Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
Too little, too late.
September 23, 2014FoxNews.com
http://www.foxnews.com/health/2014/09/23/who-forecasts-more-than-20000-ebola-cases-by-november-2/
[video at link]
The U.S. Centers for Disease Control and Prevention (CDC) is expected to release a report Tuesday predicting as many as 550,000 to 1.4 million cases of the Ebola virus in Liberia and Sierra Leone alone, by the end of January.
The CDC calculations are based, in part, on assumptions that cases have been dramatically underreported. Other projections haven't made the same kind of attempt to quantify illnesses that may have been missed in official counts.
[snip]
>Face Palm<
Look Thud, I'm dealing from certainty here.
1. We can't save everyone.
2. Our efforts will determine how many we can save from unnecessary death.
3. Ebola is coming to the USA because of the connectedness of our world.
4. Ebola fomites are a threat. How much of one is unknown and a lot of people in the Public Health community are too short term or economic impact oriented to address it.
5. The “ID50” for Ebola assumes the classic young adult male with no other immunity compromising medical conditions.
What Smokin’ Joe said here:
>>The bottom line is that we do not know how many people were initially infected by
>>fomite contact and then went on to become more infected by other means already
>>known to be effective.
>>
>>Without knowing that, we cannot assess the risk, only acknowledge it.
...Applies.
Call it a “Known, Unknown.”
Given the above we start moving to classifying the public health risk based on what we do know about the public health environment in the USA.
Specifically the so bloody obvious people forget about it — the fact that that modern public health care leaves large portions of the population as “immuno-compromised” in the treatment of their medical conditions.
AIDS, organ transplant recipients, open heart surgery survivors, and recovered chronic drug abusers are all examples of that.
However people, and the CDC it seems, forget how many people are on high-dose corticosteroid or other anti-inflammatory or immunosuppresssive medications that compromise their immunity.
Here is a partial list of autoimmune diseases many of which have just such treatments -
Asthma
Autoimmune Thyroid Diseases
Immune-Mediated or Type 1 Diabetes Mellitus
Multiple Sclerosis
Rheumatoid Arthritis
Scleroderma
Systemic Lupus Erythematosus
Psoriasis
Inflammatory Bowel Diseases
And this leaves out things like the reduced disease resistance of type 2 Diabetes which is predominantly treated with nothing but diet and exercise. Lower immunity from Type 2 Diabetes is blamed in part for the rise of latent tuberculosis in the USA and around the world.
Modern American society is if anything far more vulnerable to Ebola fomite infections than Liberia and at lower than the 10 viron ID-50 level.
The death of a little old lady to 9/11/2001 Anthrax contaminated snail-mail attack is lesson enough on that score...the classic “ID5” population problem.
We are looking at something like 20-25% of our population being immunity compromised with the majority being 50(+) years old.
Anyone in that demographic in a low socio-economic status, high population density, urban area are walking-talking petri dishes for Ebola fomite infection spread.
Since that demographic -- minus the low SES -- describes the plurality of my adult living blood relatives, in-laws, and myself, I am highly sensitive to the subject. When Ebola is endemic to Africa, which now seems certain, this will become a national security issue.
New numbers out yesterday by WHO/CDC.
On the 20th of Sep, we hit 6000 official open cases. We hit 3000 cases on 25AUG14. It took 26 days to double up this time, officially.
Unofficially, the numbers are worse. The problem with those projections is they are assailable.
The doubling rate isn’t. Frankly, there hasn’t been a global acceleration in growth above the rates in June, July, and Aug, except perhaps maybe by a day or two.
If we see an acceleration, I think it will be due to the possibility that since Ebola can infect a person with so few viruses (10 or less will do the trick), and the virus may be viable inside a mosquito, bed bug, lice, biting fly, etc.
We don’t know if it can at this point.
It can explain how health care workers in full battle headfeathers can come down with the disease if they stay around it long enough. You get bit by a mosquito or a fly, maybe you come down with it. It might explain how Writebol came down with it.
Still so much we don’t know about the transmissibility that we ought to at this point.
The following is from the PANDEMIC FLU INFORMATION FORUM (PFIF).
