splash-proof goggles, gloves,  suits, gloves, hoods, gloves, booties, gloves, droplet barrier masks, and gloves.
2) One break in protocol will be a terminal error.
3) And potentially expose everyone you come into contact with to the virus.
4) And require you to start all over again getting suited up for, or deconned out of, any hot zone
5) Oh, and lest we forget, it's June, and the ensemble inside is hot-as-fucking-hell, and gives the average person maybe two hours' time before they're ready to pass out from heat stroke, before we factor in dehydration, claustrophobia, and sheer panic.
6) Did we mention that hot, tired, dehydrated, exhausted, and panicky people make fucktons of sloppy mistakes?
7) Did we also mention that one mistake can get you and everyone you love or contact killed?

So yeah, fuck the idea of working in hazmat gear. Professionals hate it. With all the resources mentioned above you'll never have.
You?
You don't stand a chance.

Proper protective equipment for Ebola, we repeat and belabor, is several lengths of military-grade concertina, warning signs, a shotgun and supply of buckshot, and small breakable containers with a suitable flame accelerant, for emergency decontamination beyond the perimeter.

Chance of Ebola sneaking up your driveway and into you behind such a perimeter: 0%.

Odds of seeing this material again before the end of the year: better than even.

Happy Summer, kids!
Now do you see why I don't want to bring this up any more frequently?

UPDATE: 116 Africans, including Congolese refugees, caught crossing Rio Grande
What could possibly go wrong?

UPDATE II:
I repeat for the record, as of June 5th, based on available evidence, and barring any changes in worldwide response,

this one's going to blow containment.

Get your preps in order.
When it gets out, if it's near you, it'll already be too late.