Ebola and other Epidemics, Inadequate Healthcare Threatens Millions

[Eddie Teach]

Ugh, this quarantine is just going to accelerate the spread of that disease within the slum and to rest of Moravia.

Czech your spelling, please. 

[Ed Anger]

Heydrich is loose!

[jimmy olsen]

Ugh, this quarantine is just going to accelerate the spread of that disease within the slum and to rest of Moravia.

Czech your spelling, please. 

Whoops!

[jimmy olsen]

Terribly sad in depth story about the state of health care in Freetown.

http://www.washingtonpost.com/world/africa/it-was-already-the-worst-ebola-outbreak-in-history-now-its-moving-into-africas-cities/2014/08/30/31816ff2-2ed6-11e4-bb9b-997ae96fad33_story.html

[Valmy]

Imagine Tim giving updates on the Black Death back in the day.

it would have been nice.  We could have laughed at europeans and their silly, non pragmatic customs.

People sort of do that anyway, like perpetuating the myth that the Europeans went out and slaughtered all the cats thus making it worse.

[The Brain]

Heydrich is loose!

He's not the only thing.

[jimmy olsen]

Mongers is a prophet!

http://news.sciencemag.org/health/2014/08/disease-modelers-project-rapidly-rising-toll-ebola

Disease modelers project a rapidly rising toll from Ebola

Kai is a contributing correspondent for Science magazine based in Berlin, Germany.
By   Kai Kupferschmidt    31 August 2014 10:00 am

Alessandro Vespignani hopes that his latest work will turn out to be wrong. In July, the physicist from Northeastern University in Boston started modeling how the deadly Ebola virus may spread in West Africa. Extrapolating existing trends, the number of the sick and dying mounts rapidly from the current toll—more than 3000 cases and 1500 deaths—to around 10,000 cases by September 24, and hundreds of thousands in the months after that. "The numbers are really scary," he says—although he stresses that the model assumes control efforts aren't stepped up. "We all hope to see this NOT happening," Vespigani writes in an e-mail.

Vespignani is not the only one trying to predict how the unprecedented outbreak will progress. Last week, the World Health Organization (WHO) estimated that the number of cases could ultimately exceed 20,000. And scientists across the world are scrambling to create computer models that accurately describe the spread of the deadly virus. Not all of them look quite as bleak as Vespignani's. But the modelers all agree that current efforts to control the epidemic are not enough to stop the deadly pathogen in its tracks.

Computer models "are incredibly helpful" in curbing an outbreak, says infectious disease researcher Jeremy Farrar, who heads the Wellcome Trust research charity in London. They can help agencies such as WHO predict the medical supplies and personnel they will need—and can indicate which interventions will best stem the outbreak. Mathematical epidemiologist Christian Althaus of the University of Bern, who is also building Ebola models, says both WHO and Samaritan's Purse, a relief organization fighting Ebola, have contacted him to learn about his projections.

But the modelers are hampered by the paucity of data on the current outbreak and lack of knowledge about how Ebola spreads. Funerals of Ebola victims are known to spread the virus, for example—but how many people are infected that way is not known. "Before this we have never had that much Ebola, so the epidemiology was never well developed," says Ira Longini, a biostatistician at the University of Florida in Gainesville. "We are caught with our pants down."



To a mathematician, combating any outbreak is at its core a fight to reduce one number: Re, the pathogen's effective reproductive rate, the number of people that an infected person in turn infects on average. An Re above 1, and the disease spreads. Below 1, an outbreak will stall.

Outbreak models typically assume that there are four groups of people: those who are susceptible, those who have been infected but are not contagious yet, those who are sick and can transmit the virus, and those who have recovered. A model, in essence, describes the rates at which people move from one group to the next. From those, Re can be calculated.

