Ebola and other Epidemics, Inadequate Healthcare Threatens Millions

[Valmy]

Doctors Without Borders has been giving it's all, but it just doesn't have the resources to supply the medical care needed for three nations of 20 million people.

That a fact?  Glad to hear it.

[Legbiter]

It'll get better soon Tim, don't worry.

[Valmy]

It'll get better soon Tim, don't worry.

James Monroe shall rise from the dead to save Liberia?

[jimmy olsen]

Doctors Without Borders has been giving it's all, but it just doesn't have the resources to supply the medical care needed for three nations of 20 million people.

That a fact?  Glad to hear it.

Aside from some Christian charities, MSF is the only organization in the area that has been doing anything. The WHO has been gutted and aid from foreign governments is only starting to arrive now.  MSF has like 2,000 people in the hot zone.

I've read the WHO's news release that the outbreak in Nigeria and Senegal has been contained, but I'm really doubtful. Why wouldn't the same dynamic be in play there that there was in the rest of W. Africa?

http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment

...what soon became troubling to Batchyli were the phone calls from people who saw the hand of foreigners behind the epidemic. The logic followed a pattern: the virus had never been anywhere near Guinea before. Then the white people came, and only at that point did talk of "Ebola" start. The foreigners had come so fast that they had actually out-run their own messaging: there were trucks full of foreigners in yellow space suits motoring into villages to take people into isolation before people understood why isolation was necessary.

Even if you understood the reasons, the message from the government and the health workers (and the local media) had undercut the incentive to cooperate. If Ebola was a death sentence, what was the point? The public-service announcements had not been subtle—they didn't explain that mortality rates vary or that, with supportive care, patients do survive (as half the Ebola patients at the M.S.F. treatment center in Conakry had done). To a villager, the isolation centers were fearsome places. They offered a one-way maze through white tarpaulins and waist-high orange fencing. Relatives or friends went in and then you lost them. You couldn't see what was happening inside the tents—you just saw the figures in goggles and full-body protective gear. The health workers move carefully in order to avoid tears and punctures; from a distance, the effect is robotic. The health workers don't look like any people you've ever seen. They perform stiffly and slowly, and then they disappear into the tent where your mother or brother may be, and everything that happens inside is left to your imagination.Villagers began to whisper to one another—They're harvesting our organs; they're taking our limbs.

The process of finding and isolating infected patients was on one level effective and on another deeply disorienting. Batchyli didn't fully grasp the implications at the time. Nobody did. But people in Guinea were as frightened by the response to Ebola as they were by Ebola itself. As the international community started to make significant progress against the epidemic, people in the Forest Region and in the capital were starting to shut health workers out. Fear was proving to be a contagion: You want to hide from the disease. You want to deny that you have it. You want to retreat to your village behind a phalanx of family members, and when the men in space suits come looking for you, you want to crawl under the bed. And you do—and your family members throw stones at the people in space suits, and so they leave.

This dynamic did not at first register. What the medical teams in Guinea saw was that, barely a month after the international community's response began, the incidence of reported infections stopped rising, then declined. It continued to drop. In early May, the Ebola-treatment center inside Donka hospital, in Conakry, reached a milestone: a full week had elapsed since its last Ebola case. Another week passed, with nobody testing positive. The work until then had been so intense and so extraordinarily draining—working in the heat in full Tyvek suits, treating patients who often died and who posed a direct threat to care-givers—that the mood after two Ebola-free weeks was one of relief, bordering on celebration.

Another week passed in Conakry with no Ebola victims. Things slowed even further. A few patients came in and were triaged to the "suspected" section of the treatment center; none tested positive. Relief gave way to boredom. The medical team began making work for itself—taking a full inventory of supplies, cleaning and re-disinfecting tents.

Yet another week passed: once again, Ebola-free. Then, in late May, more good news. At the daily coordination meeting, a Ministry of Health representative announced that the last outstanding contact had been symptom-free for 21 days. The implication was clear: if everyone who had come into physical contact with an Ebola patient was symptom-free after the virus's incubation period had expired, there effectively was no one left who could be infected.

In Guéckédou, medical personnel received the news from the capital by phone. There were still a few patients at the treatment center there, but after an onslaught of 163 Ebola cases in that one prefecture, 119 of them fatal, the team was now following contact cases in only two villages. The news from Conakry tracked with what they were seeing in the Forest Region.

