Biggest Ebola Outbreak In History- ~10000 Cases

[Simon_Jester]

http://en.wikipedia.org/wiki/2014_West_ ... a_outbreak

To summarize, there is an ongoing Ebola outbreak in West Africa, with going on 1100 cases to date and nearly seven hundred dead. This is compared to 300-400 cases in most of the historical outbreaks over the past few decades. It is centered in Guinea, Sierra Leone, and Liberia. Authorities are still trying to get it under control. It has been going on since February but was not confirmed until late April, and it kind of rattles me that it's gotten this far without us mentioning it here.

Ebola is, for the record, very contagious and many strains kill 50-90 percent of the people who catch them. Pretty sure everyone already knew that, but just in case.

http://upload.wikimedia.org/wikipedia/c ... a_2014.png

Looking at the graph, the rate at which new victims are contracting the disease is now approaching 20/day and still rising. I perceive some hope in that the rate of increase of that rate is itself declining- in other words, more people are catching the disease, and dying from it, every day, but the rate of spread may be headed for a plateau and will hopefully start to decline.

I hope. I really, really hope so.

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And meanwhile we have some... frighteningly, insanely counterproductive actions by the public.

http://www.reuters.com/article/2014/07/ ... NL20140726

(Reuters) - Thousands marched on an Ebola treatment center in Sierra Leone on Friday after a former nurse alleged that the deadly virus was invented to conceal "cannibalistic rituals" at the ward, a regional police chief said.

Across Guinea, Liberia and Sierra Leone, at least 660 people have died from the illness, according to the World Health Organization, placing great strain on the health systems of some of Africa's poorest countries.

Sierra Leone now has the highest number of cases, at 454, surpassing neighboring Guinea where the outbreak originated in February.

Angry crowds gathered outside the country's main Ebola hospital in Kenema in the West African country's remote east where dozens are receiving treatment for the virus and threatened to burn it down and remove the patients.

Residents said that police fired tear gas to disperse the crowds and said that a nine-year-old boy was shot in the leg by a police bullet.

Assistant Inspector General Alfred Karrow-Kamara said on Saturday that the protest was sparked off by a former nurse who had told a crowd at a nearby fish market that "Ebola was unreal and a gimmick aimed at carrying out cannibalistic rituals".

He said that calm had now been restored to Kenema on Saturday, adding that a strong armed police presence was in place around the clinic and the local police station.

Some health workers from the clinic have been reported absent from work because of "misconceptions by some members of the community," according to a local doctor.

RUNAWAY FOUND

Ebola can kill up to 90 percent of those who catch it, although the fatality rate of the current outbreak is around 60 percent. Highly contagious, its symptoms include vomiting and diarrhea as well as internal and external bleeding.

President Ernest Bai Koroma said on Saturday that the government planned to "intensify activities and interventions in containing the disease and stopping it spread" with a view to ending the disease within 60-90 days.

The new strategy will focus on contact tracing, surveillance, communications and social mobilization, psychosocial services, logistics and supplies, according to the president's statement.

The WHO has previously said that poor health infrastructure and a lack of manpower were hindering efforts to contain the outbreak in Sierra Leone. Another problem is fear and mistrust of health workers among the local population, many of whom have more faith in traditional medicine.

Sierra Leone officials appealed for help on Friday to trace the first known resident in the capital with Ebola whose family forcibly removed her from a Freetown hospital after she tested positive for the deadly disease.

Amadu Sisi, senior doctor at King Harman hospital, where the patient originally escaped from, said on Saturday that she had been turned in after seeking refuge in the house of a traditional healer.

"Because of media and police pressure they decided to give her up. Maybe they are now convinced it is Ebola," he said.

(Reporting by Umaru Fofana and Adam Bailes; Writing by Emma Farge; Editing by Stephen Powell)

[Iroscato]

Shit, that's gone up a lot since I last checked in on the story. As to that article about the former nurse...this roughly sums up what I have to say to him/her...

[Steel]

Infectious diseases PhD here. The reason that normal ebola outbreaks aren't as bad as they could be despite the disease being so contagious and so deadly is that it tends to wipe out most of the community it starts off in before it can travel anywhere else.

This outbreak is could be absolutely terrible.