Pay close attention to the PFIF commentor’s analysis of CDC “messaging” below the press conference text.
CDC Telebriefing: Update on Ebola Response Tool
WHAT:
CDC is hosting a telebriefing to discuss a new Ebola Response tool highlighted in the agency’s Morbidity and Mortality Weekly Report (MMWR)
WHO:
Tom Frieden, M.D., M.P.H., Director, Centers for Disease Control and Prevention
Gayle Smith, Special Assistant to the President and Senior Director, National Security Council
WHEN:
Tuesday, September 23, 2014 at 10:30 a.m. ET
PFIF Commentor — A very rough outline of the main ideas discussed:
Frieden: Even a week or two ago I would have expected things to look differently than they do today.
The modeling shows us that even in dire scenarios if we move fast enough we can turn it around.
Gail Smith: This is something we know how to respond to. The planning tool is key here because it tells us how to bend the curve.
Troops: They are deploying…to rapidly get to scale.
We are continuing to build out our civilian response. More than 100 CDC personnel. Pushing out aggressively on community care.
Work very aggressively with countries all over the world to encourage them to ramp up their responses. UK: stand up 700 beds in Sierra Leone. Hearing from other European partners that they will support the intermediate staging base in Dakar. Good response from Asian countries as well. AU. South Africa.
Great receptivity to our joint force command, the same type of model used in Haiti, Philippines. Encouraged UN will stand up command center.
We need to keep up the pressure on the international community.
Richard Besser, ABC News: In looking at the model, it doesn’t seem to depend on the quality of care in the treatment centers. It seems to depend on the isolation. Is there a way to focus on the treatment centers to encourage people to go to them?
Frieden: In Guinea people are being discharged alive. Treatment can double your chances of surviving.
Besser: People are needed to provide direct patient care, why isn’t the U.S. doing that?
Frieden: It’s a two track approach. Scale up treatment centers. Provide care as much as we can outside of those treatment centers. Training trainers. Scale up the number of people who’ll be able to go in and provide assistance. The DoD scoping out more Ebola treatment units. USAID on its website has a way for doctors nurses to volunteer. Identifying local staff will be one of the things that people managing the treatment centers will do. Moving fast to expand ETUs. Moving to identify ways to care for people until ETUs are established. Care units where people can get rehydration, food, care, by people provided with PPE are one model we will go full speed a had with until we get the ETUs.
Mirian Falco, CNN: Projections do not provide any projected deaths. Only 550,000 cases, or 1.4 million based on the underreporting . WHat are the deaths?
As these clinics or ETUs are being established how effective can they be? At the new clinic in Monrovia - it was said that patients stood in line but CNN’s Elizabeth Cohen saw patients being dropped off, they fell to the ground, they died there. There is still a disconnect. What is being done immediately to make these new places for care effective?
Frieden: These are not projections. These are scenarios. Response and status. Things are looking more encouraging. We are seeing a rapid scale up of the response. Even core clinical services can cut the death rate in half, particularly with rehydration. The fact that the ETUs are full is requiring us to come up with other treatment that is safe for their care givers and effective. What may happen to provide a school or a health facility or another community structure and to provide food, liquids, painkillers, oral rehydration to reduce risk and to reduce risk of spread to others.
Smith: The essential ingredients here are speed and scale. The ability to do training at as many as 500 per week - we’ve got to do that at the same time as pushing out on community care. ID 400 of the most vulnerable households and push out on that.
Brown, FoxNews: That number, 550,00 to 1.4 million cases, is getting a lot of attention. Tempered by data available, not accounting for relief efforts. Is there going to be an updated number factoring in relief efforts? Can you quantify it, take a stab at it?
Frieden: We anticipate that in a month or so we will be able to see where we are going and give an update. The important findings of the model are that a surge now can break the back of the epidemic but that a delay is costly in terms of lives and effort.
The mathematical documentation of the urgency we feel in the field. Every day we do not isolate people the job of turning it around gets much bigger and much more difficult.
Smith: The other thing that is a moving target is the response but in a good way. We are getting more information about what countries are willing to do. Resources that were not available in August. A regular and daily positive change in terms of what resources are available.
