Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

[Treyfish]

<section class="sec"><time class="published" pubdate="" datetime="2014-09-02T15:07:53+00:00">September 2, 2014</time> · Abstract

Background: The 2014 West African Ebola Outbreak is so far the largest and deadliest recorded in history. The affected countries, Sierra Leone, Guinea, Liberia, and Nigeria, have been struggling to contain and to mitigate the outbreak. The ongoing rise in confirmed and suspected cases, 2615 as of 20 August 2014, is considered to increase the risk of international dissemination, especially because the epidemic is now affecting cities with major commercial airports.


Method: We use the Global Epidemic and Mobility Model to generate stochastic, individual based simulations of epidemic spread worldwide, yielding, among other measures, the incidence and seeding events at a daily resolution for 3,362 subpopulations in 220 countries. The mobility model integrates daily airline passenger traffic worldwide and the disease model includes the community, hospital, and burial transmission dynamic. We use a multimodel inference approach calibrated on data from 6 July to the date of 9 August 2014. The estimates obtained were used to generate a 3-month ensemble forecast that provides quantitative estimates of the local transmission of Ebola virus disease in West Africa and the probability of international spread if the containment measures are not successful at curtailing the outbreak.
Results: We model the short-term growth rate of the disease in the affected West African countries and estimate the basic reproductive number to be in the range 1.5 − 2.0 (interval at the 1/10 relative likelihood). We simulated the international spreading of the outbreak and pr...:tiphat:http://currents.plos.org/outbreaks/article/assessing-the-international-spreading-risk-associated-with-the-2014-west-african-ebola-outbreak/</section>

 

[JimO]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

Here is a link to the paper:

http://currents.plos.org/outbreaks/...ed-with-the-2014-west-african-ebola-outbreak/

 

[Gert van der Hoek]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

Related to discussions if we should limit air traffic, this graph from the PLOS study says it all: it reduces the CHANCE to import the disease. Nothing less, nothing more. So a travel ban doesn't seem to help much.

Only thing - theoretically speaking - that could help to prevent ebola entering the US or any other country at all, is to seal off that country. You can't seal off the USA, impossible.

They may make mistakes (US..), however the US and other western countries can deal with Ebola patients.

 

[Dani]

Re: Ebola - Travel ban or keep flights open?

Re: Ebola - Travel ban or keep flights open?

Not to be too picky over semantics, but the title of this thread is comparing apples and oranges.

A travel ban is different from closing down flights. It involves not allowing people to travel into or out of the affected areas via passport & visa control. Similar to the travel ban the US had with Cuba for decades, and that North Korea has with everyone else right now. For a while, we had a travel ban to Israel because of the fighting, it is now listed as only a "warning" which is actually worse than the "alert" given to travel to West Africa, even though the fighting there seems to have ceased.

This article does not appear to analyze a travel ban.

Stopping flights is a different way of controlling spread, and only partially effective, as the article points out. The disturbing thing to me is that the air traffic in & out of the affected areas probably already HAS decreased by 80%, and yet there is a case in the US. Of course, one data point does not contradict the study, but theoretically the US is quite low risk in that scenario, yet here we are with a case.

Travel bans could be very effective, and except for the southern border, could effectively "seal off" the US from the nations with epidemic Ebola. Although, I very much doubt someone with Ebola originating in West Africa could manage to get to Mexico or South America and find their way north in time to enter the US before they succumb to disease.

The argument against a travel ban appears to be that it will hurt the countries already affected by the epidemic, not that it won't keep Ebola out of the US in the near term. It would. It's the long-term risk that no one has any idea about, especially if it makes the situation in West Africa worse. Then, that ultimately could lead to instability and war and all kinds of things that will affect the US.

 

[sharon sanders]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

I changed the title of the thread to the title of the paper referenced in the first post.

 

[Gert van der Hoek]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

Ebola: Should the US temporarily ban incoming flights from West Africa?

