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That last part at the end bodes ill for the chance to contain this outbreak http://crofsblogs.typepad.com/h5n1/2014/08/ebola-in-rivers-state-160-now-under-surveillance-late-doctors-wife-moved-to-lagos.html quote:Ebola in Rivers state: 160 now under surveillance, late doctor’s wife moved to Lagos
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# ? Aug 30, 2014 05:32 |
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# ? May 2, 2024 21:04 |
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http://www.vancouversun.com/health/Experimental+Ebola+drug+healed+infected+monkeys+study+human+tests/10160510/story.html An experimental Ebola drug healed all 18 monkeys infected with the deadly virus in a study, boosting hopes that the treatment might help fight the outbreak raging through West Africa. Scientists gave the drug, called ZMapp, three to five days after infecting the monkeys in the lab. Most were showing symptoms by then, and all completely recovered. Three other infected monkeys not given the drug died. Seven people were given ZMapp in the current outbreak and two have died, but doctors say there is no way to know if ZMapp helped. The very small supply is now gone and it will take several months to make enough to start studies in people.
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# ? Aug 30, 2014 05:40 |
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Ebola Roulette posted:This outbreak is worse because Ebola is infecting people in cities, rather than small villages. In previous outbreaks, Ebola would hit a relatively secluded village or town, kill a lot of people, and burn itself out before it could spread. This outbreak is bad because it's not going to burn itself out. This probably has nothing to do with Western Africa being ill equipped, but a difference in culture and population density. Also, it's easy to quarantine a village out in the middle of no where, but not so much a city. Oh, I certainly don't doubt that cities (instead of rural villages) being infected is a huge factor in how bad this outbreak has become. What I was really getting at is Ebola was so firmly entrenched in Central Africa as a disease localized there that West Africa had no system when compared to what DR Congo and Uganda have set-up. The fact this is happening in West African capital cities is just an extra kick in the teeth.
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# ? Aug 30, 2014 07:02 |
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Sheng-ji Yang posted:http://www.vancouversun.com/health/Experimental+Ebola+drug+healed+infected+monkeys+study+human+tests/10160510/story.html Then we get to deal with the tricky part of informed consent restrictions on experimental drugs: we can only give experimental drugs to educated (richer) ebola patients
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# ? Aug 30, 2014 07:14 |
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Jesus. How the heck do you punish people who get a highly lethal disease and take, willingly, actions that spread it to others? What can you even do to them?
Fangz fucked around with this message at 14:57 on Aug 30, 2014 |
# ? Aug 30, 2014 14:52 |
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CSPAN Caller posted:However, West African countries are literally ill equipped. Doctor Abraham Borbor, one of the Liberian doctors that received ZMapp, died a few days ago. He was the only internist in the whole country. It's hard to overstate just how understaffed and underfunded the medical system is in the areas that are having to deal with EBOV.
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# ? Aug 30, 2014 15:26 |
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Fangz posted:Jesus. How the heck do you punish people who get a highly lethal disease and take, willingly, actions that spread it to others? What can you even do to them? A quarantined hospital room?
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# ? Aug 30, 2014 15:36 |
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TheBalor posted:A quarantined hospital room? Yeah that's pretty much it. You can't really look to punish here, there's a lot of logical distrust for the government and institutions, and humans aren't exactly rational creatures when it comes to poo poo like this (cf. people freaking out in America for absolutely no reason). Not to mention that Ebola can cause confusion and aggressive behavior. To expand a bit on my last post: Dr. Borbor worked at JFK, the national hospital of Liberia. He was one of a handful of doctors that stayed behind to treat patients during the Liberian civil war. There were stories of him & Dr. Brisbane, the chief of medicine at JFK, carrying rifles from ward to ward to chase off soldiers that were looting the place. Both he & Dr. Brisbane died of Ebola and now the hospital basically has no department of medicine.
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# ? Aug 30, 2014 16:15 |
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Pretty crazy to picture a country with only 50 doctors when I drive down any street in the US and run into a physicians building with the same amount
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# ? Aug 30, 2014 16:18 |
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Yeah, there are three towns in Benin near me within my 'zone medicale'. The total population is somewhere around 300,00. Number of doctors? 1 Number of nurses? 6 Number of midwives? 30-ish Traditional healers? Around 70 There is a huge issue with how underserved African populations are when it comes to good medicine.
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# ? Aug 30, 2014 16:26 |
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It's also really difficult to fix something like that because qualified healthcare workers can easily leave for somewhere better. It's why you end up with lots of people like Kent Brantly.