If the disease keeps spreading as it has, most of the modelers Science talked to say WHO's estimate will turn out to be conservative. "If the epidemic in Liberia were to continue in this way until the 1st of December, the cumulative number of cases would exceed 100,000," predicts Althaus. Such long-term forecasts are error-prone, he acknowledges. But other modelers aren't much more encouraging. Caitlin Rivers of the Virginia Polytechnic Institute and State University in Blacksburg expects roughly 1000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.

Vespignani has analyzed the likelihood that Ebola will spread to other countries. Using data on millions of air travelers and commuters, as well as mobility patterns based on data from censuses and mobile devices, he has built a model of the world, into which he can introduce Ebola and then run hundreds of thousands of simulations. In general, the chance of further spread beyond West Africa is small, Vespignani says, but the risk grows with the scale of the epidemic. Ghana, the United Kingdom, and the United States are among the countries most likely to have an introduced case, according to the model. (Senegal, which reported its first Ebola case last week, was in his top ten countries, too.)

The models are only as good as the data fed to them; up to three-quarters of Ebola cases may go unreported. The modelers are also assuming that key parameters, such as the virus's incubation time, are the same as in earlier outbreaks. "We might be missing the boat and we have no signal to indicate that," says Martin Meltzer of the U.S. Centers for Disease Prevention and Control in Atlanta.

The biggest uncertainty is how much doctors, nurses, and others can slow the virus. There are many ways of pushing down Re, Farrar says—washing hands, wearing masks, or quarantining people, for example. "But given the complexity of this outbreak and the limited resources, we need to find out what are the two or three things that will most help drive down infections," Farrar says, and that's where models can help. For instance, would following up on all the contacts of every case be more effective than following up on the much smaller number who had a certain type of contact with a case, such as sharing a room?

Rivers is evaluating interventions, such as increased use of protective equipment or campaigns to isolate infected people. In the most optimistic scenario, every contact of infected people is traced, and transmission in hospitals is reduced by 75%. Even that, while drastically reducing the number of Ebola deaths, did not push Re below one.

The challenge varies by country, Althaus says. "In Guinea and Sierra Leone, Re is close to 1 and the outbreak could be stopped if interventions improve a bit." In Liberia, Re has been near 1.5 the whole time. "That means work is only just beginning there." But Meltzer says there is no reason to believe the situation is any better in Sierra Leone. "We are not seeing any change in the rate of the accumulation of cases," he says.

As models get better at differentiating what is happening in places, Rivers says, "you might be able to put firelines around certain communities." But such measures are very controversial. When Liberia last week barricaded off West Point, a sprawling slum with probably more than 100,000 inhabitants, it drew a largely negative response. "Quarantines and curfews tend to instill fear and distrust towards the whole of the outbreak response including health structures," a representative for Doctors Without Borders told Science. Paul Seabright, a researcher at the Toulouse School of Economics in France who has studied such measures, says they are an incentive for people to keep it secret if they have had contact with a patient. Liberia's harsh actions are "the last thing this epidemic needs," he says.

People in West Africa will have to alter behaviors, Meltzer says. "We won't stop this outbreak solely by building hospitals. There will have to be a change in the way the community deals with the disease." Modeling that is easy enough, Vespignani says. "I can decrease the transmission at funerals by 40% easily in a model. That's one line of code. But in the field that is really hard."

[Admiral Yi]

It's nice that Timmy has a new hobby.

[jimmy olsen]

The four horseman ride together.

http://www.fao.org/news/story/en/item/242177/icode/

West Africa: Ebola outbreak puts harvests at risk, sends food prices shooting up

Agriculture in affected countries under significant strain, says new FAO special alert

2 September 2014, Rome - Disruptions in food trade and marketing in the three West African countries most affected by Ebola have made food increasingly expensive and hard to come by, while labor shortages are putting the upcoming harvest season at serious risk, FAO warned today.

In Guinea, Liberia, and Sierra Leone, quarantine zones and restrictions on people's movement aimed at combating the spread of the virus, although necessary, have seriously curtailed the movement and marketing of food. This has lead to panic buying, food shortages and significant food price hikes on some commodities, especially in urban centers, according to a special alert issued today by FAO's Global Information and Early Warning System (GIEWS).

