Ebolavirus 2014: the r0 from shitposting is 6.9

The Something Awful Forums > Discussion > Debate & Discussion > Ebolavirus 2014: the r0 from shitposting is 6.9

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

http://abcnews.go.com/Health/wireStory/sierra-leonean-doctor-sick-ebola-27588102

quote:

An official in Sierra Leone says one of the country's top doctors has contracted the Ebola virus.

Dr. Victor Willoughby is the 12th Sierra Leonean physician to become infected, 10 of whom have died.

# ? Dec 14, 2014 16:21

Adbot: ADBOT LOVES YOU

# ? May 3, 2024 01:13

IAMNOTADOCTOR: Sep 26, 2013

quote:

At a national level, Guinea, Liberia, and Sierra Leone have sufficient capacity to isolate and treat all reported EVD cases, and bury all EVD-related deaths safely and with dignity. However, local variations mean capacity is still insufficient in some areas.

This has bot been posted yet I think, but its from the December 10th WHO update. Hopefully this means that the situation in Sierra Leone will now also start improving.

# ? Dec 14, 2014 18:14

ohgodwhat: Aug 6, 2005

Ebola Roulette posted:

http://abcnews.go.com/Health/wireStory/sierra-leonean-doctor-sick-ebola-27588102

Do we fly these guys out of the country to treat them in more capable hospitals? At a 2 for 12 batting average, doesn't sound like it.

# ? Dec 15, 2014 02:01

IAMNOTADOCTOR: Sep 26, 2013

quote:

Reported case incidence is fluctuating in Guinea and declining in Liberia. In Sierra Leone, there are signs the increase in incidence has slowed, and that incidence may no longer be increasing.

More good news on ebola: http://www.who.int/csr/disease/ebola/situation-reports/en/

# ? Dec 17, 2014 22:25

Epitope: Nov 27, 2006; Grimey Drawer

IAMNOTADOCTOR posted:

More good news on ebola: http://www.who.int/csr/disease/ebola/situation-reports/en/

Cool graphs

# ? Dec 17, 2014 22:39

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

IAMNOTADOCTOR posted:

More good news on ebola: http://www.who.int/csr/disease/ebola/situation-reports/en/

That's awesome. I hope that incidence keeps decreasing in Sierra Leone

Unfortunately Dr Victor Willoughby died.

http://abcnews.go.com/Health/wireStory/11th-sierra-leonean-doctor-dies-ebola-27684697

quote:

One of Sierra Leone's most senior physicians died Thursday from Ebola, the 11th doctor in the country to succumb to the disease, a health official said.

Ebola has killed more than 350 health workers in West Africa, depleting the ranks of doctors and nurses in countries that already had too few to begin with. Because Ebola is spread through bodily fluids, it is only transmitted through close contact. It is often called the "caregivers' disease" because those infected are typically family members caring for the sick or health workers treating them.

Dr. Victor Willoughby tested positive for Ebola on Saturday and was being treated at a clinic near the capital run by the medical charity Emergency, said Dr. Brima Kargbo, the country's chief medical officer.

"Dr. Victor Willoughby was a mentor to us physicians and a big loss to the medical profession," said Kargbo. "He has always been available to help junior colleagues."

The 67-year-old died Thursday morning, just hours after an experimental drug arrived in the country for him. The arrival of ZMAb, developed in Canada, had raised hopes for Willoughby's survival. But he died before a dose could be administered, said Kargbo. ZMAb is related to ZMapp, another experimental drug that has been used to treat some Ebola patients. The drugs' efficacy in treating Ebola has not yet been proven.

Ebola has sickened more than 18,600 people, the vast majority in Sierra Leone, Guinea and Liberia. Of those, more than 6,900 have died. The disease is now spreading fastest in Sierra Leone, but the World Health Organization says there are signs the infection rate may be stabilizing there. The infection rate in Liberia has been declining, while it is fluctuating in Guinea.

# ? Dec 18, 2014 15:09

meristem: Oct 2, 2010; I HAVE THE ETIQUETTE OF STIFF AND THE PERSONALITY OF A GIANT CUNT.

IAMNOTADOCTOR posted:

More good news on ebola: http://www.who.int/csr/disease/ebola/situation-reports/en/

Awesome.

# ? Dec 21, 2014 13:53

WorldsStongestNerd: Apr 28, 2010; by Fluffdaddy

Nessus posted:

Well, the upside is that it seems like people who don't wash their dead relatives personally are hugely less likely to get Ebola, and since I don't think that's exactly a universal or frequent custom...

It is a frequent custom in that part of the world. That's why there is an epidemic in the first place, because of the customs of washing, kissing and hugging, and otherwise having contact with the dead.

# ? Dec 21, 2014 18:58

WorldsStongestNerd: Apr 28, 2010; by Fluffdaddy

SedanChair posted:

Yeah stupid fuckin' villagers not reading about ebola online with their computers.

Its not about computers. The various governments have been telling people to stop doing that for months now.

# ? Dec 21, 2014 18:59

GhostofJohnMuir: Aug 14, 2014; anime is not good

WorldsStrongestNerd posted:

Its not about computers. The various governments have been telling people to stop doing that for months now.

Perhaps they have their own reasons to not entirely trust what the government tells them?

# ? Dec 21, 2014 21:08

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

WorldsStrongestNerd posted:

It is a frequent custom in that part of the world. That's why there is an epidemic in the first place, because of the customs of washing, kissing and hugging, and otherwise having contact with the dead.

Yes, exactly. My point there was that this is not a universal condition and as it seems to be a primary (though not sole) driver of new infections, even poor people in other nations will be less likely to just blow up and all die of the Ebola, the way people were saying it was inevitable that India would experience mass die-offs a couple of months ago.

