|
RoboChrist 9000 posted:So... as an American, what's my best choice for country to flee to in order to avoid the imminent viral apocalypse that apparently we're now sure the country is going to have because one, maybe more than one, guy got the virus. Nowhere, everywhere's connected now. And if the virus is widespread enough it'll loop around a few times probably. Just act normally, you'll either live or die to it.
|
#
?
Oct 2, 2014 03:44
|
|
|
|
| # ? Jun 7, 2024 11:11 |
|
|
Horking Delight posted:Actually, the US measures in hospital beds per thousand people. http://data.worldbank.org/indicator/SH.MED.BEDS.ZS In terms of measuring it per 1000 the US is at 2.9 and Liberia is at 0.8
|
|
#
?
Oct 2, 2014 03:45
|
|
|
My Imaginary GF posted:How do you calculate R? How do you calculate k? Yeah this isn't all that stable with something like influenza, but ebola has a 3-week incubation period on top of that. Horking Delight posted:Actually, the US measures in hospital beds per thousand people. I messed up the measurement unit there - the measurement is hospital beds per 1k people for both measurements. I was using the World Bank figures - http://data.worldbank.org/indicator/SH.MED.BEDS.ZS - but the CIA world factbook has similar numbers. Salt Fish posted:This strikes me as exceptionally bad logic. Yes, if you assume that an outbreak has an arbitrary size then any amount of resources is inadequate. There is not an arbitrary size of outbreak. There is a single primary case. I guess I'm thinking of this in Order Complexity terms. We have a disease that follows exponential growth patterns (eg InitPop * 1.8^t). Fundamentally there is no linear increase of treatment capacity that can address that kind of situation - if you're not addressing the basic reproduction number (the 1.8) then you're just stalling for a couple more doubling periods. Now - things like "getting people in hospital beds" do improve the reproduction number by a vast amount. But again not everyone in the US has access to hospital beds - the poor/uninsured/underinsured very well may choose to try and ride out their "flu" instead of racking up a $10k hospital bill, the undocumented may not want to risk getting deported, etc. And at some point we run out of hospital beds, living hospital staff, and manpower to do tracing and other interventions, just like Africa does. e: Also the fact that the reproduction number that's been given for cases treated in hospitals is 0.12 is pretty concerning, in terms of what that means of burnup of healthcare staff. Some of those are family members before they hit the hospital and stuff - but even if it only means that you lose a staff member for every 50 people you treat, that's a long-term problem. Paul MaudDib fucked around with this message at 04:11 on Oct 2, 2014 |
|
#
?
Oct 2, 2014 03:48
|
|
|
Jackson Taus posted:Yeah, but that's in a large city. A lot of folks live in suburbs or rural areas, which might have a different ratio. I still don't think that adds up. 3/100k * 300 million is 9,000 beds. You have hospitals like NYC Presbyterian with 2.5k beds in one hospital system. Mt. Sinai down the street has 1k+. I would guess the number of beds is well over 100,000 in the US. Maybe you're looking at intensive care or ICU beds? That would be similar order of magnitude to a 9000 number but still pretty low.
|
|
#
?
Oct 2, 2014 03:48
|
|
|
AstheWorldWorlds posted:http://data.worldbank.org/indicator/SH.MED.BEDS.ZS Oooh, okay. So yeah, we have plenty of beds, but Liberia had a comparable amount (per capita).
|
|
#
?
Oct 2, 2014 03:51
|
|
|
Ebola Roulette posted:For sure. Lactic acid should not be looked at as a treatment. That was more of a vague possibility as to why HIV drugs helped patients with Ebola. Looking back at your original post and the paper you linked earlier, there's no evidence that HIV drugs do anything to Ebola. Completely different mechanism of replication. HIV cocktails are made up of reverse transcriptase and protease inhibitors, the former of which Ebola does not carry, the latter of which you'd need a specific inhibitor. But that's not a bad paper, if a little old. I learnt a few things from it. Firstly, immune serum from ebola patients isn't as effective as we'd think. Secondly, alot of the protective immunity is T cell mediated. Yes, you can cytokine storm, and it can kill you. But you absolutely do not want immunosuppression because then you can't control the virus at all.
|
|
#
?
