I am glad that Nigeria is officially free of Ebola now. The story is reassuring. New outbreaks of Ebola are stoppable. But the numbers are sobering. They show how far gone the situation is in West Africa.
The index patient (as the source of the outbreak is known) arrived in Lagos, a megacity of 21 million people, on July 20th — a recipe for disaster. Over the next six weeks 19 further people were diagnosed with Ebola. The death toll was eight people, many of them health workers. Those infected generated 989 contacts, and it took 18,500 in-person, follow up visits to make sure that the virus did not spread further.
Translate those ratios to West Africa, where the latest WHO situation report shows there were 2,638 new cases between September 26 and October 17. In Nigeria, each infected person on average generated 50 contacts, and each contact generated 18 follow-up visits. This is only the roughest of ballpark estimates, but if the ratios were similar, it means that solving the spread in Liberia, Sierra Leone, and Guinea would generate 130,000 contacts and require 2.4 million follow-ups in the next three weeks. By mid November that will double. Obviously things are too far gone to use the same techniques in West Africa, and the strategy must be to strategically prioritize the actions that reduce the Ro (reproduction rate) to slow that exponential curve.
If airborne transmission occurs, it must be reasonably small. The message from Nigeria is that patients are not that infectious until they hit the late stages and are hospitalized or close to it. Dr Stella Adadevo probably saved Nigeria from disaster, but tragically died from Ebola herself. We must do more to save the heath workers. (Surely we can organize blood transfusions from survivors?)
A new study suggests three people a month will fly from West Africa with the virus if no exit screening takes place. (I’m not sure how useful that number is, given the exponential growth curve, and the non-random selection of high risk people seeking better hospitals.)
…
Scientific American discusses the way Nigeria controlled the outbreak. It was not rocket-science:
- Fast and thorough tracing of all potential contacts
- Ongoing monitoring of all of these contacts
- Rapid isolation of potentially infectious contacts
One patient in Nigeria generated 526 contacts because they flew to Port Harcourt, but only three got sick. So the estimates of “50 contacts” per patient may be skewed far above the norm. But since the estimates of cases in West Africa are likely underestimates of the real total, the number of follow-ups required is still in the millions. It’s too late now for the ideal track and containment approach.
Grim statistics on beds required
BBC news assembled these figures from the WHO report October 12. Liberia needs 2310 beds now. We need an extra 5000 beds there in the next month to even catch up to the curve, let alone to get ahead.
| Country | Existing Bed Capacity | Total Beds Needed | Extra beds required |
| Guinea | 160 | 260 | 100 |
| Liberia | 620 | 2,930 | 2,310 |
| Sierra Leone | 346 | 1,198 | 852 |
The US situation
The CDC has finally issued updated new stringent protocols for Ebola. This hopefully will stop healthcare workers from being infected.
The second Nurse in Texas flew on October 10 and 13, so we are a full 7 days beyond that, and no other person so far has been diagnosed. The immediate family of Duncan Thomas (the first Ebola death in Texas) have been cleared, with a total 43 people taken off the Ebola monitoring list in Dallas, but 120 are still under watch. The next week is particularly important.
From the UNMEER latest report October 20th.
A new mobile lab can diagnose Ebola cases in three hours instead of 2 – 5 days. But it does 16 samples at a time in Liberia, where there are currently over 100 new cases a day.
Food prices have risen by an average of 24 per cent across Guinea, Liberia and Sierra Leone
forcing some families to reduce their intake to one meal a day. The FAO and WFP said that
decisions by these three governments to quarantine districts and restrict movements to contain the
spread of EVD have also impacted markets and reduced food security.
Sources: US Dept of Health — Information | Science Mag | Clinical features | Genome Ebola Portal | Timeline | Projection | CDC on Ebola | Twitter #ebola |
The key in such situations seems to be to educate yourself and to act immediately. Don’t wait for WHO.
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Sadly, the numbers suggest that the safest solution is to isolate the affected nations and wait for the infection to ‘burn out’.
I hope the authorities can come up with a more humane alternative without risking a much greater spread of infection.
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I agree, not that the U.S. will act any differently. We’ve sent 2,000 military personnel to help without even knowing what they might be able to do. Dumb — just 2,000 additional vectors who might bring the disease home with them.
