From the always great Raconteur Report blog:
Sorry about sharing this:
Since our last 21-day Ebola checkup, things have gone rather sh*t-sandwichy.
Recall then that things were basically flat-lined: no growth, just maintenance of the outbreak.
It's now started growing again.
Cases: 252
Deaths: 159
Contacts: 5,723!
IOW, the kill rate is still running 82% over three weeks time, and the number of people exposed and being tracked doubled in the last two weeks. 15 more people have survived and been discharged, and false alarms of possible EVD were reported in five neighboring countries.
Oh, and those numbers are a few days old.
The only good news is they managed to vaccinate another 3300 people last week. Over 22,000 total. But in a region with 1M people, mostly refugees, that's nothing much to be proud about.
So this has officially gone around the bend, and violence in the region has made that worse.
This is now probably going to skyrocket presently, because it's going to keep spreading exposure faster than they can contain it and vaccinate around it, not least of which because they had over 40 burials that were not done properly, which exposes family members to the virus from contaminated corpses.
That's how you get an outbreak that won't taper off.
https://raconteurreport.blogspot.com/2018/10/well-thats-problem.htmlHere is a previous series on Ebola with some relevant quotes. This was from an email I sent out to some people on August 31st, 2018.
EBOLA UPDATE (Raconteur Report)
The Ebola Outbreak Part Deux (JR NOTE: This is a series of six articles I highly recommend that you read. Ebola has largely fallen off of the radar of the news cycle and nearly all Americans, but another outbreak is currently ongoing in the Congo. In this series - mostly in responses to comments - Raconteur lays out exactly what the threat it and how bad it can potentially get. This is no joke, and he speaks from a position of authority - he has experiences as a high level RN.)
Keep an Occasional Eye on This One (8/16/18)
Remember two things:
1) 34 doublings to go from nobody to everybody. (This one is now between 6 and 7.)
That's just basic Epidemic Math.
2) In fifteen days, this outbreak has surpassed what the last one did in four months.
Which underlines:
a) virulence
b) transmissibility in this region
c) difficulty of doing what's necessary to halt the spread
It's still small potatoes, but moving roughly eight times faster than the last outbreak means it bears some scrutiny. If it gets to a population center/starts hurdling international borders, we're off to the races again like it's 2014. The only saving grace is that this time around we don't have an illegal alien Muslim idiot riding shotgun on the anti-apocalypse circus. Panic is never a good idea. Calm, rational forethought is always a good idea. Act accordingly. Think happy thoughts, and hopefully MSF/WHO manage to corral this before gets away from them, and it turns into another wildfire sh*tshow. Dealing with a biblically epic pandemic may very well be the last thing on your preparedness things-to-do, for good and prudent reasons. But it should still be on the list. I'll be very happy not to have to do another round of coverage of the Insane Clown Posse.
Addendum:
WIKIPEDIA page link for this outbreak.
Bonus fact to drive the point home:
"The area in question, North Kivu, is also currently in the middle of the Kivu Conflict, a military conflict with thousands of displaced refugees. The affected areas host over one million displaced people and shares borders with Rwanda and Uganda, with frequent cross border movement due to trade activities. The prolonged humanitarian crisis and deterioration of the security situation is expected to affect any response to the outbreak. There are about 70 armed military groups in North Kivu. The armed fighting has displaced thousands of individuals." - Wikipedia
Because what you really want is an area crawling with teenagers with AK-47s, and refugee camps cram-packed with potential infectees, right next to two international borders. And the virus, so far in this outbreak, is enjoying an approximate 80% mortality rate. What could possibly go wrong...?
https://raconteurreport.blogspot.com/2018/08/keep-occasional-eye-on-this-one.htmlEbola Meter (8/24/18)
Bad News:
It's still a thing. From outbreak onset on 8/1, there were 20 deaths originally (which is how they cleverly deduced it was Ebola). It took another 14 days to get to 40 deaths.
It's only taken another 6 days to get to 20 more. IOW, it's tracking with exponential spread quite nicely. The contacts have gone from 900 on 8/3, to over 2400 now as of 8/20. This, in a rural war-torn area teeming with 1M displaced refugees in sprawling camps, doesn't bode well for getting a handle on this anytime soon.