[Iroscato]

I see. So it's pretty much like the proverbial wildfire, burning all the available hosts out.
What's different about this particular outbreak, do you think?

[Simon_Jester]

Well, sheer (horribly bad) luck can explain a lot. One or two fluke cases (like Gaetan Dugas, a famous "Patient Zero" for AIDS) can have a huge impact on how far an epidemic spreads and how fast.

If one of the victims of the initial outbreak lives long enough to reach an urban area, or if relatives from another town visit them and/or try to 'rescue' them from medical care (GAH), it drastically changes how the disease gets opportunities to spread.

About the only hope I see here is, as I noted, that the graph of the infection rate is concave downward- more and more people are still catching Ebola every day, but the rate may be headed for a levelling-off.

[Zaune]

If this spreads to a city with an international airport, we're pretty much fucked, aren't we?

[Simon_Jester]

Zaune, it already did.

The disease has been in Conakry, the capital of Guinea, for roughly two months according to the Wikipeda article I linked in the OP.

[K. A. Pital]

If this spreads to a city with an international airport, we're pretty much fucked, aren't we?

No, we are not, because the abilities of African 'nations' to deal with outbrakes are simply not like those of the industrial nations of the North.

[Simon_Jester]

At this point, I would deem it proper to subject people traveling by air out of the affected region to some sort of quarantine/examination regimen.

[Teebs]

If this spreads to a city with an international airport, we're pretty much fucked, aren't we?

My understanding is that in a place with functioning public information systems, people who will be desperate to get their relatives into hospital rather than trying to 'rescue' them and a proper sewerage system, it would have great difficulty spreading because it simply incapacitates people too fast for them to go round infecting others.

[Ziggy Stardust]

As Steel mentioned, ebola usually kills people faster than the disease can spread. People get sick very fast; there is no prolonger "incubation" period where it is asymptomatic but contagious as there is for many other communicable diseases (AIDS, etc.).

There are a number of reasons this outbreak may be so bad. Part of it is just bad luck; some people doing some stupid things resulting in more people getting sick.

Part of it is urbanization. That part of West Africa is becoming increasingly urban and centralized in terms of population density, which naturally makes outbreaks more severe, especially since medical practice hasn't caught up to the standards in industrialized nations. Also, note that this is the FIRST outbreak of the disease in West Africa. The previous outbreaks occurred in Gabon, the Congo, Sudan, and Uganda. Look at a population density map of Africa and see how sparsely populated the regions where previous outbreaks occurred were compared to this West African cluster.

It really isn't a mystery at all why this outbreak is so bad, based on where it is taking place. The real question is WHY suddenly there is an outbreak in West Africa, hundreds of miles from the known vectors of the disease in the central African jungles. It's already been confirmed that his is NOT a new strain of the virus; this is Zaire ebolavirus, the most recognized strain. It's a long way away, in a very different environment. This may indicate new potential animal hosts/vectors for the virus.

[Steel]

The only thing that confuses me is why it is not appearing to spread more rapidly as the number of infections grows, but appears to be tailing off. It is possible the strain is mutating to be less deadly in order to spread better, but that should take much much longer. Another thing is people could be changing habits to avoid the spread of the disease. Yet another thing is it might not spread well in situations where one person throwing up in the town well kills everyone, but rather needs more personal contact than people in cities get despite the increase in population density.

[Broomstick]

It really isn't a mystery at all why this outbreak is so bad, based on where it is taking place. The real question is WHY suddenly there is an outbreak in West Africa, hundreds of miles from the known vectors of the disease in the central African jungles. It's already been confirmed that his is NOT a new strain of the virus; this is Zaire ebolavirus, the most recognized strain. It's a long way away, in a very different environment. This may indicate new potential animal hosts/vectors for the virus.

All it takes is one infected host staying well long enough to make the trip from point A to point B to spark a new epidemic at point B. A few hundred miles is a day's drive in a car (OK, maybe a couple on bad roads) and if you go by air, even by small and slow airplane, a few hours at most. A Patient Zero makes the trip, then dies before anyone realizes he (or she) has carried the virus to a new place, then everyone is so busy dealing with the sick, dying, and dead Patient Zero and the trip that person made are forgotten. Heck, if the person is incapacitated quickly enough after arriving in a city the knowledge of that trip and where they came from may well be lost.