# ? Dec 21, 2014 21:13

Brave New World: Mar 10, 2010

Ebola making it into the Ganges river would nonetheless likely be the second worst-case scenario after WA's cultural burial rites. They do everything in that river.

# ? Dec 21, 2014 23:18

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.

Brave New World posted:

Ebola making it into the Ganges river would nonetheless likely be the second worst-case scenario after WA's cultural burial rites. They do everything in that river.

Ebola doesn't persist outside the body for extended periods- it can't pollute a river.

# ? Dec 21, 2014 23:19

Grundulum: Feb 28, 2006

Discendo Vox posted:

Ebola doesn't persist outside the body for extended periods- it can't pollute a river.

Obviously you know more than me, but everything I heard about ebola's ability to persist outside the body was in terms of desiccation (does that even make sense for a virus?), oxidation, and UV exposure. All three of those processes would be hampered by the virus' suspension in water.

Grundulum fucked around with this message at 23:51 on Dec 21, 2014

# ? Dec 21, 2014 23:48

Tiny Timbs: Sep 6, 2008

GhostofJohnMuir posted:

Perhaps they have their own reasons to not entirely trust what the government tells them?

*beats aid worker to death*

# ? Dec 22, 2014 00:00

GhostofJohnMuir: Aug 14, 2014; anime is not good

GENDERWEIRD GREEDO posted:

*beats aid worker to death*

Nevermind, guess all Africans are stupid savages who bring poo poo on themselves. Man, suddenly the situation turns from a tragedy to something you shouldn't give a poo poo about. This is great!

# ? Dec 22, 2014 09:01

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Grundulum posted:

Obviously you know more than me, but everything I heard about ebola's ability to persist outside the body was in terms of desiccation (does that even make sense for a virus?), oxidation, and UV exposure. All three of those processes would be hampered by the virus' suspension in water.

From the CDC site,

quote:

How effective are wastewater treatment processes at removing or inactivating Ebola?
Information is limited about the survival of Ebola in water and wastewater systems. However, there are abundant data about the survival of similar enveloped viruses in the environment. Ebola would be expected to respond similarly to other enveloped viruses, and would be inactivated more rapidly than the non-enveloped viruses. Dilution of the viruses in the wastewater system will reduce their concentration. In addition, the combination of virucidal agents and the biological, chemical, and physical properties of wastewater, such as pH, temperature, and the presence of predatory microorganisms that could breakdown the virus, are expected to effectively inactivate and remove enveloped viruses from wastewater.

Sobsey MD, Meschke JS. [2003]. Virus Survival in the Environment with Special Attention to Survival in Sewage Droplets and Other Environmental Media of Fecal or Respiratory Origin. Report for the World Health Organization, Geneva, Switzerland.

So it sounds like if it hit the Ganges everything else would eat the bola before long, so unless you had the supreme misfortune to wallow in the immediate backwash of a freshly dumped corpse, you'd be fine.

# ? Dec 22, 2014 10:07

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

http://www.theguardian.com/world/2014/dec/22/ebola-untested-drug-patients-sierra-leone-uk-staff-leave

quote:

Ebola patients at a treatment centre in Sierra Leone have been given a heart drug that is untested against the virus in animals and humans, a move that has been deemed reckless by one senior scientist and has prompted UK medical staff at the centre to leave.

# ? Dec 23, 2014 14:37

suck my woke dick: Oct 10, 2012; I CANNOT EJACULATE WITHOUT SEEING NATIVE AMERICANS BRUTALISED!

Put this cum-loving slave on ignore immediately!

Ebola Roulette posted:

http://www.theguardian.com/world/2014/dec/22/ebola-untested-drug-patients-sierra-leone-uk-staff-leave

A heart drug of all things? :psyduck:

# ? Dec 23, 2014 15:33

Cantorsdust: Aug 10, 2008; Infinitely many points, but zero length.

Not just any heart drug--amiodarone, a class 3 antiarrhythmic. Antiarrhythmic drugs often have bad side effects, and amiodarone is known for having side effects frequently. It can frequently mess with your lungs, thyroid, and liver, along with rarer stuff more associated with long-term use. Further, I don't know of any non-heart use for the drug. It's pretty exclusively used for arrhythmias.

# ? Dec 23, 2014 17:45

CAPS LOCK BROKEN: Feb 1, 2006; by Fluffdaddy

P. Sure that Ugandan doctor who was airlifted to Germany was self medicating with that because of alleged antiviral effects and they discontinued it immediately as soon as he got there.

# ? Dec 23, 2014 19:24

Xandu: Feb 19, 2006; It's hard to be humble when you're as great as I am.

Jesus loving christ. Isn't this the second time this year they've accidentally done that?

quote:

As many as a dozen scientists may have been exposed to Ebola at a Centers for Disease Control laboratory in Atlanta earlier this week, according to a published report.

The Washington Post reported Wednesday that the potential exposure took place Monday, when scientists conducting research on the deadly virus at a high-security lab mistakenly put a sample containing the potentially infectious virus in a place where it was transferred to another CDC lab, also in Atlanta on the agency's campus.

http://www.foxnews.com/health/2014/12/24/as-many-as-dozen-cdc-scientists-exposed-to-ebola/?cmpid=cmty_twitter_fn

Xandu fucked around with this message at 23:06 on Dec 24, 2014

# ? Dec 24, 2014 23:04

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

Xandu posted:

Jesus loving christ. Isn't this the second time this year they've accidentally done that?

http://www.foxnews.com/health/2014/12/24/as-many-as-dozen-cdc-scientists-exposed-to-ebola/?cmpid=cmty_twitter_fn

This makes the third one actually. Here's the article talking about the other two:

http://www.cidrap.umn.edu/news-perspective/2014/08/cdc-probe-h5n1-cross-contamination-reveals-protocol-lapses-reporting-delays

What are they even doing Jesus Christ

# ? Dec 24, 2014 23:18

suck my woke dick: Oct 10, 2012; I CANNOT EJACULATE WITHOUT SEEING NATIVE AMERICANS BRUTALISED!

