Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

[Lizw]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Sorry, Gemineye, my response was directed at hcc, not you. I should have quoted the other post. It's hard to do on the phone, easier to just hit Reply, and I didn't realize there were already other posts.

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

So, I see this outbreak smoldering and occasionally bursting into flame in various spots for months to come but not turning into an out of control wildfire. But God help us if it does.

Sadly I can not agree. The outbreak is not smoldering at this stage is an aggressive fire with an abundant supply of fuel - at least is Liberia and Sierra Leone. Given the current control effort there is little reason to expect anything but increasing case counts, enlargement of infected regions within these countries and spread through the porous, and largely hypothetical, national boarders.

Unless, and until, it meets a zone with serious detection, treatment, isolation and contact tracing in place (AKA a fire-break) it will continue on its merry way.

There seems little doubt that the listed case counts are a severe underestimate but it does not really matter anyway. What we need to be looking at is not the numbers but the shape of cases curve which is steep and getting steeper.

As the infected pool grows, and spreads geographically, so does the probability of spread to entirely new areas by air travel. While a few countries have the fire-break in place not many do and even the EU and US countries can only handle small numbers of isolation ICU cases - it is not generally a common requirement and therefore not available in any volume.

A recent Plos paper you linked to Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak
in another post gives the probability of an infected air traveler arriving in the US this month at 5% for the UK this is 25%. As the numbers grow unchecked these percentages will grow with them.

The WHO is saying 2000 now and 20,000 later other models estimate 100,000 cases - although I can not see how you can estimate an upper limit like this without any mechanism to put a break on growth (regardless its hardly a smolder). Plugging these numbers into the Plos model gives a continuous bombardment of major transport hubs.

If this epidemic is not to become a pandemic it needs to be dealt with now by a concerted effort to reduce the infectious pool in and around the epicenter.

 

[Gemineye]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Sorry, Gemineye, my response was directed at hcc, not you. I should have quoted the other post. It's hard to do on the phone, easier to just hit Reply, and I didn't realize there were already other posts.

No problem, Lizw.

 

[Pathfinder]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

...
As the infected pool grows, and spreads geographically, so does the probability of spread to entirely new areas by air travel. While a few countries have the fire-break in place not many do and even the EU and US countries can only handle small numbers of isolation ICU cases - it is not generally a common requirement and therefore not available in any volume.
...

Cases in Guinea are rising, 133 more this week with 62 deaths. According to a news report yesterday, the outbreak in Guinea is moving towards Senegal.

-----------------------------------------------------
...
Deadly contagion + international transit hub = bad news.
?By Alex Park

...
Senegal, with a population exceeding 13 million, is the fifth country afflicted in the crisis. But it's an especially worrisome one, because Senegal is an international transit hub. More than 30 carriers fly through the L?opold S?dar Senghor airport in Dakar, on the continent's westernmost point, ferrying passengers to and from destinations in 25 countries around the world. While most of the routes are regional, some connect with major airports in New York City, Paris, Istanbul, Dubai, and Johannesburg.

Compared to Senegal, the three countries that account for the vast majority of infections to date?Liberia, Sierra Leone, and Guinea (see map below)?were isolated even before the outbreak: You could only fly directly to six destinations each from Liberia or Guinea, while carriers operating in Sierra Leone serviced ten routes. Despite the limited air traffic, the disease jumped borders when an American citizen flew from Liberia to Lagos, Nigeria, and become that country's first reported infection, prompting some regional carriers to suspend flights to the three countries most affected.
...
http://www.motherjones.com/politics...doctors-without-borders-ebola-senegal-nigeria

 

[Chicagogal]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I think whenever we're dealing with a topic requiring medical education and outside donations, it's important to look at existing negative bias (confirmation bias). I think there are two separate biases going on here.

I think many medical professionals see the lack of infrastructure as insurmountable. To truly deal with this crisis, we would have to essentially build new medical facilities in several places. That can seem overwhelming when budgets for even basic services have been cut as part of the global recession.

