Friday, May 18, 2018

Ebola 2018: Since You Asked

First one, and now another, commenters in comments on other posts asked an opinion on the latest Ebola outbreak:

(CNN) An Ebola outbreak in the Democratic Republic of Congo has entered a "new phase" after it spread to a large city, the country's health minister, Dr. Oly Ilunga Kalenga, aid Wednesday.
The new case of Ebola virus disease has been confirmed in Wangata, one of the three health zones of Mbandaka, a city of nearly 1.2 million people in Equateur Province in northwestern Congo, the World Health Organization confirmed Thursday.
The spread of the virus from rural areas into a city has raised fears it could quickly spread and become harder to control.
A total of 45 cases of hemorrhagic fever have now been reported, including 25 deaths, the health ministry said Thursday. Fourteen cases have been confirmed with laboratory tests.
Until now, the cases and deaths were reported from the rural Bikoro health zone, nearly 150 kilometers from Mbandaka, allowing authorities to attempt ring-fencing vaccinations in the the affected areas.
A newly confirmed case in a densely populated part of the country will complicate attempts to control the outbreak.

"The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area," said Dr. Matshidiso Moeti, the WHO's regional director for Africa.
"With the new case confirmed in Mbandaka, the scenario has changed," said Henry Gray, an MSF emergency coordinator in Mbandaka. "It is paramount to trace the suspect case in order to have a clearer view on how it reached the city."
In Mbandaka and Bikoro, 514 people who may have been in contact with infected people have been notified by national health authorities and are being monitored, according to MSF.
My original response still applies:
One case is just one case. No big deal.

It's when it starts morphing to two, four, eight, 16, 32 in a few weeks (like it does)that it starts getting dicey. In a city of  over 1M just improves the odds that it hops a plane to another continent before anyone's looking for it.

If Dallas had gone to four or eight cases in 2014, it would've gotten away from us in the U.S., and we would've been off to the races.

Jackasses with double-digit IQs forget that at the latter stage of the 2014 outbreak crisis, we had exactly one open BL-IV patient bed left, for the entire United States.

After that, hospitals become ghost towns pretty quickly.
I didn't like sportscasting the end of the world the last time, and I'll be dragged to it again only kicking and screaming.

One can only hope that both WHO, and TPTB in this administration are brighter than the unmitigated and incompetent @$$clowns showcased in the last one in 2014, who came within a whisker of getting everyone everywhere killed. No shit.

There are three posts from my Greatest Hits album you should probably refresh your memory upon.
Logarithmic Growth 101 : How Ebola doubles in the real world.
TL;DR: We are currently at between a 4 and a 5, on a 33-point scale of whether or not to panic. So we're still in the "small potatoes" phase.
So far.
(To recap, a 10 is 1000 cases. A 20 is just shy of 1M. A 30 is entire continents. 33 is functionally everybody.)

Do The Math : This is a breakdown of what the actual US resources are for dealing with Ebola.
TL;DR: 23 beds. It's actually worse than that: it turns out the hospitals in question are only staffed for 11 beds. For the entire U.S. At the height of things in 2014, we had 10 patients in those 11 beds. we were two actual patients away from everything turning to shite, just like Liberia/Sierra Leone/Guinea,because we were down to one open bed.

Surfing USA : how to deal with Ebola, if and when it comes here, and overwhelms our ability to treat it.
TL;DR: Forget masks. Stock up on food and water. And bullets.

You have a couple of things going for you this time around.

1) Obozo and his team of @$$clowns aren't running the show.
(That, dear friends, is yuuuuuuuuuuuuuuuuuuuuuuge.)

2) There's a new Ebola vaccine that shows some promise, unlike last time around:
The World Health Organization, which earlier this week deployed 4,000 doses of experimental vaccine along with emergency teams and equipment to the Congo to control the outbreak, described the situation as "a concerning development."
The Ebola vaccine being provided -- called rVSV-ZEBOV -- has been shown to be safe in humans and highly effective against the Ebola virus, according to the WHO.
A 2016 study found it to be 100% effective in trials in Guinea in coordination with the country's Ministry of Health after the 2014-15 outbreak.

The other shoes dropping:
1) The virus may have mutated, rendering the vaccine ineffective already.
2) This outbreak has already blown past the vaccine-ring they tried to throw around it, either because of bacteriological factors (#1, above) or because of sloppy quarantine and human cupidity and stupidity in the region in question.

Either of these may render the vaccine approach useless, and then we're back to my Greatest Hits selection.

Since you asked.

Personally, as in the Spring of 2014, I'm hoping this is the only time I need to visit this topic this year.
But if you're a religious person, a prayer or two is in order.
Ebola, unbridled, is literally hell on earth.

