Last Ebola Update of 2019

We called this one last month: The outbreak, while still active, has virtually been stopped dead in its tracks.
In the last month, there have been only 13 additional deaths (in a month!), and the number of confirmed EVD cases has gone down. (IOW, some cases they thought were Ebola, turned out not to be.)

Caveats:
1) It's Africa: they could f**k up a crowbar in a sandpile, and snatch defeat from the jaws of victory left unsupervised. Never underestimate the power of stupid people in large groups.

2) There are a couple of areas of active outbreak where the armed nitwits there have driven  away all aid, clinic, contact tracking, and vaccination efforts. This is roughly the equivalent of having a gunfight inside a nuclear power plant. In both cases, everything could blow up catastrophically.

But based on how it looks, this one's going to go away, eventually.
Think happy thoughts.

This is what happens when it hits people too poor to get away, and we have a highly effective vaccine.

So far, so good.

Until next time.

So, What's The Ebola Outbreak Gotten Up To?

Since August of this year (at our last update) up until now, it's killed another 300 people. Which is exactly how long it took from initial outbreak (four months or so) to get to 300 deaths.
So overall, it's not spreading wildly out of control, so far as we know.

Overall, there have been 2,184 deaths, out of 3,624 known cases. The bare death pctg. on that sits right around 60%, although to their credit, Wikipedia's page posts the tally at a consistent 67% going back to May of this year, which means they finally started spotting the disease the 21-day span from appearance to death, rather than not counting how many dead now vs. how many had it 21 days ago. So, finally, that penny seems to have dropped for them.

WHO reports that  a total of 243,322 people have been vaccinated to date using the 95+% effective rVSV-Zebov vaccine, which is the difference this time around between an epidemic, and a pandemic. It has also kept health worker casualties to 5% of the total, rather than 10% or more, as in prior outbreaks.

And rVSV-Zebov is now going from unproven experimental vaccine to certified treatment. Due to impossible ethics concerns, standard protocols cannot be followed, so empirical evidence from this outbreak is being substituted, and it is or will be soon certified as a standard vaccine. Long -term effects will become apparent in the long term. If it turns out to be a problem, we won't know for 5-20 years. But for this strain, it's vastly superior to nothing at all, in the short-term.

Contacts being tracked two months ago were 20,000+; now it is less than 5,000.
Granting there are certain provinces, for all these numbers, where there is no medical contact, vaccination, and treatment presence, as has been true since mid-summer, due to the usual central African state of low-intensity guerrilla warfare, seeing contacts shrink this way is yuuuuuge for how well they're containing the virus. So far.

In short, vaccination has slowed the growth rate to a crawl, and given ordinary relief efforts time to educate and vaccinate around the disease before it could get to major cities, and turn into a pandemic, unlike what happened in W.Africa in 2014ff.

That's the difference a working vaccine makes. (And would have made five years ago.)

Nonetheless, the saving grace in this outbreak continues to be raw grinding everyday poverty so severe that simply no one affected this time around could afford to get out and carry this to the first world. The rest is just happy and naked good fortune, far more than planned efforts. Had this outbreak made it to any city with an international airport, we'd have been in 2014 all over again, and it would continue to outpace all efforts, just as before. Instead, it burrowed deeper into poorer areas, and probably infected and killed more than the tally shows (as usual, because Africa), but quite nakedly, they're poor Africans beyond accounting, rather than getting to, say, Mombasa, Kampala, Nairobi, and thence to London, Rome, Paris, NYFC, and/or the rest of the world.

Huzzah. Thank the deity of your choice there. Pop a cork.
This epidemic cannon shot went over the bow without striking anything vital.
(Unless you're one of the 3000+ wretches hit there this time around, or a family member of same, in which case, God help you.)

So, barring a disaster, this one is on course to eventually burn itself out, because of a functional vaccine, and because it hit demographic cannon fodder. Sux for the Congolese, but there it is.

For further illustration, Ebola is only the third-place biggest problem in DRCongo at the moment: this year alone, malaria has already killed 14,711 people there just this year, and measles has killed another 4,149, so Ebola at a "mere" 2,184 deaths since August of 2018 is relatively small potatoes in the face of the general shitholian third-world health crisis in DRC, in this or any year, which also includes bubonic plague, cholera, and multiple other outbreaks.

In short, DRC is not a vacation spot, this millennium, and probably ever, but rather a country desperately in need of a good napalming, like much of equatorial Africa, due to multiple endemic problems. It is a sinkhole of Fail, pretty much going back to the dawn of time, as far as anyone can discern. Whether that can ever be anything other has yet to be demonstrated, for even a week.

This outbreak isn't completely gone, and it continues to grow, infinitesimally, but hasn't managed to quite get to a major city with an international airport, let alone outwards thence, but only just barely.

File this one, at this point, under Near Miss/Happy Accident, for now, and probably until there's another outbreak there or elsewhere.

Optimism is justified, cautiously, and it only took us 15 months to get there. The slow roll-out for that country of the equivalent of a WTC attack, has been swallowed up by the running sore that is year over year in most of sub-Saharan Africa back to before anyone bothered to write it down.

Posit an ordinary outbreak closer to or within a major African population center, or, God forbid, some @$$holes weaponize this and send a not-so-smart bomb human vector or three into the West deliberately, and we're right back on the bullseye. And to date, it's not like CDC or anyone else has 500,000 doses of the vaccine on hand just in case it gets somewhere far closer to home, or more vital to the spread of the disease.