And still, according to Fox News, 150 people a day arrive in the U.S. from West Africa. Any one of them could be just a few days from symptoms and could infect others before finally getting help.
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There is no real need for doctors or nurses to even be involved in patient treatment. The only thing that helps is rehydration. That takes nothing more than encouraging patients to drink a lot of Gatorade.
The very simple solution is to pay Ebola survivors to look after patients. There is no risk of further transmission.
http://www.scientificamerican.com/article/blood-transfusions-from-survivors-best-way-to-fight-ebola/
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Thhose are most sensible suggestions food scientist.
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I’d suggest that developing countries have more experience and adaptability in handling diseases than initially thought.
You could then point to the fact that poorer nations still have many diseases that developed countries have controlled or eradicated entirely.
A cynical person would add that due to certain developed countries forcing anti development initiatives on the poorer nations it will result in lack of infrastructure to achieve what the developed countries have done, Nigeria should take heart in their actions on Ebola compared to a first world government that ferries diseases around on planes.
You can smugly offer all the soccer balls that charge batteries you want Obama but you’ll never recognize real leadership in your lifetime because simply you’re a dumbass.
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I spent a few years in Nigeria and it is a bit of a shambles.
However…they can at least take tough decisions occasionally without worrying about political correctness.
Well done Nigeria.
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Love to comment but…
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… but you don’t want to point out that Nigeria still has a problem with Boko Haram.
Good on ‘ya.
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Hans Rosling underlines the bed problem in his usual charismatic fashion (yep, I am a stats nerd and a bit of a fan):
http://www.youtube.com/watch?v=GVZNGGxdxJQ
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Just reading about Dr Stella Adadevo – what a hero!
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What were the deaths from Malaria in the same time frame.
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about 1,715 deaths per day,
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As ghastly as Malaria is, and it’s awful — 600,000 deaths a year, often killing children under five, the tally from Ebola will potentially be larger if we don’t do something.
Assuming around 250 people a day are getting Ebola now, around 170 per day will die. Four months from now that will be 2700 people a day, and growing.
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At that rate, that is over 200 days to get where Malaria is per year … and then you add up that the 600,000 per year has been going on for decades …
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Imagine if we had the chance to stop the earliest cases of Malaria from spreading but didn’t do enough? Malaria is mosquito borne, so it is harder or impossible to wipe out. But Ebola — which has a far higher mortality rate — might be stopped if we do enough and do it now.
Without a working vaccine (which I think is likely within a year, but not guaranteed) the only thing that stops this wiping out 70% of 1 billion Africans, and spreading globally, is a bureaucratically managed response. At the moment only isolation and quarantine can stop the spread. (Depending on governments — What could possibly go wrong?)
Can you see why I want to draw attention to this opportunity?
Malaria is awful and it will kill a half million people again next year and the year after. But there is no chance it will kill ten million or one hundred million. Nor is it likely to mutate into a nastier and more easily spread variety.
The mortality rate of Ebola could drop to 30% but spread twice as fast (with an Ro of 4 say) and therein lies a global nightmare.
I do think (hope) we’ll get vaccines to work, but until we have one tested and in mass production we don’t know that. Think of the vaccine for AIDS…
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Actually we did do enough … it was called DDT and was doing just fine until the econuts got involved.
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Need to ask yourself why malaria is no longer endemic in Western Europe, the UK and most of North America.
Anything that interferes with the transmission vector(s) “works”. In much of Germany, malaria and similar diseases declined after the lands around the big cities were drained; turning swamps into land with streams. Were it not for that, cities like Berlin would have failed because of malaria.
The environmentailsts have put in the “fix” in Europe; extensive flooding in the UK and re-naturing of Germany on a wide scale. Tick-borne diseases are becoming more prevalent in Southern Germany; won’t be long before diseases like malaria pop up their ugly statistics in the former border region which separated the Germanys until 1990 as well as the expanses no longer cultivated for agriculture.
