Sunday, September 21, 2014

Ebola Update - UPDATED! - TWICE!!

You may have noticed last week that the CDC blasted out a info-bomb to your hospital (and every other one in the U.S.) noting that it's not a question with Ebola about if it gets here, as much as when.

So, are all your triage nurses working every day in goggles, gloves, exposure suits, and N95 or better respirators? or did management decide better to let their staff die in the first wave, rather than risk scaring away patient$?

Yeah. Thought so.

New numbers posted today, dated from the WHO report on the 17th.

Good news: Senegal and Nigeria have pretty much stopped their infections in their tracks, and have no new cases. They are almost completely out of the woods for the moment, and barring any new patient vectors, should cease to be areas of contagion within a week or so.
Congo's separate strain continues to grow and spread on its own in the backcountry, albeit slowly. They may manage to contain it small, as in previous instances. 

Bad news: Liberia has more than picked up the slack, now having gone from late arriver to the party to the main event, all by itself.
The disease pool remains on pathway to double in size about every 21 days, which points to 100K or so cases in Liberia alone by Christmas, or twenty times the size of the current level of infection, which has already completely overwhelmed all three countries even now.
In a country of 4M, Liberia virtually ceases to exist by about next Easter. 

Worse news: Guinea and Sierra Leone are showing lower growth rate, which points not to control but being unable to confirm accurate numbers, unless the spread and the virus there is miraculously half as virulent as it is in Liberia. Unlikely.
Also, there are only treatment beds for something like 20% of affected victims in any of those three countries, which means the virus is still walking around in society re-infecting more people day over day, as 4 out of 5 contagious victims are not in a treatment center.
Sierra Leone is also enforcing a 3-day total curfew to attempt to slow the spread down, so their next numbers will be low, because of no counting going on, but the infected people on the loose, trapped at home with others caring for them, mean that instead of helping, the quarantine will virtually guarantee a subsequent spike once the curfew is lifted, and the fresh cases can flock for treatment, and the bodies in the streets can be rounded up.

And just for real fun, the freshest outbreaks in Liberia are in the south, which was untouched by Ebola until recently, in the region directly bordering Ivory Coast, a nation hitherto unaffected by Ebola thus far. This points to people with infection travelling there, unable to leave, and spreading the infection within. So Ivory Coast et al are about to be gifted with Liberian visitors, and the resultant outbreak, unless they can maintain a flawless isolation (i.e. enforced at gunpoint), and the government of Liberia, including their border guards, remains intact and functional.

And CDC has quietly revised the prior rosy bullshit estimates from WHO, which was spouting numbers of 20,000 total cases; CDC now estimates things could get into the hundreds of thousands, a number much more in touch with current realities on the ground, and still probably dreadfully low. And to think, I could have saved them the money they spent to get to that brilliant deduction, since weeks ago, just by reading the news to them.

Other notable news:

The U.S. is intensifying its effort, planning to deploy about 3,000 U.S. military personnel to the region to assist with shipping and distributing medical supplies and building treatment centers.

Major General Darryl Williams, U.S. Army-Africa commander, arrived in Monrovia on Sept. 17 with a 12-person team to assess the situation there, Rear Admiral John Kirby, a Pentagon spokesman, said yesterday at a news conference. That includes deciding where to build treatment sites and what else will be needed from the U.S. military.

One C-17 transport plane has already arrived, and two more are scheduled for next week, bringing 45 personnel and helping to set up a command headquarters, Kirby said.

More from the AP report that news is based on:

The military units expected to deploy have not been identified.
Some equipment has already arrived, including a forklift and generator, and two more aircraft are expected this weekend with 45 more military troops.
U.S. troops will not be involved in the direct treatment of patients.
They'd better have a robust security element, and a bombproof exit plan, like say an LHA, with embarked Marine Corps Battalion Landing Team-SOC, and full vertical-lift contingent on 24-hour standby, or one good riot and they're all going to die in place, when the zombie hordes bite the hand that feeds them.
Here's my revised doubling timetable, based on current infection data:

Now >5K
10/11 10K
11/1 20K
11/22 40K
12/13 80K
1/3/15 160K
1/24 320K
2/14 640K
3/7 1.25M
3/28 2.5M
4/18 5M
5/9 10M
5/30 20M
6/20 40M
7/11 80M
8/1 160M
8/22 320M
9/12 640M
10/23 1.2B
10/24 2.4B
11/14 4.8B
12/4/2015 Game over, planetary reset to the 10% or so of 7 billion still alive (assuming no one decides to start a war or launch nukes, just because, in the downward spiral of civilization).

Nota bene that the CDC projection is right down the middle of the fairway, not the worst case at all, but pretty much an absolute certainty, and all I needed for my projection was a 2014/2015 calendar page, and (literally) the back of an envelope, not 50 math geniuses.
Also be aware that we lost an entire year to "Game Over" in the last 50 days, because the rate of spread has sped up.
If it does that again in the next few weeks, and we go to 14-day doubles, we would reach "Game Over" by next Fourth of July or so.