Self-quarantine is still, as always, your best defense, as in nearly all cases.
This outcome was not apparent a year ago, nor can or should you expect it to be repeated next time around. Just like mutual funds, past behavior is no guarantee of future performance.

Bear that fully in mind for the long run, particularly your own. Being able to ride out anything for 90-180 days with supplies on hand and no resupply, and complete self-sufficiency, is effective for only almost any catastrophe you could think of. Write that down on your hands in laundry marker, lest ye forget.

Where Ebola and any number of other potential plagues are concerned,

you will see this material again, kids. 

 

Ebola Update: August 2019

Perusing the most recent WHO report, and various articles, the outlook is mixed.

The Good

The rate of infection, promisingly, is slowing. In 77 days from early February to May, the outbreak doubled from 1000 cases to 2000. In the 84 days since then, it's only grown half as fast, to a shade more than 3000 cases. That's mainly a tribute to a functional experimental vaccine.

That puts us still at "only" an 11.5 (out of 34) on the Worldwide Pandemic Panic Meter©.

For reference, in 2014, the outbreak in West Africa grew from 1000 cases to 17,000 in a similar timespan "officially", which means it probably grew from 3000 cases to 50,000 cases in reality.

We are nowhere near that bad off this time. That's the difference between rVSV-ZEBOV vaccine, and no vaccine.

The Bad

The disease continues to whack between 2/3rds and 3/4ths of all those infected (depending on whether you count suspected cases or not).

The usual pre-literate idiots are still shooting up aid workers, and burning down Ebola Treatment Centers, stealing corpses to fondle and slam dance with before burial, etc.

It's still subject to African authorities, and local math capabilities and accounting practices, as always.

What is more concerning are a couple of things:

1) The appearance of new cases in Goma, a city of 2M, with international flights weekly to Nairobi, Kenya and Addis Ababa, Ethiopia, and internal flights to Kinshasa, DRC, megopolii all, connecting flights thence to everywhere in the world.

2) The fact that medical authorities have no contact route for how the latest cases there arrived over 100 miles outside the previous "Hot" Zone. A ring 100 miles in diameter places Uganda (which already had three cases, but which outbreak seems to have spent itself rapidly), Tanzania, Rwanda, Burundi, and South Sudan, let alone central areas in the DRC previously unaffected, all at high risk for the next pop-up cases.

In short, while it's spreading at a relative snail's pace, they haven't whipped it, and it's popping up (and will continue to) all over the map, amidst the poorest countries on the planet, several of which have the capability for it to blow right out of the area, and spread to new cities, and even new continents.

The Ugly

#1 is also the reason (along with seizing the moment to get more funding $upport) that WHO and the UN pulled the panic alarm on this outbreak in July. Epidemics in cities with international airports will do that.

From the WHO report:

"The committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost 2 million people bordering Rwanda. The committee determined that risk of spread remains very high at national and regional levels, but still low at global level. No restrictions on trade or travel are recommended."

That last part, given that Point of Entry/Point of Contact screening relies on detecting fever, in an outbreak their own documentation from last October confirms is totally absent in 50% of confirmed Ebola cases, ensures that at some point, infected people will slip through the perfunctory kabuki theater "screenings" everywhere, and bring this outbreak to points far removed from Kivu and Ituri provinces in DRC.

That approach to containment, i.e. waiting until the horse has left the barn to lock the stall door, goes by the quaint colloquialism of "having your head up your @$$".
(You will see this material again.)

Also for reference, airfare from Goma to NYFC via Addis Ababa is $983, one way.
The only thing helpful about this is that the average per capita income in DRC is $800 per year, which ranks them at 226 (out of 228) on the world income list.

The only thing keeping Ebola in Africa, as always so far, is poverty.
If this gets into populations with somewhat more means of livelihood than $15.38/week, it goes everywhere, at the speed of 767s.

And given that medical personnel comprise 5% of the cases of this outbreak, it's worth noting that the do-gooder aid workers are required to have round trip passage in hand before they can go there. Which was how the US got 8 of its 10 cases in 2014.

But it's okay, because now we have 15 BL-IV beds.

My take on all of the above:
You're never wrong to be prepared for bad things.
Canned food takes a long time to go bad.
And we're always just one Duncan away from reliving 2014.
Assuming Bad People don't help things along in that respect, a-purpose.
You cannot and should not expect Team Allahu Akbar to stay stupid forever.

That concludes our summary for August.
With the usual caveats about African math and accounting practices, and any developments of a more troublesome nature, we will revisit this in September, unless fate takes a hand.
Questions in comments.

For Reference Only

Here's your handy link to everything I've ever written about Ebola, that I thusly tagged.
(I skimmed the last few months, back to a year ago; this guy is pretty good!)
It will work going forward, as long as Blogger is a going concern as well.

As previously noted, unless the current outbreak in DRC hits a city with a major international airport, escapes the African continent altogether, or starts posting 500-1000+ weekly new case numbers, expect the updates to come roughly monthly. That means the next one will happen when your calendar reads "August", barring something actually earth-shattering.

If I'm not talking about it, you can assume with reasonable safety the earth has not, in fact, been shattered.

YMMV. Void where prohibited by law. May contain peanuts. Entering this area may expose you to chemicals known to the state of Califrutopia to cause birth defects or other reproductive harm. If this were an actual Ebola blog post, authorities would have told you what to do.

Ebola July 2019: Just Checking In

In the opening month of this outbreak (August of last year, FTR) there were 120 total cases.