Magie Fox, NBC News: Can you qualifty the response - is it the beginning of what’s needed? How far down the road are we?
Frieden: In Guinea we have spare capacity except in forest areas where there are security problems.
In Sierra Leone the ETUs are full but we are not seeing large numbers outside the ETUs as far as we know.
In Liberia the situation is worse.
We are seeing the rapid coming on line of ETU beds and the working with governments to find the safest alternative possible locations for community care.
What will be needed to reverse the epidemic is not a fixed number but the speed of response.
Smith: Other pieces are critical - it’s a major logistical operation. DoD, UN, World Food Program, all enablers to the approach Frieden outlined. Given the realities of this virus and the fluidity the momentum must be maintained.
Lena Sun, WaPo: Can you be more specific about when the 1700 treatment beds will be operational? Months before they come online?
Smith: I don’t’ want to give an exact date. I don’t want to prejudge. They are working on an extremely fast basis. For a command thats been on the ground for a week we are very satisfied with the speed they have been moving. We are also pushing on the community care side. All these things have to happen together. USAID wiring with increasing number of NGOs to stand up ETUs. Multiple trajectories. DoD is working as fast as they can.
Lena: Is the reason that MNWR does not include Guinea because they are doing better?
Frieden: Guniea three separate waves, not possible to model the trajectory of cases. Reflects that the situation in Guinea is very much in the balance. The center of the outbreak where the three countries join is where most of their cases come from. The regional response is so important. Faces the problem of continued importation. It was not possible to come up with a valid model.
Dennis Thompson, Health Day: Detail on presence that’s over there right now and presence that’s projected?
Frieden: 120 CDC personnel on the ground including Nigeria and Senegal, and Cote D’Ivoire. Assisting all aspects.
Smith: A joint force command goes in with small team and add personnel based on assessments. Calls in the additional personnel and capabilities that will match rhythm on the ground. We refer to DoD for specific numbers.
In Guinea - France has announced they will set up medical facility in forest in epicenter of epidemic.
Frieden: Healthworkers from African Union; seeing robust response.
Dona Young, Script News: Since you have acknowledge that you don’t think the 550,000 number will come to pass, that this can be turned around, that the data is already out of date, what was the point of putting it out there? Was it to create the hysteria that it seems to be creating? To get the attention of the international community?
Frieden: We’ve put out a model. We want to make sure it doesn’t happen. The model has very important findings. A surge now can break the back of the epidemic. We can be on track to turning it around. The costs of delay are significant. Every day counts.
Smith: Our messages are first and foremost that this is an unprecedented outbreak and in fact an epidemic. Every minute counts. It also counts in terms of what the world responds. If we do not respond steadily effectively and on time…
Comment:
The main takeaways:
1. The new “risk communications” meme-of-the-day:
First & foremost, Frieden desperately desired to get this meme-of-the-day out there (he restated it several times):
“The important findings of the model are that a surge now can break the back of the epidemic but that a delay is costly in terms of lives and effort.”
He must feel that support is more tenuous than we may wish to believe.
A reporter asked straight out if the new model’s numbers were meant to be manipulative seeing as CDC is both publishing them and dismissing them as “not going to happen” in the same breath. Frieden then simply restated his new meme.
2. The ETUs are clearly not going to be sufficient in their speed of establishment or in number to either stop the spread of this virus or to treat the quantity of patients affected. So they are now “pushing on,” according to Smith, the establishment of very basic community care centers. Community care will now be the new byword, and that care will be very basic.
3. Whatever has been going on in Guinea, it is so odd that no one can model it. That’s fairly alarming.
4. Great emphasis was placed in stressing that the speed of response is right now the critical factor.
5. No descriptions of how the actual transmission of the virus would be stopped.
6. No description of pharmaceutical countermeasures: no mention of vaccines or medications on the horizon.
I felt the presser was intended to get Frieden’s meme about speed and surge being able to “break the back” of the epidemic was their major goal, and very little other information or time for questions from reporters was afforded (in contrast to the last major presser where many reporters were allowed to ask what were incredibly insightful questions). These questions were not allowed to get beyond the basic’s of “how much and when” and those two questions were very much left unanswered in terms of specificity.