Oct 2, 2014 03:59
|
|
|
effectual posted:Nowhere, everywhere's connected now. And if the virus is widespread enough it'll loop around a few times probably. Just act normally, you'll either live or die to it. Well I imagine North Korea will weather all of this just fine. It's going to be business as usual over there. But, yeah, I was being facetious. I'm not particularly worried. I live in New York, I'm reasonably middle class, and while I'm far from in the best shape imaginable, I'm not particularly sickly either. The odds of me dying from ebola are, I imagine, vastly slimmer than the odds of me being maimed or killed by a car while I am crossing the street.
|
|
#
?
Oct 2, 2014 04:08
|
|
|
Phobophilia posted:Looking back at your original post and the paper you linked earlier, there's no evidence that HIV drugs do anything to Ebola. Completely different mechanism of replication. HIV cocktails are made up of reverse transcriptase and protease inhibitors, the former of which Ebola does not carry, the latter of which you'd need a specific inhibitor. Yeah. I almost wonder if it even was the HIV drugs that helped the patients. I'd imagine if you were desperate enough to try them in the first place, they probably weren't the only drugs you used.
|
|
#
?
Oct 2, 2014 04:13
|
|
|
Posting some highlights from the WHO Updated Roadmap I linked to earlier today: -Oct 5, two USN mobile lab for Liberia become operational -Chinese lab in Freetown, SL began operations 29 Sept. with 20/day capacity. -Loss of appetite is an ebola symptom; the casw in Dallas has reported a loss of appetite since one week -Probable cases remain any suspected case evaluated by a clinician; important to note the Dallas language has used terms with high precision: specifically, there are no additional 'suspected' and no 'confirmed' cases; nothing has been said that I've seen on 'probable' case numbers -From my count, there are thirteen, red, color-coded T(reatment fascility)'s on WHO's map, indicating "There is a high and unmet demand for Ebola Treatment Units/referral centre/isolation centre capacity
|
|
#
?
Oct 2, 2014 04:14
|
|
|
I'm pretty sure I read in the Hot Zone years ago that loss of appetite was a symptom, seems strange the WHO would just be figuring that out?
|
|
#
?
Oct 2, 2014 04:16
|
|
|
Lote posted:I still don't think that adds up. 3/100k * 300 million is 9,000 beds. You have hospitals like NYC Presbyterian with 2.5k beds in one hospital system. Mt. Sinai down the street has 1k+. I would guess the number of beds is well over 100,000 in the US. Maybe you're looking at intensive care or ICU beds? That would be similar order of magnitude to a 9000 number but still pretty low. As Paul said above, the stat is actually 3/1k in both cases, not 3/100k. My point wasn't in trying to define exactly how many beds there are, I was just saying you can't estimate hospital beds in the US based only on urban hospitals. Paul MaudDib posted:I guess I'm thinking of this in Order Complexity terms. We have a disease that follows exponential growth patterns (eg InitPop * 1.8^t). Fundamentally there is no linear increase of treatment capacity that can address that kind of situation - if you're not addressing the basic reproduction number (the 1.8) then you're just stalling for a couple more doubling periods. Proper hospitalization cuts the reproduction number by a factor of like 10 - rather than infecting 1.8 people, a person hospitalized early would infect only 0.12 people. So even if we only properly hospitalize 3/5 of cases, the average reproduction rate falls to 0.792 and the disease is contained. If you want to say that the reproduction rate should be higher in the US because we're more crowded, fine. If we double those numbers (to 3.6 and .24) then we need to hospitalize something like 78% of cases to get reproduction rate below 1.0.
|
|
#
?