Posted by Robert Herriman on October 6, 2014

The Ebola Virus Disease (EVD) found it?s way into the United States in the form of Liberian man, Thomas Eric Duncan who was confirmed positive for the lethal virus on Sept. 30. Duncan reportedly lied on official paperwork in Liberia concerning his exposure to an Ebola patient and flew to Dallas, Texas via Brussels, Belgium and Dulles International in Washington DC.

I contacted several experts in public health, infectious diseases and virology to get their thoughts?What do you think is the right thing to do and why? The expert opinions were from both ends of the spectrum.

More: Outbreak News Today

 

[Gert van der Hoek]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

U.S. working on new screenings for Ebola but no travel ban

Source: Reuters - Mon, 6 Oct 2014

By Roberta Rampton and Richard Valdmanis

WASHINGTON/DALLAS, Oct 6 (Reuters) - President Barack Obama said on Monday that the government would develop expanded screening of airline passengers for Ebola, both in the West African countries hit by the disease and the United States.

The first patient diagnosed with the disease on U.S. soil, Thomas Eric Duncan, remained in critical condition in a Dallas hospital, as Obama was briefed by agencies involved in fighting the spread of the deadly virus.

The president said it was important to follow existing protocols strictly.

"But we're also going to be working on protocols to do additional passenger screening, both at the source and here in the United States," Obama said.

However, the White House said that a ban on travel from West African countries, which some U.S. officials have called for, would slow the fight against Ebola.

White House spokesman Josh Earnest said officials did not want to impede transport systems used to send supplies and personnel to the hardest-hit countries in West Africa, so a travel ban was not being considered.

More: Trust.org

 

[Vibrant62]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

If ebola continues to spread, then they may have to rethink travel if we wish to avoid further international spread.

Ideas: it seems to me that if they wish to avoid a travel ban, then there must be 21 days monitoring of all individuals arriving from a 'hot' zone, and the authorities must know where these individuals are for the 21 day period. New arrivals must be released to a family who take legal responsibility for monitoring, and will be providing accomodation, or arrivals need to go to specific monitoring centers and stay there for the 21 day period, at their expense. Failure to report temperatures twice daily = immediate isolation (if infected) or deportation (if not). Returning US citizens would very likely be happy to comply; obviously there would not be a deportation option if they failed, but there could be fines or similar to provide added incentive over and above pure altruism.

In this way they would pick up all imported cases very early on, and as long as secondary contact monitoring is 100%, the numbers of secondary cases should be small.

This would all break down however, if anyone is lost to follow up, and is infected.

An alternative could be to create 'isolation hotels' at the point of origin, where travelers must complete 21 days of isolation and monitoring before they are allowed to board a plane. There is still a risk of coming into contact with an infected person between the hotel and the plane, but in theory at least, these should be low risk contacts.

I think the first option is probably better, but either would work. That way borders stay open and planes keep flying.

 

[Chris]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

An opinion piece from Time:

http://time.com/3475106/ebola-country-borders-new-isolationsism/

 

[Dani]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

U.S. working on new screenings for Ebola but no travel ban

Source: Reuters - Mon, 6 Oct 2014

By Roberta Rampton and Richard Valdmanis

WASHINGTON/DALLAS, Oct 6 (Reuters) - President Barack Obama said on Monday that the government would develop expanded screening of airline passengers for Ebola, both in the West African countries hit by the disease and the United States.


More: Trust.org

I saw this and it seemed a little surreal. It's like having deer getting into your yard to eat the roses, so you put a lock on the gate- when what you really need is a higher fence. With a possible 21 day incubation period and the ability to mask early symptoms with antipyretics, do the authorities really believe that a). this will accomplish anything and b). the citizenry believes it will accomplish anything? I'd rather they treat us like intelligent adults and just state that cases will get through and we'll handle them when they arrive.