Put this cum-loving slave on ignore immediately!

Xandu posted:

Jesus loving christ. Isn't this the second time this year they've accidentally done that?

http://www.foxnews.com/health/2014/12/24/as-many-as-dozen-cdc-scientists-exposed-to-ebola/?cmpid=cmty_twitter_fn

"Jim, which of these tubes was the ebola sample again?"

"The one in the drawer"

*opens wrong drawer*

# ? Dec 27, 2014 10:30

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.

Both vials contained Ebola, the tech just got which had been rendered inert switched. Fox News isn't a great source on government agency errors, it turns out. None of the incidents in question were high risk, and the problems in all but one of them involved one person not following protocol.

Discendo Vox fucked around with this message at 14:16 on Dec 27, 2014

# ? Dec 27, 2014 14:13

Ebola Roulette: Sep 13, 2010; No matter what you ~~win~~ ~~lose~~ ragepiss.

Bad news in Liberia

http://abcnews.go.com/Health/wireStory/liberia-reports-dozens-ebola-cases-border-27873523

quote:

Dozens of new Ebola cases have erupted in Liberia, near the border with Sierra Leone, Liberian health officials warned Monday, marking a setback amid recent improvements.

The flare-up is due to a number of factors including people going in and out of Liberia and traditional practices such as the washing of bodies, said Liberia's Assistant Health Minister Tolbert Nyenswah.

# ? Dec 29, 2014 14:53

Torpor: Oct 20, 2008; .. and now for my next trick, I'll pretend to be a political commentator...

HONK HONK

Is this normal or has the CDC suffered a decline in competence?

# ? Dec 29, 2014 18:25

Cabbages and VHS: Aug 25, 2004; Listen, I've been around a bit, you know, and I thought I'd seen some creepy things go on in the movie business, but I really have to say this is the most disgusting thing that's ever happened to me.

Torpor posted:

Is this normal or has the CDC suffered a decline in competence?

CDC is incompetent because one person made a mistake which appears to have resulted in no new infections, but which was nonetheless reported and thoroughly investigated? Yeah, stupid CDC always loving up.

# ? Dec 29, 2014 19:53

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.

CDC has suffered a relative decline in funding, not competence. The competence problems are mostly at the WHO level.

# ? Dec 29, 2014 20:04

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Discendo Vox posted:

CDC has suffered a relative decline in funding, not competence. The competence problems are mostly at the WHO level.

Individual departments of WHO were competent at the goals which they were feeling the pressure to achieve; they're incompetent at communicating across organizational barriers and understanding healthcare as a system.

E:

http://www.washingtonpost.com/natio...e98e_story.html

quote:

A year after it began, the Ebola epidemic in West Africa continues to be unpredictable, forcing governments and aid groups to improvise strategies as they chase a virus that is unencumbered by borders or bureaucracy.

The people fighting Ebola are coming up with lists of lessons learned — not only for the current battle, which has killed more than 7,500 people and is far from over, but also for future outbreaks of deadly contagions.

Many of the lessons are surprising and specific — the color of body bags turns out to be important, as does the design of Ebola clinics. The most common-sense lesson is that all Ebola is local; solutions can’t be dictated from Geneva or New York.

The broader and more ominous lesson is that global health organizations aren’t ready for a pandemic. There are countless conferences, reports and carefully wrought strategies for stopping epidemics, but this terrible year has demonstrated how hard it is to get resources — even something as simple as bars of soap and buckets of bleach — to vulnerable people on the front line of an explosive disease outbreak.

Man vs. microbe is certain to be a recurring narrative in the 21st century. It’s a natural consequence of a burgeoning human population. Our vulnerability to new pathogens will not be easily fixed.

LESSON: Rely on the local leadership
When Peggy Chilcott looks back on the great Ebola outbreak of 2014, she will picture herself in a remote village in West Africa where the inhabitants feared that outsiders had come to poison them.

Chilcott, 34, a doctor with the charity group Samaritan’s Purse, traveled from Spokane, Wash., to Liberia in November. One day she and two colleagues made a journey by helicopter to a remote village in Gbarpolu County, north of Monrovia. Two people there had tested positive for Ebola.

The villagers were skeptical of the outsiders and their medicines, which included malaria pills. Go away, one man said, “and take your poison with you.” Chilcott tried to reassure them by swallowing pills as they watched.

But the mood became increasingly hostile. Alarmed, Chilcott sent an emergency satellite signal for the helicopter to return. It arrived in 21 minutes and swooped everyone away before they had even buckled their seat belts.

That wasn’t the end of the story, however. A regional chief intervened. He vouched for the integrity of the foreign health workers and pleaded for them to return to help people survive the deadly contagion. The village also exiled a local troublemaker.

With the level of trust higher, Chilcott, her colleagues and other aid workers trekked back through the rain forest to the village and this time were greeted with smiles and clapping.

Countless variations of this story have played out across West Africa.

“You can’t just blast into a place and expect people to drop everything and do what you tell them to do,” says David Nabarro, the U.N. special envoy on Ebola. “They have to be utterly convinced your motives are good. They have to be able to share their view with you.”

Archie C. Gbessay, a Liberian who is coordinator of the Active Case Finders and Awareness Team in Monrovia, said recently that if foreign intervention and billions of dollars in contributions were all it took to stop the disease, “we should already be celebrating the eradication of Ebola from my country.”

This same lesson was hammered home by Monique Nagelkerke, who recently wrapped up two months as the head of mission in Sierra Leone for Doctors Without Borders.

