Posted on 04/30/2005 10:53:17 PM PDT by Judith Anne
The Angolan Ministry of Health reported totals of 275 cases of Marburg hemorrhagic fever and 255 fatalities on Wed 27 Apr 2005. Therefore there have been only 2 additional deaths during the past 72-hour period, suggesting that the situation has been stabilized despite the lapse in disease security at the Provincial Hospital in Uige. - Mod.CP]
The above commentary at ProMed is incorrect because it is relying on the daily totals in the Minstry of Health report, but the report totals included the number of new cases minus the number of discarded cases. Thus, the report on April 27 indicated the total number of cases was 270 (259 in Uige) and the deaths were 248 (237 in Uige) on April 25. However on April 26 there were 3 new cases and 5 new deaths, which raised the totals to 273 cases (262 in Uige) and 253 deaths (242 in Uige). The latest media report increases the number of cases to 277 (266 in Uige).
Thus, the number of cases and deaths have been averaging 2-3 per day, which is lower than the daily average of about 5 for April, but about the same as March, when Marburg was identified and international support began to arrive. The "stabilization" in cases has really been a stabilization in totals, which include discarded reported patients. The discarding had been at about the same rate as newly reported patients. Since the number of patients outside of Uige is now down to 11, there are not many more cases available for discarding, so the increase in cases should be more reflective of the increase in reported news cases and deaths.
However, since a large number of cases outside of Uige were discarded, it is unclear what criteria was used. Similarly, this new criteria has kept the new cases limited to Uige. The cases outside of Uige have been reduced to 11, four of which were in Luanda. Since the 3 confirmed cases in Luanda are the only confirmed cases outside of Uige, there is no evidence that any of these outlying provinces can collect a Marbug sample that tests positive in the confirmatory lab test. So the possibility of false negatives from these areas is a concern. Moreover, the has been no explanation as to what caused the symptoms in these patients, most of whom had died and there is no explanation for the symptoms pof the large number of negatives in patients outside of Uige.
Similarly, there are persistent reports of suspect cases in neighboring Democratic Republic of the Congo, but since there have been nor confirmation or reported diagnosis on these patients, there true status has remained unclear. The potential hazard caused by these negative patients is the fact that the daily report from Angola indicates that the is not monitoring of contacts outside of Uige.
The numbers within Uige are also suspect because patients have again stopped coming to the hospital. The only survivor was just announced, so 257 deaths out of 258 cases does not make a hospital admission attractive. Moreover, more health care workers have died or have a fever and more breeches of infection control procedures in the hospital have been report.
The the possibility of a serious undercount in and around Uige remains a very real possibility.
Pinging the list...
I, and others, have wondered about this for weeks.
A serious undercount, multiple breaches in infection protocols at the HOSPITALS, Marburg cases that suddenly turn out to be merely exercises (but the ministry of health was not informed), empty hospitals because the populace thinks that health workers are spreading the disease (and they may be) Marburg deaths that aren't counted because no lab confirmation is made, local healers giving "injections" to Marburg cases, porous borders, "administrative reclassification" of all cases outside of Uige...
NOT looking good.
Oh, and I forgot to mention, the Angolan president, Jose Eduardo dos Santos (did I get the name right?) out of the country on a visit to South America...
Oh my.. the truth finally starts to trickle out.
See also:
Marburg Spread to Democratic Republic of the Congo?
It's also at Recombinomics, with a news header and commentary.
http://www.recombinomics.com/News/04300501/Marburg_DRC2.html
out of the country on a visit to South America...
"How CONVEEENIENT".
That was my opinion.
s/b "That was my opinion, too."
Sorry.
Serious undercount...hmmm, I have such a bad feeling about it.
Anyone else getting worried? That becomes unknown growth...
mrsx
...And the Prez taking off to South America ?
That isn't very reassuring if this is getting loose...
maybe I am having a tin-foil episode...join me, won't you?
mrsx
277 was a possible slip of the health ministers tongue the other day, remember that? Y'all caught it then! Anyway they probably don't have a clue ...just those dying right in front of them and even those numbers are constantly tampered with!
mrs x
Listen … is that the sound of HORSES HOOVES I hear?