If ebola continues to spread, then they may have to rethink travel if we wish to avoid further international spread.

Ideas: it seems to me that if they wish to avoid a travel ban, then there must be 21 days monitoring of all individuals arriving from a 'hot' zone, and the authorities must know where these individuals are for the 21 day period. New arrivals must be released to a family who take legal responsibility for monitoring, and will be providing accomodation, or arrivals need to go to specific monitoring centers and stay there for the 21 day period, at their expense. Failure to report temperatures twice daily = immediate isolation (if infected) or deportation (if not).

In this way they would pick up all imported cases very early on, and as long as secondary contact monitoring is 100%, the numbers of secondary cases should be small.

This would all break down however, if anyone is lost to follow up, and is infected.

An alternative could be to create 'isolation hotels' at the point of origin, where travelers must complete 21 days of isolation and monitoring before they are allowed to board a plane. There is still a risk of coming into contact with an infected person between the hotel and the plane, but in theory at least, these should be low risk contacts.

I think the first option is probably better, but either would work. That way borders stay open and planes keep flying.

These are both great ideas & I particularly like the former, but I just don't think that the USA, at least, has the will to do either until it is too late. Then, when it's apparent that some type of quarantine or followup is necessary, there won't be time to implement it. I think we'll just go along with airport screenings, and when the number of cases in the US gets high enough, they'll enact a travel ban because it's quicker and easier than figuring out a workable plan.

 

[Ray]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

The graphs shown here don't have numbers on them, but another source quoting the same research gives UK's risk as 50% without restrictions and 15% with. So this graph seems to be showing U.S. risk without travel restrictions at about 80% and the risk with them as 20%.

This is a huge difference.

If you live on the Gulf Coast and the NWS tells you there's a 20% chance of being hit by a hurricane today, you will monitor the storm closely and get prepared. If they tell you there's an 80% chance, you will evacuate.

It also says that reduction in travel will only delay cases by 3-4 weeks. And until the epidemic in W. Africa is stopped, there will continue to be spread. Stop travel from those countries, people will still find ways but they may become more difficult to track. One of the arguments against restrictions?

Lack of transparency (read: countries not reporting any/all cases) which will make screening travelers quite difficult. May already be happening.

Also, this data uses WHO numbers (underestimates) and is already off if cases doubling every 10-21 days.

 

[AnnaLisa]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

If ebola continues to spread, then they may have to rethink travel if we wish to avoid further international spread.

Ideas: it seems to me that if they wish to avoid a travel ban, then there must be 21 days monitoring of all individuals arriving from a 'hot' zone, and the authorities must know where these individuals are for the 21 day period. New arrivals must be released to a family who take legal responsibility for monitoring, and will be providing accomodation, or arrivals need to go to specific monitoring centers and stay there for the 21 day period, at their expense. Failure to report temperatures twice daily = immediate isolation (if infected) or deportation (if not). Returning US citizens would very likely be happy to comply; obviously there would not be a deportation option if they failed, but there could be fines or similar to provide added incentive over and above pure altruism.

In this way they would pick up all imported cases very early on, and as long as secondary contact monitoring is 100%, the numbers of secondary cases should be small.

This would all break down however, if anyone is lost to follow up, and is infected.

An alternative could be to create 'isolation hotels' at the point of origin, where travelers must complete 21 days of isolation and monitoring before they are allowed to board a plane. There is still a risk of coming into contact with an infected person between the hotel and the plane, but in theory at least, these should be low risk contacts.

I think the first option is probably better, but either would work. That way borders stay open and planes keep flying.

This is the clearest and most reasonable solution to the problem, but it is both an economic and ethical dilemma and I wonder if any global or governmental body is going to recommend this. I'm concerned that we will not act in time to stop the spread. Indeed, they may at some point institute such actions, but I fear, it will take so much for them to do this, that by then, the virus will be disseminated already. In other words, if governments want to prevent any further spread, they had better act soon.