And as usual, it's killing the critically short ranks of health care workers there disproportionately, which means they haven't got precautions and sufficient protective apparel anywhere near in place yet. And the 45 new confirmed cases mainly came from among those in the "suspected" category.
The case tally and lethality is bouncing around, partly because some people are being ruled out, partly because you're always dealing with people who take their shoes off to count above ten, and partly because increasing numbers of victims makes some governmental ministries there look bad. It is what it is.
Reported Ebola-attributed deaths, however, have just about exactly tripled in three weeks. This isn't new, it's just exactly as gloomy as it looked on first glance.
Good News:
It hasn't jumped to someplace disastrous, like Kinshasa (pop. 13M), Luanda (pop. 6M), or Nairobi (pop. 3.5M). Yet. Also, the number of "suspected" cases tally has actually diminished, exactly as "confirmed" cases have ballooned, so either they're getting testing done more rapidly (very good), or more likely, the probables simply died, changing their status via pathology exams (very bad). You can get odds on which is likelier. And at 111 cases, it's at Level 7 (out of 34) on the Pandemic Meter.
Better News:
No one with Ebola has hopped onto a flight to Cairo, Riyadh, Rome, London, Rio, NYFC, or Atlanta. That we know of.
https://raconteurreport.blogspot.com/2018/08/ebola-meter.htmlYou don't LIKE a Fustercluck? This is how you GET a fustercluck.
Let's be clear: Ebola in Kivu, right now, is nowhere near as bad as it was in West Africa in 2014. Yet. Now, that said, and with all due respect to the commenter, my reply to that: I was like that once, too. Right up until I started digging, out of curiosity, in early 2014. Springtime, IIRC. Then Reality, with a predictability like sunrise, did its thing.
[........]
1) The modern system is exactly the problem with Ebola. One infected reference patient, Patient Zero, walks into your ER lobby with what looks like just another set of flu symptoms. During flu season. (How helpful for you.) After an hour (or as little as ten minutes, as numerous dead former cab drivers in Guinea, Liberia, and Sierra Leone could attest, if only we could dig up their ashes and re-animate them before their former owners died of Ebola infections from giving patients rides to the hospital) in the same lobby as ten other people, you have eight more Ebola patients, and you won't know it for 5-21 days. And they'll infect the triage nurse, the doctor, and the treating RN, unless you have everyone in Ebola-proof gear 24/7/365 pro-actively...
What? Of course neither you nor anyone else does that? Ever? Sux to be you, man.
Then, if you're really lucky, and Triage is on that, they ask the magic questions:
"Have you been exposed to Ebola?" "Oh, no sir."
"Have you been to Africa recently?" "Oh, no sir."
2) Once the symptoms of Ebola pop up, they've already exposed people for 1-3 weeks, so it's the 500 contacts you didn't know about that are going to be the next casualties. And they expose 50,000 more contacts you don't know about. And they expose 5,000,000 contacts you didn't know about. And they expose virtually everyone in the continent, and you're still waiting for the first patient's diagnosis to come back from the lab. How does America with a few million to a few hundred million dead sound to you? Another 10% of that crippled for life, and carrying the disease in their own bodies? Wildlife becoming a native virus reservoir on this continent, forever? Coyotes, rats, skunks, bats, whatever.
We still don't even know where in hell it lives in Africa, after looking for decades.
3) Quarantine? You're kidding me, right?
Look up Kaci Hickox.
Then Dr. Craig Spencer.
Then Dr. Nancy Snyderman.
4) Look up how Ebola was handled at Texas Health Presbyterian Hospital. One case infected two nurses (for life, it appears) despite them scrupulously following the CDC "guidelines" (instead of the actual field-tested MSF/DWB protective gear guidelines), they generated tons of medical waste, lost their ICU and ER wholesale for months, and nearly bankrupted the hospital. For one case. Then three cases. Then, they shipped the two surviving nurses to Emory in Atlanta ricky-tick, one of the actual BL-IV hospitals, and virtually shuttered their hospital for months, until the stigma and the story finally went away. Think about that: a cornerstone regional acute care hospital, 968-beds, turned into a virtual ghost town for three people. (Oh, and about a gazillion dollars in indefensible liability suits.) Their entire ER staff basically told management, "Either close the ER, now, or we all walk forever." The hospital closed that week. They had to; their patient census that week dropped literally to single digits. It was costing them more to turn the lights and AC on for a day than they were making in a month of that.