The President of Guinea announced that "for the moment, the situation is well in hand." The foreigners began to leave. The C.D.C. cycled its staff out of Guinea. At the treatment center at Donka hospital, preparations went forward to hand leadership over to local staff. By this point, toward the end of May, there had been 248 clinical cases of Ebola throughout Guinea, and 171 deaths. But there were no more cases in the pipeline. The worst was over.

Much of the medical community in Conakry savored a moment of respite. But it was illusory. As the doctors would learn all too soon, many people had simply stopped cooperating with health workers. They had gone to ground and taken Ebola with them—until so many people had become sick in a community that it was no longer possible to conceal them.

On May 27, a patient with Ebola was admitted to the treatment center in Conakry—the first such patient in a month. On June 2, five more people with Ebola were admitted. On June 3, two more arrived. The cases weren't coming from just Conakry. They were also coming from places a hundred miles or more from the capital: Télimélé, Boffa—everywhere. Down in the Forest Region, between May 29 and June 1, there were 15 new Ebola cases. Out of nowhere, from a flat bottom, the curve had begun to rise, and to rise more steeply than ever.

[jimmy olsen]

NPR had this to say about fundraising.

http://www.npr.org/blogs/money/2014/09/22/349962559/why-raising-money-to-fight-ebola-is-hard

Radio
Why Raising Money To Fight Ebola Is Hard

by Zoe Chace
September 22, 2014 4:24 PM ET

The response to the 2010 earthquake in Haiti was massive: Billions of dollars in donations poured in.

"It had everything," says Joel Charny, who works with InterAction, a group that coordinates disaster relief. "It had this element of being an act of God in one of the poorest countries on the planet that's very close to the United States. ... And the global public just mobilized tremendously."

People haven't responded to the Ebola outbreak in the same way; it just hasn't led to that kind of philanthropic response.

From the point of view of philanthropy, the Ebola outbreak is the opposite of the Haiti earthquake. It's far from the U.S. It's hard to understand. The outbreak emerged over a period of months — not in one dramatic moment — and it wasn't initially clear how bad it was.

Donors like being part of a recovery story. In Haiti, buildings and lives were destroyed. The pitch was, let's help them rebuild.

In the case of Ebola, it's been harder to make a pitch.

Doctors Without Borders tried to tell stories about Ebola for months. But much of the public wasn't listening. The story wasn't prominent in the news until things became dire. Experts who have worked on famine relief say their field is similar.

"There's plenty of early warning," says Gary Shaye, who works with Save the Children. "All the people on the ground know what's going to happen; they talk about it. But until it's something much more visible in the media, it's almost impossible to raise funds."

The Ebola outbreak is unimaginable, says Sophie Delaunay, the director of Doctors Without Borders in the U.S. "It is so horrific, that once you realize how dramatic the situation is, then you just keep thinking about Ebola all the time," Delaunay says. "But until you make that step, you prefer to get away from it."

[alfred russel]

When there were a small number of cases medical assistance would have been decisive. 

I'm not sure. Anything less than a really big intervention would mean that the identification of new cases would still have to be done locally, and I doubt the critical factor in the outbreak was the spread of the disease after identification (though it didn't obviously didn't help).

[jimmy olsen]

WHO finally starts to give in to reality, predicts more than 20,000 cases by November, admits this strain has a 71% fatality rate. (64% if you're lucky enough to gain admitance to a hospital). It may become endemic in W. Africa.

http://www.latimes.com/science/sciencenow/la-sci-sn-ebola-may-be-endemic-in-people-20140922-story.html

Ebola virus in humans may be here to stay; fatality rate is 71%

By Monte Morin 

In a grim assessment of the Ebola epidemic, researchers say the deadly virus threatens to become endemic to West Africa instead of eventually disappearing from humans..

"The current epidemiologic outlook is bleak," wrote a panel of more than 60 World Health Organization experts in a study published Tuesday by the New England Journal of Medicine.

"We must therefore face the possibility that Ebola virus disease will become endemic among the human population of West Africa, a prospect that has never previously been contemplated."

In the absence of new control measures, the authors estimated that the total case load would exceed 20,000 by Nov 2.

"The numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months," the authors wrote.

As of Monday, the United Nations health organization reported that out of a total of 5,864 confirmed and probable cases, 2,811 deaths have resulted.

"The true numbers of cases and deaths are certainly higher," the authors wrote. "There are numerous reports of symptomatic persons evading diagnosis and treatment, of laboratory diagnoses that have not been included in national databases, and of persons with suspected Ebola virus disease who were buried without a diagnosis having been made."