Many medical and scientific professionals seem to have a real blind spot with regard to addressing underlying bias. They believe that giving accurate medical information is the end of the road. Sadly, people just don't respond to accurate information. They respond to emotion.

With individuals, I think (hopefully subconscious) bias of "they deserve what they get" is in play here. These are countries that have been war-torn for decades, and many blame their people for corruption, terrorism, internet spam, and piracy. This frankly also plays into racism. All the old stereotypes of ignorant natives have been dredged up with the Obama presidency. West Africa is as "other" as you can get.

There does not seem to be any existing messaging/marketing framework. The WHO has sounded the alarm, but they haven't marketed this issue. That's the starting point.

Perhaps the "it's coming to our shores" will provide enough of a framework to start motivating donations.

 

[Lizw]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

With individuals, I think (hopefully subconscious) bias of "they deserve what they get" is in play here. These are countries that have been war-torn for decades, and many blame their people for corruption, terrorism, internet spam, and piracy. This frankly also plays into racism. All the old stereotypes of ignorant natives have been dredged up with the Obama presidency. West Africa is as "other" as you can get.

Yep, that's exactly how I feel about it. And the reaction of 'they deserve it' is sadly not sub-conscious, even among people who would not ordinarily make overtly racist remarks. I hear things like "What do you expect with all the civil war and ignorance and corruption?" As though every man or woman or child who becomes ill somehow shares in the blame for years of Western exploitation of their country's resources and support of whatever strong man made it easiest to do so.

Sorry, all, I'm really grumpy today.

 

[Pathfinder]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Thinking outside the box ...

Obviously, what is being done right now doesn't work.

This Ebola outbreak needs to be coordinated in small sections, not by a few large treatment centers in specific areas.

Several "treatment centers" need to be distributed all over the affected areas. As an example, each village could assign a building or install large tents. The chief of the village could choose healers and women in the community and they could be trained to take care of the patients and trace contacts. In providing them protective gears, bleach, soap, medecine, food and water, the population would not have to hide, trusting their own people to take care of them.

Same in cities. Find the people with the most influence in quarters and assigned them to take charge of small areas, again by training them...

Give money, extra food and water as a reward to the workers and families of patients. Also reward on merits by giving diplomas after training, medals to the people who accomplish a positive action...

One medical worker can train several people at a time, answering the problem of lack of staff. It would also answer the difficulty in trust that the international organizations are facing.

There is no cure, but if patients can at least be well fed, well hydrate and kept in a clean environment with people that they trust, it gives them a better chance to survive.

I believe that people of Africa can take care of the people of Africa with international help in training and supplies.

 

[Ray]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Many medical and scientific professionals seem to have a real blind spot with regard to addressing underlying bias. They believe that giving accurate medical information is the end of the road. Sadly, people just don't respond to accurate information. They respond to emotion.

There does not seem to be any existing messaging/marketing framework. The WHO has sounded the alarm, but they haven't marketed this issue. That's the starting point.

Perhaps the "it's coming to our shores" will provide enough of a framework to start motivating donations.

After lurking since 2009, I finally joined to chime in on this. No one I know (largely non-science field college-educated US suburbanites) thinks this disease is a threat outside of Africa. Not a single person of many in my social media/personal circles.

Despite the severity of the outbreak and the implications of the scaling up, numbers etc, Ebola is seen as an African problem. People simply do NOT believe it can spread outside of Africa. The message the media/WHO/CDC sent early on, that this disease is not a threat, does not have "legs" etc. cannot be walked back quickly enough. Scientists may not like to speak to potential outcomes/prefer dealing strictly with facts, but someone (other than a handful of health reporters like Laurie Garrett have to improve the messaging/social media on this. Articles like the "Kardashian" one in wapo and Yahoo headlines from experts that this will "burn itself out" don't help.

 

[AnnaLisa]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I agree with Ray, that most people do not think it will reach our shores. We have been told that it is a hard disease to catch. As we see in west Africa, if enough people catch it, then it becomes very hard to avoid.

