Wednesday, November 12, 2014

The Guinea-Mali Connection


As noted by commentor Ex-Dissident, WHO is doing a great job of detailing the Ebola outbreak proceeding unhindered in Guinea (shortly after the horses leave the barn and gallop down the road) now regularly being transmitted to Mali, helped by adherence to beliefs in both witchcraft, and Mohammed.

Mali: Case 1

Highlights: The child’s history begins with the death of her father, of unidentified causes, on 3 October.The father was a Red Cross worker who also provided care at a private medical clinic owned by his father (the paternal grandfather of the index case). The paternal grandfather was a retired health care worker.
While working at the private medical clinic, the child’s father had contact with a farmer from another village who died, of undiagnosed causes, on 12 September.
Ebola bodycount: 1
The farmer sought treatment accompanied by his two daughters. Both daughters died, of undiagnosed causes, in Beyla on 23 September, one at dawn and the other in the evening. Ebola bodycount: 3 
The child’s father fell ill sometime during the third week of September. Fellow residents and neighbours in Beyla believed he was the victim of a bad-luck “curse” following an argument with the village chief. Witchcraft, and not Ebola, was suspected.
Shunned by the community, and on the advice of his own father (the paternal grandfather of the index case and the head of the family), the father returned to his native village of Sokodougou, in the sub-prefecture of Moussadou – a trip of more than 70 kilometres. He died there on 3 October.
         Ebola bodycount: 4
This pattern of returning to a native village to grow old or die is commonly seen in Guinea, Liberia, Sierra Leone and many other countries around the world. Such frequent travels by symptomatic Ebola patients, often via public transportation and over long distances, unquestionably create multiple opportunities for high-risk exposures – en route and also when the patient reaches his home and is greeted by family and friends.
Meanwhile in Beyla, the paternal grandfather and family head lost his wife to an unknown disease on 8 October. He then allowed health officials to undertake contact tracing of 16 family members who had been in close contact with his deceased son (the father of the index case in Mali).
         Ebola bodycount: 5
On the following day (9 October), two of his other sons were admitted to hospital. The hospital referred them to a MSF-run Ebola transit centre in Macenta.
The first son died the same day en route to Macenta. On 10 October, samples from both sons tested positive for Ebola, strongly suggesting that other family members had also died from Ebola virus disease.
On 16 October, the paternal grandfather travelled to Macenta, seeking treatment for what he told medical staff was “rheumatoid arthritis”. As part of a thorough medical examination, he was tested for Ebola. Positive results were received from the laboratory on 17 October. The paternal grandfather died at an Ebola treatment centre in Gueckedou on 20 October.
         Ebola bodycount: 8; 3 diagnosed
Following news of the death of relatives in Guinea, the child’s grand aunt or “Grandma” (the second wife of the maternal grandfather) travelled to Beyla, Guinea, to offer her condolences to her relatives. The “Grandma” resides in Kayes, Mali.
She left Guinea to return to Mali on 19 October, taking the 2-year-old index case and her 5-year-old sister with her. A maternal uncle, the mother’s brother, also accompanied them. The index case was showing haemorrhagic symptoms in Guinea when the three began their extensive travels.
The mother is alive and is in regular telephone contact with the Mali team. She has to remain in the village where her husband was buried for 40 days for the official mourning, before she can leave. Her three-month-old baby is with her in Guinea. Both are under observation and, to date, neither has shown any symptoms.
The family group travelled via public transportation, taking at least one bus and 3 taxi rides as they journeyed more than 1200 kilometres through Mali. The buses made frequent stops for fuel or to let passengers on. The four spent 2 hours in the capital, Bamako, visiting relatives in a household with 25 people.
On 19–20 October, they travelled overnight in one bus from Bamako to Kayes. Between Bamako and Kayes, only two persons left the bus at Niamiga village. Persistent tracking eventually located both at their final destinations, in Dakar, Senegal and Paris, France.
Once in Kayes, the Grandma and index case consulted two traditional healers. The second healer took them to a retired nurse, who was alarmed by the child’s high temperature, which was above 40° C. When he learned they had recently travelled in Guinea, he suspected Ebola and advised them to seek treatment at a hospital.
The child was admitted to the hospital in Kayes on 21 October and diagnosed with Ebola following receipt of positive laboratory results on 23 October. She was hospitalized and treated in isolation, with infection prevention and control equipment and procedures in place. She died on 24 October.
         Ebola bodycount 9: 4 actually diagnosed, only 1 in Mali.

