Posted on 04/28/2005 8:33:10 AM PDT by tdewey10
In Brief
This Information Bulletin (no. 1/2005) is being issued for information only. The Federation is not seeking funding or other assistance from donors for this operation at this time.
This Buletin is issued in conjunction with the Minor Emergency for Angola: Marburg haemorrhagic fever outbreak, no. 05ME021, and it intended to highlight the response in countries neighbouring Angola.
The Situation
The recent surge in cases of Marburg haemorrhagic fever in Angola has alerted many neighbouring countries to the risk it poses. Many have responded by means of task forces or focus committees. Cross-border travel and high mobility of people can easily lead to a spread of Marburg fever to countries like the Democratic Republic of the Congo (DRC) and the Republic of Congo (Congo). This potential risk has panicked many in these two countries, particularly in the border provinces of Bas Congo, Bandundu, Kasai Occidental and Katanga in DRC, and the provinces of Kouilou and Niari in Congo-Brazzaville.
Some cases that are suspected to be Marburg have been reported in Matadi (2), Kisantu (1) and Kinshasa (1), DRC; however, these are unconfirmed. There are currently no reported cases in Congo.
(Excerpt) Read more at reliefweb.int ...
I guess that's still a possibility sometime in the future, but it doesn't seem to be an inevitability.
Good point. WHO has an update due tomorrow. We'll see what the status is then.
I've been following these threads for primarily 2 reasons - this poses a serious worldwide threat, but also because I have little trust in the PR of WHO and our own CDC. WHO is notorious for issuing statements that later turn out to be wrong - but they will not back off in some idiotic idea of saving face.
The lack of open, timely, and honest information coming from WHO, the Angolan authorities, and to a lesser extent our own CDC, poses nearly as big a threat as the Marburg itself, IMO.
Since week 10, that would mean another 100+ cases. If last week was week 15--or is it this week?--and they may have missed some cases while concentrating on Uige, I seriously question whether the rate is slowing. And that seems to give the lie to the "administratively reclassified" numbers. Or am I mistaken?
I've had the Mrs. translate an Angolan press release (the Mrs is near-fluent in Portugese):
http://www.angolapress-angop.ao/noticia.asp?ID=337440
Key section:
"Entretanto, 175 casos suspeitos foram notificados até quarta-feira última, na província do Uíge, tendo sido confirmados 89, o que elevou para 264 o número de casos desde o surgimento da doença. A febre hemorrágica matou já 264 pessoas a nível da região."
Translation: There are 175 more suspected cases in Uige. 89 of which are confirmed Marburg. Bringing the total to 264 active or potential cases. It notes that this is equal to the number already killed by the virus.
This ties into Judith Anne's analysis above.
You mean another still living 175 suspected cases, and 89 confirmed cases?
It begins to look like 2ndreconmarine's original projection of around 500 cases by the end of April was closer than we thought....
Ai, caramba!
Yes 264 (175 suspected/89 confirmed) still living (at the time of the press release). Note that in another press release on the same day (today) 28 April 2005,
http://www.angolapress-angop.ao/noticia.asp?ID=337535
(300 women in a the city of Rangel [suburb of Luando] came for an information talk about Marburg)
They use old numbers 264 cases (total) 239 deaths (total).
Strange. Two press releases, same day, different data.
I don't know what to say except that I'm resigned to merely following trends and anecdotal reporting. This report sounds very bad on the upper extreme, but I am quite sure that there will be one sounding quite credible which is lower in the next couple of days.
To be fair, nobody can possibly know how many infected people have Marsburg in Angola. It's way too primitive and the people are way too superstititous to provide good date for our review. Nobody knows, not WHO, not the Angolan government, not Doctors Without Borders.
They only know what they know and nothing about possible cases that haven't come to their attention.
The official numbers are untrue to the low side, simply because of the reporting problem. I think if they were four times as high, we'd know that as well from anecdotal reporting.
The crisis is far from over. It's still spreading and it could conceivably spread into a major metropolitan center.
But it hasn't yet, and for that I'm thankful.
We've run into this conflicting data problem before, many times. Depending on the source, the day of the week, and the particular spokesperson, you could easily think that this outbreak was undergoing a decline, a linear, or an exponential increase.
What you said.
Thank you, Mrs. tdewey10 for the translation.
If that is true, it is disturbing information.
If these numbers are correct, then however you do the analysis (D_c/I_c or # active cases), the growth rate is back up to what it had been in the early part of the epidemic: exponential with maybe a 9 day e-folding time. I don't care particularly about the number of cases per se, it is the growth rate that is of concern.
It is pretty clear that in the early part of the epidemic, this thing was growing fast.