Now, eleven months along, there are 120 new cases just this week (that we know of, in the 75% of the outbreak area currently actively monitored, and despite 140,000 rVSV-ZEBOB vaccinations). That's 2,634 cases, and still 11 out of 33 or so on the Pandemic Panic Scale. It's going to take awhile, even at that rate, to get to 12. And when it got to 13 in 2014, that's when the virus made its appearance in the U.S.A., just for reference.

We're also in a wait-and-see mode to find out if Uganda
a) has any more Ebola cases
b) truthfully reports them
c) stops the outbreak there.
I wouldn't be holding my breath for good news on any of those, but that's only based on how this works out there, since forever.

Also, in an act of rare candor, TPTB are actually finally posting legit numbers for mortality, reflecting the number dead now as a percentage of those infected 21 days ago.
Mirabile dictu!

Which number is a solid 67%, or 2 out of 3 cases (with the usual caveats regarding reporting accuracy, and African facility with counting whilst wearing shoes).

And now random reports have thousands of Africans miraculously teleported to Central America, bound for America, apparently suddenly in receipt of the wherewithal to purchase not only plane tickets across the Atlantic, but with enough left over to have rolls of $100 bills in their possession to complete the journey northwards.

And boys and girls:
Don't bother linking to stories about this or that agency or other officialdom bunch "preparing" for Ebola.
Like the TSA's crotch-grabbing, what you're seeing is kabuki theatre, and what the late great Daniel Patrick Moynihan aptly referred to as "boob bait for the Bubbas".

So please: keep the boob bait to yourselves. I've seen the man behind the curtain, and I'm not impressed by the Wizard portrayed in news reports.

Since You Asked

Someone asked in comments to the various previous posts about a review of "best practices" to shelter wherever (here, there, wherever) to ride out Ebola.

Okay, here goes.

1) Go to your Happy Place.

2) Seal your perimeter (I suggest with concertina rolls, at minimum), and defend up to and including deadly force.

3) Decon anything within throwing range of that perimeter with a bottle of 1/2 gasoline, and 1/2 dish soap, with some metallic aluminum glitter mixed it as condensation nuclei. (The precocious will notice that is functionally called napalm.) Or, get yourself an XL-18. (Perhaps several!)

4) Stay inside until 40+ days beyond the last reported case. I'd probably wait 60-90 days. YMMV. And it assumes anyone will be able to tell you the last infectious date. Got comms??
(Bear in mind in West Africa, the December 2013 outbreak lasted until January 2016. 25 months. That is not a typo, anywhere.)

5) Don't come out of your perimeter for anything, and don't let anyone else in for that time.
Ever. Whatsoever. Period.

The perspicacious may notice this would have no small effect on, um...civilization as we know it. Then again, so would a pandemic and hundreds of thousands to millions of deaths. Just saying.
You pays your nickel and you takes your chances.
I'm just assuming you're a bit more concerned about the lives of you and your own family than you are about those other 7 billion souls' problems. As you should be.

That's it, easy-peasey.
The entire strategy.

(People who've thought about this stuff realize, probably long before this point in the post, that this means being able to supply yourself with food, water, power, heating, medical aid, fire-fighting and security, communications, local intelligence, and all the other necessities of life, for an extended period, with zero outside resources. Such details are far beyond the scope of a single blog post. So I'd advise those to whom this is news to get on with providing yourself those abilities, I beseech you.)

Ebola will not low-crawl under your wire and butt-rape you.
I'd be sure and screen out transit in or out by four-legged visitors too, including squirrels and such, not to mention der fleiedermaus species, on principle.

And FWIW, I wouldn't try to simulate Ebola infection marking, nor any other.
a) People who actually have Ebola will not be deterred.
b) People starving and desperate will not be deterred either.
c) Such marking may be used by TPTB as a means of deciding which places to burn to the ground at some point. (That'd really suck for you, to survive a pandemic, only to be wiped out by whatever follows, because of them thinking you were infected. Don't get cute about this.)
d) Sensible people might shoot you on sight if they ever saw you coming out, thinking you were still infected.
So don't do anything that stupid.
Hang your own version of  "F**K OFF!" signs, with a skull and crossbones, and that should do the trick.




Someone else asked what I'd be doing if it came to my hospital.

In a nutshell:

Ebola comes in, confirmed, and I'm going out. Then and there.
I have been in no hospital in my entire working career that's remotely prepared to do anything but get me, you, and everyone else in proximity, killed by attempting to deal with this disease.
I have no compunctions about "looking badass" in the face of a virus not impressed by half-assed measures and trying to "save face". Others can save face. I'll be saving my ass.

I can take my license literally anywhere I like, including anywhere from the Arctic Circle to Tierra Del Fuego just in this hemisphere, and I'm not worried about "looking good" to people who want to re-arrange deck chairs on the Titanic, instead of heading for the lifeboats. Heroes, in this sort of thing, become dead heroes. I don't want to die because I was stupid, in hopes maybe someone who survived, somewhere may someday carve my name on a stone monument, along with hundreds of others.

I'ma GTFO, and I'll be one of those survivors.

We get a BL-IV containment wing, and train on its use, and we can talk about me staying and playing under those circumstances. Nothing less will suffice.

Never share a foxhole with anyone braver than you. - Murphy's Laws Of Combat

That is all.

Your Monday Morning Ray Of Sunshine

While you were sleeping...

Pay Attention!:

1) This is not confirmed. Just someone with "Ebola-like symptoms." Could turn out to be a nothingburger, like dozens of similar false alarms during past outbreaks. (O please, please, please, please...)