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# ? Aug 30, 2014 16:58 |
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Fangz posted:Jesus. How the heck do you punish people who get a highly lethal disease and take, willingly, actions that spread it to others? What can you even do to them? "actions that willingly spread disease" is a pretty vague term that covers vastly different conduct. There's a big difference between someone who is just not following proper medical practice and someone who is intentionally spreading the disease. It's the difference between malicious and negligent behavior. To put this into the terms of something like HIV, there's a difference between someone whose partner tested positive and still isn't wearing a condom and "bug chasers" who knowingly and deliberately are trying to spread infection. You can argue that a diplomat should have known better, but ultimately they're still human and the same cognitive biases apply to them as anyone else. No one wants to believe they've contracted an incredibly deadly disease and are likely about to die, the brain will often avoid acknowledging that until it's absolutely undeniable, and sometimes won't admit it even then. Especially if it means that they're going to get locked into a quarantine ward with people who definitely have Ebola, which is practically a death sentence in the event they don't have it. So how do you punish someone for trying to evade a death sentence? I mean the real dumbass in the story sounds like the doctor who instructed the patient to dodge quarantine and travel to his country in the first place, and he paid with his life. Paul MaudDib fucked around with this message at 17:52 on Aug 30, 2014 |
# ? Aug 30, 2014 17:39 |
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Paul MaudDib posted:So how do you punish someone for trying to evade a death sentence? There are truly very few options, some more free and productive than others. Here are the policy suggestions I've come across which address this: 1. Adequately, accurately, and independently pay all civil servants-- direct deposit of salary into the individual's bank account, made at reegular intervals and adjusting upward to deal with cost of living issues. Or, the US system of paying Federal employees 2. Make Ebolavirus infection a 50/50, rather than 90/10, sentence. This requires both basic healthcare allocations without much corruption AND basic infrastructure spending. Two policies which cannot be enacted when nations are dependent upon cyclical market forces for revenue intake from tarrifs. 3. Rapid and independent, non-national government, response when potential outbreak is identified: this is most effective when dealing with isolated clustering of cases and efficacy is rapidly reduced the wider the area necessitating a response 4. Use of force to ensure quarantine violation is greater death risk than untreated Ebolavirus; effectively, sanitary quarantine with use of force. This only works when forces regularly, adequately, and independently paid, who expect a risk to themselves and the community-grouping they most highly value from any infraction of compliance, are employed for enforcement mechanisms 5. You can't, and develop contingency plans to deal with regional outbreaks in any area where the above four operational guidelines will not work Guess which strategy WHO is pursuing im Ebolavirus-outbreak nations? E: the options for bordering and regional nations are similar, while varying slightly: A) Ban cross-border travel from endemic regions--can only effectively be enforced if the nation can adequately pay its enforcers a decent wage continuously through an accountable financial organization in order to vastly reduce the risk of bribery B) Accept cross-border travel, so long as travelers are willing to register with a central authority: subject to the same issue of corruption, in addition to inaccurate information provised by the individual migrant and political pressures the migrant may resort to C) Institute a policy of strict, 48-day quarantine and contact-tracing for all cross-border migrants from outbreak nations; this is what most of the world is implementing, and is hard to implement in the West African region. D) Isolate and hold any migrants from outbreak nations in hastily-constructed or converted containment facilities; this is a tried and proven policy intervention that, while costly, is effective when its enforcers are adequately, frequently, and officially paid. All of these require logistics capacity and non-corruption which, frankly, does not much exist outside the Western world. My Imaginary GF fucked around with this message at 23:52 on Aug 30, 2014 |
# ? Aug 30, 2014 23:38 |
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My Imaginary GF posted:
Yeah because nonwhites are all corrupt, except for the notably nonwhite nations of Singapore, Japan, and Hong Kong
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# ? Aug 31, 2014 00:03 |
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If anyone's interested in reading a book on zoonotic diseases, I recently finished Spillover and really enjoyed it. The author downplayed the disease from the perspective of possible global outbreak for various reasons—lack of a real latency period, quick deaths, and the fact that it is a blood-borne disease. But my god is it a terrifying disease once you have it or if you're in the area of an active outbreak.
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# ? Aug 31, 2014 00:22 |
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Peven Stan posted:Yeah because nonwhites are all corrupt, except for the notably nonwhite nations of Singapore, Japan, and Hong Kong I don't know, Russia and the ex-Soviet republics are right up there with the best of the field. It's just a function of political corruption not yet having progressed to the level of subtle grifting a la Wall St et al. Hell, all three countries you mentioned are ridiculously corrupt, they just have institutionalized rituals for keeping up appearances and make sure the peasants don't all die of the plague.