When a virus is slow to mutate, as Ebola appears to be, the pathogen steadily wanes as the number of people who have developed immunity increases. With proper controls, experts say the virus would find it increasingly difficult to spread among the population until it eventually disappeared from humans and survived only in its so-called animal reservoir, which is believed to be a fruit bat.

In this case however, epidemiologists fear that the virus could continue to linger in small pockets, extending its life in humans and potentially mutating in a way that makes fighting it more difficult.

In an accompanying editorial, Dr. Jeremy Farrar, director of the Wellcome Trust, and Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine, said the epidemic has helped to degrade an already meager system of healthcare.


This "disintegration" would have broad consequences and "only worsen as the epidemic progresses," they wrote.

"West Africa will see much more suffering and many more deaths during childbirth and from malaria, tuberculosis, HIV-AIDS, enteric and respiratory illnesses, diabetes, cancer, cardiovascular disease, and mental health during and after the Ebola epidemic."

Farrar and Piot also warned that here was "a very real danger of a complete breakdown in civic society."

In the WHO paper, researchers presented their first, full statistical snapshot of the epidemic, which gained a foothold in December of last year and has fallen hardest on Guinea, Liberia and Sierra Leone.

The majority of patients stricken by Ebola are 15 to 44 years old, with men and women suffering at a nearly equal rates, according to researchers. The case fatality rate -- based on confirmed cases only -- is 70.8%, with a slightly lower chance of death -- 64.3% -- for those admitted to a hospital.

Although the epidemic has already killed more people than all previous outbreaks combined, researchers said the virus now wreaking havoc on some of the world's poorest nations is no more lethal or virulent than other strains.

Instead, its rapid spread is due to "insufficient" control efforts, and a "large intermixing" population that has transported the virus across borders and between rural and urban areas.

In order to stop the epidemic, researchers say the rate of transmission would have to be cut in half. This would be equivalent to vaccinating 50% of the population.

Several experimental vaccines are under development, and -- if they prove to be effective -- won't be available in large quantities for months.

Study authors made the following observations on the effects of the outbreak.

The average age of a person infected with Ebola is 32, and 49.9% of patients are male, researchers said. The age group that has been most affected by the virus makes up 44% of the total population.

The most common symptoms reported by patients included fever (87.1%), fatigue (76.4%), loss of appetite (64.5%), vomiting (67.6%), diarrhea (65.6%), headache (53.4%), and abdominal pain (44.3%).

Although the disease is infamously known for causing bleeding, "specific hemorrhagic symptoms were rarely reported (in less than 1% to 5.7% of patients)," authors wrote. "Unexplained bleeding" however was reported in 18% of cases.

People age 45 or older faced a significantly greater threat of death, as did those who suffered a number of the following symptoms: diarrhea, conjunctivitis, difficulty breathing or swallowing, confusion or disorientation and coma, unexplained bleeding, bleeding gums, bloody nose, bleeding at injection sites and bleeding from the vagina.

"The risk of continued epidemic expansion and the prospect of endemic EVD in West Africa call for the most forceful implementation of present control measures and the rapid development and deployment of new drugs and vaccines," the authors concluded.

[jimmy olsen]

Given these numbers from just one cemetery in one slum, I'm gonna say that S. Leone by itself may have 20,000 cases already.

http://www.nytimes.com/2014/09/23/world/africa/23ebola.html?_r=0

Fresh Graves Point to Undercount of Ebola Toll

By ADAM NOSSITERSEPT. 22, 2014

FREETOWN, Sierra Leone — The gravedigger hacked at the cemetery's dense undergrowth, clearing space for the day's Ebola victims. A burial team, in protective suits torn with gaping holes, arrived with fresh bodies.

The backs of the battered secondhand vans carrying the dead were closed with twisted, rusting wire. Bodies were dumped in new graves, and a worker in a short-sleeve shirt carried away the stretcher, wearing only plastic bags over his hands as protection. The outlook for the day at King Tom Cemetery was busy.

"We will need much more space," said James C. O. Hamilton, the chief gravedigger, as a colleague cleared the bush with his machete.

The Ebola epidemic is spreading rapidly in Sierra Leone's densely packed capital — and it may already be far worse than the authorities acknowledge.

Since the beginning of the outbreak more than six months ago, the Sierra Leone Health Ministry reported only 10 confirmed Ebola deaths here in Freetown, the capital of more than one million people, and its suburbs as of Sunday — a hopeful sign that this city, unlike the capital of neighboring Liberia, had been relatively spared the ravages of the outbreak.