Oct 2, 2014 04:16
|
|
|
Sheng-ji Yang posted:I'm pretty sure I read in the Hot Zone years ago that loss of appetite was a symptom, seems strange the WHO would just be figuring that out? WHO has had loss of appetite/anorexia as a symptom for a while now. Why I highlight it is because the Dallas case has been reported as not consuming food for one week previous to sometime between the 29th and today.
|
|
#
?
Oct 2, 2014 04:18
|
|
|
I wanted a list of twitters that have come up in this thread and so I put one together - https://twitter.com/EbolaPope/lists/awful-ebola-tweets and a script to RT them (just back to the EbolaPope twitter). I'll try to keep adding them as they come up, and probably add some other crap from D&D and GBS be it uh, irreverent or informative.
|
|
#
?
Oct 2, 2014 04:20
|
|
|
Paul MaudDib posted:I guess I'm thinking of this in Order Complexity terms. We have a disease that follows exponential growth patterns (eg InitPop * 1.8^t). Fundamentally there is no linear increase of treatment capacity that can address that kind of situation - if you're not addressing the basic reproduction number (the 1.8) then you're just stalling for a couple more doubling periods. Ebola doesn't have an intrinsic growth pattern or rate. The number of infected individuals can increase or decrease linearly, exponentially, geometrically, or any other way depending on a huge variety of factors. Some of these factors are: education and awareness, availability of PPE, health care access, burial practices, hand washing prevalence, population density, etc. In a war-torn poverty stricken African nation that has a ritual of touching dead bodies and where many homes lack plumbing we are seeing an exponential growth in the number of reported cases. In a developed and modernized African nation we saw a steady decrease in cases. I don't see any reason to assume that the U.S "outbreak" would be more similar to Liberia and less similar to Nigeria.
|
|
#
?
Oct 2, 2014 04:23
|
|
|
So are my odds of becoming an Ebola corpse eaten by a wild pig in the streets going up, going down, or staying the same?
|
|
#
?
Oct 2, 2014 04:26
|
|
|
Nessus posted:So are my odds of becoming an Ebola corpse eaten by a wild pig in the streets going up, going down, or staying the same? Go ask in the GBS thread.
|
|
#
?
Oct 2, 2014 04:26
|
|
|
RoboChrist 9000 posted:So... as an American, what's my best choice for country to flee to in order to avoid the imminent viral apocalypse that apparently we're now sure the country is going to have because one, maybe more than one, guy got the virus. Madagascar
|
|
#
?
Oct 2, 2014 04:27
|
|
|
Job Truniht posted:Madagascar That's only in the old flash version. In Plague Inc. it's not particularly hard to get Madagascar.
|
|
#
?
Oct 2, 2014 04:31
|
|
|
north korea
|
|
#
?
Oct 2, 2014 04:33
|
|
|
Forgive me if this has been posted but there's another potential case in Hawaii: http://khon2.com/2014/10/01/patient-in-isolation-in-honolulu-hospital-officials-say-ebola-a-possibility/
|
|
#
?
Oct 2, 2014 04:35
|
|
|
Salt Fish posted:Ebola doesn't have an intrinsic growth pattern or rate. The number of infected individuals can increase or decrease linearly, exponentially, geometrically, or any other way depending on a huge variety of factors. Some of these factors are: education and awareness, availability of PPE, health care access, burial practices, hand washing prevalence, population density, etc. In a war-torn poverty stricken African nation that has a ritual of touching dead bodies and where many homes lack plumbing we are seeing an exponential growth in the number of reported cases. In a developed and modernized African nation we saw a steady decrease in cases. I don't see any reason to assume that the U.S "outbreak" would be more similar to Liberia and less similar to Nigeria. Nigeria and Senegal both successfully handled a situation like what we're seeing in Texas. The idea that we're going to jump from 1 dude to a thousands of folks infected seems like a stretch, but seeing half a dozen or a dozen cases in Texas before it gets handled is possible.
|
|
#
?
