Friday, October 17, 2014

We Have to What?!?

We're knowingly and happily letting 100-150 potential Duncans come here every day, from the three most Ebola-stricken countries on earth.
We've deployed 500 out of a planned contingent of 3000 troops to build 17 100-bed Ebola treatment centers there.
Because, according to the President, we have to fight Ebola there to make it safe for us here.

So howzat going to work, exactly?

There are, according to WHO numbers from 12 October, 8997 Ebola cases, and 4485 deaths, so far, from this outbreak of Ebola. (For reference, the largest prior Ebola outbreak was 425 cases in Uganda in 2000.) When Thomas Duncan got here on 20 September, there were then about 6200 cases, and 2900 total deaths. So in the intervening period, nearly 2800 new cases sprung up, and over 1500 of those previously infected died. And Ebola came to two additional countries, including ours, bringing that number to seven, up from five.

(Nota bene that those are the "official" numbers, representing only those cases that have been confirmed as Ebola by laboratory diagnosis. WHO and CDC have both long-acknowledged that those numbers are dreadfully lower than the actual tally, because those governments are incompetent, officials lie about numbers to downplay how far out of control it's gotten there, those counting cases are exhausted and overwhelmed, patients die at home undiagnosed in droves, don't come forward out of shame, fear, and disbelief even as they're dying, and frequently wander off into the jungle to meet death, or die in the street unseen, undiagnosed, and get buried or cremated before any testing or official diagnosis can be made. Thus the best estimates from outside agencies is that the real numbers are 2 to 2.5 times greater that those "official" statistics, at any point in time going back to early summer of this year.)

The three countries have filled every available treatment bed for Ebola patients they have, and it averages less than 30% of the number of beds needed to remove those patients from the general population, and do what they can to treat those infected.
As of 12 October, there are 1216 existing treatment beds, for over 3000 official infectees.
By mid-November, when the US contingent has built the planned 1700 additional beds, there will be an additional 6000 cases. Even if we were to double down, stay longer, and build 1700 more beds in another 6 weeks after that, there will then be 15,000-20,000 additional cases. The more we do, over the longer we spend there, the further behind our efforts fall, and fail.

That ignores the utter lack of Ebola workers. There are no people to work in even the first
17 centers. To care for 100 patients, it probably demands at least 20, and likely more like 50 people per makeshift Ebola hospital. That's 340-850 healthcare workers. International NGOs working this epidemic there struggle to find so many as 10. So when those centers are filled the minute they open, there'll be no one to care for the patients whatsoever.

Supposedly, part of our mission is to train the soldiers of the armies in question to fill some of those roles. Liberia's army, for example, has a total of only 2000 enlisted soldiers. Most of whom enforce border quarantine and public order. Pulling a sizable chunk of that force into Ebola treatment will weaken border restrictions, and allow Ebola to spread to Mali and Cote d'Ivoire. Further, these are soldiers who were used to enforce quarantine before, and were routinely bribed by people to get out and break the quarantine. These are not professional troops, they're nothing but minimally skilled illiterate thugs with weapons; their diligence at either the quarantine or the treatment role is highly suspect, and leads to the likelihood that they have already let Ebola spread to bordering countries, who themselves have done what such countries do: lie and deny to avoid the stigma of "Ebola-infected" being applied to to their lands. They control the press and the official reports, and the NGOs who might report otherwise are already buried in work in the original three afflicted countries, and have neither the time nor the inclination to go looking for troubles next door.

Thus, Ebola probably already is there now, gaining a foothold unreported, quietly festering and spreading until the truth comes out, and will thus be far too advanced and entrenched to affect when the truth finally bursts forth. And with no one left to go there to help anyway.

Even within the acknowledged Ebola-stricken countries, supplies for care are critically short. The average worker can only work in the protective gear for an hour or so before the boots are full of water from sweat, the masks are too fogged up to see through, and the worker is too dehydrated from fluid loss to work safely or effectively. Which necessitates another 25 minutes to carefully strip the gear off, and go rehydrate and recuperate. Then back into a mostly fresh ensemble, and repeat the process. So the average worker goes through up to 7 suits a day, each costing an average of $75 in real-world money, in countries where the average income is a few bucks a day, when there's any work.