Mali :Case 2
Highlights: Mali’s Ministry of Health has confirmed the country’s second fatal case of Ebola virus disease. The case occurred in a nurse who worked at a privately-run clinic in the capital city, Bamako. The nurse, who was showing Ebola-like symptoms, was isolated on the evening of 10 November following suspicions of Ebola infection in a patient from Guinea who was treated at the clinic in late October. These suspicions were raised by an alert from health authorities in Guinea. The nurse died during the night of 11 November.
          Ebola bodycount: 1
According to the preliminary investigation, a 70-year-old male resident of Kourémalé village, in the Siguiri prefecture of Guinea, had onset of symptoms from an undiagnosed disease on 17 October. On 18 October, he was admitted to a private clinic in the mining town of Siguiri.
The town, which is located along Guinea’s 800 km border with Mali, was an intense focus of Ebola virus transmission from early July to mid-August.
As his condition did not improve, he was transferred to another clinic located just across the border in Mali. On 25 October, he travelled by car, together with 4 family members to seek treatment at the Pasteur Clinic in Bamako.
He was suffering from acute kidney failure, a complication often seen in late-stage Ebola virus disease. Multiple laboratory tests were performed, but not for Ebola.
He was treated at the Pasteur Clinic from 25 October until his death, from kidney failure, on 27 October. In addition, a friend who visited him at the clinic also died abruptly from an undiagnosed disease. Both are considered probable Ebola cases. For both, no samples are available for testing.
The nurse, whose fatal Ebola infection was confirmed on 11 November, worked at the Pasteur Clinic.
         Ebola bodycount: 3; only 1 confirmed.
Because of his religious status as a Grand Imam, his body was transported to a mosque in Bamako for a ritual washing ceremony. The body was then returned to the native village of Kourémalé for formal funeral and burial ceremonies. Although these events are still under investigation, WHO staff assume that many mourners attended the ceremonies.  
In that same village, the deceased patient’s first wife died of an undiagnosed disease on 6 November. His brother and his second wife are currently being managed at an Ebola treatment centre in Gueckedou, Guinea. All 3 accompanied the patient during the car trip to Bamako.
         Ebola bodycount 6; 1 confirmed, 2 suspected.
On 10 November, his daughter died from an undiagnosed disease. The family declined offers of a safe burial.
On 11 November, the man’s son, who is currently at the Ebola treatment center in Gueckedou, tested positive for Ebola at the European Union’s mobile biosafety level 3 laboratory there. He was the fourth family member in the car trip to Bamako. Confirmation of his infection further increases the likelihood that deaths in other family members were caused by Ebola.
         Ebola bodycount 8; 2 confirmed, 2 suspected, only 1 in Mali (So far.)
To date, 28 health care workers who had contact with the deceased patient at the Pasteur Clinic have been identified and are being placed under observation. A second team, deployed in the field, is tracing contacts in the community, including at the Bamako mosque.
Grand Total:
17 Ebola deaths
6 confirmed
2 suspected
2 in Mali

This is why this disease isn't "under control", likely never will be there, and why the "official numbers" from every country concerned are thoroughly and totally a dumptruck full of bullshi  rose fertilizer.

And as long as people "decline" safe burial practices, refuse contact tracing, play with dead bodies, and take 700-mile bus trips all around the effing bush there, Ebola is going to keep cropping up until they get a raging outbreak in Bamako, rapidly overwhelming their primitive facilities, and Mali too is then gloriously aflame with the outbreak, if in fact this latest set of imports haven't accomplished that already.