2) Kericho Hospital in Kenya is some 400 miles from the Congo outbreak Hot Zone, clear the other side of Uganda. If, I repeat if, this case is confirmed as Ebola, that's a horrifyingly yuuuuuuuge leap outside all prior containment.

3) Obviously, if confirmed, this result would indicate Ebola is now active in three countries.
Stop me if you've heard this one before...

4) FYI, Kericho, while quite distant from Congo, is only about 80 mi. from Nairobi (pop 3.4M), with an international airport, and direct regular flights on Air Kenya from their airport right to JFK Airport, NYFC. Flights can be had for about US $700-1400, which would challenge people living in mud huts, but if they're flying there, there are people there to pay for the seats, and it's a 15h hop, direct. That's how Duncan got from Liberia to Dallas. Cheers, Big Apple!

5) Just a reminder that the method - the only method - they're currently using to screen for Ebola at airports and ports of entry is elevated temps, and as we've noted, and the WHO confirmed in print, publicly, last October, fever is completely absent in 50% of confirmed Ebola cases in the current outbreak.

6) This shows the impact the mere possibility of this epidemic disease's spread is having on surrounding countries and populations. Kudos to local officials for taking this seriously, and taking due diligence precautions.

If it's just one of 57 other tropical diseases with similar symptoms, and not Ebola, be happy. Be very happy. This time.
If it's confirmed to be Ebola, sphincters will puckering in Nairobi, Geneva, D.C., and pretty much anyplace with a jet airport, not to mention the next 20 closest countries to the outbreak. Good times all around.

Either way, the underlying truth remains: this thing is leaking out, and there's probably going to be a further spread, to a horrible likelihood.

We may know definitively which way this breaks within the day, and certainly within 48-72 hours.

So, how are you doing on your food and water stockpile, sanitary accomodations, concertina rolls, and 12 ga. buckshot supplies?
Just curious.

And if you were interested, there are some great options out there for emergency decon:

Buying three or more gets a volume discount!

Happy Monday.

(And I should mention: when the posts on this start writing themselves again, and I can't swing a dead cat without hitting the next three stories, this outbreak has officially jumped the shark, and it's going to land in a smoking hole on the ground. Like that napalm above.)

UPDATE: NO Ebola. Ducked a bullet there. This time.
Hopefully they will tighten up border checks. But with people there travelling in and out of the DRC Hot Zone all the time, we'll see how long before they get hit.
I doubt this luck today will last.

Where The Problem Is

Frequent commenter Nick asks:

"Aesop, you know I'm with you on this topic, and I've been adding to my long term bulk food storage every two weeks...

But, the MSF guys are all volunteers, and they not only go to work, but do so at a loss financially.

Most africans are not particularly diligent or methodical but they seem to manage the deconn, donning and doffing reasonably well.

Given the conditions on the ground in this and the last outbreak, how can we reconcile what you (and I for that matter) expect, with the lived experience of the medical teams in africa? After all, there are LOTS of Drs and staff involved, and no or few reported deaths among staff, and none among the Drs.

I don't think the vaccine is the difference because we didn't have widespread losses among the foreign Drs and staff last time around either. (the one nurse iirc, and that from a social engagement not work)

I agree that it's the knock on effects that would be so devastating here or other first world countries due to the dependence on infrastructure and Just In Time delivery.

We also have the experience in Dallas of the guys POWER WASHING the index patient's effluvia off the walk, and the patient's own family who were closeted with him in the apartment, yet none of them got sick.

Is it possible that it's harder to spread this than we think? It can't be luck every time...."

Serious questions deserve thoughtful answers.
My response:

1) They manage donning and doffing pretty well, because they have five times the staff we'll allocate, because none of them are drawing paychecks. From 2014:

The Ebola epidemic caused an increasing demand for protective clothing. A full set of protective clothing includes a suit, goggles, a mask, socks and boots, and an apron. Boots and aprons can be disinfected and reused, but everything else must be destroyed after use. Health workers change garments frequently, discarding gear that has barely been used. This not only takes a great deal of time but also exposes them to the virus because, for those wearing protective clothing, one of the most dangerous moments for contracting Ebola is while suits are being removed.
The protective clothing sets that MSF uses cost about $75 apiece. Staff who have returned from deployments to Western Africa say the clothing is so heavy that it can be worn for only about 40 minutes at a stretch. A physician working in Sierra Leone has said: "After about 30 or 40 minutes, your goggles have fogged up; your socks are completely drenched in sweat. You're just walking in water in your boots. And at that point, you have to exit for your own safety ... Here it takes 20–25 minutes to take off a protective suit and must be done with two trained supervisors who watch every step in a military manner to ensure no mistakes are made, because a slip up can easily occur and of course can be fatal." Link

Do that math: $75 x 24 hrs/day, x 30 days, per patient. Times 6-10 staff members. At minimums, that's $324,000 per Ebola patient, just for the protective ensemble. and that's 4320 protective gear ensembles. For each patient. 25-75% of whom will die anyways.

Generating, if each suit only weighs 2 pounds, some eight tons of highly infectious medical waste, which no one in this country wants or knows how to handle, short of open pit gasoline fires.

Asking for a friend:
Which way do the prevailing winds blow from the nearest hospital?
How are the people living downwind in the Ash Zone going to feel about that?
Just curious.