We were foolish as a species not to fight this far earlier. Now the logistics of fighting it in West Africa are very difficult, and it seems that no nation or group of nations is willing to invest the manpower in terms of personnel to squash this. We can throw money at this, but, it will take more than money.

 

[Laidback Al]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

. . . Ebola is seen as an African problem. . .

Welcome to FluTrackers, Ray. Thanks for changing from a lurker to a poster.

Yes, early on national and international health organization donwplayed the risk. Now the general (and uninformed) attitude is that these organizations are just "crying wolf" to get more funds.

As soon as a latent Ebola case crops up in a first world country, the public outcry will be very different.

 

[Emily]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

...

There does not seem to be any existing messaging/marketing framework. The WHO has sounded the alarm, but they haven't marketed this issue. That's the starting point.

Perhaps the "it's coming to our shores" will provide enough of a framework to start motivating donations.

That message is already out there and it motivates only selfishness and hysteria.

http://www.thedailybeast.com/articles/2014/08/20/ebola-fueled-racism-is-on-the-rise-in-europe.html

Ebola-Fueled Racism Is on the Rise in Europe
A Berlin building locked down after an African woman faints. An African man with a nosebleed removed from a mall in Brussels. With Ebola panic spreading, racial profiling could be next.

When a black woman from Africa collapsed at a business meeting in Berlin on Tuesday, German police dispatched more than 60 police officers and firefighters to lock down the building, isolating some 600 people who worked there. The woman, who lives in Berlin and who was rumored to have just returned from Africa a week earlier, along with two others who had come to her aid when she collapsed, were rushed to an isolation ward at Berlin?s Charit? Hospital. No one was allowed in or out of the building as armed police stood guard...

Veterinarians say the most dangerous dogs to work with are the "fear-biters." They are unpredictable, hyped up on cortisol, and do as much damage as they can because they believe they are in mortal danger. A dangerous mob is already being created by fear-mongering, not a donation base.

 

[sharon sanders]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Welcome Ray and hcc!

 

[Ray]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

That message is already out there and it motivates only selfishness and hysteria.

Many developed nations will increase funding disasters/epidemics if it is in their best interest from a national security or economic standpoint. (The day after the PLOS air travel modeling/projection came out, EU and US added millions.) Since part of national policy/funding of emergencies in many countries is dictated by constituent interest, it can aid the funding of a cause if citizens become concerned, involved and vocal.

I think mass public concern/awareness that this is not just an "African" problem, is the only thing that will translate into the kind of aid desperately needed and response MSF is calling for.

As soon as a latent Ebola case crops up in a first world country, the public outcry will be very different.

Sharon, I'm afraid that is what it will take for the US to send the personnel and aid to W. Africa. I'm concerned about the economic fallout, globally, from that outcry.

 

[Farmer]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

We now know current efforts at establishing Ebola treatment centers are grossly inadequate in hard hit places such as affected urban areas of Liberia.

http://www.reuters.com/article/2014/09/06/us-health-ebola-politics-idUSKBN0H106M20140906

http://frontpageafricaonline.com/in...nts-flee-turned-away-suspected-ebola-patients

The infrastructure upon which to build a new, effective response to the Ebola epidemic is generally lacking among these countries. Health care: trained workers and support staff, supplies and physical infrastructure are needed. Food and supplies: quarantines, societal disruption and supply interruptions have created scarcity in affected areas. Travel: many commercial carriers have eliminated flights to affected countries.

In short, for an effective response, donor countries would need to send massive amounts of personnel, supplies and infrastructure to affected areas. Implementation of field hospitals, areas for worker housing, food provision, water purification, etc. would need to be established. This kind of aid is on the scale of a military invasion, and may be culturally inappropriate: people really may feel they are being invaded. Additionally, the epidemic is now very diffuse, the logistics are truly daunting.

Because of these overwhelming needs, donor countries lack the financial resources and the political will to mount an effective response. Additionally, geopolitical unrest has created multiple competing priorities for foreign aid and potential military action, certainly in the US, Middle east and Europe.

It is a very difficult situation and does not bode well for an effective global response to other emerging infections that develop into epidemics in resource-poor areas.

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Its the contact tracing, which is at the heart of Ebola containment efforts, that I find mind-boggling.
I note that 65 people are being monitored in Senegal for one contact who was a know entity and quickly tracked down. Given the WHO's conservative estimate of 16,000 cases (4,000 known and their estimate that that is a quarter of the actual number) and a similar number of contacts per infection that gives 1,000,000 people who need to be traced, found and monitored. As the case rate is roughly doubling each month, at present, that equates to nearly the population of London by Christmas.

 

[etudiant]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

The lack of outside intervention is obviously because there is no practical intervention possible. We have no vaccine or immunization, so all outsiders can do is die in place of less well trained locals.
Well meaning organizations such as MSF call for a big intervention push which would just multiply the global casualties, because they have no better ideas, just like the World War 1 generals.
This is a disaster which at best will remain localized. At worst, it will become global, in which case all bets are off. Nigeria will be the canary in the coal mine. If there are 100 Nigeria cases by Oct 1, better lay in an emergency stash of food and water, because things will get very ugly.

 

[Emily]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Welcome etudiant! I think people should research donations carefully. Didn't Tom Friedan suggest MSF and a CDC affiliated NGO? I doubt either of those 2 will make matters worse or end up mired in scandal like some that operated in Haiti.

Initially I think the belief that ebola was not endemic in West Africa is what drove some wider spread by HCW's. Now that the risk is known, I that risk is lower.

Nigeria is a worry, but I don't believe that we private citizens need to stockpile supply supplies here in the U.S. if that situation deteriorates if that is what you are suggesting. The ugliness I fear would be conflict between Liberia and Nigeria, due to the index case in Nigeria being a Liberian diplomat.

 

[mixin]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

On ProMED, this man brought up the good question as to why at least the medical ships haven't been sent yet.

Dr Gerhard Boecken
Regional Medical Advisor
German Foreign Office
German Embassy Nairobi/Kenya

http://promedmail.org/direct.php?id=20140906.2754003

 

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

The lack of outside intervention is obviously because there is no practical intervention possible. We have no vaccine or immunization, so all outsiders can do is die in place of less well trained locals.
Well meaning organizations such as MSF call for a big intervention push which would just multiply the global casualties, because they have no better ideas, just like the World War 1 generals.
This is a disaster which at best will remain localized. At worst, it will become global, in which case all bets are off. Nigeria will be the canary in the coal mine. If there are 100 Nigeria cases by Oct 1, better lay in an emergency stash of food and water, because things will get very ugly.

etudiant welcome, but I can't agree with your analysis.
There are practical interventions that are possible and needed if you don't want cases where you live. The primary one is not pharmaceutical but containment which requires contact tracing, testing and monitoring. There aren't enough resources to do this locally so we either let it burn and take our chances or through enlightened self interest, if not out of compassion, we send equipment and trainers in its use.
The same goes for medical care and education. If patients arrive at a clinic and are just locked in a room without food or water until they die from dehydration (yes it happened) because staff did not have the training or PPE to feel safe helping them then locals do not bring in their family - more spread.

MSF's big push is essential if we (the Ebola susceptible mammals of this planet) do not contain this epidemic it will just keep pushing tendrils into virgin territory. Which, of the aforementioned mammals, should take on this burden? We could leave it to the fruit bats and monkeys (hey, they started all this), or just the area effected today, or the G8, G20, G33.

On the Nigeria bit I am with you. The danger is the poorer areas of Lagos. If the poorer areas house one third of the population then you have the population of London living in optimal conditions for sending the virus's Reproductive Number (Ro) so high there is no chance of containment.

 

[Laidback Al]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

etudiant, I agree with JJackson's perspective. There are non-pharmaceutical interventions that can be implemented that could slow the infection rate. An important one is an education program to help local populations understand the nature of Ebola transmission.

JJackson, I appreciate your verbal imagery. "[Ebola] will just keep pushing tendrils into virgin territory."