Oct 2, 2014 04:36
|
|
|
pfffhahahaha I was expecting this post the instant I saw MIGF's. MIGF, that link is a free stat platform that's much more sophisticated than SPSS, although it can also be difficult to use. Give it a try.
|
|
|
#
?
Oct 2, 2014 04:39
|
|
|
Jackson Taus posted:Nigeria and Senegal both successfully handled a situation like what we're seeing in Texas. The idea that we're going to jump from 1 dude to a thousands of folks infected seems like a stretch, but seeing half a dozen or a dozen cases in Texas before it gets handled is possible. Eh...I'm going to remain skeptical for another 3-4 weeks before buying that they managed it. It could be spreading slowly in a slum undetected now and take a while to build up the numbers to be noticed.
|
|
#
?
Oct 2, 2014 04:41
|
|
|
Paul MaudDib posted:Not from the real-world side of epidemiology - I generally work from the modeling side of things. But if it's such an easy thing to do, then why can't these African countries handle it? Is Bumfuck, Alabama going to be able to do significantly better? Because Bumfuck, Alabama has a functioning government and at least public trust in county/local institutions even if they might think the president is a satanic muslim or whatever. Sheriff Bob's your buddy.
|
|
#
?
Oct 2, 2014 04:41
|
|
|
Discendo Vox posted:pfffhahahaha I was expecting this post the instant I saw MIGF's. I would if I could use it on Android :-( That, and I know SPSS. I'm familiar with it and all its kinks. I'm not as familiar with R. I guess I'll have to try and get it running to see how things go. E: I do expect any cases with travel history to west africa and febrile symptoms to be immediately isolated and quarantined until the second test comes back negative. I wonder though, how many individuals with those criteria have been turned away or prescribed antibiotics. My Imaginary GF fucked around with this message at 04:55 on Oct 2, 2014 |
|
#
?
Oct 2, 2014 04:52
|
|
|
And even the most backwards part of the most backwards state can have experts and supplies arrive within hours. For a bunch of pretty smart cats I feel that sometimes some of you don't really have a good understanding of the developing world.
|
|
#
?
Oct 2, 2014 04:54
|
|
|
There are parts of the United States that are quite poor and disgraceful for a first world country, but none are anywhere close to comparable to, say, Liberia.
|
|
#
?
Oct 2, 2014 04:55
|
|
|
Salt Fish posted:Ebola doesn't have an intrinsic growth pattern or rate. So I mean - that's wrong. Every disease has an intrinsic growth pattern - transmission from infected to susceptible, within an average or baseline population member, absent interventions, etc. That's more or less one of the conceits that disease modeling asks you to accept. That however you define it, there's some disease baseline. quote:The number of infected individuals can increase or decrease linearly, exponentially, geometrically, or any other way depending on a huge variety of factors. Some of these factors are: education and awareness, availability of PPE, health care access, burial practices, hand washing prevalence, population density, etc. Of course that's true - those factors are what make the intrinsic growth pattern difficult to predict. That's why there's variation on the baseline, these factors have unpredictable effects. quote:In a war-torn poverty stricken African nation that has a ritual of touching dead bodies and where many homes lack plumbing we are seeing an exponential growth in the number of reported cases. In a developed and modernized African nation we saw a steady decrease in cases. I don't see any reason to assume that the U.S "outbreak" would be more similar to Liberia and less similar to Nigeria. For sure - things like running water certainly help at a bare minimum. Washing your hands with soap and hot water gives you a fighting chance of resisting an infection. You might model that as a region/country-wide reproduction number once the data were available for it. Totally possible that the US has a much lower "local" reproduction number from such factors. Nintendo Kid posted:Because Bumfuck, Alabama has a functioning government and at least public trust in county/local institutions even if they might think the president is a satanic muslim or whatever. Sheriff Bob's your buddy. True, although only as long as the intervention remains localized and it's Sheriff Bob running things. Guys in MOPP suits, maybe not so much. Jackson Taus posted:There's