Monday, September 15, 2014

Stark Ebola Warning: Act Now or Regret It, The Mathematics of Ebola - New Cases go Exponential | Journal

#Ebola Outbreak Update:

Stark Ebola Warning Update:16.09.2014

CDC: Now is the Time to Prepare.

- See more at:


'When one of the most senior disease detectives in the US begins talking about “plague,” knowing how emotive that word can be, and another suggests calling out the military, it is time to start paying attention.' wired Science Blog

It was revealed this week by the Department of Homeland Security's Office of the inspector General that DHS is "ill-prepared" for something like the 2009 H1N1 influenza pandemic -- or something worse, such as a global Ebola outbreak. - Threat Journal

The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It

BY MARYN MCKENNA   09.14.14  |   12:07 PM

Daliborlev (CC), FLickr

The Ebola epidemic in Africa has continued to expand since I last wrote about it, and as of a week ago, has accounted for more than 4,200 cases and 2,200 deaths in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. That is extraordinary: Since the virus was discovered, no Ebola outbreak’s toll has risen above several hundred cases. This now truly is a type of epidemic that the world has never seen before. In light of that, several articles were published recently that are very worth reading.
The most arresting is a piece published last week in the journal Eurosurveillance, which is the peer-reviewed publication of the European Centre for Disease Prevention and Control (the EU’s Stockholm-based version of the US CDC). The piece is an attempt to assess mathematically how the epidemic is growing, by using case reports to determine the “reproductive number.” (Note for non-epidemiology geeks: The basic reproductive number — usually shorted to R0 or “R-nought” — expresses how many cases of disease are likely to be caused by any one infected person. An R0 of less than 1 means an outbreak will die out; an R0 of more than 1 means an outbreak can be expected to increase. If you saw the movie Contagion, this is what Kate Winslet stood up and wrote on a whiteboard early in the film.)

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually Rt.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.

Nishiura Curves The epidemic curves of the Ebola epidemic; look especially at the line for Liberia. From Nishiura and Chowell; original here.

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What should we do with information like this? At the end of last week, two public health experts published warnings that we need to act urgently in response.

First, Dr. Richard E. Besser: He is now the chief health editor of ABC News, but earlier was acting director of the US CDC, including during the 2009-10 pandemic of H1N1 flu; so, someone who understands what it takes to stand up a public-health response to an epidemic. In his piece in the Washington Post, “The world yawns as Ebola takes hold in West Africa,” he says bluntly: “I don’t think the world is getting the message.”

He goes on:

The level of response to the Ebola outbreak is totally inadequate. At the CDC, we learned that a military-style response during a major health crisis saves lives…

We need to establish large field hospitals staffed by Americans to treat the sick. We need to implement infection-control practices to save the lives of health-care providers. We need to staff burial teams to curb disease transmission at funerals. We need to implement systems to detect new flare-ups that can be quickly extinguished. A few thousand U.S. troops could provide the support that is so desperately needed.

Aid ought to be provided on humanitarian grounds alone, he argues — but if that isn’t adequate rationale, he adds that aid offered now could protect us in the West from the non-medical effects of Ebola’s continuing to spread: “Epidemics destabilize governments, and many governments in West Africa have a very short history of stability. U.S. aid would improve global security.”

Should we really be concerned about the global effect of this Ebola epidemic? In the New York Times, Dr. Michael T. Osterholm of the University of Minnesota* — an epidemiologist and federal advisor famous for inadvertently predicting the 2001 anthrax attacks — says yes, we should. In “What We’re Afraid to Say About Ebola,” he warns: “The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.”

He goes on:

There are two possible future chapters to this story that should keep us up at night.

The first possibility is that the Ebola virus spreads from West Africa to megacities in other regions of the developing world. This outbreak is very different from the 19 that have occurred in Africa over the past 40 years. It is much easier to control Ebola infections in isolated villages. But there has been a 300 percent increase in Africa’s population over the last four decades, much of it in large city slums…

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air… viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

Like Besser, Osterholm says that the speed, size and organization of the response that is needed demands a governmental investment, but he looks beyond the US government alone:

We need someone to take over the position of “command and control.” The United Nations is the only international organization that can direct the immense amount of medical, public health and humanitarian aid that must come from many different countries and nongovernmental groups to smother this epidemic. Thus far it has played at best a collaborating role, and with everyone in charge, no one is in charge.

A Security Council resolution could give the United Nations total responsibility for controlling the outbreak, while respecting West African nations’ sovereignty as much as possible. The United Nations could, for instance, secure aircraft and landing rights…

The United Nations should provide whatever number of beds are needed; the World Health Organization has recommended 1,500, but we may need thousands more. It should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. Many countries are pledging medical resources, but donations will not result in an effective treatment system if no single group is responsible for coordinating them.