“It’s the experts that get interviewed, but it’s people from the region themselves that come to work day after day,” Nagelkerke said. “They are the real heroes.”

LESSON: Be sensitive to peoples’ cultures
Julienne Anoko, an anthropologist working on the Ebola response in Guinea, faced a situation involving a pregnant woman who had died of Ebola with her dead baby inside her. Tribal custom required that the baby be removed from the womb and buried separately. The doctors forbade the baby’s removal, saying such surgery could spread the disease.

Anoko had to find a way to satisfy the family and the medical establishment. She tracked down an 80-year-old ritualist. He put together a culturally acceptable set of rituals that included the sacrifice of a goat and prayers to appease the ancestors.

The people suffering through this epidemic, Anoko said, “have something to say, and it’s important to listen to them first, instead of building solutions elsewhere and saying to the community, ‘We know your problem; this is the solution.’ ”

LESSON: Simple changes can yield significant results
Many lessons were learned on the fly, in crisis mode, and they amounted to slight adjustments in tactics based on feedback from locals. For example, Western aid workers initially used black body bags for burials in Liberia. But white is a traditional color of mourning, especially for Muslims, and Liberians balked. Simple fix: Officials ordered white body bags.

Another simple innovation involved the design of Ebola treatment units.

“By the end of July, no one had ever heard of an Ebola treatment unit, and at the same time there was a requirement to move fast, at scale, and mount a response that could intercept this crazy, increasing infection rate,” said Nancy Lindborg, a top official at the U.S. Agency for International Development.

Family members didn’t want to send loved ones to the centers, afraid they might never see them again. They had seen too many people simply vanish. Officials came up with an innovation: transparency. They replaced walls with fences and added windows, which improved air circulation and offered a glimpse inside.

“Make it look less like Guantanamo Bay and make it more of a patient-friendly kind of environment,” Nagelkerke said.

LESSON: Speed and agility matter more than size
Ebola has repeatedly outfoxed and outraced global responders.

The United States developed a plan in late summer for a massive intervention in Liberia, centered on the construction of up to 17 large Ebola treatment units — but then the infection rate began dropping rapidly.

The result is that Americans are, at great cost, finishing ETUs that have many beds but few patients. These are temporary structures that can’t be used for other purposes and, when the epidemic is over, will probably be burned to the ground.

Meanwhile, Sierra Leone has surpassed Liberia as the country with the highest infection rate. The global response has been divided up along colonial-era lines: Britain is focused on Sierra Leone and France on Guinea.

The United States is starting to shift some resources to Sierra Leone, deploying additional personnel under the auspices of USAID, sending two Defense Department laboratories and talking to nongovernmental organizations and other global partners about dispatching more of their health-care workers, according to a senior administration official.

“You can get a strategy and it becomes an immovable constraint,” Lindborg said. As the epidemic has evolved, she said, the United States has decided to shift to “a rapid-response strategy” aimed at smothering Ebola wherever it pops up. “You have to be adaptable to the course of the disease.”

LESSON: We’re all connected — and unprepared for the consequences
In an increasingly interconnected world, affluent countries have to be aware of — and care about — what’s happening in the poorest.

“This is the poster child for why we should pay attention to fragile states,” Lindborg said. “This is a wake-up call. Thank God it was Ebola and not something airborne.”

Ken Isaacs, head of Samaritan’s Purse, the North Carolina-based Christian missionary organization that has been working in West Africa, argues that the global community cannot merely rely on the World Health Organization, which has a decentralized management structure and got caught flat-footed by Ebola. He would like to see a new structure formed, one with political leverage, laboratory research capabilities and a global reach.

Experts have warned for years that all countries need to do more to improve their ability to detect and curb outbreaks. Multiple initiatives on that front have had mixed results.

In February, in the middle of a Washington snowstorm, the White House launched the Global Health Security Agenda. The United States has pledged to help 30 countries bolster their capacity to deal with biological threats of any kind, from natural epidemics to bioterrorism. Vulnerable countries should also take several steps to protect themselves, such as identifying and tracking the most prevalent deadly pathogens and being able to activate an emergency operations center within hours of an outbreak.

In the current epidemic, countries in West Africa were slow to create a functional “incident command” structure, one in which officials were empowered to make decisions quickly.

Money for the Global Health Security Agenda is materializing: Congress just approved over $5 billion in emergency Ebola funding, more than $800 million of which will go to efforts to stop future epidemics.

LESSON: An ounce of prevention
The year of Ebola showed that it is a lot cheaper and easier to stop a viral outbreak early, before it metastasizes into a full-blown epidemic. But that common-sense notion collides with another one: Watching out for emerging diseases and other proactive efforts aren’t terribly glamorous.

The epidemic that didn’t happen is like the nuclear power plant that didn’t have a meltdown — desirable, but not headline-grabbing. That can make such efforts a tough sell, politically.

Ebola surveillance and research is now getting abundant funding, but Ebola isn’t necessarily the most dangerous pathogen that humanity could face in the near future.

“We’re always chasing what just happened,” said Jonna Mazet, a professor of epidemiology and disease ecology at the University of California at Davis and the director of the Predict project, a disease-surveillance program funded largely by USAID and operating in 20 countries.

The project Mazet oversees has set up dozens of labs in the developing world. It has tested thousands of animals — bats, rats and monkeys among them — and identified about 800 previously unknown viruses.

“If we don’t start getting ahead of the curve on pandemics, we’re sitting here like victims waiting for the next one,” said Peter Daszak, a well-known disease ecologist who works on the same project.

In an office 17 floors above West 34th Street in Manhattan, analysts working for Daszak pour data into complex mathematical models, trying to decipher the most likely places an epidemic might surface next. The data behind those “heat maps” come from intense detective work around the globe, from Thailand and Tanzania to Bolivia and Bangladesh.

