Ebola and fragility

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Dream of Freedom
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Re: Ebola and fragility

Post by Dream of Freedom » Thu Oct 23, 2014 5:17 pm

"But the only solution to pandemic has been to let it burn out. Look at what it actually took to wipe out polio and small pox. " -Riggerjack

That isn't quite true and besides the problem with letting it burn out is that a disease can be both endemic (a constant threat) and pandemic at the same time. Look at small pox or tuberculosis for instance. And its not the only option. Vaccinations stopped small pox. Quarantine lessened the impact of the black plague. Sanitation put an end to cholera in developed nations. Destruction of vectors,* (animals that carry the disease) though not engineered by us, finally put the plague to rest when the reclusive brown rat took over the niche of black rats that had more contact with humans. Even programs to lift people out of poverty have been effective in lessening the impact of pandemics overall since poverty with its overcrowding, poor sanitation, and poor shelter from certain vectors is a contributing factor to many diseases.

*Bats are thought to be the main vector for Ebola.

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Re: Ebola and fragility

Post by Riggerjack » Thu Oct 23, 2014 7:48 pm

[quote.]a disease can be both endemic (a constant threat) and pandemic at the same time. [/quote]

True, but viruses mutate. That's why we need new flu vaccinations every year, and can still get the flu. An Ebola vaccine that works on this outbreak, won't necessarily work on the next one. If Ebola becomes endemic, there will be multiple strains, some preventable, some not.

The only protection is to quarantine, depriving the virus the environment necessary to evolve multiple strains. There is a reason the public health laws are on the books.

Ebola isn't like measles, where virus, dried on dust particles is still infectious. It seems to be more infectious than the protocols are designed for, though.

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Re: Ebola and fragility

Post by Riggerjack » Thu Oct 23, 2014 8:02 pm

The arch druid report is a fun read. Fairly well thought out disaster porn.

Like Marx, his logic is faultless, but his assumptions are wrong. He calls folks out for belief in a "progress fairy", then speaks of doom and gloom on the same basis. Yes, all the societal factors (warbands, senile elite, etc) he names are easily identified in our modern society. But they have always been with us, on one form or another. He just spins these groups, who he just defined for this purpose, into a coherent storyline. There has been no time in recorded history that all of these groups weren't with us, so their presence today is no indicator of future doom or future prosperity.

It was fun reading, though.

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Re: Ebola and fragility

Post by Pronoid » Thu Oct 23, 2014 8:25 pm

Doctor in NYC just tested positive... I'm screwed now. brb moving next week.

Edit: So I'm watching the live conference with the Mayor, Governor, and several Drs and experts. Supposedly he didn't show any symptoms until this morning when he was already home. Then called himself into the hospital. The people in the conference keep trying their best to diffuse the situation obviously. But it does make me wonder how much they are saying is actually true and what has been fudged. I mean, I doubt they would go on to admit the sick doctor was showing symptoms while he went bowling and riding the subway the night before. If that were true, then the situation would be ridiculously bad.

I still don't understand why the fuck a doctor who just came from africa treating ebola wouldn't quarantine himself immediately even without showing symptoms...

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Re: Ebola and fragility

Post by jennypenny » Fri Oct 24, 2014 7:03 am

NYTimes article

(emphasis mine)
"People infected with Ebola cannot spread the disease until they begin to display symptoms, and it cannot be spread through the air. As people become sicker, the viral load in the body builds, and they become increasingly contagious.

Mayor Bill de Blasio, speaking at a news conference at Bellevue on Thursday night, sought to reassure New Yorkers that there was no reason to be alarmed.

Being on the same subway car or living near a person with Ebola does not in itself put someone at risk,” he said."


I know I'm repeating myself, but I can't help it. The biggest overall threat IMO is the mishandling of the situation and the misinformation being given to the public. We know now that those statements are patently false, and I could post 10 different statements from credible scientists to prove it. How does lying to the public help the situation?