Then, the WHO stepped in and from all indications the growth rate stopped. (We may not like their data reporting, but they evidently did a superb job in slowing / stopping this thing). The number of cases flattened out pretty quickly. Moreover, it is clear from the anecdotal evidence that they succeeded somewhat--as we have all pointed out, the number of cases predicted by the original data did not materialize.
However, as Dog Gone pointed out in his "firefighter" post earlier, the "containment" of the epidemic is dynamic. The natural growth of the epidemic is balanced against the isolation efforts of the WHO.
What I personally have found unsettling about that is that it is funamentally an unstable equilibrium. Like trying to balance a pencil on its end. If it gets away from you, the equilibrium is lost and you are back on the growth curve.
We can still hope that there is something lost in translation here (apologies to the Mrs., tdewey10). Perhaps they meant total cases not active cases. Or perhaps it is a total of 175 potential active cases and only 89 confirmed active cases. 89 is more than 24, but it is only a factor of 4 more, not a factor of 10 more.
As I recall, they had first around 500, then around 400 people who were under surveillance after potential exposure to Marburg. We heard nothing about those people, until now, perhaps?
I'm seriously thinking that's what happened. In fact, until I hear differently, that's what happened.
http://www.promedmail.org/pls/askus/f?p=2400:1001:8799812236100773040::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,28779
Could be.
"Around 526 people who have been in direct contact with
the sick or corpses are being tested and [quarantined]."
The promed release is based on another angolan press release [in english and portugese] on the 27th.
http://www.angolapress-angop.ao/noticia-e.asp?ID=336900
Uíge: Three More Marburg Cases Detected
Luanda, April 27 - Three more Marburg cases, from which one resulted in death, were detected on April 25 in the north uíge province, making a total of 256 registered cases since the outbreak.
According to data from the Health Ministry (MINSA), from the three cases, two were confirmed at laboratory. Untill Tuesday two of the sick were hospitalised at the provincial.
Around 526 people who were in direct contact with the sick ou corpses, are being tested and controlled.
On the other hand, since the outbreak, in October 2004, 267 cases and 247 deaths, were detected in the whole country.
I absolutely agree with you.
Indeed, I would argue that part of this is an artifact of the "administrative re-classification" of data.
The initial growth rate was quite high. It seems pretty clear that the WHO slowed it down a lot. However, they probably didn't slow it down as much as they advertised. By administratively reclassifying their data, they made it look like they had stopped this cold.
However, you can't change the underlying reality. So, the disease continued to spread: at a rate much slower than originally because of the isolation efforts, but somewhat faster than they were advertising. Well, it may have caught up with them. The data looks like: fast growth, no growth, then fast growth.
The reality, as you correctly observe, may have been fast growth followed by slower growth.
Of course, this is predicated on the assumption that the current report is accurate, and that is problematic given that the data have been all over the map.
The next official WHO report will be telling. If they continue to claim only ~20 active cases, then I will be concerned. Either the present report is wrong, or the WHO is REALLY doing an "administrative reclassification" of data. Big time. However, if their report confirms ~100-250 active cases, it will appear that the epidemic fully broke out of containment. Alas, if you tell a lie, you must tell another one to cover it up and so on....
This whole thing is giving me the willies.
I absolutely do NOT trust the UN-WHO. It seems apparent to me from all we have learned about the UN recently that they will say whatever is most expedient for the money, or some sort of gain.
WHO has a definite agenda, and looking like failures confronting a Marburg outbreak in Angola is not on it. Gabz, correct me if I'm wrong.
The problem I have with that statement is that it doesn't make logical or mathematical sense.
If 89 cases are confirmed, they're no longer suspected. You certainly don't get to add that total onto the suspected cases to come with a new total.
This whole thing is frustrating. The data sucks. The reporting sucks. Much of the problem may come from cultural issues and translation errors.
I dunno, but we're sitting here analyzing garbage date trying to determine a threat assessment. It's not really possible to do so with any assurance that it has any validity.
garbage DATA, although I suspect you all recognized the typo.
http://www.who.int/infectious-disease-news/IDdocs/whocds200528/whocds200528en.pdf
A little humour for you ;-)
I agree with every sentence you made.
I think we are relegated to considering orders of magnitude only. So, for the current data set:
89 ~= 175 ~= 264 >> 20
And that assumes that this report is correct.
It also give me the willies.......
While I would really like to believe 2ndreconmarine's premise that it appears WHO has actually accomplished something here is actually what is happening - without independent verification I have a hard time swallowing very much of anything that comes from them.
Based on past experience with other issues where WHO and affiliates have outrighted lied - I have a hard time believing anything they say. I'm in complete agreement with Judith Anne - looking bad is not on WHO's agenda, even if it means people die. My utter contempt for them and their agenda goes beyond words.
With all of that said - in this case I actually hope that I am proven to be 100% wrong.
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