In Vietnam, for example, researchers affiliated with Oxford University head out almost daily to slaughterhouses and animal farms. They visit open-air markets teeming with ducks, porcupines, bamboo rats and other animals to understand what viruses and bacteria the animals harbor and to watch closely for the moment any of them might infect humans.

This kind of work is more crucial than ever, said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh in Scotland.

“The early 21st century is about as good as it gets for emerging viruses and pathogens,” he said. “Changes in trade, travel and population — it’s a perfect storm for viral emergence.”

LESSON: Keep fear in check
When Tom Frieden, director of the Centers for Disease Control and Prevention, visited Liberia in August, he went to a crematorium that operated day and night as the bodies of Ebola victims were immolated.

The Washington Post

Health & Science
Ebola’s lessons, painfully learned at great cost in dollars and human lives
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By Lena H. Sun, Brady Dennis and Joel Achenbach December 28 at 8:25 PM
Treating Ebola in rural Liberia
View Photos The village of Quewein, without electricity or clean water, and others like it pose new challenges in the campaign to stop the virus.
A year after it began, the Ebola epidemic in West Africa continues to be unpredictable, forcing governments and aid groups to improvise strategies as they chase a virus that is unencumbered by borders or bureaucracy.

The people fighting Ebola are coming up with lists of lessons learned — not only for the current battle, which has killed more than 7,500 people and is far from over, but also for future outbreaks of deadly contagions.

Many of the lessons are surprising and specific — the color of body bags turns out to be important, as does the design of Ebola clinics. The most common-sense lesson is that all Ebola is local; solutions can’t be dictated from Geneva or New York.

The broader and more ominous lesson is that global health organizations aren’t ready for a pandemic. There are countless conferences, reports and carefully wrought strategies for stopping epidemics, but this terrible year has demonstrated how hard it is to get resources — even something as simple as bars of soap and buckets of bleach — to vulnerable people on the front line of an explosive disease outbreak.

Man vs. microbe is certain to be a recurring narrative in the 21st century. It’s a natural consequence of a burgeoning human population. Our vulnerability to new pathogens will not be easily fixed.

Archie C. Gbessay, coordinator of the Active Case Finders and Awareness Team in West Point, discusses Ebola efforts with his team in a school classroom in Monrovia, Liberia. (Michel du Cille/The Washington Post)
LESSON: Rely on the local leadership
When Peggy Chilcott looks back on the great Ebola outbreak of 2014, she will picture herself in a remote village in West Africa where the inhabitants feared that outsiders had come to poison them.

Chilcott, 34, a doctor with the charity group Samaritan’s Purse, traveled from Spokane, Wash., to Liberia in November. One day she and two colleagues made a journey by helicopter to a remote village in Gbarpolu County, north of Monrovia. Two people there had tested positive for Ebola.

The villagers were skeptical of the outsiders and their medicines, which included malaria pills. Go away, one man said, “and take your poison with you.” Chilcott tried to reassure them by swallowing pills as they watched.

But the mood became increasingly hostile. Alarmed, Chilcott sent an emergency satellite signal for the helicopter to return. It arrived in 21 minutes and swooped everyone away before they had even buckled their seat belts.

That wasn’t the end of the story, however. A regional chief intervened. He vouched for the integrity of the foreign health workers and pleaded for them to return to help people survive the deadly contagion. The village also exiled a local troublemaker.

With the level of trust higher, Chilcott, her colleagues and other aid workers trekked back through the rain forest to the village and this time were greeted with smiles and clapping.

Countless variations of this story have played out across West Africa.

“You can’t just blast into a place and expect people to drop everything and do what you tell them to do,” says David Nabarro, the U.N. special envoy on Ebola. “They have to be utterly convinced your motives are good. They have to be able to share their view with you.”

Archie C. Gbessay, a Liberian who is coordinator of the Active Case Finders and Awareness Team in Monrovia, said recently that if foreign intervention and billions of dollars in contributions were all it took to stop the disease, “we should already be celebrating the eradication of Ebola from my country.”

This same lesson was hammered home by Monique Nagelkerke, who recently wrapped up two months as the head of mission in Sierra Leone for Doctors Without Borders.

“It’s the experts that get interviewed, but it’s people from the region themselves that come to work day after day,” Nagelkerke said. “They are the real heroes.”

The body of a 12 year-old boy is taken to the newly constructed morgue and then buried near the Bong County Ebola Treatment Unit in Monrovia, Liberia. (Michel du Cille/The Washington Post )
LESSON: Be sensitive to peoples’ cultures
Julienne Anoko, an anthropologist working on the Ebola response in Guinea, faced a situation involving a pregnant woman who had died of Ebola with her dead baby inside her. Tribal custom required that the baby be removed from the womb and buried separately. The doctors forbade the baby’s removal, saying such surgery could spread the disease.

Anoko had to find a way to satisfy the family and the medical establishment. She tracked down an 80-year-old ritualist. He put together a culturally acceptable set of rituals that included the sacrifice of a goat and prayers to appease the ancestors.

The people suffering through this epidemic, Anoko said, “have something to say, and it’s important to listen to them first, instead of building solutions elsewhere and saying to the community, ‘We know your problem; this is the solution.’ ”

The body of Jacqueline Morris is carried to the back of a pickup truck by a county health burial team in Voinjama, Liberia. (Michel du Cille/The Washington Post )
LESSON: Simple changes can yield significant results
Many lessons were learned on the fly, in crisis mode, and they amounted to slight adjustments in tactics based on feedback from locals. For example, Western aid workers initially used black body bags for burials in Liberia. But white is a traditional color of mourning, especially for Muslims, and Liberians balked. Simple fix: Officials ordered white body bags.