5) Hospitals here, outside the four BL-IV hospitals actually trained and sort-of staffed to care for a grand continent-wide total of - wait for it - eleven Ebola patients, maximum, are utterly, completely, and massively unprepared to deal with this , as the Dallas example proved in about 21 days, and neither they nor the CDC wants to talk honestly about this. Neither you, I, nor 2M other RNs nor 1M doctors has the slightest effing CLUE about dealing with this (unless they volunteered in West Africa in 2014) and come the day, they're going to make simple mistakes that'll get them dead, along with thousands to millions of their patients. The suiting up and decon process takes half an hour each coming and going, requires scrupulous attention to detail at every step, unless you want to die, the gear is hot, a lot hotter than most people can work in for more than a couple of hours, and a "simple" pee break requires the entire 30 minute decon, then another 30 minutes to re-suit. It takes two people who do nothing but suit you up, and another who does nothing but monitor you peeling out of it without effing up and killing yourself. So imagine with me a staffing ratio of four people for every one person who can actually render bedside treatment. And you think the nursing shortage is bad now?
Bear in mind the age of the average nurse in the US is something like 50 years old, not 21 or 22. So you'll have people old enough to be retirees in the military, in the equivalent of MOPP Level IV, which is hotter than hell even in an air-conditioned room, sweating like a pigs, and doing everything through a fogged up facepiece and two layers of gloves, in a rubber suit, with a virus that only has to get lucky once, with delirious feverish patients oozing blood from every orifice onto everything, and coughing a miasma of bloody sputum into the air. Yeah, that should work. And then, tell me how many CNAs, EMTs, and PCTs are going to risk their lives for $10-15/hr.? In someone's effing dreams, baby; hospitals will become ghost towns, just like Texas Health in Dallas did. In minutes and hours, not days. You'll have patients and staff going out the fire escapes and jumping down laundry chutes, mark my words. In Africa, they make Ebola survivors unpaid help with patient care. They have to help anyways, since they get stoned and shunned in town when they come out afterwards, and it's the only place they can get fed. And anyways, most of the victims are the very people they infected, and who infected them: family, friends, and neighbors. Good luck pulling that off here.
And it requires literal fuck-tons of gear, that your hospital and mine don't have and never will, dedicated facilities that they don't have, HEPA-filtered air- and waste-handling facilities they've never had, and generates even more fuck-tons of BL-IV HazMat waste that no one on the entire continent knows how to or is willing to deal with. The pyres burning it are going to look like Kuwait in 1991, people downwind fleeing the ashes are going to look like villagers fleeing Mongol hordes, and if you try to ship it across state lines, the trucks and trains will be met by smiling national guardsmen, with bayonet-mounted locked-and-loaded rifles and battle-ready tanks, and a serious dose of the ass with you for trying to transship it.
6) Canada has zero BL-IV beds, AFAIK. But hey, free health care! Just like in Ebola clinics in the African bush. Should work out great for them. Mexico has...wait, you're shitting me, right? Mexico has what you'd expect Mexico to have: a corrupt government, and an overabundance of expendable and illiterate peones. No points for guessing who'll handle clean-up there. Then take the disease home to papi y los niños, Tío Juan and Tía Julietta, y los viejos. Who will cheerfully and unknowingly spread it to all their friends, and pretty soon, you solved the immigration problem by erasing everyone from Tijuana to Tierra del Fuego, except maybe some lucky isolated Indians in the deep Amazon rainforest. ¡Viva! So, in between those two, there are actually 23 BL-IV hospital beds, but cleverly, only 11 are actually staffed to operate anytime, and you can't just call Joe's Nursing Registry in Missoula or Baltimore or Omaha or Atlanta and whistle up more BL-IV-qualified nurses to pick up the open shifts. Bummer. Oh, and one to three of those 11 beds are reserved by law for the potential military casualties at their neighboring state-of-the-art Infectious Disease (and chem-bio warfare, which of course we swear we don't do
military research center(s) in UT and MT, so there are really, actually only 8 beds. We have 8 beds for 453,000,000 people (those poor Caribbean islanders from Cuba around to Trinidad can just suck it, like they always do). Bermuda is looking pretty good, but only if they shoot down incoming aircraft, and sink cruise liners off the continental shelf at the merest suspicion of a pandemic.