Have A Nice Day.

Image © First (White) Horseman of the Apocalypse, AKA Pestilence


Angantyr said...

Wait! I thought Wakunda was a technologically advanced paradise - how could this happen?!?!?

Oh - "Wangata"...

My bad.

Aesop said...

Wakanda is.

That's why, even in the Marvel-verse, they keep the ignorant Congolese and other native tribes out, by force.

loren said...

I had great hopes for the Anally Inserted Disease Syndrome to clean up that continent. Maybe this one is the ticket.
And yeah, I live in a rural retreat with lots of all kinds of good stuff.

Aesop said...

The trouble with that, is airplanes fly from there to everywhere.

Just like last time.

Deana said...

I want to thank you for writing this.

I am a nurse at a large trauma center in the US. When this hit the last time, I talked to a nurse who was participating in our hospital’s planning in the event we received an Ebola case.

Forget the discussions on how to handle the laundry, or any food deliveries to the pt, or how to deal with the trash. Forget the discussions about how they would provide the various treatments should, say, kidney failure start to kick in (do you do dialysis on that pt? Really? And use that machine again with confidence?)

The lunacy of it all centered on the staffing. Where we would normally burn through ~ 30 nurses in a 24 hour period to take care of around 20 ICU pts, the plan they were discussing would have burned through 12 nurses in a 24 hour period JUST TO TAKE CARE OF THAT ONE EBOLA PT.

The math does not add up. There are not endless ICU nurses available. And what do you do? Take a nurse who took care of that Ebola pt on Monday come in and take care of someone else the next day?

I distinctly recall the media playing a speech Obama gave during that time and I remember him making some sort of comment about how we as a nation were totally prepared to deal with Ebola. He and everyone in the White House knew that was a lie.

How many nurses in the US have ever been trained to deal with Ebola? 100? Less? I have no idea. But that time period frightened me - there was something evil in how that was handled. I had never liked Obama’s from the beginning but this revealed a desire to create a disaster in this country, a panic unlike anything we have ever experienced.

Aesop said...


Go back and read what I wrote on Ebola in 2014 on this blog, esp. starting around the end of September that year.

I don't have much use for the idiots who were pimping the "We can handle this, because First World medicine...", and exactly as I predicted before it happened, they were wrong, and they knew they were lying before, during, and after lying their way into that exact disasterpiece theater. The only alternative is that they were too stupid and incompetent to know they were dreadfully and totally wrong. I can't decide which alternative scares me more.

Why it didn't become a global pandemic that year is anyone's guess.
The WHO never achieved a single one of their multiple stated criteria to contain the spread of the virus in W. Africa. Not one.

I think mainly it stopped because it killed people faster than the idiots in charge could keep making the problem worse.

And I am thankful for such random mercies.

JJ said...

The governments will lie again this time. None of them can afford to acknowledge that the nanny state isn’t really capable of taking care of everyone, much less that they actually cannot deal with a major pandemic.
At best, Trump closes the airlines from flying in and then the black robed merchants of death will overrule whatever the Trump administration tries to do.

Anonymous said...

Akantjan Alibekhov defected to the West, changed his name, and told tale of his days as director of Biopreparat, Russia's bughouse

He reported they'd successfully combined the infectivity of smallpox [ viral dose need for infection: 5 virons ] with the lethality of the hemorrhagic fevers. "We called it Blackpox"

Air transmissible in droplets. Nightmare stuff

Someday, the difference between the incubation period for one of these species killers and the time period needed to jet into Boston, or NYC, or ... or ... is gonna remind us why immigration and border controls is an existential PubHealth issue


Jonathan H said...

You have very good points - like with your comment on NBC/CBRN 2 weeks ago; we can't handle them on a small scale, so just stay away. Compared to nuclear and chemical, even the US can't handle more than a very small situation, so don't expect the government to do anything constructive there.

Fortunately for mankind, Ebola makes a poor large scale contagion - unlike the worst of flu and plaque.
Every time Ebola gets transmitted from its reservoir, it gets weakened; most of the survivors of Ebola are the later generations, who got it several times removed from its natural reservoir.
In previous epidemics, it had an 80+% deathrate - in the last epidemic, it was lower than 50% - people didn't get as sick as fast, so they had a chance to pass it on to more people, but it also mutated away from lethality quickly too. We can't count on it doing this again.
Ever read Tom Clancy's book Executive Orders? Scary!
Ever hear of Ebola Reston, the outbreak in Reston Virginia in the 90's? Again, fortunately for us it only affected animals and not humans.