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Re: Ebola and fragility

Post by jacob » Fri Oct 24, 2014 7:23 am

IwantLess wrote: I still don't understand why the fuck a doctor who just came from africa treating ebola wouldn't quarantine himself immediately even without showing symptoms...
Because it's not procedure... and "Hey, what are the odds that I'm the one?" :-P However, as far as I understand it now is procedure for _anyone_ returning from W-A to self-monitor for 21 days. I'm guessing this is why the response to this case was quick and correct.

I know a couple of nurses who are also repeating the party line of "no symptoms = no risk" presumably for the good of the public.

I think what the authorities are trying to do is to avoid panic decisions that lead to a more stupid situation using partial truths. Now, that's not really a new thing is it? ;-P

E.g. 9/11 causes fear of flying so people drive instead. Result: The additional death toll of that extra driving exceeds 9/11 itself.

E.g. closing all air traffic causes individuals from high-risk countries to enter the US through the largely unmonitored borders instead making contact tracing virtually impossible.

E.g. suggesting airborne transmission could lead to increased violence or at least overwhelm ER: "Aaaah somebody sneezed on me, am I gonna die now?!?!!"

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Re: Ebola and fragility

Post by Chad » Fri Oct 24, 2014 7:36 am

jacob wrote:
Because it's not procedure... and "Hey, what are the odds that I'm the one?" :-P However, as far as I understand it now is procedure for _anyone_ returning from W-A to self-monitor for 21 days. I'm guessing this is why the response to this case was quick and correct.
I thought you were against procedures/checklists? :D I understand you aren't necessarily promoting procedure/checklist use and that the procedures/checklist failed because it is not comprehensive enough, but this also demonstrates that no one is going to think for themselves. If a doctor who was actively treating ebola patients can't think for himself, who is?

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Re: Ebola and fragility

Post by jacob » Fri Oct 24, 2014 1:47 pm

http://fivethirtyeight.com/features/is- ... uarantine/

Tail risk of the 21 days. Still lots to learn ...

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Re: Ebola and fragility

Post by jennypenny » Thu Nov 06, 2014 12:19 pm

There's a story making the rounds today that says the new Ebola Czar is putting pressure on news outlets not to report suspected cases of ebola until they are confirmed. Here is one link ... http://downtrend.com/donn-marten/obama- ... -of-ebola/

They quoted a Forbes article, "The Associated Press and other press outlets have agreed not to report on suspected cases of Ebola in the United States until a positive viral RNA test is completed." When I went to find the original article and see what it said, the quote had been pulled from the article.

I guess we know what the new Ebola Czar's job description is now. :roll:

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Re: Ebola and fragility

Post by jennypenny » Tue Jan 06, 2015 8:19 pm

http://www.cdc.gov/flu/news/first-human ... ericas.htm

According to Canadian health officials, the patient, who died on January 3, 2014, recently traveled to Beijing, China, where avian influenza A H5N1 is endemic among poultry. This is the first detected case of human infection with avian influenza A H5N1 virus in North or South America. It also is the first case of H5N1 infection ever imported by a traveler into a country where this virus is not present in poultry. No such H5N1 viruses have been detected in people or in animals in the United States.

While human infection is rare, it often results in serious illness with very high mortality (60%). CDC has recommended enhanced surveillance measures to detect possible cases of H5N1 in this country since 2003. In 2007, “novel influenza A infections” such as H5N1, became nationally notifiable diseases in the United States. Novel influenza A virus infections include all human infections with influenza A viruses that are different from currently circulating human seasonal influenza H1 and H3 viruses. Rapid reporting of human infections with novel influenza A viruses facilitates prompt detection and characterization of influenza A viruses and accelerates the implementation of effective public health responses.



I think this one worries me as much as ebola, especially when it pops up during an already troublesome flu season. At a visit to the pulmonologist last week, we were warned not to visit the ER without contacting them first so they could have an isolation room ready to protect us from the flu. How could they possibly handle more than a handful of cases like that during an outbreak?