So Twelve Ebola cases flood and overflow every available BL-IV treatment bed extant in North America. Twenty actual Ebola cases will shut down any city in America. Overnight. For months.
Fifty cases, and the USA is Liberia in 2014. Times 1,000. That's not a guesstimate, those are the hard numbers. There are 52 active cases in Congo right now, who haven't died. Yet. 80% of them will. And the survivors will carry virus reservoirs in their bodies functionally forever. And probably go blind from retinal damage due to disease-related coagulopathy. (That includes the two nurses from Dallas who contracted it, BTW. You'll notice a deafening silence on that, since 2014.) God help those people, every one of them.
IMHO, it's a dice roll whether living with Ebola or dying from it are worse.
This disease is from Hell.
In 2014, we had TEN cases here. We were two Ebola patients away from swamping the lifeboats, and turning any other hospital into Texas Health Presbyterian, which was Tier One disasterpiece theater. They exposed thousands of people, unwittingly. They had the infected guy in once, misdiagnosed it totally, and sent him home. They didn't catch on until he was brought in again in total collapse, and after throwing the entire best the first world had to offer at him, he died anyways. And infected a perfect R-naught of 2 additional victims. Only fate, or a benevolent deity, kept that incident from turning Dallas into Freetown, Liberia in about two weeks, and wiping out their whole ER shift staff that night. Poorly protected clean-up crews in Dallas were pressure-washing the guy's vomit - live, active virus - onto everything within yards of his apartment in suburban Dallas, the day after it happened. Because illegal aliens with a fourth-grade education are the front line in that clean-up, hired by companies with no more sense than God gave a jackass about Hazmat gear, or proper Ebola precautions. In NYFC, they were handling stuff with no PPE whatsoever. Hand to God on that.
https://raconteurreport.blogspot.com/2018/08/you-dont-like-fustercluck-this-is-how.htmlThis is Why I Blog (8/26/18)
When the house is on fire, perhaps pulling an alarm is what's called for.
But hey, thanks for letting us know that life will go on fine, once everyone realizes they can't go to work, school, church, the mall, the grocery store, the gas station, the pharmacy, the bank, the ATM, or anywhere else, nor touch anything they haven't disinfected with bleach and sunlight for 10 minutes, after gowning up in the equivalent of MOPP IV, including N95 respirator, head to toe disposable overgarments including hood, goggles, and face covering, rubber booties, and two pairs of gloves, and following a strict series of decontamination again when they remove the garments, any time they venture outside their perimeter (God knows why they would, other than oh, I dunno, the exact food, water, medicine, money, and all those other luxuries we can skip for a few months/years). Or else stay locked up in their homes with food, water, medicine, and such, for at least 40+ days after the last reported case, nor come closer than 20' to anyone coughing or sneezing until 10 or more minutes have passed to let the droplets settle, if they're crazy enough to go out at all, for any reason whatsoever, because that won't affect the largest economy in the world in the SLIGHTEST, will it, jackass?
Do you have a spare two years' income handy? In cash? Do you have twenty-four months' food at home? The 2013 outbreak wasn't over until 2016 in West Africa.(But, you knew that, right?) And you've also got a 40' ISO container full of limitless supplies of HazMat gear, and an incinerator and fuel to dispose of used gear properly?