Another simple innovation involved the design of Ebola treatment units.

“By the end of July, no one had ever heard of an Ebola treatment unit, and at the same time there was a requirement to move fast, at scale, and mount a response that could intercept this crazy, increasing infection rate,” said Nancy Lindborg, a top official at the U.S. Agency for International Development.

Family members didn’t want to send loved ones to the centers, afraid they might never see them again. They had seen too many people simply vanish. Officials came up with an innovation: transparency. They replaced walls with fences and added windows, which improved air circulation and offered a glimpse inside.

“Make it look less like Guantanamo Bay and make it more of a patient-friendly kind of environment,” Nagelkerke said.

Dominic Kollie, an Ebola survivor, suits up to go inside an Ebola ward as other staff members move in to the MSF (Doctors without Borders) ELWA3 Ebola Treatment Unit in Monrovia, Liberia. (Michel du Cille/The Washington Post )
LESSON: Speed and agility matter more than size
Ebola has repeatedly outfoxed and outraced global responders.

The United States developed a plan in late summer for a massive intervention in Liberia, centered on the construction of up to 17 large Ebola treatment units — but then the infection rate began dropping rapidly.

The result is that Americans are, at great cost, finishing ETUs that have many beds but few patients. These are temporary structures that can’t be used for other purposes and, when the epidemic is over, will probably be burned to the ground.

Meanwhile, Sierra Leone has surpassed Liberia as the country with the highest infection rate. The global response has been divided up along colonial-era lines: Britain is focused on Sierra Leone and France on Guinea.

The United States is starting to shift some resources to Sierra Leone, deploying additional personnel under the auspices of USAID, sending two Defense Department laboratories and talking to nongovernmental organizations and other global partners about dispatching more of their health-care workers, according to a senior administration official.

“You can get a strategy and it becomes an immovable constraint,” Lindborg said. As the epidemic has evolved, she said, the United States has decided to shift to “a rapid-response strategy” aimed at smothering Ebola wherever it pops up. “You have to be adaptable to the course of the disease.”

President Barack Obama holds a meeting with senior aides at the White House to discuss the U.S. fight against the Ebola virus on Dec. 12, 2014. (Kevin Lamarque/Reuters)
LESSON: We’re all connected — and unprepared for the consequences
In an increasingly interconnected world, affluent countries have to be aware of — and care about — what’s happening in the poorest.

“This is the poster child for why we should pay attention to fragile states,” Lindborg said. “This is a wake-up call. Thank God it was Ebola and not something airborne.”

Ken Isaacs, head of Samaritan’s Purse, the North Carolina-based Christian missionary organization that has been working in West Africa, argues that the global community cannot merely rely on the World Health Organization, which has a decentralized management structure and got caught flat-footed by Ebola. He would like to see a new structure formed, one with political leverage, laboratory research capabilities and a global reach.

Experts have warned for years that all countries need to do more to improve their ability to detect and curb outbreaks. Multiple initiatives on that front have had mixed results.

In February, in the middle of a Washington snowstorm, the White House launched the Global Health Security Agenda. The United States has pledged to help 30 countries bolster their capacity to deal with biological threats of any kind, from natural epidemics to bioterrorism. Vulnerable countries should also take several steps to protect themselves, such as identifying and tracking the most prevalent deadly pathogens and being able to activate an emergency operations center within hours of an outbreak.

In the current epidemic, countries in West Africa were slow to create a functional “incident command” structure, one in which officials were empowered to make decisions quickly.

Money for the Global Health Security Agenda is materializing: Congress just approved over $5 billion in emergency Ebola funding, more than $800 million of which will go to efforts to stop future epidemics.

Alice Jallabah, head of a bushmeat seller group, holds dried bushmeat in Monrovia. (Zoom Dosso/AFP/Getty Images)
LESSON: An ounce of prevention
The year of Ebola showed that it is a lot cheaper and easier to stop a viral outbreak early, before it metastasizes into a full-blown epidemic. But that common-sense notion collides with another one: Watching out for emerging diseases and other proactive efforts aren’t terribly glamorous.

The epidemic that didn’t happen is like the nuclear power plant that didn’t have a meltdown — desirable, but not headline-grabbing. That can make such efforts a tough sell, politically.

Ebola surveillance and research is now getting abundant funding, but Ebola isn’t necessarily the most dangerous pathogen that humanity could face in the near future.

“We’re always chasing what just happened,” said Jonna Mazet, a professor of epidemiology and disease ecology at the University of California at Davis and the director of the Predict project, a disease-surveillance program funded largely by USAID and operating in 20 countries.

The project Mazet oversees has set up dozens of labs in the developing world. It has tested thousands of animals — bats, rats and monkeys among them — and identified about 800 previously unknown viruses.

“If we don’t start getting ahead of the curve on pandemics, we’re sitting here like victims waiting for the next one,” said Peter Daszak, a well-known disease ecologist who works on the same project.

In an office 17 floors above West 34th Street in Manhattan, analysts working for Daszak pour data into complex mathematical models, trying to decipher the most likely places an epidemic might surface next. The data behind those “heat maps” come from intense detective work around the globe, from Thailand and Tanzania to Bolivia and Bangladesh.

In Vietnam, for example, researchers affiliated with Oxford University head out almost daily to slaughterhouses and animal farms. They visit open-air markets teeming with ducks, porcupines, bamboo rats and other animals to understand what viruses and bacteria the animals harbor and to watch closely for the moment any of them might infect humans.

This kind of work is more crucial than ever, said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh in Scotland.

“The early 21st century is about as good as it gets for emerging viruses and pathogens,” he said. “Changes in trade, travel and population — it’s a perfect storm for viral emergence.”