a vicious spiral in these outbreaks - as more folks get infected, hospitals become more dangerous, so people become less willing to go to hospitals, which just increases the infection rate. I've heard this proposed as "presence of fear". I've never heard a model for it though. quote:The difference between the US and Africa is that we're at the top of this spiral and our hospital capacity means the disease will have to get a lot more out of hand before folks start to be afraid of going to the hospital. Right now, if you're in the USA, you're symptomatic and there's a chance you have Ebola, the smart move is getting to the hospital as fast as you can, because that probably doubles your odds of survival. Right now in Sierra Leone, going to the hospital doesn't really improve your chances of survival much, and you're pretty likely to be exposed to Ebola if you go, so fleeing the hospital until you're literally puking blood is more or less the smart move. The problem is that you end up testing everyone with the flu for ebola. Which is problematic during flu season. You're basically betting the inertia of US hospital capacity can beat the rate of testing/hospitalizing a good chunk of the flu population. And people won't do it because they don't have insurance and stuff. Is it the flu or ebola? Do you want a wildcard hospital bill to find out? Is there enough lab capacity to find out? What is your burn rate in terms of medical staff? These are things that could be concerning. I don't claim to know all the factors here, but the overarching disease dynamics are kind of concerning on the surface. A reproduction number of 1.8 is concerning even given the factors involved - what if it really takes a pretty serious epidemic to get people to respect the personal protective equipment needed for some transmission vector? Or a scenario like low-lying land becoming reservoirs would be concerning in the south. Paul MaudDib fucked around with this message at 07:43 on Oct 2, 2014 |
|
#
?
Oct 2, 2014 05:25
|
|
|
America has closed sewage, common knowledge of germ theory of disease (even among yokels), a large amount of living space, and a culture that doesn't encourage physical contact nearly as much as many others. All good things for containing disease, on top of superior healthcare infrastructure and better-organized, more trusted institutions. Biggest downside is that we also have a lot of cars. Probably harder to keep track of where folks have been when they don't have to walk everywhere.
|
|
#
?
Oct 2, 2014 05:27
|
|
|
Guidelines for EMS personnel are out from the CDC. Found at: http://www.flutrackers.com/forum/showthread.php?t=228276 It would really suck for that ambulance crew if they performed pre-hospital resuscitation procedures. One interesting takeaway: CDC posted:If blood, body fluids, secretions, or excretions from a patient with suspected Ebola come into direct contact with the EMS provider’s skin or mucous membranes, then the EMS provider should immediately stop working. They should wash the affected skin surfaces with soap and water and report exposure to an occupational health provider or supervisor for follow-up.
|
|
#
?
Oct 2, 2014 05:44
|
|
|
Paul MaudDib posted:True, although only as long as the intervention remains localized and it's Sheriff Bob running things. Guys in MOPP suits, maybe not so much. Sheriff Bob and his temporary deputies can carry out the duties in protective suits if need be. They don't need to treat people after all, just get the obviously sick guy handed off to a friendly ambulance drive. Really, you're trying much too hard to blow things out of proportion - worst comes to worst sealing off county access becomes quite easy with some spare troops and state police.
|
|
#
?
Oct 2, 2014 05:46
|
|
|
We're going to ramp up production of ZMAPP, in spite of the fact that there's no clinical evidence that it works. U.S. to Increase Production of the Ebola Drug ZMapp, but May Not Meet Demand I hope we blanket Africa in the stuff. Even if it's just a placebo, handing it out will tamp down on the rumors that we're withholding it just to be evil motherfuckers.
|
|
#
?
Oct 2, 2014 06:32
|
|
|
Zeroisanumber posted:We're going to ramp up production of ZMAPP, in spite of the fact that there's no clinical evidence that it works. It's basically a hail mary since they didn't even complete the most basic phase testing. Also without phase testing it's impossible to nail down details like side effects or correct dosage
|
|
#
?