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# ? Aug 31, 2014 01:05 |
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Xandu posted:Liberia's lifting quarantine of West Point. That didn't last long. How long ago was it that the medical center with the Ebola patients was raided? Like 2 weeks ago? Doesn't the virus take up to 21 days to show symptoms? It sounds like it's way too early to lift the quarantine. Maybe keeping it in place was getting too difficult.
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# ? Aug 31, 2014 03:05 |
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Not only that, but that's not how a quarantine works. If you're going to quarantine a neighborhood, the quarantine should be lifted three weeks after the last case occurs. So as soon as someone in the quarantined area gets sick, the timer resets.
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# ? Aug 31, 2014 04:19 |
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Ebola Roulette posted:Not only that, but that's not how a quarantine works. If you're going to quarantine a neighborhood, the quarantine should be lifted three weeks after the last case occurs. So as soon as someone in the quarantined area gets sick, the timer resets. Yes, well, Liberia seems to be on life-support as a nation right now. I wouldn't be surprised if mass riots begin to break out soon over food issues. I've yet to come across a 'daily food price' aggregator for impacted nations and would love if anyone could make a suggestion for that. In the meantime, came across a new resource with lots of easily-comprehensible graphs: http://maimunamajumder.wordpress.com This whole epidemic has me a bit , at least the post-epidemic regions that maintain some state government can't be worse, right? Right?
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# ? Aug 31, 2014 04:45 |
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When can we expect it to spread outside of Africa? Because unfortunately, I think that's when the world will actually start to take it seriously.
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# ? Aug 31, 2014 04:51 |
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enraged_camel posted:When can we expect it to spread outside of Africa? Because unfortunately, I think that's when the world will actually start to take it seriously. Welcome to advanced linear modeling, or, God I hate my life why'd I choose to take this class with a bunch of MPHers? Multiply the chance of an individual acquiring Ebolavirus by coming into contact with an infected individual by the number of individuals coming into contact with Ebolavirus-cases, determine with p=.01 on the timeframe it takes for them to develop transmission potential, the timeframe during which they are most likely to secrete the virus and have another individual go on to develop a case, and you'll find an answer. That's the really, really, really dumbed down version of it. I'll see if I can find all the numbers I need to write up a very simple model. E: Once again I must recommend Pepin's Origins, as that's where I'm copying some speculative methodology for cross-species transmission and whatnot. If interested, please do read CDC's book review: http://wwwnc.cdc.gov/eid/article/18/7/12-0461_article My Imaginary GF fucked around with this message at 06:18 on Aug 31, 2014 |
# ? Aug 31, 2014 05:06 |
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Charliegrs posted:How long ago was it that the medical center with the Ebola patients was raided? Like 2 weeks ago? Doesn't the virus take up to 21 days to show symptoms? It sounds like it's way too early to lift the quarantine. Maybe keeping it in place was getting too difficult. The quarantine was totally ineffectual. It was ended not because they thought it had achieved its goals, but because it was just a waste of resources and if anything helped spread the disease. Any mass quarantines in Liberia are going to fail. http://www.nytimes.com/2014/08/29/world/africa/in-liberias-capital-an-ebola-outbreak-like-no-other.html
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# ? Aug 31, 2014 07:28 |
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Terribly sad in depth story about the state of health care in Freetown. http://www.washingtonpost.com/world...ad33_story.html
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# ? Aug 31, 2014 13:33 |
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enraged_camel posted:When can we expect it to spread outside of Africa? Because unfortunately, I think that's when the world will actually start to take it seriously. Probably right before the Nigeria oil exports collapse and Book Haram rides into Lagos. (It's a long way off, or is it? )
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# ? Aug 31, 2014 15:14 |
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Sheng-ji Yang posted:The quarantine was totally ineffectual. It was ended not because they thought it had achieved its goals, but because it was just a waste of resources and if anything helped spread the disease. Any mass quarantines in Liberia are going to fail. I had read some accounts of bribes and smugglers being used to get in and out of the quarantine zone, it was porous and pointless unfortunately. Considering how ever-present the threat of a re-eruption of the Liberian Civil War is, was this really the best show of authoritarian police force Liberia could come up with?
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# ? Aug 31, 2014 15:18 |
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http://grantbrown.github.io/libspatialSEIR/doc/tutorials/Ebola2014/Ebola2014.html#conclusions-sect This guy (biostatician/epidemiologist) is still updating his predictions and theyre still super dire. quote:As of 8/28, these look like reasonable predictions, however the models appear to have resumed predicting a fairly catastrophic continued spread, especially in liberia. In particular, the models predict that the epidemic will take off in Nigeria, as the countries are assumed in this case to share several intensity parameters. We may hope that this particular simplifying assumption is invalid, however it is not a hopeful sign that WHO predictions are also becoming catastrophic. These models can not anticipate public health interventions and sudden changes in governmental policy and individual behavior, but recent news from the region gives little reason to hope for a swift end to the epidemic. It is more important now than ever to support the efforts of involved governmental and non-governmental organizations like the WHO and MSF Sheng-Ji Yang fucked around with this message at 15:22 on Aug 31, 2014 |
# ? Aug 31, 2014 15:20 |
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Charlz Guybon posted:Terribly sad in depth story about the state of health care in Freetown. This article is excellent and I recommend everyone here read it. Here's a figure from the article: It's just mind blowing. The article also goes into really great depth on how shame, ostracizing, misinformation, and lying to avoid shame make this outbreak hard to control.
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# ? Aug 31, 2014 15:34 |
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Sheng-ji Yang posted:http://grantbrown.github.io/libspatialSEIR/doc/tutorials/Ebola2014/Ebola2014.html#conclusions-sect I've seen his analysis and I don't buy it. 1. His predictive performance seems pretty rubbish overall in the past, and more concerning it seems like he underestimates his degree of uncertainty. (Those 90% credible intervals are way too tight.) http://grantbrown.github.io/libspatialSEIR/doc/tutorials/Ebola2014/Ebola2014_PastPred.html 2. A lot of his work seems to be based on the assumption that the rate of infection and death is constant over time, and across areas. This seems deeply suspicious.
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# ? Aug 31, 2014 15:57 |
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Sheng-ji Yang posted:http://grantbrown.github.io/libspatialSEIR/doc/tutorials/Ebola2014/Ebola2014.html#conclusions-sect What does "infectious count" actually mean? The number of people currently infectious? The number of people infected per day? Per week?
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# ? Aug 31, 2014 16:12 |
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Charlz Guybon posted:What does "infectious count" actually mean? The number of people currently infectious? The number of people infected per day? Per week? I believe it's the number of confirmed ebola cases.
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# ? Aug 31, 2014 16:47 |
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etalian posted:I believe it's the number of confirmed ebola cases. Per day? Per week? It can't be total, there are more than that now.
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# ? Sep 1, 2014 01:06 |
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Charlz Guybon posted:Per day? Per week? It can't be total, there are more than that now. Reported cases at any given moment, I believe.
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# ? Sep 1, 2014 01:36 |
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Devastating new projections. http://news.sciencemag.org/health/2014/08/disease-modelers-project-rapidly-rising-toll-ebola quote:
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# ? Sep 1, 2014 05:14 |
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How do human trials for a vaccine work?
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# ? Sep 1, 2014 06:17 |
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Xandu posted:How do human trials for a vaccine work? In general, by giving the people chosen for the study the vaccine and exposing them to the disease causing agent. With emergency response units on alert at all times to treat people who end up getting the disease.
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# ? Sep 1, 2014 06:28 |
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Can't imagine volunteering for that study. Seems like giving it to people already at risk and them having a control group would work well, though less scientific I guess.
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# ? Sep 1, 2014 06:31 |
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Nintendo Kid posted:In general, by giving the people chosen for the study the vaccine and exposing them to the disease causing agent. With emergency response units on alert at all times to treat people who end up getting the disease. The name Helsinki keeps popping up in my head as I read this.
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# ? Sep 1, 2014 07:10 |
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Xandu posted:Seems like giving it to people already at risk and them having a control group would work well, though less scientific I guess.
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# ? Sep 1, 2014 07:23 |
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I haven't spent as much time studying clinical vaccine trials, or the additional exigencies that would apply in this circumstance, but generally speaking, the Declaration of Helsinki has fallen out of favor in a number of settings, for good and poor reasons. The FDA stopped referring to it altogether- it's seen as, in different situations, either giving researchers too much or too little ethical latitude.
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# ? Sep 1, 2014 07:26 |
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# ? May 2, 2024 21:04 |
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Xandu posted:Can't imagine volunteering for that study. Pretty much. It is usually loved ones, caretakers, the genetically susceptible, etc who are given the vaccine trial because they will probably end up with the disease without having to go Full Nazi and outright infecting them.
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# ? Sep 1, 2014 07:55 |