U.N. chief Ban Ki-moon greets a member of a medical unit in Monrovia. (Evan Schneider/AFP/Getty Images)
LESSON: Keep fear in check
When Tom Frieden, director of the Centers for Disease Control and Prevention, visited Liberia in August, he went to a crematorium that operated day and night as the bodies of Ebola victims were immolated.

Soon afterward, he developed a nosebleed. “To have blood spurting out of your nose in the middle of an Ebola outbreak is a little bit anxiety producing,” he recalled.

Rationally, he knew he didn’t have Ebola. He figured the nosebleed was caused by the dryness from his recent flight. His main concern was that people would think he had Ebola. But even the CDC director wrestled with nagging doubts about his health.

“You worry about every symptom, like a sore throat,” he said, “even if you had no chance of being infected.”

One of his deputies, Jordan Tappero, spent five weeks in Liberia in late summer and had a bout of travelers’ diarrhea. “Stuff goes through your head when you’re getting up in the middle of the night,” Tappero said. “I was always able to talk myself off the ledge.”

These anxieties were minor compared with the national hysteria that accompanied the Ebola epidemic when it crossed the Atlantic. More than one school system shut down over a worry that the parent of a student possibly had contact with an Ebola victim. A controversy broke out over whether returning humanitarian volunteers should be quarantined for weeks. Scientists who had been to West Africa were disinvited to a medical conference.

In mid-October, a U.S. Coast Guard helicopter and plane were dispatched to a cruise ship off the coast of Mexico to obtain blood samples from a passenger on vacation. She had, 19 days earlier, been working in a lab at a Dallas hospital and possibly had come in contact with a sealed vial of blood belonging to Thomas Eric Duncan, a Liberian who became the first person to die of the disease in the United States. She had no symptoms.

The plane flew her sample to Austin, where lab technicians confirmed what doctors already knew: She did not have Ebola. The Coast Guard spent $86,256 to retrieve and deliver the blood, an agency spokesman said.

This eruption of alarmism came despite repeated assurances from experts that Ebola is not very contagious, as viral diseases go. The only two people who caught Ebola in the United States were nurses caring for Duncan.

But Frieden acknowledges a basic mistake in his communication efforts. In a Sept. 30 news conference after it was confirmed that Duncan had Ebola, Frieden assured the public that the virus wouldn’t spread here. “I have no doubt that we will stop it in its tracks in the U.S.,” he said.

Then the two nurses got sick.

Frieden’s words, on their face, were correct: Ebola did not “go viral” in the United States. But his confident language implied an element of certainty that is hard to back up during an evolving public-health emergency.

“Clearly I did not convey adequately the degree it was going to be hard” to stop the virus, Frieden recently told The Washington Post, “and that we would be adjusting and learning.”

Lenny Bernstein contributed to this report.

tl;dr a series of mistakes have been made at all levels and without need. Old contingency plans have failed to become adapted to the modern world; the future existance of WHO is in doubt, and certainly will not take the form of the pre-EVD organization.

My Imaginary GF fucked around with this message at 20:19 on Dec 29, 2014

# ? Dec 29, 2014 20:07

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.

MIGF, I'd really like to hear more from you about the problems of WHO structure- it's not something the rest of us in the thread have access to.

# ? Dec 29, 2014 20:17

ukle: Nov 28, 2005

New case in Glasgow -

http://www.bbc.co.uk/news/uk-scotland-30628349

quote:

A healthcare worker who has just returned from West Africa has been diagnosed with Ebola and is being treated in hospital in Glasgow.

The patient, who arrived from Sierra Leone on Sunday night, is in isolation at Glasgow's Gartnavel Hospital.

All possible contacts with the case are being investigated. The patient will be transferred to high level isolation in London as soon as possible.

Sources told the BBC the Ebola case involved a female aid worker.

NHS Scotland said infectious diseases procedures had been put into effect at the Brownlee Unit for Infectious Diseases at Gartnavel.

The patient returned to Scotland from Sierra Leone late on Sunday via Casablanca and London Heathrow, arriving into Glasgow Airport on a British Airways flight at about 23:30.

# ? Dec 29, 2014 20:17

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Discendo Vox posted:

MIGF, I'd really like to hear more from you about the problems of WHO structure- it's not something the rest of us in the thread have access to.

Hah, where do you want me to start? WHO has been, first and foremost, a political organization with a healthcare mission, rather than a healthcare organization with a political mission. I'm sure someone more qualified will begin their dissertation on WHO as responsive for AIDs, thus making the organization unprepared for novel disease outbreaks.

Really though, "problems with the structure of WHO" is an extremely broad topic. Where should I begin?

Well, I recall detailing Chan's management and power-sharing early on in this thread, so I'll assume that context as given. With those discussions in mind, let's focus on what WHO was orientated towards from 2002 to 2014---HIV/AIDs and healthcare as a developmental challenge.

Bush achieved some great impact from his push to contain HIV transmission in Africa. For WHO, what this meant was American donors focused upon synergizing the organization with USAID program goals and impact metrics. Where USAID had Gates Foundation funding for malaria eradication programs, such as in West Africa, you'd have WHO national coordinators with tunnel vision towards malaria eradication.

In action, what this meant, and one of the WaPo stories details it better with primary source interviews, is that the epidemiologist responsible for Liberia was more concerned with maintaining the schedule for the planned malaria and HIV eradication program implementations than for dropping everything and responding to EVD.

That's the gist of it, where departments who jumped the gun would have their programs cut in favor of those program resources going elsewhere, say, East Asia, and when you're suspicious of the program being used as a tool of Chinese soft power projection, you try to hold onto it in your region for as long as possible.