Additional supplies sit in containers in the harbors, because the government officials won't pay the freight for free supplies, haven't received their customary bribes, and so additional supplies sit in harbors overseas unshipped because the first shipments haven't even cleared customs yet. Clinic workers get exposed and die for want of the stuff sitting a few miles away, because someone's palm hasn't been greased, as has been the standard procedure in Africa since forever. And Ebola just keeps rolling along.

Even if the gear gets cleared, it has to be delivered in the most inhospitable places, over the most unimproved road and transportation systems on earth, by the most inefficient workers anywhere, to the most overwhelmed caregivers known to man.

And all the while, those thousands of infected but untreated and unhospitalized Ebola carriers wander the streets, ride taxis, lay around the house, and die in the public thoroughfares, spreading more Ebola to more people every minute of every day, infecting a widening population with a Malthusian relentlessness. Ebola is a savings bond that yields about 25-30% interest per week. Every three to four weeks (going by those woefully inaccurate official numbers) it doubles.

The affected nations can't even keep up with burials, because people are simply dropping too fast to collect. And as they train more body collectors, the disease doubles again.

And as all this goes on, outside trade is non-existent, thus no employment, and therefore no hard currency for governments to buy and do with, no money to pay anyone, not even the soldiers, clinic staff, burial details, or customs workers, no food to eat, no paycheck to buy it with, and all that amidst a backdrop of endemic problems that have slain those populations in droves since long before Ebola's arrival, like malaria, yellow fever, and AIDS. And now, hunger and starvation, which further weakens immune systems, at a time when healthcare for anything other than Ebola there is non-existent, because the hospitals are closed, and the staffs have fled to parts unknown indefinitely.

Thus, at some unknown but inevitable point, the pitifully incompetent, bankrupt, and thoroughly overwhelmed shell of a government in each and every country, simply collapses. They don't accomplish much at the best of times, and this is certainly anything but that. And when the last shreds of civilization fail, and chaos, panic, suspicion, and anger meet ignorance and superstition, mobs form, riots break out, and there'll be no one to stop them. The current facilities will be swept away, the staffs beaten, kidnapped, or killed outright, and the entire region will descend into unimaginable chaos from coastlines to borders, in true African fashion. Then there'll just be Ebola, and lots of people, and no one to get between the two, as both are carried in a symbiotic tango of death over the next set of borders, where the entire process will repeat all over again, with the inevitability of the sun coming up in the morning.

And fixing all that, while cheerfully ignoring the certain end-state for those three countries, and the new realities for three more that will spring up in hours to days, is what we're supposed to jump in and fix with a handful of do-gooders, LGOPs, a contingent of techs, clerks, and jerks, and a few Marines.

On a continent that eats outsiders up metaphorically and literally in a thousand ways, and for a thousand years and more, going back to time out of mind.

To which my thoughtfully considered response can only be:
"Pull the other one, it's got bells on it."


  1. I'm not an expert, but would it be possible for Ebola survivors to fill some of the staffing gaps in these hospitals? Every time I read an article about the monumental challenges of safely caring for someone with Ebola, I'm struck by how much simpler and safer every task involved in that job would be for someone with natural immunity to the disease. Amateurs have absolutely no business trying to use BSL-4 gear, but natural immunity requires absolutely no training to operate, weighs nothing, costs nothing, and (barring a significant mutation) never runs out. And next to corpses, immune survivors are Ebola's most plentiful byproduct. Since this seems to be the only point at which the brutal math of the outbreak works in humanity's favor, I'm surprised that we're not seeing more in the way of systematic attempts to leverage it.

    1. The survivors face immune system damage, alienation, with severe physical, spiritual, mental incapacitation.
      One survivor reported she was so mentally disabled she wasn't able to function even after six moths of recovery.
      An Ebola survivor is simply not in shape to do more than stay alive at that point.
      Living through it is not saying much.

  2. They've been doing that right along in Africa.
    The problem is you're talking about a survival rate of between 28-10%.
    And these are weakened recuperating people, and untrained in medical care beyond the basics, in a country where a high school diploma is a notable achievement, and maybe 60% of the adults can read and write.

    So they aren't going to replace college-degreed nurses nor medical doctors.
    They can spray chlorine bleach solution, empty squat buckets, and mop floors, and that's about it.
    That level of medical care is what one could expect in the Crimea, or the Civil War, and wasn't notable for success.

  3. Africa always wins.
    >Kim Du Toit<