I agree. Freiden’s approach is stupid, and risky. The US government already is fresh out of credibility. Putting out a model designed to manipulate is foolish.
Yesterday, they officially went over 6000 cases globally. About 25 days from 23SEP14, we’ll be at 12,000. 25 more days, 24,000, then 48,000 cases, 96,000 by Christmas. The more their models match the actuals, the more credibility they will build.
When the actual numbers match the model, it will do the same job that a hurricane tracker does in mobilizing communities.
Release some actual information about transmission, and now you look at the disease coming over by boat instead of by plane.
The WHO Ebola case data previously supported a monthly doubling trend. In black and white numbers, from May thru Sept 2014.
May 1 = 180 cases (actual reported was 243),
June 1 = 375 cases,
July 1 = 750 cases,
Aug 1 = 1500 cases (After Foreign Policy article reported July RO of 2.83 for Sierra Leone and WHO declared an international health emergency),
Sept 1 = 3000 cases.
This was an 8 Sept 2014 projection for the rest of 2014 based on monthly doubling —
Oct 1 = 6000 (Actual 22 Sept 2014 WHO Roadmap Report, A 20-21 day doubling rate est.)
Nov 1 = 12,000
Dec 1 = 24,000
Since that model failed per latest WHO Ebola Roadmap data. Here is a new Sept 23, 2014 Updated Ebola projection for the rest of 2014 with a 21 day Doubling time period -
Oct 13 = 12,000
Nov 03 = 24,000
Nov 24 = 48,000
Dec 15 = 96,000
If the MSF worse case is correct, multiple those numbers _by five_, AKA we will be at a half million cases in the middle of December 2014, not by late January 2015 in the CDC/Freiden’s 515,000 to 1.4 million Ebola case load “manipulative model.”
We are dealing with a force of nature unleashed, not something amenable to man's politically correct puny efforts. The international public health community cannot “model manipulate” big enough to actually match on-the-ground reality.
We have to face facts...Ebola is going to become endemic to West Africa.
“We have to face facts...Ebola is going to become endemic to West Africa.”
A population control wackjob’s dream come true.
The commentor over on the PANDEMIC FLU INFORMATION FORUM that I quoted in 2382 above just added the following 7-8-9 to his 1-thru-6 analysis above —
“7. Frieden really, really, stepped in it, imo, and put his credibility on the line in a big way by stating that fatalities could be reduced hugely - to a CFR under 50% — by getting patients proper care. Apart from those few Western individuals who have been fortunate enough to obtain the pinnacle of modern heroic medical care, that is likely simply untrue. Frieden has *no* basis on which to make his claim. For the head of the CDC, that's dangerous territory to venture into. He's going to hold out the promise that turning oneself in for treatment — whether in West Africa or here — will give at least even odds of survival. Very quickly, it will be apparent on the ground that this is likely untrue. All data seems to indicate that Frieden’s assertion is very much wanting in terms of veracity. That's a bad place to be, because if trust is lost it will be almost impossible to get it back. I can see why Frieden is leaning this way, because whether in Monrovia or in Manhattan, the only public health measure that can stem the tide of an Ebola disease outbreak is isolation of the infected. But holding out a false promise, false hope, will prove as deadly to containment as it is to the trust in public health leaders if that sort of life and death bargain is indeed untrue, or “overstated,” as the “risk communicators” might prefer to say. I'm worried that Frieden is practicing his “get them into the hospital, don't hide cases” speech now, but he's added this maybe not so factual bonus claim to the mix to enhance his message. That makes me worried he's rehearsing for the speech's use here. Add a codicil about “modern medical care” to the promise of “more likely to survive than not with care so bring in your sick and exposed” and you can pretty much see him doing it on a podium in Miami or Portland or Louisville. It's just that, according to current data, that level of reduction in fatalities is not supported by the evidence. And Frieden is saying it about West Africa, and very likely will say it about cases here in America, regardless. Which makes him sound not just deceptive and intentionally so but a little bit desperate (yes, and it won't read that way just to me). So you might want to work on that, Director, and cite your facts.