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I agree with you Jo. But, please recall it was Rachel Carson (another doomsday crisis maker)and Silent Spring” that were largely responsible for the DDT ban. DDT w would have been very helpful in fighting malaria in Africa. “Silent Spring” was yesterday’s “Inconvenient Truth” & IPPC Reports. Money, power, fame, and political correctness bring these doomsday fantasies to the world. But why is it the Africans who seem to suffer most?
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“DDT w would have been very helpful in fighting malaria in Africa.”
Uh, Silent Spring didn’t stop DDT from being used to combat Malaria. DDT was banned in the US as a pesticide. DDT was and still is used as a vector control to combat Malaria in Africa and Asia. It became less effective because mozzies developed a resistance to it.
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DDT was stopped because mosquitoes developed almost total resistance. Far better insecticides, such as neonicotinoids and pyrethroids, are now available for general use.
[RE “almost total DDT resistance” I’d like to see supporting information.] ED
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There is widespread immunity to malaria in West Africa. https://en.wikipedia.org/wiki/Genetic_resistance_to_malaria
As a Westerner, with zero innate immunity, I’d probably prefer to take my chances with Ebola rather than falciparum malaria. Falciparum is far harder to treat and often leads to irreversible brain damage and blindness. It is also a permanent condition with multiple relapses.
I once saw a girl go suddenly blind in Brisbane from cerebral malaria. She had just returned from a holiday in New Guinea. It was a pretty scary stuff for all involved.
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Surprising facts on local food supplies in events of national crisis
from The Chiefio.
http://chiefio.wordpress.com/2009/04/06/food-storage-systems/
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So let’s not forget that the editor of the British Medical Journal stated that “Climate Change is more dangerous than Ebola” Words fail me!!!!! Although some very strong language can ensue if my self control weakens!!!!
ACTUALLY THE BIG DANGER FOR VERY POOR COUNTRIES SUCH AS LIBERIA AND SIERRA LEONE IS THE DENIAL OF ECONOMIC GROWTH FROM STUPID POLICIES TOWARDS MODERN ENERGY USE AND THAT MEANS INTELLIGENT USE OF FOSSIL FUELS. Sorry, rant over. Is it possible to move towards sensible economic growth in our poorest nations. Bloody hell, I hope so.
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The biggest danger to Liberia is Liberians. The country is full of insanely dangerous lunatics. Everyone is corrupt and greedy or both. Violence is common. They live in a paradise and have made it into a hell.
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There’s another reason we can be glad Nigeria is in the clear, because a spread of the epidemic to neighbouring Cote d’Ivoire would threaten the chocolate supply.
You might think Ebola is a real money-maker; Wait for Cadbury and Lindt to drop in share price and then make the “casino gulag economy” work for you. Double your money in 30 days if you time it right. Never let a good crisis go to waste. You’d have to buy after the hype then sell soon after the official placation.
Turns out the chocolate was safe all along.
Well call me cynical but if you want quicker action on Ebola, tell the West the chocolate supply will be threatened even if it probably won’t. It worked for global warming, right?
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Andrew,
I think if you say their coffee supplies were threatened as well, it would be a double-whammy and the bureaucrats would be flattened in the stampede to get this sorted.
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If they are needed people to work on Ebola – might I suggest that an awful lot of delegates to those climate conferences don’t have anything much to do these days and they wouldn’t be missed.
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Everyone should make some basic preparations just in case, such as stocking up on flu remedies, non-perishable food, soap and bleach, toilet paper, anything you need to survive at home for a couple of weeks. If you get flu like symptoms you then won’t have to go out and possibly infect others.
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You’d need to be holed up for months (years?) not weeks. You’d only be safe when every other person had been infected and had either died or fully recovered.
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I was talking about protecting others. Yes, it would be difficult to protect yourself by total isolation for months, but relatively easy to protect others by isolation for a few weeks following the onset of symptoms.
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Liberia may be the next to be declared ebola free thanks to warm weather.
“Moreover as the Dry Season approaches in Liberia, he said, intense heat and sunlight will contribute to Liberia’s effort to eradicate the disease. The Ebola Virus has been described as ‘fragile’ by the US Centers for Disease Control and Prevention, CDC, and is easily destroyed by heat and sunlight.”
http://www.liberianobserver.com/news/less-400-ebola-cases-nationwide-ebola-declines-says-dorbor-jallah
Looks like climate refugees may soon be heading away from global cooling towards safety in west Africa.
