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Is it time to think about Ebola again?

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  • Tue, Jun 18, 2019 - 12:01am   (Reply to #38)

    #41

    davefairtex

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    traveling while symptomatic

My sense is, we don’t know what the R0 of Ebola will be in an industrialized country because we don’t have enough experience.  In Africa, where the pattern appears to be, “people take care of their family at home – mostly until they die”, this ends up being a (70%) death sentence for the caregivers due to fluid exposure, who then pass it on to their caregivers and relatives.  If you intervene and remove the patient from the home and protect the caregivers, the epidemic stops.

But that’s not the pattern here in the US.  Mostly, if you catch something nasty, you go to the ER, even if you’re poor.  So all that risk borne by friends and family in Africa is transferred to the ER staff at US hospitals.  (And that’s why our ER docs are…understandably concerned).  So what’s R0 in the US?  It probably depends on the number of cases we get.

Certainly the people in the ER are better equipped to handle exposure – if they are aware of the risk.  But that initial exposure, before the ER staff is aware of Ebola risk, will probably end up killing 40% of that first ER staff.  (I pull that number from what happened in Nigeria – more on that, below).

But as you say, the big issue is when an infected, symptomatic patient gets the urge to travel.  The case in Lagos, Nigeria (largest city in Africa) was one such instance.  The R0 value for the index case was 12 (!).  Once the system responded (and it sure seems from the report as though they did an excellent job), it dropped off to 0.25 in generation 2, which saved the day.  There’s an excellent graph at the bottom of the report, here:  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm

The first known case of Ebola in Nigeria was in a traveler exposed in Liberia. On July 17, 2014, while under observation in a Monrovia, Liberia, hospital for possible Ebola, the patient developed a fever and, while symptomatic, left the hospital against medical advice. Despite advice against travel, on July 20 he flew by commercial airline from Monrovia via Accra, Ghana, to Lomé, Togo, then changed aircraft, and flew to Lagos. On arrival the afternoon of July 20, he was acutely ill and immediately transported to a private hospital where he was noted to have fever, vomiting, and diarrhea. During hospital admission, the patient was queried about Ebola and said he had no known exposure; he was initially treated for presumed malaria. Based on the patient’s failure to respond to malaria treatment and his travel from an Ebola-affected country in the region, treating physicians suspected Ebola. The patient was isolated and tested for Ebola virus infection while local public health authorities were alerted about a suspected case of Ebola. A blood specimen sent to Lagos University Teaching Hospital was confirmed positive for acute Ebola virus infection. The patient died on July 25.

This was probably the second-worst case scenario.  The only thing worse would have been if the index patient had staggered around the plane vomiting on all of the other passengers.  [Note: none of the other passengers on either plane were infected]

I think this case is probably instructive for us.  In responding to this outbreak, here were the challenges that they identified:

* there were discrepancies among the levels of political leadership in fully appreciating the enormous consequences that even a small Ebola outbreak could have on civil institutions such as hospitals, airports, and public gatherings

* the Nigerian public did not have specific information about Ebola, and early information provided by the press, in advance of official information from the health authorities, was sometimes inaccurate and created a nationwide scare. This scare resulted in some persons resorting to extreme and sometimes harmful and ineffective measures to avoid infection such as consuming large quantities of salt water, even in places distant from the outbreak.

* early efforts to establish an isolation ward were delayed due to a lack of Nigerian health care workers willing to care for patients with Ebola because of a lack of information and training about how to care for Ebola patients, and because care providers had been disproportionately impacted by Ebola in other affected countries

There’s a lot more in the report.  It makes for fascinating reading.

Clearly Ebola is a high risk situation, especially for the initial people who get infected (which will most likely be doctors and nurses – and being trained, they are totally aware of this), but if Lagos, Nigeria can do it, we probably can too, with the following caveat – as long as the number of patients who decide to travel while symptomatic remains relatively small.

Our best defense is a strong effort to contain the outbreak over in Africa.

Good news is, symptomatic patients appear to have only a small window in which they can travel relatively undetected.  And they aren’t able to transmit the disease until they are symptomatic.  Presumably.  I mean, I wouldn’t go around touching a pre-symptomatic Ebola patient just to test out the math.  But that’s what the statistics suggest.

  • Tue, Jun 18, 2019 - 04:52am

    #42

    sand_puppy

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    The Spread to Lagos Incident–Graph

The guy traveling to Lagos in 2014, the spread of Ebola, then its containment.

The first known case of Ebola in Nigeria was in a traveler exposed in Liberia. On July 17, 2014, while under observation in a Monrovia, Liberia, hospital for possible Ebola, the patient developed a fever and, while symptomatic, left the hospital against medical advice. Despite advice against travel, on July 20 he flew by commercial airline from Monrovia via Accra, Ghana, to Lomé, Togo, then changed aircraft, and flew to Lagos. On arrival the afternoon of July 20, he was acutely ill and immediately transported to a private hospital where he was noted to have fever, vomiting, and diarrhea. During hospital admission, the patient was queried about Ebola and said he had no known exposure; he was initially treated for presumed malaria. Based on the patient’s failure to respond to malaria treatment and his travel from an Ebola-affected country in the region, treating physicians suspected Ebola. The patient was isolated and tested for Ebola virus infection while local public health authorities were alerted about a suspected case of Ebola. A blood specimen sent to Lagos University Teaching Hospital was confirmed positive for acute Ebola virus infection. The patient died on July 25.

