[Dark Wing]

It is compare and contrast time for the Ebola surveillance thread.

See the following:

1,671 posted on Friday, September 05, 2014 2:38:25 PM by RinaseaofDs

Slightly reformatted for clarity —

---

Easiest way to look at this is that the new cases double each month. The reported data clearly supports that trend in black and white numbers.

May 1 = 180 cases (actual reported was 243),
June 1 = 375 cases,
July 1 = 750 cases,
Aug 1 = 1500 cases,
Sept 1 = 3000, (projection from here)
Oct 1 = 6000,
Nov 1 = 12,000,
Dec 1 = 24,000.

Now, the WHO is saying 100,000 by Dec 1, right? They believe their numbers are off by a factor of 4 with respect to ACTUAL open cases.

4 * 24,000 = 96,000 or so cases.

I realize it doesn’t match the pattern we are seeing in terms of WHO reported cases, but it does in one important way:

May 1 = 375 cases,
July 1 = 750 cases and
Aug 1 = 1500 cases.

We crossed 3000 reported open cases sooner than Sep 1, but not significantly. If we double again Oct 1, then it fits the data WHO is reporting. Essentially, we are doubling cases every 28 to 30 days, give or take a day. Mostly, now, we are taking days - it’s doubling sooner than when the first of the next month arrives.

Where the math gets scary is in 2015.

Using WHO data:

Dec 1 = 24,000 cases (no 4 x fudge factor - confirmed cases).
Jan 1 = 48K
Feb 1 = 96K
Mar 1 = 200K
Apr 1 = 400K
May 1 = 800K
Jun 1 = 1.6M
Jul 1 = 3.2M
Aug 1 = 6.4M
Sep 1 = 12.8M

Next year, by Labor day, 13 million open cases, reported on the way they are now by WHO.

Say WHO is right and they are off by a factor of 2. That means 25M cases open on Sept 1, 2015. Off by 4? 50 million infected by start of school 2015.

This assumes: no vaccine, no serum, and a clearly crappy field test for the disease like we have today.

If the tests get better, this number will increase. Right now the tests are very poor at actually diagnosing Ebola Guinea. That’s why WHO is guestimating they are off by either 2 or 4.

So, let’s go into 2015 - 2016, conservatively, as we are wont to do:

Jan 1, 2016 = 192M cases. By April you are at a billion cases.

---

We are significantly over RinaseaofDs’ 1 November 2014 projection about four to five days early in terms of Who data.

There will be no significant change in Africa in terms of Ebola treatment unit (ETU) space until Feb 2015.

Given that 1/2 of the current ETU space in Liberia is unused due to cultural burial practice issues. Additional ETU space is irrelevant.

Nothing short of a full military occupation with roughly five infantry divisions in the three effected Ebola countries with forcible Ebola clearance will make any difference, and the decision to do that had to be made last June.

There may be around 250,000 doses of Ebola vaccine of doubtful effectively in May 2015.

There will be over 800K Ebola infected at WHO data reporting rates, that may in fact represent only 20% of the actual total (4 million) on that date of whom at least 35% (1.4 million worse case) will be dead.

[RinaseaofDs]

It sucks being right.

[Thud]

Vaccine production estimates are unreliable because they are generally based on figures given for a single vaccine, and sometimes even just a single producer. There are at least five different vaccines, using at least three quite different methods, projected to be in production in the US, Canada and Europe during 2015. This does not include Ebola vaccines under development in Russia, Japan and China.

As an example, a story from yesterday projected 12 MILLION units of vaccine being available from an Iowa company by March 31, 2015. See:

http://news.sciencemag.org/health/2014/10/ebola-vaccine-underdog

Also see this month-old article about vaccine production of 50 million doses in four months after a 4-12 week ramp-up period:

http://www.xconomy.com/raleigh-durham/2014/09/30/zmapp-ebola-drug-production-set-for-texas-possibly-north-carolina/

I have read some concerns on-line about facile reliance upon vaccines saving the day, but those all assume reliance on a single vaccine. I repeat, I know of five under development or already in production using at least three quite different methods. I expect at least one of those will be effective in protecting people from contracting Ebola.

A single .32 pistol round probably won't stop a small bear or large cougar, but a dozen .33 shotgun pellets in a single 12-gauge shotgun round very likely will. "Quantity has a quality all its own."

[scouter]

There will be over 800K Ebola infected at WHO data reporting rates, that may in fact represent only 20% of the actual total (4 million) on that date of whom at least 35% (1.4 million worse case) will be dead.

My current projections are for 1,152,017 cases and 707,203 deaths by May 31, 2015.

I'll try to post my next full round of projections shortly after October's final numbers are reported.

[Covenantor]

Jim, when you were engaged in the “Winter” scenarios, what was the time lapse between threat identification and finally taking the correct albeit late response? That is if you are not bound by an NDA.

How does that compare to current events?

[PA Engineer]

The New England Journal of Medicine Article Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections, provided some interesting insights into the numbers.

The growing numbers of cases reported from Guinea, Liberia, and Sierra Leone in August and early September suggest that the Rt remains above 1 in a still-expanding epidemic (reliable estimates of Rt could be obtained only to early September owing to reporting delays). 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 Observed and Projected Case Incidence. The true case load, including suspected cases and undetected cases, will be higher still.

***************************************************************************************************************

We estimate the R 0 to have varied between 1.71 (upper boundary of the 95% confidence interval, 2.01) in Guinea to 2.02 (upper boundary of the 95% confidence interval, 2.26) in Sierra Leone.

***************************************************************************************************************

Our estimates of case fatality are consistent in Guinea (70.7%), Liberia (72.3%), and Sierra Leone (69.0%) when estimates are derived with data only for patients with recorded definitive clinical outcomes (1737 patients).

Frankly, I think the numbers are twice the case rate reported in this study.

[Shelayne]

I was just watching an interview with Joanne Liu, President of MSF, and I was struck by the “official” case numbers at that time. She talked about 4700 cases, and this was just on September 22. The numbers have nearly tripled since then.

Of course, she also said the WHO numbers represented merely 20% of actual cases. Very sobering.

Thank you for the ping!