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“Nigeria declared free of Ebola, but do the maths”
Ignore those WHO guys, because they haven’t done the real maths. Stupid epidemiologists.
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Sure Tristan, so who has done the real maths, and why are the WHO wrong?
I’ve seen several projections and they are all exponential. But I’m all ears if you have an argument…
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My mistake. I misread your statement.
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Human Clinical Trial of TKM-Ebola (before the outbreak)
From Tekmira website:
In January 2014, Tekmira commenced a Phase I clinical trial evaluating TKM-Ebola in healthy volunteers. The TKM-Ebola Phase I clinical trial is a randomized, single-blind, placebo-controlled study involving single ascending doses and multiple ascending doses of TKM-Ebola. The study will assess the safety, tolerability and pharmacokinetics of administering TKM-Ebola to healthy adult subjects.
In May 2014, Tekmira successfully completed the single ascending dose portion of the TKM-Ebola Phase I Clinical Trial in healthy human volunteers.
http://www.tekmira.com/pipeline/tkm-ebola.php
First WHO alert:
23 March 2014 – The Ministry of Health (MoH) of Guinea has notified WHO of a rapidly evolving outbreak of Ebola virus disease (EVD) in forested areas of south-eastern Guinea. As of 22 March 2014, a total of 49 cases including 29 deaths (case fatality ratio: 59%) had been reported.
http://www.who.int/csr/don/archive/disease/ebola/en/
Interesting read by Dr. Cyril Broderick, Professor of Plant Pathology at the University of Liberia’s College of Agriculture and Forestry:
SITES AROUND AFRICA, AND IN WEST AFRICA, HAVE OVER THE YEARS BEEN SET UP FOR TESTING EMERGING DISEASES, ESPECIALLY EBOLA
http://www.liberianobserver.com/security/ebola-aids-manufactured-western-pharmaceuticals-us-dod
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First outbreak of Ebola was traced back to a two year old boy on December 6th last year near the border of the three main countries affected. It killed him, his mother, his sister, and his grandmother.
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West Africa: What are US Biological Warfare Researchers Doing in the Ebola Zone?
” For the last several years, researchers from Tulane University have been active in the African areas where Ebola is said to have broken out in 2014.
These researchers are working with other institutions, one of which is USAMRIID, the US Army Medical Research Institute of Infectious Diseases, a well-known center for biowar research, located at Fort Detrick, Maryland.
In Sierra Leone, the Tulane group has been researching new diagnostic tests for hemorrhagic fevers.”
Centre for Research on Globalization
http://www.globalresearch.ca/what-are-us-biological-warfare-researchers-doing-in-the-ebola-zone/5394582
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REPLY: Lassa fever — another very fatal haemorraghic fever occurs in the area where Ebola broke out. I don’t know that we can read much into that. Research against bio warfare has to occur somewhere and the start of the Ebola outbreak seems to have been traced back to early December 2013. – Jo
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22 Oct: Bloomberg: Ebola Survivors Become Caregivers, Testing Their Immunity
By Makiko Kitamura, Simeon Bennett and Michelle Fay Cortez
Her most valuable asset: As an Ebola survivor, she believes she is now immune. That means Subah doesn’t need to wear the stifling protective suits that limit doctors’ shifts to 45 minutes, and can spend hours caring for her patients protected by only a blue surgical robe, apron, mask, gloves and red boots.
“I’m not worried,” the 39-year-old midwife said in a telephone interview between shifts. “I know I will not contract the virus even if someone vomits on me.” …
Subah is one of 11 survivors working at the Elwa 3 hospital in Monrovia with the aid group Doctors Without Borders. The physicians’ group, which has treated about a third of the 9,000 people infected in West Africa, has never seen a survivor become reinfected with the same strain of virus, said Athena Viscusi, a social worker for the aid organization who works alongside the survivor caregivers…
***The WHO and others are investigating whether survivors’ blood, which would contain these antibodies, can be used to help hold off the disease in the current outbreak…
http://www.bloomberg.com/news/2014-10-21/ebola-survivors-become-caregivers-testing-their-immunity.html?hootPostID=3f2e6f9ce52939ea677b5d769b34a010
***doesn’t say anything about transfusions to cure the disease! incredibly, doesn’t mention all the US victims who have recovered after getting transfusions!