[Simon_Jester]

The only thing that confuses me is why it is not appearing to spread more rapidly as the number of infections grows, but appears to be tailing off. It is possible the strain is mutating to be less deadly in order to spread better, but that should take much much longer. Another thing is people could be changing habits to avoid the spread of the disease. Yet another thing is it might not spread well in situations where one person throwing up in the town well kills everyone, but rather needs more personal contact than people in cities get despite the increase in population density.

I'm very much a layman, but... like you say, I think.

Since it's a disease spread by contact with bodily fluids and infected flesh, changes of habits could reduce the transmission rate pretty effectively. As long as there's no hellish bad luck (like an Ebola victim dying and falling in a water supply, mirroring what you say about one person throwing up in the town well), the disease can be stopped and gradually brought under control.

If Ebola were mutating to become less deadly, we'd expect the ratio of today's deaths versus last week's cases to be declining, because it usually kills within a week or two, right?

[Steel]

If Ebola were mutating to become less deadly, we'd expect the ratio of today's deaths versus last week's cases to be declining, because it usually kills within a week or two, right?

I mean, buggery knows with these things.

A huge issue with disease outbreaks is reporting. It is actually very hard to get data about total number of infections or mortality rate, because people who get the disease but don't get very sick won't be counted, so your estimate of mortality is (almost) always going to be an overestimate but your estimate of infections is probably going to be an underestimate. Not to mention that these things will change over the course of an epidemic, so you could see a phantom exponentially growing outbreak in your data that comes purely from people reporting symptoms more frequently as awareness spreads, so what you actually saw was an outbreak of awareness while disease levels remained constant.

Deaths could easily be many times worse than reported if a couple of villages out in the middle of nowhere have been wiped out but nobody bothered to tell the people who are managing the statistics. Less likely in the case of fatal diseases because it tends to be quite noticeable when people drop dead.

I would assume that it is changes in the habits of people that is causing this outbreak to slow down after a few months (if indeed it is slowing down...). The weather doesn't change too much over the course of the year in the region where its going on, so it isn't like a cold snap is stopping it. You wouldn't expect the growth rate of the disease incidence to slow down without a change to one of environment, hosts or the pathogen. All things being equal each case independently has the same ability to cause new infections, so 10x the cases can cause infections at 10x the rate. The fact that it has not continued its exponential growth while in these densely populated places and with cases being << 1% of the available population presumably means we have to look at one of the three major factors for some explanation.

The funny thing is that most outbreaks start with one or so cases, and then go on to become the big epidemic you end up seeing. That means that even if the epidemic comes under control in this region, one case escaping to somewhere new and it all starts again*.

Human diseases, biology, ebola and this outbreak in particular are not my research specialities so don't expect me to be able to say anything more than generic comments on an outbreak.

*(with some probability)

[Borgholio]

Sierra Leone officials appealed for help on Friday to trace the first known resident in the capital with Ebola whose family forcibly removed her from a Freetown hospital after she tested positive for the deadly disease.

I hope that whole family gets sick. Fuck them. Seriously, their loved one tested positive for one of the nastiest diseases on the planet and they break them out of the hospital so they can infect who knows how many more people?

I'm sorry if I sound like an asshole, but how many hundreds of people may have died because these idiots don't trust doctors?

[fgalkin]

Sierra Leone officials appealed for help on Friday to trace the first known resident in the capital with Ebola whose family forcibly removed her from a Freetown hospital after she tested positive for the deadly disease.

I hope that whole family gets sick. Fuck them. Seriously, their loved one tested positive for one of the nastiest diseases on the planet and they break them out of the hospital so they can infect who knows how many more people?

I'm sorry if I sound like an asshole, but how many hundreds of people may have died because these idiots don't trust doctors?

http://1.bp.blogspot.com/-QdGOPCfU_CI/U ... n_ward.jpg

This is the isolation ward in Freetown being set up. Now, imagine it's 90F (32C) with 100% humidity, there's no running water, and that room is full of shit, blood, and liquefied organs. All around you, people are dying horribly, and the only people who are not dying are your faceless caretakers in full biohazard gear. Who can't actually do anything for you except to watch you die.