And hundreds of gallons of bleach? And a sprayer for it? Who's going to spot for you putting it on and taking it off? Or were you just going to wing it? Who's going to run the water plant when everyone stays home? How will water get pumped when no one comes to work at the power plant either? Who's going to fill up barrels and distribute water door to door when there's no gas, no water supply, and no power? You? How many cops and firemen will come to work at all, let alone when they have to work in gear so hot you can't do it for more than a couple of hours? Who's going to be giving those vaccinations when no one comes to work at the hospital, for all the reasons outlined above? (Oh, BTW, as the name would imply, "ring vaccination" isn't vaccinating "those at highest risk" - that would be medical relief workers, primarily, and probably be called "highest risk vaccination" - it means vaccinating those proximately closest to those already infected, i.e. family, neighbors, friends, and other closest contacts, and putting a literal ring of immunized people around the outbreak. Plain English is funny like that: it tends to mean what it says. If you're going to be the smartest guy in the room, and sling the terms around, it's probably a good idea to get them right. Just saying.) What happens if it doesn't work so well? If your weasel-worded ("apparently") morphs into "Whoops, my bad, not so much..."
What are you going to do with the 25% idiots who won't even get vaccinated now? Shoot them? Round them up? Ignore them and let them die? And merrily spread the outbreak in the meantime? What about their minor children? Do we just let mommy and daddy give them Mr. Jones' nice cup of kool-aid? Because father knows best?
As a certifiable jet-fuel genius technocrat with all the answers, tell us how to deal with that. And then you're going to do...what, exactly, about those 75M dead bodies, from Ebola, in some cases, but also from heart attacks, dehydration, heatstroke or freezing to death, running out of their meds, not to mention what happens when any semblance of civil government breaks down and blows away in the wind? Who's going out on body pick up and disposal? What are you going to do about the 20% of America on anti-depressants and other psych meds when they run out? Who you gonna call when there's no power for that information grid, TV, radio, cell towers, or the internet, about three days after this hits any place, and the lights start going out?
In 2014, with exactly that sort of "We can do this!" thinking, Texas Health managed, despite the CDC's sub-standard "protocols", to infect 2 ICU nurses, despite more information, protective gear, and better training than you've got right now, and exactly doubled the US outbreak in less than 21 days, while exposing thousands more to the potential to become the next wave, shutting down schools, completely closing that entire 968-bed major hospital in our 9th largest city for one patient, and spreading the exact amount of fear and panic totally justified when TPTB turn out to be so stupid, incompetent, and recklessly dismissive of the public's safety and best interests.
So, wow. Totally fucking ignorant of reality much there?
And just to help your reading comprehension along, notice where I said that this Congo outbreak now isn't nearly as bad now as it was in West Africa 2014. Yet. But the post was in reply to someone, a trained medical professional, in fact, who - exactly like you - didn't think this was that big a deal at all. So I'm guessing the return fire landed inside your perimeter, and you're running critically low on butthurt creme, right?
https://raconteurreport.blogspot.com/2018/08/this-is-why-i-blog.htmlAnd The Hits Just Keep On Coming (8/27/18)
This is not the story, or topic, I wanted to open the week with. I was going to put off even looking at the topic until the end of the week, for just a cursory check-in, like last week. I would have been happy not to speak of this story again. Ever. That's how "alarmist" I am. Well, so much for fond hopes. Y'all do as you like. For me, this news moves the currently-small outbreak in DRC from an occasional glance, to a regular visit, with both eyes on:
WSJ - "This outbreak is still in the escalation phase,” said Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, which has staff working to stem the outbreak in Congo, neighboring countries and the Geneva headquarters of the World Health Organization. “The key is identifying (patients’) contacts and getting people vaccinated.” On Friday, the WHO said a doctor in the town of Oicha in Ituri province had become ill with Ebola and may have infected his wife. The cases are the first in “an area of high insecurity,” said Peter Salama, the WHO’s emergency response chief. “It really was the problem we were anticipating, and the problem at the same time that we were dreading,” he said. Officials have identified 97 people in the town who may have been exposed and need to be vaccinated, but haven’t been able to reach them all due to security concerns, Dr. Salama said.
[......]
