Discussion: What is going on in Liberia?

gsgs · Oct 26, 2014

they are obviously doing some re-counting,
160 cases in Montserrado on one day on Oct.17 ,
some addition errors, some tables skipped, some
Counties not reporting, few confirmed cases (Lab down ?)

they had strikes

newest reports are listed here:
http://www.mohsw.gov.lr/content_display.php?sub=report2

latest is #158 , Oct.20

they could tell us, what kind the problems are ... (but won't)

headlines:
Ebola cremation ruling prompts secret burials in Liberia
Liberian Slum Takes Ebola Treatment Into Its Own Hands
Dozens threaten to break Ebola quarantine over food
How foreign aid screwed up Liberia's ability to fight Ebola

-------------------------------------------

http://www.shanghaidaily.com/article/article_xinhua.aspx?id=248012
The Director of Health Communication, John Sumo, in an Ebola update issued in Monrovia,
the nation's capital city said between Oct. 17 and Oct. 18, 98 Ebola patients were discharged
after testing negative for the virus.

According to him the situation in Montserrado is hampered by community resistance
and secret burials without the involvement of designated burial teams.

[91 suspected and 65 probable cases reported on Oct.17 , usually only 20-30 cases per day]

Sharky · Oct 26, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

I understand the Liberian government has decided to censor Ebola-related reports. The numbers were already under-reported, and I think this has further compounded the problem.

http://en.rsf.org/africa-freedom-of-information-hit-by-08-10-2014,47071.html

My guess is that they're starting to worry about economic impacts, social unrest, disrupting trade, and so on -- all very real concerns, but hiding in the dark isn't going to help.

gsgs · Oct 26, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

http://en.rsf.org/africa-freedom-of-information-hit-by-08-10-2014,47071.html

deliberately manipulating case-counts is another issue. It is also hard to hide,
the numbers are being compared with other regions, other sources, future outbreaks.
I have seen no signs for this yet.

When I first saw the reports, I thought they were surprisingly good.

WHO should edit them, merge the country-reports into one big daily report, make them uniform
and computer-readable, estimate missing numbers

I suppose the national health departments receive some kind of reports from the
counties/regions/provinces. These should be made public too.

Laidback Al · Oct 26, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

gsgs said:
. . .
When I first saw the reports, I thought they were surprisingly good.

WHO should edit them, merge the country-reports into one big daily report, make them uniform and computer-readable, estimate missing numbers. . . .

How would suggest these estimates be derived. If the estimates have no correlation with the actual number of unreported/untested cases, they are just guesses.

Emily · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

gsgs said:
http://en.rsf.org/africa-freedom-of-information-hit-by-08-10-2014,47071.html

deliberately manipulating case-counts is another issue. It is also hard to hide,
the numbers are being compared with other regions, other sources, future outbreaks.
I have seen no signs for this yet.

...

I agree. That article Sharky posted does not offer evidence of case under-reporting. It just speculates that the harsh punishment meted out in Senegal for false (over)reporting cases there might intimidate other reporting.

The concerns in the article are valid, but related more to the reporting of human rights violations.

gsgs · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

Laidback Al said:
How would suggest these estimates be derived. If the estimates have no correlation with the actual number of unreported/untested cases, they are just guesses.

we need these estimates to make the lists complete,computer-readable.

So they can be compared with other data
so we can make charts, statistics

estimate from previous data, trends, other regions

also, sometimes there are obvious errors or typos
correct them as good as possible

gsgs · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

2 more days are available now:

http://www.mohsw.gov.lr/content_display.php?sub=report2

there was some reclassification with a massive increase of cases

6166 total cases now ! up from 4772

mostly in Montserrado : 2158 --> 3466 and Margibi:632-->1100

4772,096,481,10,147,43,4,41,818,0632,08,2158,282,19,10,23
6166,154,264,12,121,59,4,26,622,1100,13,3466,280,08,10,27

deaths down from 2770 to 2168

1.) From daily email county reports of aggregated data for that day - DAILY EMAIL REPORT
2.) From individual-level data from the Case Investigation form; cases may be reclassified
according to surveillance case definitions - VHF DATABASE

shall they make available the past daily or at least weekly entries from the "VHF DATABASE" !

VHF-database:
http://www.cdc.gov/media/releases/2014/p0429-new-software.html
http://wwwn.cdc.gov/epiinfo/

http://gcn.com/articles/2014/10/22/ebola-technology.aspx
http://gcn.com/articles/2014/08/11/ebola-virus-tracking-app.aspx

Graupel · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

that is deeply concerning- I know things are exceedingly challenging, but 1500 cases?? That means either things are so dire that the totals are totally unreliable (very bad news), or that we are seeing further exponential growth (very bad news) with a reporting delay?

gsgs · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

they should really do some explanation now.
Presumably WHO will also have some explanations
in their next report (due Oct29).

How I understand it, they had the 2 reporting systems in parallel
all the time and now switched from one to the other.

They always had the "number of contacts" table with >5 contacts
per reported case, this was presumably from the VHF database
all the time.
But then, the VHF database had always also given the number of
cases, contacts that became symptomatic.
But this number was always low, afair, much lower than the total cases -
I'll have to recheck.
Then they had contacts that had been lost.

Sierra Leone and Guinea also have that "contacts" table,
so, will they make available their VHF-case-counts now also ?

------------------------------
I posted a chart of the number of contacts recently ... I don't know where it is now.
(it was probably named lico_something)
AFAIR it had not the steep decline that we saw in Liberia since mid-Sep,
it was still increasing, but flattened. I thought that was probably due to more intense
contact-tracing recently, I think we had the same in Sierra-Leone

======================================

maybe UNO/WHO can take over the health-department for the duration
of the ebola-outbreak ?!?!

gsgs · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

maybe WHO knew about these VHF-data all the time (but won't tell us)
and that was the base for their 50%,100%,150% underreporting
estimates for Guinea/SierraLeone/Liberia ?

and maybe it was even WHO-pressure, that Liberia now released
the data to public

-----------------------------------

or/and the Cuban doctors required access ?

Oct.21
On Tuesday, the intensive care specialist was headed to the epicenter of the Ebola epidemic
along with 90 other Cuban medical workers as part of a half-century-old strategy that puts
doctors on the front lines of the country’s foreign policy. The 91 nurses and doctors going
to Guinea and Liberia join 165 already in Sierra Leone – making this island of 11 million people
one of the largest global contributors of medical workers to the fight against Ebola.

Read more here: http://www.mercedsunstar.com/2014/10/21/3913108/oct-21-heres-the-latest-on-ebola.html#storylink=cpy

91 is also the number of new suspected cases on Oct.17(Fr)

gsgs · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

they also give a chart of weekly incidence per 10000 population
for the 5 most affected counties, week 33-42

Montserrado is going up in that chart for week 41 to a new high
while week 42 for Montserrado is missing

it also doesn't show that decline in Montserrado over the last
5 weeks, that the data so far showed

JimO · Oct 27, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

gsgs said:
6166 total cases now ! up from 4772

deaths down from 2770 to 2168

They changed reporting formats from Situation Report 159 to 160 and that is when the numbers were dramatically changed. I don't see any evidence to support decreasing the number of deaths by more than 600. Besides, even if they had a backlog of lab testing, what else could be responsible for 600 deaths in a few weeks? Based on the new numbers, they would have nearly 3,000 unresolved cases (cases other than deaths and recovered). They don't have nearly the capacity to treat that many cases. Plus, many of those who are turned away from one of the treatment centers are counted as a case, but no follow up is done to determine whether or not they survived.

gsgs · Oct 29, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

report #146 from Oct08 had some earlier VHF-data
and lots of charts:

http://www.mohsw.gov.lr/documents/SITRep 146 Oct 8th, 2014.pdf

in the chart on page 3 they have blue for VHF-cases,
light grey or green for SitRep-cases, but what are the dark-grey cases ??
and no more SitRep-cases since 09/19 ?

well, maybe confirmed only vs.total, they should say it

------------------------------------------------------------------

OK, what I now think about that 3-clolor chart on page 3 of report #146 : (took me some hours to figure out ..)

it's 2 charts in one:

1.) delete the light color and merge the 2 darker colors to get the VFH-chart
2.) delete the blue color and merge the 2 other ones to get the SitRep-chart
(suspected+probable+confirmed)

but that also means, that the VFH-cases had gone down a lot since Sep20,
even more than the SitRep-cases and although the contact-tracing still increased.

The larger number of total VFH cases (6267 vs. 4993) would then be because
the much larger number of VFH-cases in the period before Sep10 which weights more
than the smaller number since Sep11

Now the mystery is why the have more contacts been traced since Sep17, although
the cases were declining.

Gert van der Hoek · Oct 29, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

In Liberia, a Good or Very Bad Sign: Empty Hospital Beds

By SHERI FINKOCT. 28, 2014

SUAKOKO, Liberia — For days this month, the ambulances from this Ebola treatment unit went out in search of patients, only to return with just one or two suspected cases. And many times, those people ended up testing negative for the disease.

“Where are the patients?” an aid worker wondered aloud as colleagues puzzled over the empty beds at the International Medical Corps treatment unit here in Bong County, Liberia, which opened in mid-September. Around the country, treatment centers, laboratory workers who test for Ebola, and international and national health officials trying to track the epidemic have noticed an unexpected pattern: There are far fewer people being treated for Ebola than anticipated.

Anna Halford, a field coordinator for Doctors Without Borders, said the charity had a broad network of community members who promoted Ebola awareness in and around the capital.

“Not a single one of the supervisors believes there is a significant drop in cases,” she said.

More: NY Times

Gert van der Hoek · Oct 29, 2014

Re: What is going on in Liberia?

Re: What is going on in Liberia?

oct 27 2014

Liberia: The Hidden Truth About Ebola

Helen Epstein

Even as Ebola hysteria rages in the US, the epidemic here in Liberia, which is supposed to be its epicenter, seems to be subsiding. According to official counts, this impoverished West African country of 4 million people is currently home to fewer than four hundred Ebola patients. Not millions of patients; not tens of thousands of patients; not even thousands of patients. Fewer than four hundred patients. Even as the World Health Organization warns that any day now we could be seeing thousands of new cases, and Obama’s UN Ambassador Samantha Power claims the global response to the epidemic is “failing,” the number of new cases each week in Liberia is falling, not rising. In August, the streets of Monrovia were strewn with bodies and emergency Ebola clinics were turning away patients. Today, nearly half of the beds in those treatment units are empty. I’ve been here a week and have yet to see a single body in the street. Funeral directors say business is off by half.

(..................)

Is the decline in cases real? Aid groups warn that families could be hiding patients in slums and villages because they believe in voodoo and want to give their beloved a proper African funeral. No doubt there are such cases, but according to studies carried out here by scientists from the US Centers for Disease Control and Prevention, there appear to be few of them. CDC researchers working closely with Liberian officials have been scouring the country for sick people. In Monrovia, health workers travel from house to house in the slums checking on people who had contact with those who are already sick or have died. In July, nearly half of those contacts went on to succumb to the disease themselves. Today, fewer than 20 percent of them do.

Discussion: What is going on in Liberia?

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