And just for S and G:
Total number of countries with any flight restrictions on travelers from Mali: zero.
Total number of countries doing even kabuki BS temperature "screening" on travelers from Mali: zero.
Total number of persons arriving in France, the US, and everywhere else from Mali daily: ???

This is going to end well, for them and everyone else.
Blame Islam, and witchcraft.



GamegetterII said...

What I find amazing is that in that part of the world,TPTB could even begin to trace the contacts.
That's an extremely detailed portrait of the progression of Ebola in the two countries.
I would guess that a fairly large number of people had contact with the grand Imam's body,guaranteed to add a significant number of cases.

Sherm said...

Lets multiply the fallout from these two cases by two-three-four hundred a day and pretend math never happened.
Yep, the smart people are in charge.

Ex-Dissident said...

Wonderful job of dissecting these 2 episodes of Ebola crossing into Mali. I suspect there is a whole lot of cases we won't know about because no one important - like a nurse or a doctor, had died. Who really knows just how prevalent this disease is in Guinea? Also the numbers in Sierra Leone seem unbelievable: 1500 dead among 5400 cases would imply a mortality of only 28%...not bloody likely with Ebola and the sophisticated Sierra Leone health care system.

Anonymous said...

You think that a disease with a doubling time of 2-3 weeks would allow people to LEARN how to prevent its spread. But some people are too stupid to learn (and not just in Africa).

Maybe because the horrific deaths occur over a two week interval, that people begin to accept them as "normal."? If it killed people in a day, maybe the horror would drive people to run screaming away faster?

Or maybe we would just be at 2^32 cases by now?

geoffb said...

"On Wednesday evening, Malian health authorities confirmed that one of the clinic’s doctors also had Ebola."

Bezzle said...

In past outbreaks of the EBOV strain, lethality was 80%+ anywhere the caseload exceeded 300 (i.e., had swamped medical treatment capacity).

If there are 5,400 *cases* in a backwards dump like Sierra Leone, that extrapolates to 4,300 or more dead or days-from-croaking.

Anonymous said...

As you were saying about TOP. MEN.:

Yes, it's real.

You can't MAKE this crap up.

Anonymous said...

"But the GOP took over the Senate." "The architect of Obamacare says the American people are stupid." etc. etc. etc. The beat goes on...
every day that passes brings Africa closer to... napalm.
Prepare for the quarantine, friends. Grandpa sends his regards.

Anonymous said...

150 new cases per day over the past week, according to the new numbers released yesterday, with SL having the majority of those with an average of 87 new cases per day, Liberia with about half of that rate, and Guinea with about half of Liberia's rate.

Not good.

Since they wiped out a bunch of cases in the 11/2 report, it's hard to know which way the trend is heading - even in the official numbers, but it's starting to look like Sierra Leone might pass Liberia's case total in the next few weeks.

Aesop said...

The trend is so bad they're not even making any effort to test people for Ebola, and if they just die first, they write them off to witchcraft.

As the two case studies make excruciatingly plain, the number of confirmed cases is about 1/3 of the actual cases, even just looking at the two Mali examples.

Mali itself went nearly overnight from 1 case/1 fatality, to 4 cases/4 fatalities, so they aren't doing any better either, except to admit that when people drop dead, it probably isn't witchcraft.

Nobola said...

Interesting take written by a Liberian on the NGOs that have set up their tents. Nigeria had no such help/intervention from the white saviors.

Ex-Dissident said...

Wow, I followed the link anonymous provided and just WOW. I am speechless. Imagine Nabarro, Obama, and Cynthia Mckinney all in one room.

Anonymous said...

Unless Obama leaves his ego outside, they won't all fit in one room. But if they were all in one room, the three of them would surpass the total "stupidly" of the American voter...

Anonymous said...

Holy crap, my brain aches after reading that link.

Who funded Nigeria's efforts?--if not western nations directly, then the money from western oil exploration and extraction.

Where did those health workers learn medicine?--not from witch doctors in the bush. Even if they learned in local schools, the KNOWLEDGE came from the western medical establishment.