[exposure to death was 8 days, exposure to sick enough to need hospitalization 3 days.]

(Source mentioned by DaveF above)

  • Tue, Jun 18, 2019 - 12:28pm

    #43

    Barbara

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    We already know what will happen in the US when ebola arrives in the ER

The ER won’t diagnose it properly and ER staff will be infected.  No reason to believe things have improved in the last 4-5 years.

https://www.nbcnews.com/storyline/ebola-virus-outbreak/nurse-who-caught-ebola-settles-suit-against-dallas-hospital-n672081

https://www.washingtonpost.com/

 

  • Mon, Jul 08, 2019 - 06:49pm

    #44

    thc0655

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    Fictional account of an Ebola outbreak in the US

http://eatonrapidsjoe.blogspot.com/2019/01/fourteen-cows-10-prelude.html

  • Sat, Jul 13, 2019 - 06:26am

    #45

    thc0655

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    Latest WHO report

https://apps.who.int/iris/bitstream/handle/10665/325790/SITREP_EVD_DRC_20190707-eng.pdf?ua=1

  • Tue, Jul 16, 2019 - 06:34am

    #46

    sand_puppy

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    Ebola: Infected Pastor take bus trip to city of Goma

The Congolese health ministry announced that a pastor infected with Ebola took a bus from the epidemic center in Butembo, in the Kivu District of the Democratic Republic of the Congo, to the city of Goma, Rwanda, late Sunday, the first time the virus has spread to the major travel hub and home to more than two million people.

The man, traveling from Butembo, was quickly identified and transported to an Ebola treatment center, while authorities say that they have tracked down the other 18 passengers aboard the bus and would vaccinate them on Monday, according to the Washington Post.

  • Wed, Jul 17, 2019 - 11:44am

    #47

    sand_puppy

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    WHO recategorizes Ebola as "Global Health Emergency"

Just last month the WHO concluded that the current Ebola outbreak did NOT warrant the “global health emergency” categorization.  Today, with the crossing of an infected into a neighboring country, they changed their minds.

I don’t have the impression that really much changed.  In fact, last week the number of new cases dropped.  (see recent links by thc0655 and DaveF).  The border crossing prompted the re-categorizion.

And we remember that it is not so much the Known Infected going into the big city that is the danger, but the Incubating and Not-Yet-Known to be Infected that are the danger.

  • Thu, Aug 01, 2019 - 11:06am

    #48

    thc0655

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    Ebola update from Aesop

http://raconteurreport.blogspot.com/2019/08/ebola-update-august-2019.html?m=1

Also for reference, airfare from Goma to NYFC via Addis Ababa is $983, one way.
The only thing helpful about this is that the average per capita income in DRC is $800 per year, which ranks them at 226 (out of 228) on the world income list.

The only thing keeping Ebola in Africa, as always so far, is poverty.
If this gets into populations with somewhat more means of livelihood than $15.38/week, it goes everywhere, at the speed of 767s.

And given that medical personnel comprise 5% of the cases of this outbreak, it’s worth noting that the do-gooder aid workers are required to have round trip passage in hand before they can go there. Which was how the US got 8 of its 10 cases in 2014.

But it’s okay, because now we have 15 BL-IV beds.

My take on all of the above:
You’re never wrong to be prepared for bad things.
Canned food takes a long time to go bad.
And we’re always just one Duncan away from reliving 2014.
Assuming Bad People don’t help things along in that respect, a-purpose.
You cannot and should not expect Team Allahu Akbar to stay stupid forever.

That concludes our summary for August.
With the usual caveats about African math and accounting practices, and any developments of a more troublesome nature, we will revisit this in September, unless fate takes a hand.

  • Tue, Aug 13, 2019 - 09:54pm

    #49
    Jessica Cooper

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    Reply To: Is it time to think about Ebola again?

Ebola can spread rapidly, through contact with even small amounts of bodily fluid of those infected. Its early flu-like symptoms are not always obvious.

Its appearance in Bikoro – a market town close to other local towns, well connected by major rivers and near the national border – is a cause for concern.

This is an area where people connect, trade and travel – an environment ripe for spreading disease.

The West African epidemic of 2014-16 began in a small border village in Guinea, its first victim thought to be a two-year-old boy who died in December 2013.

  • Sun, Aug 18, 2019 - 06:33am

    #50

    thc0655

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    Good news Sunday

Early indications are of a cure.

https://www.wired.com/story/ebola-is-now-curable-heres-how-the-new-treatments-work/?verso=true

 

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