2) "Pretty well" is a relative term:

In August 2014 (two years before the outbreak was over!), healthcare workers represented nearly 10 percent of cases and fatalities—significantly impairing the capacity to respond to an outbreak in an area already facing severe shortages. By 1 July 2015, the WHO reported that a total of 874 health workers had been infected, of which 509 had died. Link

As of 30 April 2019, there have been 92 health care workers in the Democratic Republic of the Congo infected with EVD, of which 33 have died. Link

 And MSF's precautions are done in a no-sh*t Hot Zone. An unknown number of those helping are "survivors" of the current outbreak, each time, with obvious immunity going forward (with all the caveats about EVSyndrome for such "survivors").

We are not being trained in their MSF protocols here, we're trained to CDC protocols.
You know, the ones that got two nurses here infected within 21 days, despite doing everything the CDC thought was sufficient. Which is exactly how well Ebola spreads in the wild, with zero precautions.

BLUF: The CDC guidelines are the same as slam-dancing naked with Ebola-riddled corpses.

The same CDC that gave an infectious nurse permission (WTF?) to take commercial air home, knowing someone with a fever (which she had) was infectious to everyone at the airport and flight she came into contact with, including the guys that handled her baggage.

( "Hey, we're the Government, rules of Nature, like physics and epidemiology, don't apply to us, Because we say so.")

It isn't that Ebola is less effective at transmission than we thought, it's that early, before you're literally coughing out your lungs, vomiting out your esophageal tract, and sh*tting your intestinal walls out, it's a somewhat (but unknown amount) less infectious than the final stages.

That's a pretty fine razor to skate on barefoot.
That was the luck we were living on with Duncan, with both nurses he infected, with Dr. Dumbass in NYFC, and with exposed-but-not-infected-roommate-of-Ebola-victim Nurse Mimi Crybabypants.

[The later two, failing actual 40-day-lockdown-hard-isolation quarantine, should by rights have been shot on sight for breaking quarantine, gross professional negligence, and 20,000 counts of attempted murder.(I.e., if you point a gun at someone and pull the trigger because you thought it might be loaded, but it wasn't, you're still fully legally culpable in 50 states and 7 territories for the attempt.)
If somebody capped them both tomorrow, on their own, it would still be justifiable homicide IMHO.]

And if/when this gets here, some medical professionals will decide they're Special Snowflakes, and don't need to follow all the rules, and don't have to be quarantined, because it violates their rights or harshes their mellow, and exactly like the family from DRC that sneaked into Uganda, they'll transplant the outbreak to others. And we won't find out for another 3-21 days, on average, and some not for longer, by which point it's already an epidemic shitshow here.

That should be a shoot-on-sight situation, followed by burning the corpses immediately, after obtaining a blood sample under BL-IV precautions.

But this is America, and we're too squeamish to do that, and we'll end up killing people with kindness by not doing it. (Like letting infectious nurses travel commercial air, rather than sending a BL-IV jet to whisk her and her stuff into full containment. Like your government did in 2014.)

Also, the people working with Ebola in Africa for MSF are only providing palliative care, i.e. assistance for the 80-90% who're going to die, to do so less uncomfortably than they would in a rut by a dirt road.

They aren't taking blood samples, starting IVs, or 57 other things. Their height of care is a cool cloth for the forehead, a cup of water (which becomes the next bout of projectile vomitus), and trying to contain the piles of bloody diarrhea being launched into bedding and over at the patient on either side.

And they burn the entire treatment center when they're done, down to the concrete pad (unless, like in DRC, the locals don't wait until its over, as they've already done over 40 times during this outbreak, and killing or injuring over 80 health workers there, which is why 25% of the affected areas in DRC have zero MSF or WHO presence). Now, think of your local ghetto 'hood or barrio. Think it will be better here??

It isn't just HIPPA concerns that keep TPTB from showing you that bloody reality in each and every outbreak. People would be at the White House fence line with AR-15s and Molotovs in earnest, clamoring for POTUS to nuke Africa if they knew that and saw it on the Nightly Snooze on the major networks. You're being lied to daily, including by massive omission, and have been since forever. I post what I post because I figure people can handle the reality with the bark on. But in 2014, I had to drop it, because by Presidential Fiat Decree, the news media were told Not To Talk About Ebola Anymore. Leaving us with just the happygas from foreign sources (who largely also complied with the gag order) and the lying African nations' self-serving press releases that under-reported the breadth and depth of things, on purpose, by a minimum of 300%. Even the UN/WHO admitted that, during the outbreak, openly. "It'll be different this time." Sh'yeah, as if. Neither there, nor here.

And one of those factoids is that once it's more patients than our BL-IV beds can handle, the care and protocols and training become so sketchy as to constitute gross professional negligence on the part of all hands participating, from POTUS and the CDC director, down to the sloppy housekeeping person with a GED who'll be sent in to mop up after patients #16 to #Infinity, with half-assed don/doff training, protocols, faulty equipment, and insufficient staff.

Ebola's always going to find the weak links in any chain of infection.

In the West in general, the weak links are the chain itself.

Instead of screening this stuff and keeping it at arm's length, because of ignorance, deliberate stupidity, negligence, malpractice, and malign indifference to all of the above, the very people who stay and play with it are going to be the same ones who insure that everyone else gets it, mostly through accidental exposures like the two nurses in Dallas, along with the selfish and stupid infectees who won't seek treatment, and will keep sending sick kids to school and going to work until either one collapses shooting blood out their eyeballs.

That's before we even talk about the open borders and lackadaisical attitude towards quarantine that's been rampant non-stop from 2014 until now. This is deliberately engineering Ebola's arrival and release among the population, which we've already seem with measles, TB, Chikungunya virus, West Nile virus, and a witches' brew of other diseases we had formerly whipped here.