But the bodies pouring in to the graveyard tell a different story. In the last eight days alone, 110 Ebola victims have been buried at King Tom Cemetery, according to the supervisor, Abdul Rahman Parker, suggesting an outbreak that is much more deadly than either the government or international health officials have announced.

"I'm working with the burial team, and the first question I ask them is, 'Are they Ebola-positive?' " said Mr. Parker, adding that the figures were based on medical certificates that he had seen himself. The deaths are carefully recorded by name and date in a notebook headed "Ebola Burials."

A burial team supervisor who drove up with fresh bodies echoed Mr. Parker's assertion. "Any body we collect is a positive case," said Sorie Kessebeh. "All the bodies that we are bringing in are positive."

Beyond the many worrisome trends in the Ebola epidemic seizing parts of West Africa — the overflowing hospitals, the presence of the disease in crowded cities, the deaths of scores of health workers trying to help — another basic problem has stymied attempts to contain the disease: No one seems to know how bad the outbreak really is.

The World Health Organization acknowledged weeks ago that despite its efforts to tally the thousands of cases in the region, the official statistics probably "vastly underestimate the magnitude of the outbreak."

Here in Sierra Leone, the government just finished an aggressive national lockdown to get a handle on the epidemic, ordering the entire country to stay indoors for three days as an army of volunteers went door to door, explaining the dangers of the virus and trying to root out hidden pockets of illness.

Still, the Health Ministry spokesman insisted that the epidemic was not as bad as the flow of bodies at the cemetery suggested.

"It is not possible that all of them are Ebola-related deaths," said Sidie Yahya Tunis, the Health Ministry spokesman, saying the corpses included people who died of other causes.

But as the cemetery records show, the challenge facing the government might be of a different magnitude than previously thought.

The majority of the recent deaths recorded at the cemetery were young people — young adults, people in early middle age, or children — with very few elderly people on the list. Several of the deaths also occurred in a concentrated area, sometimes in the same house, suggesting that a virulent infection had struck.

At the house of Marion Seisay — the third name on the list — her son acknowledged she was a secretary at Wilberforce Hospital, had died of Ebola and was buried on Sept. 14. The house was now under quarantine, with some of its eight residents lingering on the cinder-block porch.

"The way my Mummy died was pathetic," said the son, Michael Foday, clearly frustrated by the quarantine. "How do you expect us to get food?"

Other houses in Wilberforce Barracks, the village-like compound surrounding the hospital, were on the list of the dead and placed under quarantine, marked off from the surrounding jumble of shacks and cinder-block houses by a thin line of red or blue string.

In one of them, the house of Momoh Lomeh, the residents said that a total of five people who lived there had died of Ebola — yet four of them did not even appear on the cemetery list. At another, the house of Andrew Mansoray, a family member said that the disease had been ruthless and unrelenting.

"It wouldn't stop," Abdul R. Kallon said of the diarrhea that Mr. Mansoray, his brother-in-law, had endured before dying. "They took him to the hospital, and they wouldn't let him out."

At another six households on the cemetery supervisor's list of the dead, residents gave similar accounts. One family said the victim had definitely died of Ebola, while five others described Ebola-like symptoms — vomiting, diarrhea, fever — though none had been given an official cause of death.

International health experts here had no explanation for the striking discrepancy between the government's tally of the dead in the capital and the cemetery crew's statistics. Several of them noted the general confusion surrounding official statistics here from the beginning, with one leading international health official saying: "We don't know exactly what is going on."

But nobody disputed that things appear to be getting worse. The W.H.O. has shown a sharp increase in new cases in Freetown in recent weeks, rising from almost none early in the summer to more than 50 during the week of Sept. 14.

Various models of the growth of the epidemic here "all show an exponential increase," said Peter H. Kilmarx, the head of the Centers for Disease Control and Prevention team in Sierra Leone. "The conditions are amenable to Ebola spread."

The goal of the government's national lockdown was to reach every household in the country, and officials claimed success in doing so on Monday, saying that progress had been made in the fight against the disease.
Continue reading the main story Continue reading the main story
Continue reading the main story

But the exhaustion of the Ebola gravediggers at King Tom Cemetery, who dig as many as 16 graves a day, indicated that the disease was far from being contained.

"It's a herculean task," said Mr. Hamilton, the chief gravedigger. "It's only out of patriotism that we are doing it."

The Ebola victims were buried in an expanding stretch of fresh muddy graves under a giant cotton tree, and the makeshift arrangements are seen as a looming threat by the residents of the slum next to it. No barrier stops the pigs rooting in the adjoining trash field from digging in the fresh Ebola graves, which residents say they often do.