At the same time, the main harvest season for two key crops - rice and maize - is just weeks away. Labor shortages on farms due to movement restrictions and migration to other areas will seriously impact farm production, jeopardizing the food security of large numbers of people, the alert says.

Generally adequate rains during the 2014 cropping season had previously pointed to likely favorable harvests in the main Ebola-affected countries. But now food production - the areas most affected by the outbreak are among the most productive in Sierra Leone and Liberia - stands to be seriously scaled back.

Likewise, production of cash crops like palm oil, cocoa and rubber - on which the livelihoods and food purchasing power of many families depend - is expected to be seriously affected.

"Access to food has become a pressing concern for many people in the three affected countries and their neighbors," said Bukar Tijani, FAO Regional Representative for Africa. "With the main harvest now at risk and trade and movements of goods severely restricted, food insecurity is poised to intensify in the weeks and months to come. The situation will have long-lasting impacts on farmers' livelihoods and rural economies," he added.

Major spikes in food prices

Guinea, Liberia and Sierra Leone are all net cereal importers, with Liberia being the most reliant on external supplies. The closure of some border crossings and the isolation of border areas where the three countries intersect - as well as reduced trade from seaports, the main conduit for large-scale commercial imports - are resulting in tighter supplies and sharply increasing food prices.

In Monrovia, Liberia, a recently conducted rapid market assessment indicates that prices of some food items have increased rapidly - for example, in Monrovia's Redlight Market the price of cassava went up 150 percent within the first weeks of August.

"Even prior to the Ebola outbreak, households in some of the affected areas were spending up to 80 percent of their incomes on food," said Vincent Martin, Head of FAO's Dakar-based Resilience Hub, which is coordinating the agency's response. "Now these latest price spikes are effectively putting food completely out of their reach. This situation may have social repercussions that could lead to subsequent impact on the disease containment."

The depreciation of national currencies in Sierra Leone and Liberia in recent months is expected to exert further upward price pressure on imported food commodities.

Response efforts

To meet short-term food relief needs, the UN World Food Programme (WFP) has launched a regional emergency operation targeting some 65,000 tonnes of food to 1.3 million people.

At the same time, FAO's special alert says that "rapid assessments are required to identify the type of measures that are feasible to mitigate the impact of labour shortages during the harvesting period and for related post-harvest activities."

And measures to revive internal trade are essential to ease supply constraints and mitigate further food price increases, it notes.

Preventing further loss of human life and stopping the spread of the virus remain the top priorities at this time. FAO has joined the coordinated UN effort to support affected countries, is in daily communication with WHO and other key actors, and has personnel in West Africa aiding technical and logistical efforts.

It is critical that rural communities understand which practices pose the highest risks of human-to-human transmission as well as the potential spill-over from wildlife. Toward that end, FAO has activated its networks of local animal health clubs, community animal health workers, producer organizations, forestry contacts and agriculture extension and rural radio services to help UNICEF and WHO communicate risk to affected populations.

[Eddie Teach]

Still impressed by Languish's blase assurance that this epidemic won't be able to spread to the First World. 

[Liep]

Still impressed by Languish's blase assurance that this epidemic won't be able to spread to the First World. 

I guess it could get traction if someone flew back unknowingly infected and perhaps worked in a food service industry of sorts. But that's only really viable if it had been a tourist area full with stupid people.

[jimmy olsen]

Still impressed by Languish's blase assurance that this epidemic won't be able to spread to the First World. 

There can be outbreaks of course, but they can't blow up into epidemics in first world countries unless the method of transmission mutates.

[Eddie Teach]

Nobody listened to Jeff Goldblum. 

[Liep]

Nobody listened to Jeff Goldblum. 

We should fear either an alien or dinosaur invasion?

[CountDeMoney]

Nature will always find a way to make you bleed out your ass.