re British nurse, William Pooley:
UK Independent: Mr Pooley has travelled to Atlanta for an emergency blood transfusion which could save the life of a doctor who contracted the disease while working in Sierra Leone…
Mr Pooley, from Suffolk, and the new patient, who has not been named, are said to be close friends after working together at the Ebola treatment centre in Kenema, Sierra Leone…
The pair, who both contracted the disease while helping to save the lives of thousands of Africans suffering from the disease, have the same blood type, making Mr Pooley an ideal donor…
There is no approved cure for Ebola and in the short term the WHO has said that blood transfusions from survivors are likely to be the most effective method of tackling the outbreak. Work is currently under way to establish a registry of survivors complete with their blood types in order to begin the process of extracting their plasma for use to treat future victims…
Rick Sacra, a 51-year-old American doctor who contracted Ebola while working in a maternity hospital in Liberia, is currently being treated with blood plasma transfusions at Nebraska Medical Centre in Omaha from survivor and fellow US missionary Dr Kent Brantly, 33…
http://www.independent.co.uk/life-style/health-and-families/ebola-outbreak-survivor-william-pooley-flown-to-us-to-give-doctor-with-virus-emergency-blood-transfusion-9737888.html
see next comment for update.
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the Atlanta patient who received transfusion from William Pooley has recovered and been released from hospital:
20 Oct: CNBC: He’s out! Ebola patient leaves Atlanta hospital
An unidentified Ebola patient who had been treated at an Atlanta hospital since early September was discharged Sunday after he was found “free of the virus”—and doctors in Nebraska hope to release an NBC News freelancer who also had Ebola later this week.
The Atlanta patient is a World Health Organization doctor who had contracted the often-deadly disease in Africa. He arrived at Emory University Hospital on Sept. 9.
“The patient has asked to remain anonymous and left the hospital for an undisclosed location. He will make a statement at a later date.”
http://www.cnbc.com/id/102102357
Heymann mentions Zaire transfusions vaguely, downplays; doesn’t cite success rate; doesn’t mention transfusions given to US eblola victims, which have all been successful.
audio: BBC Health Check: Ebola outbreak
We’ll also hear about how the blood of patients who recover from Ebola could be used to treat others. Dr David Heymann an epidemiologist from the London hygiene of tropical medicine and the chairman of Public Health England was involved in the first Ebola outbreak in 1976 and discusses plasma screening as one of the therapies that is now being looked at as a possible treatment.
Chapter:
Blood treatment
How the blood of patients who recover from Ebola could be used to treat others
Duration: 08:37
http://www.bbc.co.uk/programmes/p028q53s
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Nancy Writebol, who was at the Atlanta hospital:
Science Mag: Q: Did you have a blood transfusion?
Nancy Writebol: I did. I had blood transfusions in Liberia and Emory. Neither was convalescent serum, though. There wasn’t a match.
http://news.sciencemag.org/africa/2014/10/ebola-survivor-ii-nancy-writebol-we-just-dont-even-have-clue-what-happened
reminder:
Why Dr. Kent Brantly Couldn’t Donate Blood to Thomas Eric Duncan
Thomas Eric Duncan, the first person in the United States to be diagnosed with Ebola and who later died, didn’t receive a blood transfusion from a physician who survived the virus because their blood types didn’t match…
He said he has since given blood plasma to Ashoka Mukpo, Dr. Richard Sacra and Nina Pham…
http://abcnews.go.com/Health/dr-kent-brantly-donate-blood-thomas-eric-duncan/story?id=26226388
why couldn’t Duncan be given what Writebol got?
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Writebol got a dose of ZMAPP, like Brantly did, but I’m surprised if she didn’t get convalescent serum. It is not like there would be a shortage of blood types matched in Africa, but the hospitals in Africa don’t seem to be doing that sort of plasma transfer.
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In a place where AIDS is not uncommon you’d want to be careful with blood transfusions. However if you had Ebola it would surely be worth the risk.