I figure Liberia collapses by New Year's if not far sooner, all of West Africa shortly afterwards, and by late spring, the black hole spreads outward at the speed of transmission.

Important caveat: If the infection spread is halted by literal draconian gunpoint quarantine, the timeline may be extended. Understand this will require triaging most or substantial swaths of Africa to certain death by disease and/or starvation, and ruthlessly exterminating and preventing any spread of the disease beyond that continent, something never accomplished in recorded history. So I don't give that option a lot of hope, on either moral or logistical grounds, take your pick.
Once it gets to any other continent, we're right back on track. Asia, in particular, would pretty much guarantee a global meltdown, and all that takes is one pilgrimage to Mecca, or one latent-infected health worker going back to, say, India.

Hoping for a medical intervention is on a par with hoping for the appearance of Mary Poppins. It's theoretically possible, but highly statistically unlikely, unless you're looking for proof of the existence of a benevolent deity who loves us and wants us to prosper.

And you can probably bump those dates one place or two sooner, if the current outbreak is as under-reported as I suspect.
And of course, if the rate accelerates as the spread widens, the doubles happen even faster.

Either way, the 2016 presidential races just got a lot less interesting.
From the NYTimes  and WHO, a day or two after this was first posted here:
"The epidemiologic outlook is bleak,” the report said.
If control does not improve now, there will be more than 20,000 cases by Nov. 2, and the numbers of cases and deaths will continue increasing from hundreds to thousands per week for months to come, according to the report.

As Casey Stengel said, "You could look it up."
Either they finally found someone at WHO who can count. Or the WHO/NYTimes poaches my blogfodder.
It's not hard to be smarter than the UN and the Fishwrap of Record when you aren't hampered by peddling BS and the "Remain clam. All is well!" brand of happygas they've been full of on this topic.
Now let's hope someone in charge pays attention, and stops mollycoddling the response to this, before the bottom end of my projections becomes as correct as the top end.

Oh, look, the CDC has just noticed that the WHO numbers might be a wee bit optimistic:
"The U.S. Centers for Disease Control and Prevention (CDC) released a report Tuesday [9/23/14] predicting as many as 550,000 to 1.4 million cases of the Ebola virus in Liberia and Sierra Leone alone, by the end of January. "
I'm impressed. It's almost like someone at the CDC Press Office has learned to read, and count, in the same week. I hope they do epidemiology better than they do media relations and basic statistics. But better late than never, I suppose.

Welcome to the party, guys.


  1. Of course, your post scared me to death. What can an average person do? Or is there no hope? From what I understand, it is spread by bodily fluids---isn't there any way to avoid those?

  2. 1) There's an outside chance they may find a drug that will work. Lamivudine has been touted by one doctor on the ground as a possibility. Let's hope that pans out. GalxoSmithKline hold the (expired) patent on it, but it it turns out to be a useful Ebola anti-viral, that patent could be extended. Provide, IMO, that GSK is instructed to cough up $1M for 20,000 doses of the drug, and another $1M to study the effectiveness on the ground. With annual profits of $11B, that would be chump change to them for a drug already documented safe for humans, and potentially the only drug to treat Ebola at the moment. that would be huge.
    2) We need to nix sending 3000 troops there. Even if they built a fully staffed, ready for patients 500-bed hospital every hour, (as if that's even possible), by Halloween the outbreak's progression in Liberia alone engulfs their efforts.
    3) Barring a miracle, Liberia is going to die. And the collapse of order and government there will come first, sending infected people outwards to the four points of the compass. We need to wrap our heads around shutting down the country here, the minute that happens. Otherwise this thing doesn't kill hundreds of thousands, or millions, but billions.
    4) Personally, start stocking up on canned goods, stored water, and cash.
    Imagine you can't go outside. For months. Because if Ebola makes it here, that's what a quarantine will look like. But it isn't going to kick your door down; staying home until it burns out would stop it.
    What that will do the national and worldwide economy is an entirely different kettle of fish.

    If this had scared the hell out of TPTB at WHO, CDC, and in Washington back in April, when 3000 troops and more money and resources would have stopped it small, we wouldn't be looking at this now. The governments in the affected nations are a bunch of squabbling retards, and their collective incompetence is going to kill millions.
    Currently, what we're doing is like trying to duct tape the wings on an airliner in flight that's already headed towards the ground.

    A better approach is to consider what it looks like when we triage the entire nation out of the path of this disease. We're doing none of that.

    And the fact that everyone at every er isn't going to work in hazmat suits is proof that every hospital that got the CDC memo - which is every hospital in the US - is totally ignoring it.
    It's cheaper in the short term to risk people and staff dying than to scare folks and spend money.
    Those are the genius moves that make a pandemic not just possible, but inevitable.

  3. Just out of curious, and after your post scared me silly, how much more worried should I be after the confirmed ebola patient in Dallas.

  4. Look up.: