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Charlz Guybon
Nov 16, 2010
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

Via the Nigerian Tribune: Ebola in Rivers: 160 now under surveillance, late doctor’s wife moved to Lagos. The full report:

quote:

A total of 160 people have now been quarantined in Rivers State to contain the spread of the Ebola virus, according to Dr Sampson Parker, the state’s Commissioner for health.

Parker also told newsmen in the state capital, Port Harcourt, on Friday that Rivers State was in a war-time situation as it fought Ebola headlong.

Governor Rotimi Amaechi, the commissioner said, had pledged to provide funds to enable the state procure all relevant materials, as well as the services of medical experts from Nigeria and abroad, to make sure the Ebola virus is contained.

Parker also revealed that the late Dr Iyke Enemuo, who died of Ebola disease, last week Friday, in Port Harcourt was aware that Olu Ibikunle Koye, a Nigerian diplomat, working with the Economic Community of West Arican States (ECOWAS), was a carrier of the Ebola virus.

Speaking further, Parker said, “He (Koye) had received the late Dr Patrick Sawyer (the Liberian-American who transmitted the virus) in Lagos. Upon developing the symptom, he confided in a female colleague, called Lillian, who contacted the late Dr Enemuo.

“It was after contact was established with Dr. Enemuo that Olu Ibikunle Koye flew to Port Harcourt to see Dr Enemuo,” he said.

According to the health commissioner, to conceal his movement, Koye, who had been quarantined along with other people for having primary contact with Sawyer, sneaked out of the isolation unit and took a flight to Port Harcourt and switched off his phone so that he cannot be reached or traced.

Parker said, on arrival in Port Harcourt, Koye obfuscated being traced, checked into a Mandate Gardens, a local hotel in the Rumunokoro area in Obio/Akpor Local Government Area, within the vicinity where Enemuo’s private health facility, Sam Steel Clinic, was located.

“From what we have gathered so far, Dr Enemuo, knowing full well that Koye was positive of the Ebola virus, took some measures of precaution to protect himself while treating Koye.

“Knowing the enormity of what he was doing, Dr Enemuo, upon Koye’s departure for Lagos, poured bleach all over the room that Koye slept in order to sanitise the place.

“Upon developing the Ebola symptom, Dr Enemuo approached one of our colleagues for treatment at Green Heart Hospital, along Evboh Road, in the GRA. Dr Enemuo did not tell the doctor that was treating him the truth. He merely told him that he had fever. He lied. He did not tell the doctor that was treating him his full story.

“But the doctor, a nice and conscientious professional, suspected that Dr Enemuo was either hiding something or was suffering from a strange ailment because he proved negative to malaria, fever and typhoid fever.

“To be sure of what he was doing, he spoke to other very experienced doctors about the strange case he was handling in his hospital. He even invited some of his colleagues to come over to his hospital to study Dr Enemuo’s medical history.

“Of course, the news of the Ebola virus was everywhere. So, they were afraid to go. None of them showed up at the hospital where Dr Enemuo was being treated. His condition continued to deteriorate and he eventually died and his body was taken to the University of Port Harcourt Teaching Hospital (UPTH),” he said.

The Commissioner for Health further said when news got to Koye that the doctor that treated him in Port Harcourt had died, he collapsed and it was then that he opened up and confessed that Enemuo had treated him when he travelled to Port Harcourt.

Mr. Koye has more to answer for than infecting Dr. Enemuo: He presumably came in contact with dozens of people in the process of leavng Lagos, flying to Port Harcourt, and then returning. Patrick Sawyer and some of his contacts seem to have lost their wits as well as their lives.

Even more worrying: Koye felt ill but he was able to make the round trip and then "recover," evidently without seeing the inside of a hospital. Yet he was contagious enough to kill Dr. Enemuo.

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Sheng-Ji Yang
Mar 5, 2014


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.

Justin Godscock
Oct 12, 2004

Listen here, funnyman!

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.

on the left
Nov 2, 2013
I Am A Gigantic Piece Of Shit

Literally poo from a diseased human butt

Sheng-ji Yang posted:

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.

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

Fangz
Jul 5, 2007

Oh I see! This must be the Bad Opinion Zone!
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

Johnny Cache Hit
Oct 17, 2011

CSPAN Caller posted:

However, West African countries are literally ill equipped.
A MSF doctor on NPR two weeks ago was talking about shortages of basic supplies like bleach, gloves, and masks.

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.

TheBalor
Jun 18, 2001

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?

Johnny Cache Hit
Oct 17, 2011

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. :smith:

CAPS LOCK BROKEN
Feb 1, 2006

by Fluffdaddy
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

Slaan
Mar 16, 2009



ASHERAH DEMANDS I FEAST, I VOTE FOR A FEAST OF FLESH
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.

Xandu
Feb 19, 2006


It's hard to be humble when you're as great as I am.
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.

Paul MaudDib
May 3, 2006

TEAM NVIDIA:
FORUM POLICE

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

My Imaginary GF
Jul 17, 2005

by R. Guyovich

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

CAPS LOCK BROKEN
Feb 1, 2006

by Fluffdaddy

My Imaginary GF posted:


All of these require logistics capacity and non-corruption which, frankly, does not much exist outside the Western world.

Yeah because nonwhites are all corrupt, except for the notably nonwhite nations of Singapore, Japan, and Hong Kong

Prime Sinister
Mar 23, 2005

tony scare
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.

GROVER CURES HOUSE
Aug 26, 2007

Go on...

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.

Charliegrs
Aug 10, 2009

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.

Ebola Roulette
Sep 13, 2010

No matter what you win lose ragepiss.
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.

My Imaginary GF
Jul 17, 2005

by R. Guyovich

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 :smith:, at least the post-epidemic regions that maintain some state government can't be worse, right? Right?

Slow News Day
Jul 4, 2007

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.

My Imaginary GF
Jul 17, 2005

by R. Guyovich

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

Sheng-Ji Yang
Mar 5, 2014


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

Charlz Guybon
Nov 16, 2010
Terribly sad in depth story about the state of health care in Freetown. :(

http://www.washingtonpost.com/world...ad33_story.html

Randandal
Feb 26, 2009

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? :ninja: )

Randandal
Feb 26, 2009

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.

http://www.nytimes.com/2014/08/29/world/africa/in-liberias-capital-an-ebola-outbreak-like-no-other.html

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?

Sheng-Ji Yang
Mar 5, 2014


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

Ebola Roulette
Sep 13, 2010

No matter what you win lose ragepiss.

Charlz Guybon posted:

Terribly sad in depth story about the state of health care in Freetown. :(

http://www.washingtonpost.com/world...ad33_story.html

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. :smith:

Fangz
Jul 5, 2007

Oh I see! This must be the Bad Opinion Zone!

Sheng-ji Yang posted:

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.



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.

Charlz Guybon
Nov 16, 2010

Sheng-ji Yang posted:

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.
=

What does "infectious count" actually mean? The number of people currently infectious? The number of people infected per day? Per week?

etalian
Mar 20, 2006

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.

Charlz Guybon
Nov 16, 2010

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.

treasured8elief
Jul 25, 2011

Salad Prong

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.

Charlz Guybon
Nov 16, 2010
Devastating new projections. :stonk:

http://news.sciencemag.org/health/2014/08/disease-modelers-project-rapidly-rising-toll-ebola

quote:


Disease modelers project a rapidly rising toll from Ebola

Kai is a contributing correspondent for Science magazine based in Berlin, Germany.
By Kai Kupferschmidt 31 August 2014 10:00 am

Alessandro Vespignani hopes that his latest work will turn out to be wrong. In July, the physicist from Northeastern University in Boston started modeling how the deadly Ebola virus may spread in West Africa. Extrapolating existing trends, the number of the sick and dying mounts rapidly from the current toll—more than 3000 cases and 1500 deaths—to around 10,000 cases by September 24, and hundreds of thousands in the months after that. “The numbers are really scary,” he says—although he stresses that the model assumes control efforts aren't stepped up. "We all hope to see this NOT happening," Vespigani writes in an e-mail.

Vespignani is not the only one trying to predict how the unprecedented outbreak will progress. Last week, the World Health Organization (WHO) estimated that the number of cases could ultimately exceed 20,000. And scientists across the world are scrambling to create computer models that accurately describe the spread of the deadly virus. Not all of them look quite as bleak as Vespignani's. But the modelers all agree that current efforts to control the epidemic are not enough to stop the deadly pathogen in its tracks.

Computer models “are incredibly helpful” in curbing an outbreak, says infectious disease researcher Jeremy Farrar, who heads the Wellcome Trust research charity in London. They can help agencies such as WHO predict the medical supplies and personnel they will need—and can indicate which interventions will best stem the outbreak. Mathematical epidemiologist Christian Althaus of the University of Bern, who is also building Ebola models, says both WHO and Samaritan's Purse, a relief organization fighting Ebola, have contacted him to learn about his projections.

But the modelers are hampered by the paucity of data on the current outbreak and lack of knowledge about how Ebola spreads. Funerals of Ebola victims are known to spread the virus, for example—but how many people are infected that way is not known. “Before this we have never had that much Ebola, so the epidemiology was never well developed,” says Ira Longini, a biostatistician at the University of Florida in Gainesville. “We are caught with our pants down.”