8. No mention of the risk of spread of the virus either around Africa or out of Africa to other points on the globe - some of them very fragile places not unlike the countries already affected. This is a glaring oversight. We have demonstrated hubris so far and it's gotten us here. The virus can outsmart our containment - it has already proven very good at doing so. Failing to mention any concern about the spread of the virus outside of Africa (travel patterns via air from West Africa may trend towards other continents rather than the other side of the African continent) as well as the dangers it presents to other African nations is a major lapse when discussing a model which states that 550, 000 to 1.4 million cases of Ebola may occur in West Africa by late January. That was a major oversight, and an intentional one. It's the pink elephant in the room. “Breaking the back of the epidemic” at some unknown point does not alleviate the risk to Manilla, to Cairo, to Kolkata. Avoiding discussing that reality doesn't mitigate that risk.
9. No kudos to the Ivory Coast — where CDC advisors are embedded, Frieden stated — for closing their border and effectively slowing the entry of the virus into their nation. While this measure can't promise that the Ivory Coast will remain free of Ebola, the time bought by closing its borders has given that nation a greater ability to prepare for its arrival — and that may make all the difference. Kudos should be given to strategies that are working — and Ivory Coast's strategy is working, so far and maybe well enough to make a difference.”
Ping to 2,388.
Gee, WHO, I guess closing one’s borders DOES work to keep it mostly away.
7 and 8 are the big ones.
Thing is, they keep inflating the fudge factor. First it was 2, then 4, now 5.
There is a strong enough case for action without the fudge factor.
Without the fudge factor, you end up with 500,000 open cases by March or May, officially, instead of January.
Since the people controlling the purse strings can’t be on the ground, they better not find out that the numbers were over inflated in order to snake money away from the mobilization and into some warlord’s bank account.
There is evidence that R0 is increasing. Any epidemiologist worth their salt can make a case to a politician that this is enough of a reason to mobilize now. Couple that with insufficient information about whether pests can vector the bug (think Bubonic Plague) and you should be able to get as big a check as you need without blowing your cred.
Anybody trying to make some money on the side using Ebola as the justification should be involuntarily infected with it. I’m not kidding.
Don’t use an epidemic to fatten your autocratic retirement account. Were I in DC, I’d be thinking in that direction for sure. I’d be counting on it.
The fact is, they are going to need to throw real money at this sooner than later. Billions. That’s going to take somebody inside of the USG managing this that has real credibility for doing a good job on that front.
The USCG has a great reputation for managing their resources prudently. Somebody on the quasi-military, disaster abatement side of the bureaucracy with that sort of cred.
There are 2 ways this fudging goes.
Firstly, to overestimate the number will get more foreign aid you can graft and corrupt into the Swiss bank accounts.
Secondly, if you make the numbers TOO high you will cut off all trade, investment and those foreign companies will pull all their workers. (as in the recent exodus from Port Harcourt in Nigeria of foreign oil workers) And for some of these countries, those are critical needs (firestone, Hersheys, etc). And you have to add in the graft/corrupt factor associated with foreign business deals.
No way at this point to gauge which of these, if either, would be the stronger motivator.
The grave digger’s story in NYTimes yesterday was compelling though. And completely contradictory to the ‘10 deaths so far in Freetown’ story that’s being told.
Given the stories (and pictures) of dead bodies in homes and in the streets and the numbers of fresh graves in the bush I’d suspect there are way more dead/dying/infected than anyone has any idea of.
"As of September 14, the doubling time of the epidemic was 15.7 days in Guinea, 23.6 days in Liberia, and 30.2 days in Sierra Leone (Table 2). We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 (the end of week 44 of the epidemic) will be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 cases in total (Figure 4FIGURE 4 , and Table S8 in Supplementary Appendix 2). The true case load, including suspected cases and undetected cases, will be higher still."
That is significantly ahead of my doubling time update of 2,386 up thread. They are at 20K versus a 12K for a 21 day infected population double. Guinea's 15 day doubling is overwhelming Liberia's and Sierra Leone' slower doubling.
Thanks for the ping!
I will check these out!
You’re Welcome, Shelayne!
Now I am shedding tears...
What hell is this...
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