Verstehen sie?

We aren't set up for this, and we're doing nothing to stop it getting here (rather the opposite in fact).
And when it does, after those first 15 beds are occupied, we've done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we've done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can't bullshit me or countless other doctors, nurses, and ancillary staff who'll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we're standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can't collect paychecks at Forest Lawn, and I won't be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you'll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly - by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO's lackadaisical clipboard commandos - we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.
There's just death.

I'll do my damnedest to save your life if you come into my ER.
But I won't kill myself to do it, and I won't die for you because TPTB at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain't in my contract, and unlike joining the Marines, I took no such oath, and it isn't part of the deal.

I don't know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Unless you're one of the original few cases in the outbreak, before anyone knew it was here, so you didn't have the sense to self-quarantine while you were uninfected, if you come to the hospital with Ebola, you're de facto part of the problem, not the solution.

And you're probably going to die, and there's a better than even chance you had it coming.

To All Concerned:

Get. Your. Sh*t. Together.

Nobody else is going to save you if this gets here. Save yourself. Don't get it.
Because if you catch it, you're getting a Viking funeral, about a minute after you're dead.

Just like they do Over There.

Do The Math, 2019 version

My Inner 12-year-old loves that the placement of the filtration units
on the German hazmat suits means your farts are immediately
vented into the infected patient's room.

The title may be familiar to long-time readers of this blog. If you want, you can peruse the original 2014 version, which according to Blogger is one of my Top Five Greatest Hits, feel free. (Go read it. Take it to heart. It's five years later, and US hospitals are still as unprepared now as they were then. Worse even. Because now, they've pen-whipped imaginary policies into place, but with zero training, and no/inadequate supplies, so now they think they know what they're doing. But they don't. And TPTB, locally, and nationally, know it, and they don't care. Sleep tight. Pleasant dreams.)

But Anonymous poster in Comments to the last post thoughtfully sent along the following info, and the link to it:

Thanks for all the (terrifying) information. I researched and found some information on BL-IV beds here. Apparently they call them "High-Level Isolation Units" in the EU.

London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 6
Madrid, Hospital La Paz - 5
Berlin, Charity University Medicine - 4
Hamburg, unnamed hospital - 6
Rome, Lazzaro Spallanzani - 8
Unnamed other center in Italy - ?

Most don't have the staff to care for that many patients at once.

This information is from the following blog by a NHS nurse at the Newcastle facility who won a grant to tour the BL-IV beds of US and Germany, Italy and Spain in 2018:
http://www.nhshighlevelisolation.com

Since I do the slogging so you don't have to, I read that grant recipient's blog report.
I recommend it. For general information.

The information shows Europe, in its entirety, could handle perhaps 31 BL-IV/HLIU patients, per that research/blog.

So how many could they really handle?

London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 2
Madrid, Hospital La Paz - 2
Berlin, Charity University Medicine - 2
Hamburg, unnamed hospital - 3
Rome, Lazzaro Spallanzani - 2
Unnamed other center in Italy - 1

So in actuality, they can only deal with 13 Ebola or other HLIU patients out of 31 beds.
(Presumably, Eastern Europe and Russia could do something similar, or perhaps to a lesser degree.)

Not bad, for tiny outbreaks locally, like in 2014.

Recall, for those who don't, the US/N.A. numbers were 23 notional beds, and staffed for only 11 actual BL-IV level patients.  With the addition of U Iowa and Bellevue in NYFC, we get 4 more actual BL-IV beds in the US, maybe another dozen notional but unstaffed beds.
So let's guesstimate it now up to 15 beds. (And 3 of those beds are nominally "reserved" for military cases from ASAMRIID, and the associated network of .MIL facilities in MD, UT, MT, and CO, we have working on chem/bio weapons which we aren't creating, merely defending against. And I have a bridge for sale, cheap.)

That's with Canada and Mexico providing 0 beds apiece.
For reality, let's assume in a crunch, Canada could cobble up perhaps 1-2 beds, and Mexico would still be zero, because they can't, and would recognize that futility with brilliant Latin fatalismo, so they likely wouldn't even make the effort. They're predictable like that.

So 50 beds so far, maybe 100 all in, if Australia, Japan, Switzerland, France, and everyone else pitches in, but staffed, on the best day, for between a quarter and half that many actual patients.

350,000,000 people live in the U.S.
We have, perhaps, 15 beds available to treat Ebola patients safely. As many as 50% of whom would live and survive the infection. 75% if you're really lucky.
So your best odds in an Ebola outbreak if you become infected, are a 1 in 35,000,000 chance of survival. I'd have to check, but I think winning the Powerball lottery is generally about that level.

In short, a dozen or two active cases, and everyone's screwed.
Which means local hospitals and ICUs are trying to bootstrap their way to bare competency in handling BL-IV/HLIU cases. We saw the consequences of having untrained amateurs try that at Texas Health Presbyterian in Dallas in 2014. It infected two people exactly 21 days after trying it, and shut down an entire 875-bed major tertiary care facility that was key to medical capability in that region, and within a month. (The entire staff threatened a mass walk-out if they didn't shut the whole effing thing down. The ER and ICU were closed for months afterwards. And let's be serious: would you go to the Ebola ER or Ebola ICU the week after they infected two nurses?? Neither would people in Dallas. Double bonus: That hospital is 93 beds smaller (a 10% shrinkage) now than it was in 2014 (968 beds to 875). I'm sure hundreds of millions of dollars of liability and lost revenue from their 2014 escapades had nothing to do with that downsizing.)
I get trained in this nonsense every year, and exactly like military MOPP level training, it reinforces the reality: GTFO of the Hot Zone ASAP, and don't play there, or you're all going to die. The training is only to reduce panic, not save any lives, and keep people from running, screaming, for the hills. The issued gear is a joke, and will be criminally ineffective, and anyone who tries this on the cheap, which is how every hospital in 50 states and 7 territories rolls, is going to infect and kill staff and the public, in about a month.
You read that right, and here, first. Take it to the bank.