I read that the latest medical issue to hit West Africa (related to Ebola) is problem pregnancies and deliveries. Pregnant women were told to avoid medical centers so they didn't get infected with Ebola, but a consequence of that was little or no prenatal care.

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Re: Ebola and fragility

Post by jennypenny » Sun Jan 18, 2015 10:20 am

It's not really slowing down ...

Image


I also read an interview with a WHO official this week. He said that this year's Ebola outbreak has made it clear to WHO officials that their whole approach to containing epidemics and pandemics is flawed and they need to go back to the drawing board.

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Re: Ebola and fragility

Post by tonyedgecombe » Sun Jan 18, 2015 11:20 am

jennypenny wrote:It's not really slowing down ...
It's quite difficult to say that from the graph you posted, you really need to look at the number of new cases over time.

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Re: Ebola and fragility

Post by jennypenny » Sun Jan 18, 2015 11:58 am

The number of new cases has stabilized or declined in the hardest hit areas (even in Sierra Leone), but the disease is spreading and new cases are being reported in previously unaffected areas. Several groups, including Doctors without Borders, say that's a disturbing development. Community engagement infrastructure isn't in place in new areas which slows detection and containment of new cases (including proper burial practices). Hopefully, the number of cases will start to level off. It's concerning that even though Liberia has stabilized and progress is finally being made in Sierra Leone, the disease is still spreading in Guinea increasing the overall geographic area affected by the disease.
Last edited by jennypenny on Sun Jan 18, 2015 12:24 pm, edited 1 time in total.

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Re: Ebola and fragility

Post by Ego » Sun Jan 18, 2015 12:14 pm

A few days ago we flew from Casablanca to Cairo then Cairo to Johannesburg. The Moroccans seemed to be interrogating the West African at the baggage screening area before letting them on a plane. Once on the South African plane they gave us an illness self reporting sheets asking if we had fever, cough, etc. On the ground in Joburg they had nurses from the department of health looking us over and then ran us through thermal cameras. It would be difficult to get through with a high fever. They seem to be getting better with containment. Hopefully treatment will improve soon.

http://www.washingtonpost.com/opinions/ ... story.html

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Re: Ebola and fragility

Post by jacob » Fri Jan 30, 2015 7:33 pm

Ebola seems to be converging asymptotically towards killing off 0.1-2% of the entire population in the worst hit Sierra Leone and Liberia. They seem to have it under control now. Good thing too. That only makes it as deadly as measles is to the group of anti-vaxxers who will suffer a similar loss (measles seems to be the current health issue in the US). So in terms of fragility it's not the disease itself as much as the psychological (and now legal?) impact of the diseases.

(The profile of the two are very different. It's just the numbers that turned out to be similar. Measles has an R of 18-20 (each person tends to infect that many others), it persists and is supercontagious. It only kills 0.1-0.2% of those infected though. Conversely, ebola is not very contagious. It has an R of 1.6 but it kills 40-60% of those infected. Another fun fact ... ebola mutates albeit not as much as the flu but measles is super-stable. There is only one single strain in the world. (There's no special "Disney-strain" :-P ))

In any case that's still a factor 10 less than the lifetime chance of dying in a car crash. Something that we all accept without a second thought.

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Re: Ebola and fragility

Post by workathome » Mon Feb 02, 2015 7:09 pm

@Jacob - Could you explain R factor more? Compounding 18 suggests the entire world would be infected in only 8 periods. It looks like infection is transmittable for about 8 days around the period of rash onset, which occurs 7-21 days. Even being very conservative that's 11 billion transmission events in only 8 months (assuming the entire world wasn't immunized). This was still probably limited by natural immunity, etc. - so how do they come up with the figure and actually plot likely outbreak ranges?

For example, I'm surprised "the Disney outbreak" wasn't much bigger.

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Re: Ebola and fragility

Post by jacob » Mon Feb 02, 2015 8:43 pm

R(0) is the reproduction factor. It's the number of additional people that each infected person manages to infect. More specifically, if N people are infected, they will go on to infect R(0)*N people. These R(0)*N people will go on to infect R(1)*R(0)*N people ... if R>1 this will blow up. If R<1 then the infection will ultimately die out. (I might be using bad notation here ... but basically R is a multiplicative time series with a value for each "generation" of infections.)