"We have creatures in the community, and they dig in the graves," said Henry S. Momoh, who lives in the adjoining slum, which residents call Kolleh Town. "They are burying the Ebola patients in there, but not in the proper manner."

Five yards from where the new graves begin, a well-used path connects the slum to the main road. Residents all use it, passing close to the freshly dug graves, and are frightened by the intensifying activity in the cemetery.

"Since last month, it's every day, any minute and hour, and often, they are coming" to bury the Ebola dead, said Desmond Kamara, a police officer.

A cloudy stream drains from the area of the new graves into the slum, further frightening the residents.

"We are at risk, big risk," said Ousman Kamara, a resident. "We have made many complaints."

But the bodies, he said, keep coming.

"Even at night," he said. "You stand here, and you see them coming."
Correction: September 22, 2014

A caption with an earlier version of this article misstated the sex of a possible victim of Ebola whose body was being removed from a house in Freetown, Sierra Leone. It was a man, not a woman.

[Legbiter]

If true then on the bright side first-time buyers in the S. Leone real estate market will be spoilt for choice.

[jimmy olsen]

If Fox is to be trusted, 550,000 cases is the CDC's low estimate, the high is 1.4 million by the end of January!

http://www.foxnews.com/health/2014/09/23/who-forecasts-more-than-20000-ebola-cases-by-november-2/

[HVC]

If Fox is to be trusted

answered your own question.

[Grey Fox]

I am very trustworthy!

[jimmy olsen]

You can read the report here.

http://apps.washingtonpost.com/g/page/national/ebola-cases-could-skyrocket-by-2015-says-cdc/1337/

Some analysis

http://www.nytimes.com/2014/09/24/health/ebola-cases-could-reach-14-million-in-4-months-cdc-estimates.html?_r=0

The above calculations leave out Guinea and just refer to S. Leone and Liberia, so presuming their calculations are correct they're hundreds of thousands of cases too low for the total outbreak.

However the calculations assume that the true number of cases is 2.5 higher than the recorded cases. I'm skeptical that the numbers are that low, which of course would magnify the exponential growth.

The fantasies within of effective intervention are laughable.

[jimmy olsen]

Dude with the awesome name is right, I just don't see how this is going to be able to be turned around.

http://www.reuters.com/article/2014/09/23/us-health-ebola-idUSKCN0HI2A120140923

Antonio Vigilante, head of the U.N. Development Programme in Liberia, said Liberia now had 350 to 400 beds for Ebola patients, but that fell far short of the 2,000 needed.

"Even if we are at 2,000 beds two or three weeks from now, the cases we'll have in any single day may be more than that," he said.

[jimmy olsen]

It's time for someone to say it like it is rather than pussy footing around it.

The CDC report is decidedly optimistic.

They only cover S. Leone and Liberia, they do not count Guinea.

They estimate that there are 2.5 times as many cases as has been reported, a conservative estimate.

The report holds out hope that Western intervention will somehow hold and then reverse the tide rather than acting as speed bump that will only very temporarily delay complete Malthusian collapse.

How could we possibly build enough beds and more importantly man them with enough health care workers to treat 3,400 daily cases, let alone 10 or 25 thousand? This is a complete fantasy.

http://m.theatlantic.com/health/archive/2014/09/chasing-ebola/380456/
 

If they are able to increase the percentage from 10 to 13 starting today, hit 25 percent on October 23, 40 percent on November 22, and the 70-percent goal by December 22, the outbreak will peak at up to 3,408 daily cases, and will drop to less than 300 daily cases by late January.

If they don't start increasing from 10 to 13 percent until October 23, there could be 10,646 daily cases (accounting for underreporting), and if it's pushed back to November 22, there could be 25,847 daily cases by January 20, 2015, according to the CDC's Ebola Response model. In that case, there could be more than 1.4 million cases of Ebola in two countries with a combined population of approximately 10.4 million people.

It is time to face facts. In the absence of a literal miracle in which the behavior of the virus changes in an unexpected and positive way, then Liberia and Sierra Leone will be completely destroyed in a way that no nation has since the Spanish inadvertently brought smallpox and measles to the New World.

If three quarters of the population of S. Leone, Liberia and Guinea contract the virus and 70% die that's 52.5% off the population dead just from that. That's 11 million people. How many more will die from starvation, other diseases and injuries that can no longer be treated, and conflict over dwindling food and medical supplies?

A 70% die off of the population is not unthinkable.