 

[JJackson]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

For my country (also Vibrant62's), the UK, I don't know how practical this would be. While we don't have massive numbers of arrivals from the West African countries with cases we do have for both the US and Spain. Also under the IHR if a country wants to isolate visitors they are obliged to foot the bill for housing, feeding, and testing them. We could just not allow in Americans and Liberians but the Spanish have rights under UK law.

 

[AlaskaDenise]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

It was only a short time ago that incoming immigrants to the US had to pass through Ellis Island Immigration and could be held in quarantine for weeks.

A Short History of Quarantine

The practice of quarantine?the separation of the diseased from the healthy?has been around a long time. As early as the writing of the Old Testament, for instance, rules existed for isolating lepers. It wasn't until the Black Death of the 14th century, however, that Venice established the first formal system of quarantine, requiring ships to lay at anchor for 40 days before landing. ("Quarantine" comes from the Latin for forty.)

The Venetian model held sway until the discovery in the late 1800s that germs cause disease, after which health officials began tailoring quarantines with individual microbes in mind. In the mid-20th century, the advent of antibiotics and routine vaccinations made large-scale quarantines a thing of the past, but today bioterrorism and newly emergent diseases like SARS threaten to resurrect the age-old custom, potentially on the scale of entire cities. In this time line, follow the evolution of quarantine, from Roman times to the present......

(44 different quarantines from 549 AD to 2003)

.

 

[Ray]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

How many different injections of contagion into our country?

I'm not concerned about the US ability to handle isolated imported cases of Ebola.

I'm am concerned about spread of Ebola within Africa and to developing nations. The loss of life and implications for the global economy are horrifying.

If a pandemic materializes I will be concerned about spread in the US but by then we will be seeing more fallout from the collapse of the global economy, shortages of goods we import from affected countries in the developing world and political instability.

 

[Chicagogal]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

OK, I give up. I posted a cartoon about American isolationism, which I thought very germain to the conversation, considering that we are talking about 14-century quarantine... Apparently not allowed, since it's gone.

What's not allowed? Cartoons? Can someone please point me to the rules for this forum?

 

[Ray]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

OK, I give up. I posted a cartoon about American isolationism, which I thought very germain to the conversation, considering that we are talking about 14-century quarantine... Apparently not allowed, since it's gone.

What's not allowed? Cartoons? Can someone please point me to the rules for this forum?

Sharon can but I know they took down pictures last week? Something about copyrights & forums?
Great cartoon by the way. There is another you might like entitled "pandumbic"

 

[sharon sanders]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

OK, I give up. I posted a cartoon about American isolationism, which I thought very germain to the conversation, considering that we are talking about 14-century quarantine... Apparently not allowed, since it's gone.

What's not allowed? Cartoons? Can someone please point me to the rules for this forum?

I moved the cartoon to the archives. Unfortunately copyright can be used to censor the internet by filing legal actions alleging infringement. We can not post any photos, images, graphics, etc. without written permission of the author. I try to catch them all.

I meant to private message you but I got busy...sorry.

Please see link for history on this issue:

http://www.vegasinc.com/business/le...aven-chilling-effect-prompts-nonprofit-adjus/

 

[Chicagogal]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

Got it - thank you. The point was that isolationism has a history of not working out well for America. We are in bed with this illness, whether we "close" our borders or not.

 

[Gert van der Hoek]

Re: Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak

Ebola can?t be fought by sealing off the United States

By Editorial Board October 8 at 7:56 PM

THE DEATH of Thomas Duncan in Dallas from Ebola virus is a sobering reminder that we live in a world more connected and fluid than at any time in human history.

The Ebola virus and other deadly pathogens can accompany people from one point on the globe to another in a matter of hours ? and attempts to identify and stop carriers of the disease won?t always work, in part because of long incubation periods. Viruses and bacteria do not stop at passport control.

More: Washington Post