To a mathematician, combating any outbreak is at its core a fight to reduce one number: Re, the pathogen’s effective reproductive rate, the number of people that an infected person in turn infects on average. An Re above 1, and the disease spreads. Below 1, an outbreak will stall.

Outbreak models typically assume that there are four groups of people: those who are susceptible, those who have been infected but are not contagious yet, those who are sick and can transmit the virus, and those who have recovered. A model, in essence, describes the rates at which people move from one group to the next. From those, Re can be calculated.

If the disease keeps spreading as it has, most of the modelers Science talked to say WHO’s estimate will turn out to be conservative. “If the epidemic in Liberia were to continue in this way until the 1st of December, the cumulative number of cases would exceed 100,000,” predicts Althaus. Such long-term forecasts are error-prone, he acknowledges. But other modelers aren’t much more encouraging. Caitlin Rivers of the Virginia Polytechnic Institute and State University in Blacksburg expects roughly 1000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.

Vespignani has analyzed the likelihood that Ebola will spread to other countries. Using data on millions of air travelers and commuters, as well as mobility patterns based on data from censuses and mobile devices, he has built a model of the world, into which he can introduce Ebola and then run hundreds of thousands of simulations. In general, the chance of further spread beyond West Africa is small, Vespignani says, but the risk grows with the scale of the epidemic. Ghana, the United Kingdom, and the United States are among the countries most likely to have an introduced case, according to the model. (Senegal, which reported its first Ebola case last week, was in his top ten countries, too.)

The models are only as good as the data fed to them; up to three-quarters of Ebola cases may go unreported. The modelers are also assuming that key parameters, such as the virus’s incubation time, are the same as in earlier outbreaks. “We might be missing the boat and we have no signal to indicate that,” says Martin Meltzer of the U.S. Centers for Disease Prevention and Control in Atlanta.

The biggest uncertainty is how much doctors, nurses, and others can slow the virus. There are many ways of pushing down Re, Farrar says—washing hands, wearing masks, or quarantining people, for example. “But given the complexity of this outbreak and the limited resources, we need to find out what are the two or three things that will most help drive down infections,” Farrar says, and that’s where models can help. For instance, would following up on all the contacts of every case be more effective than following up on the much smaller number who had a certain type of contact with a case, such as sharing a room?

Rivers is evaluating interventions, such as increased use of protective equipment or campaigns to isolate infected people. In the most optimistic scenario, every contact of infected people is traced, and transmission in hospitals is reduced by 75%. Even that, while drastically reducing the number of Ebola deaths, did not push Re below one.

The challenge varies by country, Althaus says. “In Guinea and Sierra Leone, Re is close to 1 and the outbreak could be stopped if interventions improve a bit.” In Liberia, Re has been near 1.5 the whole time. “That means work is only just beginning there.” But Meltzer says there is no reason to believe the situation is any better in Sierra Leone. “We are not seeing any change in the rate of the accumulation of cases,” he says.

As models get better at differentiating what is happening in places, Rivers says, “you might be able to put firelines around certain communities.” But such measures are very controversial. When Liberia last week barricaded off West Point, a sprawling slum with probably more than 100,000 inhabitants, it drew a largely negative response. “Quarantines and curfews tend to instill fear and distrust towards the whole of the outbreak response including health structures,” a representative for Doctors Without Borders told Science. Paul Seabright, a researcher at the Toulouse School of Economics in France who has studied such measures, says they are an incentive for people to keep it secret if they have had contact with a patient. Liberia’s harsh actions are “the last thing this epidemic needs,” he says.

People in West Africa will have to alter behaviors, Meltzer says. “We won’t stop this outbreak solely by building hospitals. There will have to be a change in the way the community deals with the disease.” Modeling that is easy enough, Vespignani says. “I can decrease the transmission at funerals by 40% easily in a model. That’s one line of code. But in the field that is really hard.”

Xandu
Feb 19, 2006


It's hard to be humble when you're as great as I am.
How do human trials for a vaccine work?

Nintendo Kid
Aug 4, 2011

by Smythe

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.

Xandu
Feb 19, 2006


It's hard to be humble when you're as great as I am.
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.

GROVER CURES HOUSE
Aug 26, 2007

Go on...

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.

Cicero
Dec 17, 2003

Jumpjet, melta, jumpjet. Repeat for ten minutes or until victory is assured.

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.
Yeah, isn't that how they did/do it with HIV vaccines?

Discendo Vox
Mar 21, 2013

We don't need to have that dialogue because it's obvious, trivial, and has already been had a thousand times.
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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Slaan
Mar 16, 2009



ASHERAH DEMANDS I FEAST, I VOTE FOR A FEAST OF FLESH

Xandu posted:

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.

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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