In my mind, its impossible to separate politics from WHO pre-EVD, and geopolitical context must be taken into consideration to answer specific questions on WHO's structural failings.

tl;dr politics, inertia, and fighting the last fuckup caused WHO to drop the ball on EVD. It didn't have to be EVD, it could be something novel anywhere else; WHO was unprepared to rapidly adapt and respond due to contradictory organizational practices, silo'd departments having an added barrier of nationalist skepticism, and global actors unwilling or unable to pursue best-practices developmental policies.

# ? Dec 29, 2014 20:39

My Imaginary GF: Jul 17, 2005; by R. Guyovich

Really, WHO was designed for and evolved to respond to global healthcare issues under a structure adapted to the cold-war and unipolar world. That's why I've been so critical of Chan's leadership: in an attempt to learn from the lessons of pre-war Europe, America has been attempting to integrate China into its international systems. Chan was supposed to be the model success for Chinese participation in the international community as a great and developed power.

Unfortunately, power-sharing does not work during times of emergency when national governments are unwilling to step up and contribute in accord to the best of their ability.

I realize this is a bit general and may not answer your questions about WHO's structural issues Discendo Vox. They're a legacy organization fighting the last pandemic without a clear and independent mission. In structure, this means that not only do regions fight each other for limited resource allocations, regional deputies fight amongst their departments on lines of nationalism and colonial spheres of influence.

In practice, this means a WHO project lead will only advance within the organization if their department has the appropriate alignment of international patronage and organizational directorship. So let's say you do condom distribution in Nigeria through WHO: if you align your program to assist with other departments in subsaharan Africa, you'll have just demonstrated the lack of need for your department and have your human and project resources stripped by other regions and by distributed to other departments. You need redundancy in an organization like WHO, as redundancy creates excess capacity which allows rapid and adaptive response to novel situations, whereas Chan's whole schtik was to eliminate organization legacy costs and streamline regional operations.

# ? Dec 29, 2014 21:08

GhostofJohnMuir: Aug 14, 2014; anime is not good

Discendo Vox posted:

CDC has suffered a relative decline in funding, not competence. The competence problems are mostly at the WHO level.

Well it can't be ignored that the decline in funding is driving competent people into the private sector or into other fields all together. The current slashing of federal science funding is maddening, because I'm seeing a lot of people who's talent I respect throw in the towel when their pay is frozen or they can't get a grant. Whenever congress decides to turn the money spigot back on, those people aren't going to be there and it'll take years to rebuild the institutional knowledge and talent. It's what makes the recent Republicans harrumphing during the Ebola scare about how they restored most of the CDC's funding for next year from the huge cuts they had enacted in the sequester. It doesn't work like that and that they think it does means that they have no idea how the things they have oversight on work.

# ? Dec 29, 2014 23:42

Grundulum: Feb 28, 2006

GhostofJohnMuir posted:

that they think it does means that they have no idea how the things they have oversight on work.

This is not a uniquely Republican problem, nor even one limited to Congress. Many people have made lots of money (Dilbert and Office Space spring to mind) lampooning this exact thing.

# ? Dec 30, 2014 00:18

Xandu: Feb 19, 2006; It's hard to be humble when you're as great as I am.

http://news.yahoo.com/just-five-ebola-cases-left-liberia-govt-103515357.html

quote:

Monrovia (AFP) - Liberia said on Saturday it had just five remaining cases of Ebola, confirming it was close to eradicating an epidemic which has left thousands dead.

The worst outbreak of the virus in history has seen the west African nation and its neighbours Guinea and Sierra Leone register almost 9,000 deaths in a year, although experts believe the real toll could be far higher.

"We have five confirmed Ebola cases in Liberia as of today," assistant health minister Tolbert Nyensuwah told AFP.

He said three of the cases were in the capital Monrovia, while the others were in the northwestern counties of Bomi and Grand Cape Mount.

"It means that we are going down to zero if everything goes well, if other people don't get sick in other places."

The announcement has not been verified by World Health Organization (WHO) officials, whose statistics often differ from the tallies of individual countries.

# ? Jan 24, 2015 16:16

Fangz: Jul 5, 2007; Oh I see! This must be the Bad Opinion Zone!

Ah, the joys of fitting exponentials to graphs. When will people ever learn....

http://time.com/3627900/behind-the-changing-forecast-for-ebola-infections/

# ? Jan 30, 2015 14:38

BattleMaster: Aug 14, 2000

Fangz posted:

Ah, the joys of fitting exponentials to graphs. When will people ever learn....

http://time.com/3627900/behind-the-changing-forecast-for-ebola-infections/

Hey man, plot those points in Excel, add a trendline, pick the regression type that gives the best r², you're golden. Right? :downs:

# ? Jan 30, 2015 14:52

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# ? May 3, 2024 01:13

IAMNOTADOCTOR: Sep 26, 2013

The weird thing is, that looking back the vast majority of genuine experts in the field made reasonable reports and predictions that fitted the data of the moment and left enough uncertainty in their predictions so that the current outcome is not surprising.

However, the general public and to a lesser extent journalists used these same reports to convince themselves and others that doomsday scenarios were unavoidable and imminent.

I'm reading back through this thread and there seems to be some emotional commitment to such a catastrophic event, regardless of expert consensus. Examples of these recurrent themes not supported at any point by evidence are:

"but what if Ebola becomes airborne?"
"Ebola will be spreading through America/Europe /India"

and the later insistence that the WHO/CDC numbers pointing to weeks of slowing infection rates must be false or the notion that the WHO has no idea what they are talking about.

My questions: is there some underlying desire for these types of catastrophic events? Do non prepping people crave an apocalypse scenario?

# ? Jan 30, 2015 16:54

The Something Awful Forums > Discussion > Debate & Discussion > Ebolavirus 2014: the r0 from shitposting is 6.9

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