Your chances, without even those clown-car levels of resources, of "surviving" fulminant Ebola, only to suffer EVSyndrome for life, are about 1 in 4 during an actual outbreak. 3 chances out of 4, with "palliative" (i.e. helping you die inside your skin a wee bit more comfortably) care, you simply die.

If you read the blog linked, she toured US and European Infectious Disease suites.
I'm here to tell you, looking at the procedures required, those are not going to operate well under higher pressure of actual patients, they will be degraded. Mistakes will happen. Staff members will screw up, and may die as a result. They will, in a short amount of time, realize this, and the people willing to suit up will not increase, it will dwindle, and the units will fail. Ditto for transport, laboratory, and ancillary staff. Most people don't enter any medical occupations, including doctors, thinking they ought to risk their lives to treat patients. The whole point, in fact, is that the only person rolling the dice in any situation is the patient. Your heart attack isn't going to kill me. Nor your gunshot wound, nor your stabbing. Even your HIV is defeatable with $0.03 worth of nitrile gloves.

But your Ebola?
The period in any sentence on this page would be a ball of 100,000,000 Ebola viruses in a patient fully involved and infectious. Enough to wipe out everyone east of the Mississippi.
The number of those viruses from that period-sized ball necessary to infect a medical caregiver, transport person, lab worker, and kill them just as horribly?

One.

With a patient convulsing, explosively sh*tting out their guts, literally coughing out their lungs, and blood running from their eyes, nose, and mouth, all rife with fatally infectious blood-borne pathogens.

Go back to that linked blog, and imagine someone with a couple of gallon jugs of red gloppy dye, and tell them, amidst everyone in their shiny hazmat suits, to randomly squirt out a turkey baster of it up, out, and down, while the staff walks and works in the room. Say once every couple of minutes. Splatter face shields, plop out a juicy glob or three on the floor, and let a constant amount dribble off the edge of the bed.

Some of the staff members will probably start to freak out, even knowing it's just a drill, which is why we never do that even in drills, so as not to let the cat out of the bag.
Ask me how I know this.

Then, after 3-4 hours in those hot, claustrophobic suits, now dripping with deadly simulated goo on the outside, the masks fogged over with sweat and condensed breath on the inside, and not able to hear anything but the powered respirator blower whooshing loudly past your ears for every minute of those same 3-4 hours, and the inhabitants thereof dehydrated, tired, woozy, sensory-deprived, and hopefully not panicky, see how crisp and precise their procedures are. Like starting a simple IV, or drawing blood from the patient. Like we do 10-50 times a shift. (How many hospitals' staff operate in diving gear at depths of >100'? None?? Why d'ya suppose that is, hmmm?)

Sh'yeah, that'll happen.

And with truncated operating times, you'll need 3-6x the number of staff you need for ordinary patients. {Hint: We can't get adequate staffing in any hospital, anywhere, right effing NOW. Do you really think we'll be inundated with 6X as many when Ebola hits?? Sh'yeah, as IF.}

Those people will do one or two shifts like that, and then they're
g-o-n-e.
Called out sick.
Didn't answer their phones.
Never heard from again.

Reality: left skidmarks in the driveway, after mailing in their resignations, loading up the family and gear, and pointing the car towards Bumfuck, Egypt, 500 miles from the next living soul out in the Great American Outback, beyond the black stump.

If they're smart.

We make minor mistakes in clinical care every day, now.
In just scrubs, and comfortable and competent at our jobs.

Put people in unfamiliar environments, in uncomfortable working conditions, with nothing but the prospect of endless more, times months to years, and with the added prospect that the slightest error could result in slow, agonizing nightmarish death? And take out their family and friends as well?

Game. Over.

Throw in vaccination with a highly experimental and clinically untested Ebola vaccine (even one with >98% efficacy like RVSV-ZEBOV, but no idea of long term consequences to recipients; ask the Gulf War I vets how that experimental Anthrax shot worked out), which you don't have enough right effing now of to cover even 10% of the health workers in only the U.S., let alone anyplace else, and you might get 1-5% compliance with hanging around a month or two. By which time, the outbreak will have doubled or quadrupled, for any value of Wherever You're Talking About.

"Best wishes with that plan. 
Love and kisses.
Wish you were here."
-Aesop
BF,E

Now get your stuff together to either shelter in place in self-quarantine, or GTFO to your Happy Place, and do the same thing. For weeks to months, perhaps as long as a year or two. (The West African outbreak, in a population smaller - yes, also dumber, but not by much - than that of the U.S., lasted from December 2013-January 2016, 25 months, before it was officially declared Ebola-free.)
Think about that one long and hard.
BONUS: That will also come in handy for twenty-seven other potential crises. Win-win.

That's what you could be dealing with, if/when it gets here again, and if it overwhelms our ability to adequately deal with it. The margin for error in such an outbreak is zero.
And if it never happens, you've wasted your time, and are now only prepared for a couple of dozen other major problems. How sad for you.