Simply put, it's hell. Can you blame the family for not wanting someone they love to die like that? They also have no idea just how scary Ebola really is (remember, first case ever in the country!), nor do they trust doctors (who, this being Africa, are often corrupt incompetent assholes with fake degrees). So, we get things like this.

Yes, it's pretty horrible for all involved.

Have a very nice day.
-fgalkin

[Grumman]

This is the isolation ward in Freetown being set up. Now, imagine it's 90F (32C) with 100% humidity, there's no running water, and that room is full of shit, blood, and liquefied organs. All around you, people are dying horribly, and the only people who are not dying are your faceless caretakers in full biohazard gear. Who can't actually do anything for you except to watch you die.

Simply put, it's hell. Can you blame the family for not wanting someone they love to die like that?

I don't blame them for not liking it. But anyone who thinks that dying of a highly contagious, incredibly lethal disease is best done surrounded by new victims and tries to make that a reality is literally too stupid to live.

[Lolpah]

I don't blame them for not liking it. But anyone who thinks that dying of a highly contagious, incredibly lethal disease is best done surrounded by new victims and tries to make that a reality is literally too stupid to live.

As has been reported, people like them probably think the whole disease is a government plot to extort money or some variation on that. Remember, these people are poor, likely badly educated, not very informed about world events or Ebola, and have every reason to distrust their corrupt, incompetent and often dictatorial governments and local officials.

[Simon_Jester]

A few science fiction authors I'm otherwise not fond of came up with a pithy expression they tend to share among themselves, making attribution difficult. They usually use it in the context of a disaster- an army being shattered by an enemy attack, a city laid waste by bombardment. And the phrase they use is "This is defeat. Avoid it."

I like that, because it's compact and illustrates why people bother to do a lot of what they do in wars.
___________________________________

As I would put it, looking at the family breaking out their Ebola-infected relative from a hospital and the consequences...

"This is ignorance. Combat it."

This is exactly why it is bad to tolerate the idea that there are large groups of people in the world who are kept ignorant of basic facts about medicine, who are not educated. Who fear and avoid authority figures because said authorities are nearly always out to cheat them. Who are subject to governments that lie to them so much that they'd rather trust a random stranger on the street than their own national news media.

Of all the things out there with the potential to stunt the growth of civilization, ignorance is one of the most powerful. Not just the lack of knowledge that is listed in the dictionary definition of 'ignorance,' but ignorance as a stance. Ignorance as a permanent frame of mind, in which the true answers to questions are deemed unknown and unknowable, in which decisions are governed by emotion and prejudice rather than fact, and in which any attempt to reach in and deliver facts will be feared and likely rejected.

[Irbis]

Fun fact, Ebola outbreak just spread to Nigeria:

http://www.bbc.com/news/world-africa-28485041

Someone collapsed in airport in Lagos, tested positive for disease. Hopefully didn't infected anyone.

For reference, Lagos has 17.5-21 million inhabitants and sits right in the middle of country with 180 mln population. If you thought situation was dangerous before, well...

[slebetman]

This is exactly why it is bad to tolerate the idea that there are large groups of people in the world who are kept ignorant of basic facts about medicine, who are not educated.

It is not that simple. Education alone doesn't work. Just look at the whole climate change debacle. Both sides know all the arguments yet the deniers simply refuse to believe the proof. It's not ignorance it's belief.

Studies have shown that if you ask the question in a neutral tone (for example asking what scientists think rather than what "you" think) then people will generally answer correctly: http://arstechnica.com/science/2014/07/ ... -informed/

This same phenomenon applies to conspiracy theories, anti-government/anti-authority rhetoric, religion and superstition. I can attest to the fact that even though I know ghosts/demons/monsters don't exist I still sometimes freak out when I'm alone late at night expecting to be devoured in one way or another or see something horrible lurking just behind some dark corner of the room. It's not the kind of fear you get when watching horror movies. It's real fear. My wife, who is a physicist, still believes in djinns and black magic. It's the result of spending a lifetime immersed in a superstitious culture. When asked seriously most people will say they're not superstitious but when pressed most will admit to actually believing it deep inside (or at least doubting their disbelief).

Education, in the sense of giving people all the right information, is often not enough. Even telling people their what they believe is wrong is not enough. In fact it can be counterproductive if their belief system includes some form of conspiracy theory about the government/scientists/the authority suppressing what they believe.