I’ve spent enough time around public health people, in the US and in the field, to understand that they prefer to express themselves conservatively. So when they indulge in apocalyptic language, it is unusual, and notable.

When one of the most senior disease detectives in the US begins talking about “plague,” knowing how emotive that word can be, and another suggests calling out the military, it is time to start paying attention.


Ebola Cases Go Exponential,
Threat of Becoming Airborne, 
U.S. Military Headed to West Africa

Sept 14, 2014

Ebola Virus Closeup - ALLOW IMAGES

What You Need to Know

On multiple occasions this week AlertsUSA subscribers were notified via text messages to their mobile devices regarding the worsening Ebola outbreak. On Monday, the World Health Organization warned that Ebola infections are increasing at an exponential rate and many thousands of new cases are expected this month in Liberia alone.

WHO also warned that conventional means of controlling the outbreak are not working and the number of cases and deaths have doubled in just the past 3 weeks.

Disease modelers at Northeastern University and the Fred Hutchinson Cancer Research Center predict as many as 10,000 cases of Ebola could be detected by Sept. 24th. According to Dr. Ira Longini, a biostatistician at the University of Florida and an affiliated member of Fred Hutch's Vaccine and Infectious Disease and Public Health Sciences divisions:

"The epidemic just continues to spread without any end in sight. The cat's already out of the box – way, way out.”

Early in the week President Obama described the outbreak as a national security threat to the United States and has authorized the deployment of U.S. military forces to the region to assist in the setting up field hospitals and isolation units, to provide protection for medical staff as well as other tasks in an effort to help in the overall international response.

DHS Not Ready for Pandemic

It was revealed this week by the Department of Homeland Security's Office of the inspector General that DHS is "ill-prepared" for something like the 2009 H1N1 influenza pandemic -- or something worse, such as a global Ebola outbreak.

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"The Department of Homeland Security failed to effectively manage its stockpile of pandemic personal protective equipment and antiviral medical countermeasures. As a result, the Department of Homeland Security has no assurance it has sufficient personal protective equipment and antiviral medical countermeasures for a national pandemic response."

More Ebola Patients Transported to U.S. Than Reported

It was also revealed this week that the USGOV has been quietly transporting many more Ebola exposed and Ebola infected individuals to the U.S. than has been previously disclosed. According to Dent Thompson, vice president of Phoenix Air Group, the specialized air ambulance company contracted by the State Department five weeks ago to bring two American missionaries infected with Ebola to Emory University:

“We moved a lot of other people who had an exposure event."

Thompson states that medical privacy laws and his company's contract with the State Department prevent him from revealing the figure, though he does indicate that Phoenix Air has flown 10 Ebola-related missions in the past six weeks.

The State department refuses to identify neither the locations the patients were flown to or the names of the medical facilities where they are being treated.

Ebola Update: Escaped Patient chased through Market looking for Food (Video)
CDC: Window of Opportunity to contain Virus closing The Centers for Disease Control Director stated yesterday in a Press Conference that this current #Epidemic is likely to get worse and is "Out of Control".
“The window of opportunity really is closing. I could not possibly overstate the need for an urgent response.” - CDC
See more at:

Mathematical Model Shows How Ebola Will Spread: "Worse Case Scenario... An Extinction Event"  The@DailySheeple 

Danger of Ebola Becoming Airborne

Late this week Michael T. Osterholm, the director of the highly respected Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, wrote a lengthy op-ed piece for the New York Times within which he discusses the growing global danger from this outbreak, as well as the strong potential for Ebola to become airborne. Osterholm states that "viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next." He goes onto state that "the current Ebola virus's hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years."

Source Report:

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Home Isolation Protocols

This suggested list is based on CDC Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals. (

Patient Placement

·Single patient room (containing a private bathroom) with the door closed.

Suggest that the home’s Master Bedroom be utilized for this use.
Room should also have access to entertainment; TV, Radio, or computer
Prior to entering room, have another person check to ensure PPE is properly worn and no tares are obvious.
Personal Protective Equipment (PPE)

·All persons entering the patient room should wear at least:

o    Gloves

o    Gown (fluid resistant or impermeable)

o    Eye protection (goggles or face shield)

o    Facemask

·Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:

o    Double gloving

o    Disposable shoe covers

o    Leg coverings

Recommended PPE should be worn upon entry into patient rooms or care areas. Upon exit from the patient room or care area, PPE should be carefully removed without contaminating one’s eyes, mucous membranes, or clothing with potentially infectious materials, and either
Discarded, or
For re-useable PPE, cleaned and disinfected according to the manufacturer's reprocessing instructions and hospital policies.
Hand hygiene should be performed immediately after removal of PPE
Patient Care Equipment:

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