R for measles starts at 18 in an "typical" environment of unvaccinated people. 99.9% of these people will live and become immune. 0.1% will die. The survivors become immune and can not be infected again. Obviously the dead are out of the population too. Since measles is really fast, you run out of uninfected people soon. In fact the only thing that used to keep it endemic in the population was a continuous supply of kids that got sent to school and got it from others, etc. That's how I got it when I was a kid (no vaccinations were given back then). It sucked but I don't personally know of anyone who died or had any adverse effects ... then again when I was 8 or 10 or however old I was, maybe I wasn't aware of much of anything anyway).

Now thanks to overall vaccinations, measles had been eradicated in the US. Basically, R<<1 because everyone had either had it or was vaccinated. That's population immunity. There's just no one around for the disease to jump to.

Until now ... because of a lack of vaccinations, R>1 again, especially in certain communities where people have convinced each other not to vaccinate. (Hello Marin County, CA). In such areas, measles can now run freely because there are enough "candidates" to jump to.

Furthermore, it's my understanding that those of you (that would be most Americans younger than 50) who got the vaccine instead of the disease, it might only have been 97% effective(??) This means that there are three people in every group of 100 that each measles patient who has coughed in a train wagon or room in the past 2 hours that that patient can infect. So when a lot of these people all jump on the same ride at a fun fair ... a lot of them will be infected.

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Re: Ebola and fragility

Post by workathome » Wed Feb 04, 2015 7:05 pm

Is the 1 in 1,000 deaths based on worldwide mortality?

It looks like the recent outbreak in France had a .0005% mortality rate.

http://www.riskscience.umich.edu/measle ... ak-france/

I find it interesting how easy it is for the media to kick up a hornets nest. For example, everyone on Facebook is suddenly deathly afraid of Measles and a lot of vitriol is spent towards hipster-types, but it seems no one dies in the US from Measles. But many of these same people post feeding their kids Coca-Cola and McGarbage, and the leading causes of death in the US are actually heart disease, cancer, diabetes, and auto accidents...

I understand the real push is the fear that it could grow and some people could die it a major outbreak occurred, but even prior to nation-wide vaccine, only ~500/year died from it in the US while the Flu still killed ~3k-50k/year. Yet people in general don't seem to concerned about grocery shopping, going to work, being around their neighbors kids, etc. with the Flu.

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Re: Ebola and fragility

Post by jacob » Thu Feb 05, 2015 11:09 am

@workathome - I don't know if it's a worldwide number. I suspect the deaths are mainly from pneumonia that develops in 5% of the cases. Surviving pneumonia depends on the efficacy of the available healthcare. So I'd guess it hits the poor a lot harder than the rich.

Lots human behaviour doesn't make sense when viewed through the lens of statistics. Indeed, in the grand scheme of things measles is absolutely overhyped. But so are many other things some of which we even spend billions of dollars on. For example, if you remove 9/11 (as an outlier) or only consider data since 2002, you're somewhat more likely to be shot by a toddler than by a terrorist. And yet ... In any case, on average falls in bathtubs are far more lethal than that. Cars way more so than bathtubs. I'm waiting for the day someone invents a vaccine against cars.

The difference may be that the measles vaccine is very effective. The flu vaccine is quite ineffective. Also measles is much suckier than the flu (measles = the worst flu you ever had, but with rashes all over, and for two weeks). In short, we could in principle easily and at almost zero cost (two injections for everybody) completely eliminate measles. In other words, the risk is needless. Whereas the risk of the flu is almost unavoidable. Now as for cars ...

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Re: Ebola and fragility

Post by Chad » Thu Feb 05, 2015 4:48 pm

Actually, measles vaccinations would theoretically save us money if Bloomberg is correct about the cost of each case ($142,000).

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