That sharp stinging sensation in the back of your head is Reality bitchslapping you back to itself, once the Official Partyline Happy Gas wears off.




[Blog note: We'll return to blogposts on other regular topics as the Muse moves us, if it ever stops being SS;DD. Just saying.]

Trust, But Verify

Despite some monumentally asinine carping from world-class trolls on several sites, all I've done is consolidated and condensed current information on Ebola, and I present it with the bark on, and reality settings turned up to 100%.

Which is why I get it right, early, more frequently than the acknowledged "experts". I also don't have anybody's @$$ to kiss.

Someone asked me where I'd gotten it into my head that fever was not a component in a yuuuuuge percentage of cases.

I could tell you "Trust me" but that would be b.s.

So instead, I tracked back my quotes, posts, and comments on other blogs, to pin down when and where that factoid came to be.

Here you go:

"In addition, around 50% of confirmed cases do not present fever symptoms which hinders their detection in health facilities and increase the risk of exposure for health workers." - WHO 10/26/2018 Outbreak Summary, p.3 (bottom of page) {emphasis mine -A.}

Tell 'em Casey Stengel sent ya.

The UN's best and brightest medical experts admitted 9 months ago, publicly, and in their own house bulletin, that fever doesn't appear in 50% of people with actual Ebola, in this outbreak.

So no, I didn't just pull this out of my fourth point of contact, or, unlike the CDC @$$clowns, "just make sh*t up".

Now you've got chapter and verse on where this came from.
And it's as reliable a source as you'll ever get.

So now I can say, with a straight face, that when I tell you something, you can trust me.
But I'll give you the references and bibliography if necessary.

Now bear in mind that the one and only tool they use to screen people at airports and Ports Of Entry is...fever.

Told You So

h/t Comments

This blog, June 5th:

"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." - moi

World Health Organization - Africa, yesterday:

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.
The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.
The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

 Also FTR, Here's the WHO party line happy-gas they were passing just 3 days ago:

The continued decline in new EVD cases in North Kivu and Ituri provinces is encouraging, highlighting the commitment of local and national authorities and partners to an effective response to this serious outbreak. All community mobilization activities, focused on enlisting local populations as partners in the response must continue, as well as proven public health measures, in order to capitalize on this trend and bring he outbreak to a swift close.

Allow me to translate that freely, after running it through the Reality Filter™:

"We're f**ked. Your f**ked. Everyone's f**ked. In fact, we're so far past f**ked, we can't even see f**ked in our rear view mirror, with a telescope. The average IQ hereabouts is 75. The average education is second grade. And those are the geniuses. They go to witch doctors. They can't count to 11 with their shoes on. And they think Ebola is caused by evil spirits, or being passed out by the White Devils, instead of the infected blood of dead Auntie, which they then slam dance and play with, bare-handed, after she's dead. After burning the local Ebola Treatment Center and stealing her festering corpse, if necessary. So bend over, grab your ankles, and kiss your @$$ goodbye, because this is going to run hog wild, and there's not a damned thing we can do to stop it. We've tried everything for ten months non-stop, and it's like pissing on a brush fire. Into the wind."

It also bears noting that until now, the closest the disease had come to the border with Uganda was some 50 miles, which the disease, borne by ignorant idiots, hurdled in one move. And this is just the first confirmed case, that they know about.

Twenty-one to forty days from now, it may turn out that they nipped it in the bud, and they heave a sigh of obvious relief.

Or, they find they have 10-50 secondary and tertiary cases, just like in DRC, and the first clue is when 20 people drop dead on the same day, shooting blood out their eyeballs and @$$#$.
And nobody - nobody - can tell you truthfully which outcome it will be, until then.

So the only thing keeping it there, instead of here, with several hundred Congolese refugees now released in Texas, this minute, is that airfare from there to here is more than the average Congolese person makes in a year.

 

 

UPDATED 11:55A PDT: Original case kid is dead, two more cases confirmed in Uganda.

 

(EBOLAVILLE, UGANDA) Uganda announced two more cases of Ebola on Wednesday - a grandmother and a three-year-old boy, confirming that a deadly outbreak has spread for the first time beyond the Democratic republic of Congo.

The Ugandan cases show the epidemic is entering a "truly frightening" phase and could kill many more people, one infectious disease specialist told Reuters.

A five-year-old boy who had crossed into Uganda from Congo died late on Tuesday, said Uganda's health minister, Jane Ruth Aceng, and his family were now being monitored in isolation.

The original Uganda case is dead, and that means he probably had Ebola for three weeks, and was infectious for two. The two new cases mean his parents probably killed two more people, and will ultimately be responsible for hundreds to thousands of deaths in Uganda.

And the shit has officially hit the fan.

Ebola hit Uganda, and officially doubled in 24 hours.
This is now West Africa 2014, all over again.
And I repeat what I said on the 5th:
At this point in 2014, the U.S.A. was 6 weeks from the first Ebola case here when the outbreak had reached this size. (We didn't know that at the time, but that's how it worked out.) The only difference is this outbreak is moving half as fast.
And unlike 2014, we have hundreds of refugees headed here from the exact affected country. This time around, fever (or lack of it) is no longer a reliable tool to screen out the infected from the uninfected.
And it's the only tool anyone, including the TSA, is using.

Meanwhile, WHO had barely 50% of the resources they needed, to monitor Ebola in only 75% of the affected health zones in DRC.
Now they've got to shift some of the resources they already don't have enough of to Uganda, to try and head off things there going totally to crap, like they will.
That will end well. Not.

Sleep tight, folks. Nothing to see here.

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.