Oct 2, 2014 06:35
|
|
|
etalian posted:It's basically a hail mary since they didn't even complete the most basic phase testing. However, it is made more possible to get individuals to go to treatment when they're guaranteed a dose--even if the dose has yet proven effective.
|
|
#
?
Oct 2, 2014 06:37
|
|
|
Sheng-ji Yang posted:I'm pretty sure I read in the Hot Zone years ago that loss of appetite was a symptom, seems strange the WHO would just be figuring that out? It always has been a symptom, along with mood changes. One of the field docs was talking about this 2014 outbreak being especially sneaky because it masquerades as gastroenteritis. The initial symptoms are milder than in other strains, and milder than a lot of US doctors would expect for loving ebola, which is why the question about recent travel is so important. I wouldn't depend on The Hot Zone for an accurate representation of ebola. Read Level 4 Virus Hunters of the CDC if you want an book's account with less bullshit. Plus they cover Lassa and HIV. I bet these books seem hilarious quaint in the light of the current outbreak.
|
|
#
?
Oct 2, 2014 06:40
|
|
|
Honestly the ethics of testing drugs on Ebola is rather hairy. You have to rely on instances where people are infected with it, and you can't withhold ordinary treatment (without violating equipose), so there's no real good way to test ZMapp in controlled settings. It is a sign of desperation though, which is bad. There isn't any real reason to think ZMapp is effective, and it's unclear that if it's deployed to Africa it'll slow transmission of the disease. It's a crapshoot that has no good answers.
|
|
#
?
Oct 2, 2014 06:43
|
|
|
Ghost of Reagan Past posted:Honestly the ethics of testing drugs on Ebola is rather hairy. You have to rely on instances where people are infected with it, and you can't withhold ordinary treatment (without violating equipose), so there's no real good way to test ZMapp in controlled settings. There are no good answers. A one-in-a-thousand chance at a quick fix is better than the almost-assured humanitarian disaster that is beginning to gather great momentum in West Africa. Cases are growing faster than treatment can be deployed. What do you do? Evacuate everyone to an area where treatment may be provided? At most, thats 81,000 air passengers per month who are already doing so. I don't see how disaster can be avoided st this juncture in West Africa, especially with the oncoming malaria season, the collapse of all non-ebola healthcare infrastructure, the collapse of the food supply system, and the intra-ECOWAS seasonal migration of millions of individuals. Simply, Ebola is spreading at human speed. When cholera emerged, it was at maximum 2-3 years before all of Africa has endemic cholera; what prevents EVD from moving at the speed of its human hosts?
|
|
#
?
Oct 2, 2014 06:52
|
|
|
Jackson Taus posted:Nigeria and Senegal both successfully handled a situation like what we're seeing in Texas. The idea that we're going to jump from 1 dude to a thousands of folks infected seems like a stretch, but seeing half a dozen or a dozen cases in Texas before it gets handled is possible. Has Nigeria really handled it?
|
|
#
?
Oct 2, 2014 06:54
|
|
|
Just for the near panicky readers. Refute as necessary: http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-phobia-5-reasons-why-you-should-not-panic-over-n216246
|
|
#
?
Oct 2, 2014 06:57
|
|
|
|
| # ? Jun 7, 2024 11:11 |
|
|
Zeroisanumber posted:We're going to ramp up production of ZMAPP, in spite of the fact that there's no clinical evidence that it works. Even if it doesn't work, production involves transgenic tobacco (it's a great model organism for genetic research, this has nothing to do with the smokable tobacco industry). The process of producing large amounts of antibodies in tobacco still needs a lot of refinement. Even if ZMAPP doesn't work at all, it's useful knowledge and money well spent because god knows there's a lot of potential for transgenic tobacco to churn out inexpensive medical products (rabies immunoglobulin, for one. That poo poo's $1500 per dose.)
|
|
#
?
Oct 2, 2014 06:57
|
|