The only approach I've seen that works is to make fun of that belief. Make it a stigma to profess a belief in a conspiracy theory and people will stop believing. But it's not easy. And it's hard to do it as a deliberate campaign.

[fgalkin]

Basically, the problem is that most people there have never heard of Ebola, and so they think that this is all a scam and/or a coverup for horrible rituals, as that article above shows. So, they don't know just how deadly Ebola really is.

Have a very nice day.
-fgalkin

[Steel]

If it spread to somewhere like Lagos that could be absolutely devastating. I really hope it didn't get out into the environment around there. If it did get out into the city proper then there would be basically nothing that could be done, and it could spread incredibly rapidly given how dense the population is there, so there would be a vast number of cases by the time anything was reported. Given that the google search suggestion autocompletes "lagos floating slum" for me, it really is one of the best environments for it to spread.

[The Grim Squeaker]

Since it claimed its first victims in Guinea last March, the Ebola virus epidemic has killed 660 people in three countries and infected nearly 1,100—more lethal than any other outbreak in the virus’s nearly 40-year history.
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​
But last week’s developments could transform this outbreak from an unusually nasty regional epidemic to something much bigger. On Jul. 24, Nigerian authorities confirmed that a Liberian man, Patrick Sawyer, had collapsed in Lagos after flying there from the Liberian capital, Monrovia, and tested positive for Ebola; Sawyer died on the night of July 24-25.
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This is alarming. So far, Ebola has been confined to Guinea, Sierra Leone, and Liberia—war-torn and largely rural west African countries. But Lagos is different; not only is it Africa’s biggest city, with 21 million people. It’s also one of the world’s most densely populated. And perhaps scariest of all, it’s a center for international travel—meaning that if it’s not contained, the virus could easily go global. Sawyer’s was the first-ever recorded case of Ebola in Nigeria, according to the Nigerian Tribune.
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So far, the Nigerian government’s efforts to contain it inspire little confidence. The World Health Organization says that Sawyer, who worked for the Liberian finance ministry, turned himself in to Nigerian health authorities after he began vomiting and having diarrhea in the middle of the three-hour flight from Monrovia to Lagos. Nigeria’s health minister says authorities are currently trying to track down an unspecified number of the 100 or so other passengers on the flight.
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This might be tricky. The 35 Nigerian co-passengers took flight once word got out that the health ministry was supposed to have quarantined them, prompting the federal government to launch a manhunt to track them down, reports Sunday Newswatch, a Nigerian newspaper, citing a federal security agent. The government has only now begun screening passengers arriving from foreign countries for the virus, according to the Tribune.
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One of the problems for airport screeners is that the first signs of Ebola, which is thought to be spread by bats, are a jumble of flu-like symptoms (e.g. headache, fever and stomach pain). “Unfortunately the initial signs of Ebola imitate other diseases, like malaria or typhoid,” Dr. Lance Plyler of the aid organization Samaritan’s Purse told the Associated Press.
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Those symptoms soon become more noticeable, giving way to vomiting and diarrhea. Within a week, the sickened often begin bleeding from mucus membranes, particularly from the intestines. Victims die when internal organs begin shutting down; Ebola typically kills nine-tenths of those infected.
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Causing its victims to spew mucus and blood helps Ebola enter the mucus membranes or cuts of its next host. It’s devastatingly good at this. Though medical workers are usually swaddled in biohazard gear, it’s still infected some 100 health workers. So far, 50 have died, including a prominent doctor.
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Given that deadly efficiency, the fact that at least 35 people who might have been exposed are at large in Lagos—to say nothing of the other passengers arriving from infected areas of West Africa—is disquieting as well. Confined by geography, the built-up areas of metropolitan Lagos now have more than 20,000 people per square kilometer (53,000 per square mile)—about the same urban density as Dhaka or Mumbai. It has among the highest prevalence rates of open defecation of all major African cities, as well as some of Africa’s lousiest healthcare infrastructure.
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Updated on July 28, 2014, 1pm (EST): A previous version of the headline of this piece misidentified Lagos as Nigeria’s capital instead of Abuja.

http://qz.com/241241

Eeep.
(Aka, confirmation on the prior story. The bit about the passengers is new, no?)