And WOW, he claims the 200 dead medical workers as evidence of their SUCCESS.

I will acknowledge that it must suck for them to see westerners medivac'd out for 1st world care when they get sick, leaving the locals to get salty drinks and bum wipes... but they could solve that in one go by simply denying entry to the western medical staff. I won't hold my breath waiting.


Let them all burn. We have no interest there that won't wait. I've said it before, there is no point in providing aid to someone that is hostile to it. Don't like us in your country, Ok, we'll go home. Problem solved for us.

Anonymous said...

Oh, and the irony, the author is sucking on the public teat in LONDON.


geoffb said...

"Martin Salia is a citizen of Sierra Leone but is also a legal permanent US resident, according to an official. The 44-year-old doctor will be treated at Nebraska Medical Centre in Omaha.

He will be the third Ebola patient at the Omaha hospital and the 10th person with Ebola to be treated in the US.

Bezzle said...

From the link in the post above: "He came down with symptoms of Ebola on November 6 but test results were negative for the virus. He was tested again on Monday (the 10th) and the results were positive...."

-- That's the second time in a couple days I've seen an initial false negative.

Aesop said...

A false negative initial test is normal, which is why the protocol is to repeat a second test 72 hours after the initial one.

Anonymous said...

Boon Vickerson is out there said...

Anonymous said...

Another one likely coming to Nebraska.

Note the terminology: "...often-deadly Ebola virus...".

Anonymous said...

Yup, from UK Daily Mail"

Ebola-stricken Sierra Leone surgeon, 44, who will become first non-U.S. citizen flown back to America for treatment.

Apparently he is a permanent resident (has his green card) so not quite flying in foreign afflicted, but pretty close. Wonder if they'll charge him the $500,000 in the State dept letter?


Robin Datta said...

This is going very well for the nucleotide sequence (negative sense single strand RNA). The competition is between various nucleotide sequesces. Cells, organisms, communities, societies, nations, empires: these are all epiphenomena.

Anonymous said...

Above the organism level though, memetics rather than genetics run the show.

The great thing about memetics is that they can change on the fly and enable groups of social organisms to change behaviors orders of magnitude more rapidly than genetics can.

The downside is that memetics make lying possible, and behaviors that are predicated on false memes tend to have really bad outcomes for the groups that adopt them.

Ex-Dissident said...

My several questions to the readers here. Essentially these are all aspects of same question and it has to do with risk prediction in the US.

If you look at the numbers closely in any of the 3 top countries, they don't seem realistic. For Sierra Leone and Liberia, the dead number seems far too low. Also, just as the speed with which new cases are being discovered in Sierra Leone is increasing, the number of new cases in Liberia seems to have fallen drastically. I agree with Aesop in that, in all likelihood, most of the new dead are not being investigated and are attributed to something as insane as witchcraft.

Prior to news crews leaving the area and when case tallies sort of made sense, in August and September, there were models that could predict how many Ebola stricken arrivals we could expect in the Western World from these 3 hot zones. Is there any way one could estimate what we should be expecting in the US, at this point? Is there any way to estimate when we will start importing more than 1 new case per month in the US? I am guessing that a dozen such patients will likely overwhelm any current US city's capacity. Any statisticians out there willing to give their 2 cents worth of advice here.

Aesop said...

The numbers will get much more accurate once people start dying in the U.S.

The West African numbers stopped bearing any relation to reality around the 1st of October.

And as you noted, once outside media disappeared, all further impetus to count and report accurate numbers left with them.
Their own media they simply toss in jail until they learn to shut up.

geoffb said...

Like this, "Sierra Leone: Journalist arrested after questioning official Ebola response ," and this, "Journalist covering protest about Ebola virus arrested, detained in Liberia."

Anonymous said...

Back in the early-mid summer, lethality was measured by MSF as running between 79% and 86%.

Aesop said...

And presumably it still is, but as the Liberian and Sierra Leonian governments have figured out, if you can't stop the disease, the next best thing is to stop the reporting of it.

Anonymous said...

And evidently OUR government too....