No, this looks like there is a numbers game going on to keep a panic down, as they are not reporting many cases which may or may not be confirmed (ever) because there is no way to run lab tests.
I would bet there are not many other likely suspects for someone dying this way, and few in circulation at present.
Things that don't make sense (TM)
(1) Blaming "Traditional Healers" for the spread.
see e.g.,
http://www.unicef.org/infobycountry/angola_26332.html
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/04/25/MNGOBCEFEV1.DTL&type=health
The poblem, according to the unicef article there are only around 150 traditional healers. If they were responsible for the spread, you think they'd all be dead by now.
(2) Blaming home "injections."
Same problem as above. If this was a source in the past, I don't see how it could be a continuing source, given that everyone who was injected or did the injections should be dead by now.
The Uigeians seem to be moderately on-the-ball, their concern with hospitals has turned out to be justified.
The recent BBC video showing no-one going near the dying baby suggests that they are no longer doing any kind of traditional mourning (laying hands on the dead, etc.)
And yet, the virus still spreads.
Possibilities:
(A) It's getting spread by mosquitos. We know that it can be spread via eating dead animals, could it have mutated such that it can stay alive in a mosquito host-body.
(B) It's being transmitted via the air.
(C) Your guess.
Yes, the numbers are suspect and almost certainly wrong. But this is freaking Angola where people still believe in witch doctors and reliable communication is rare. They can't even keep the power on to their hospitals.
I think it's more "clueless" than coverup.
A pale horse by the sound of it...
(Not zebras)
Fascinating article. Tons of good information. I will address my response in two posts.
First, consider the number of new cases and deaths at 2-3 per day. In addition, we know that there are about 20 active cases at any one time. (Again, using Angola Health / WHO statistics). Well, the simple calculation for the lifetime of a patient after symptoms until death is:
tau_d=active / rate = 21 / 3 = 7-10 days
OK, now we have a good number for the lifetime. Using the model, (c.f. Model Derivation) we know that the growth rate is then:
tau_g = tau_d * (1/((I_c/D_c) - 1))
D_c/I_c = .92, ==> I_c/D_c = 1.08 ==>
tau_g = 11.5 * tau_d
Since tau_d ~= 7 days,
tau_g = 80 days.
So, the growth rate is exponential with a time constant of 80 days. This number is perfectly consistent with the growth rate reported. Moreover, he reports:
Thus, the number of cases and deaths have been averaging 2-3 per day
With 250 cases, we have roughly that the daily new cases should be:
250*(exp(1/80) -1) = 3
It all fits very nicely. So, we have a real measure of the growth that is reliable, assuming reported data are correct. This is nice because the data fit the model perfectly. Indeed, a comparison between the 2nd and 3rd growth plots that we showed yesterday (c.f. Marburg Growth Plots) show the same thing. The calculation for D_c/I_c = .92 matches the reported growth in the third plot exactly.
A very disturbing point, and also the point you and many other posters to these threads have made.
How many real, but unreported Marburg cases are there?
The concern is not the number of cases, per se, but the fact that the growth rate determinations (by calculation or curve fit) would be wrong. What makes this a real threat is the potential for growth, not the numbers today.
If we take his statements as litteral truth, then:
1. There was no slowing of the growth rate, it was all due to "administrative reclassification."
2. The number of new, unreported cases is identical to the number of new, reported cases.
Therefore, the number of new, reported cases in April was:
277 - 120 = 157
If there were an equal number of unreported cases, 157, then the total number of cases would now stand at:
277 + 157 = 434
These numbers are disturbingly close to the growth rate predictions. The growth curve prior to April 10 suggested a growth rate that would have 500 cases by today (c.f. Growth Plots ). Moreover, we discussed a thread a few days ago (c.f. Additional Active cases post, and subsequent), that there were either 89, 174, or 263 additional, unreported cases. (Depending on the meaning of the English). Well
157 ~ 174
So, this report would be consistent too. Therefore, extending the Recombiniometrics analysis, there may the reported 277 cases, or the true number may be as high as ~450 or so.
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