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WaPo: The Nebraska hospital treating Ebola patient Ashoka Mukpo said that he is scheduled on Wednesday to receive the same convalescent serum from the same donor – Ebola survivor Kent Brantly – as American doctor Rick Sacra received several weeks ago…
***In what the hospital called “an amazing stroke of luck,” Brantly was traveling through the Midwest on Tuesday on his way to Texas…
http://www.washingtonpost.com/news/to-your-health/wp/2014/10/08/ebola-survivor-kent-brantly-donates-blood-to-help-treat-nbc-cameraman-ashoka-mukpo/
rather like Heymann, in the BBC interview (who says rigorous testing is necessary first), WHO seem determined to block transfusions in the Hot Zones!
CTV: Black market sale of Ebola survivors’ blood raises concerns
World Health Organization Director-General Margaret Chan referred to the development earlier this month, saying her group has brought the matter to the attention of local governments and is working to “stamp out any black market activity.”…
Bioethicists say selling the blood of Ebola survivors is rife with ethical — and safety – concerns.
Nancy Walton, an associate professor of nursing and bioethicist at Ryerson University, says it’s important to note there is little hard evidence of the effectiveness of “convalescent serum,” as such blood products are called…
What’s more, treating patients this way means there’s no opportunity for Ebola researchers to collect data on the treatment’s outcome, Walton says…
http://www.ctvnews.ca/health/health-headlines/black-market-sale-of-ebola-survivors-blood-raises-concerns-1.2023892
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i’d give a transfusion a try. the latest WHO admission is being covered by a few MSM outlets, tho i wouldn’t be surprised if the true figures were even higher:
Official WHO Ebola toll near 5,000 with true number nearer 15,000
The WHO has said real numbers of cases are believed to be much higher than reported: by a factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in Liberia, while the death rate is thought to be about 70 percent of all cases. That would suggest a toll of almost 15,000…
http://whtc.com/news/articles/2014/oct/22/ebola-deaths-at-4877-as-cases-near-10000-who/
no-one else but Fox is reporting that Amber Vinson got a transfusion, so can’t be sure this is accurate, but it is interesting that Brantly would have been a match for so many of the US victims. would his A+ blood type be extremely common in US?
Fox: Dallas nurse’s dog tests negative for Ebola
Brantly also supplied a blood transfusion to 29-year-old Amber Vinson, a second Dallas nurse infected with Ebola…
http://www.foxnews.com/health/2014/10/22/dallas-nurses-dog-tests-negative-for-ebola/
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Vinson is now said to be free of the virus:
22 Oct: Ebola Nurse Amber Vinson Now ‘Free’ of Virus, Family Says
http://www.philly.com/philly/health/topics/HealthDay692956_20141022_Ebola_Nurse_Amber_Vinson_Now__Free__of_Virus__Family_Says.html
why i’m documenting stuff today is because i am saddened by some alt websites claiming it’s all a hoax because they haven’t seen dead bodies. there certainly are pics, showing dead bodies in the streets, that i have seen on occasion, but i also wonder who has seen any of the 8,000+ cholera dead in Haiti. i certainly haven’t, even tho i have followed that that story closely.
the BBC Health Check program also talks of the WHO’s estimate of the number of new cases daily in Liberia and Sierra Leone at present – from memory max 100 in one of the countries and max 70 in the other – but i have not found this documented anywhere today and i haven’t had time to re-listen to the program as yet. however, if true, the number of dead should be rising fast, & it isn’t. if anything, the outbreak in West Africa is being downplayed.
not sure if i posted the documentary about the Zaire outbreak, tho i did post a document about it.
41 mins in, is the nurse & the blood transfusion (only time for a quick HIV test on the blood she is to receive), plus the story of the final victims receiving transfusions, and almost all recovering:
Nova: Ebola – The Plague Fighters
http://www.youtube.com/watch?v=za_ZW1vpkzI
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Thanks for the update. I am glad to hear she is clear. (It seems too soon though?) Pat! Jo
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I do not know if the quote below is true, but its worth sharing.
Note that it is often easier to fly between an African country and Europe or the US than between African countries with a commercial airliner. Maybe this explains Rwanda’s precautions(lol)?
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