That all is concerning, but they bury the real money quotes at the bottom of the article:
WSJ - The 1.3 million people, including thousands of refugees, who live in the region have endured violent insurgencies dating back to the 1990s. But it is their first time experiencing an Ebola outbreak, stunning a rural population where many believe the virus is sent by evil spirits, aid officials say. “Many can’t comprehend the idea of not being able to bury dead loved ones according to tradition,” said Hassan Coulibaly, a field director in eastern Congo for the International Rescue Committee. “We are trying to educate them, but the environment is hostile”. Last week, locals angered by health officials’ insisting they forego traditional burial practices, including washing bodies to avoid infection, burned down a health center in Mangina, the epicenter of the outbreak, pushing out medical personnel, according to the WHO. A local team administering vaccinations was also beaten up in Manbangu village, some 10 kilometers west of Mangina, while the IRC was forced to close down its health facility in the village of Mabalako following an attack from locals.
So, just like with the ignorant tribal jackholes in West African nations in 2014, this is going to take months to try and get a handle on, not days nor even weeks, by which time it will multiply by several orders of magnitude, like it does, to hundreds and thousands of cases, even with a vaccine, and cross one or two international borders, and so on, and so on, and so on. And it's already off to the races now.
Grab your hats; here we go again.
https://raconteurreport.blogspot.com/2018/08/and-hits-just-keep-on-coming.htmlNothing Good to See Here (8/28/18)
UPDATE: Today's Ebola box score (with figures from WHO 8/24 report):
117 Ebola cases
73 dead
3,421 contacts.
So the metric to watch is to see what that looks like in 21 days.
I.e., From 8/3-8/24, they went from 33 deaths to 72, so it's doubling a bit faster than expected. Not good. On or about 9/14, if they have 144 deaths, they're on track for no control on the outbreak. The first batch were the people infected largely before the outbreak was detected, because you're always behind the curve with this disease. The 40 or so who've died since 8/3 are the second wave. The 72 probable between now and 9/14 are the next wave. If the dead count is less than 144 then - assuming the counting is accurate (because Africa) - that means vaccinations and so on are slowing the spread. That would be hopeful news. If it's 144 or more, that's very, very bad.
That the contacts they need to trace have already quadrupled in three weeks is the reason epidemics become pandemics. One other note on the panel on Wikipedia:
IGNORE their published CFR. They're doing it wrong.
Allow me to explain:
The death rate isn't the number dead now vs. the number infected now. Ebola isn't a lightning bolt.In 2014, Duncan, with first-world ICU care, took 10 days to die. He'd been sick several days before that. In Africa, a week, or two, or more between obvious infection, and death, is not uncommon. So if you're going to be honest, look at how many cases they had 21 days ago (that time span being the rough average of 5-42 days between contraction and appearance of Ebola) and how many dead people they have now. 21 days ago, there were 76 cases. Today, there are 72 dead. That's a CFR of 95%.
So unless they're going to publish survivor numbers, this thing is doing what you'd expect it to do in Africa: it's killing 95% of the people who catch it. It's like scoring bowling. With strikes and spares, you know you have to go a frame or three back, to get the correct current score.
You can shorten the time frame to the average number of days an infected person lives in a Congolese Ebola clinic, or you can tell us how many of the people infected two week ago are dead now, and how many have recovered; those are both statistically honest options. Anything else is b.s.ing with numbers, and purely dishonest. And whatever mook at Wikipedia is skewing the percentage should know that (and either isn't savvy enough to grasp this simple epidemiological concept, or someone there is holding their thumb on the scale). It's a coin-toss there; you can guess which option, stupid or evil, is more likely. Neither one makes them look very good. If they plead "we're just re-posting the numbers from WHO", which are the numbers from DRCongo, that's fine, but it simply underlines the biggest problem with Ebola: Africa wins again.
Note:
Unless this either
a) crosses an international border,
b) appears in a major (pop. > 1M) city, or
c) some modern Thomas Duncan gets through an airport and brings it outside DRCongo,
d) something really major happens, internationally
we're still keeping an eye on this, but won't be talking about it much, if at all, for the next three weeks. Anything other than that, grim as it may be, will just be Africa being Africa.
Which it does just fine whether we watch, or not. I brought it up at all, because it's moved into being a thing, and mainly - since neither you nor I can affect what's happening 6000 miles away - as a reminder to make sure (or start making sure) you could ride things out at home if this goes as sideways as - or, God forbid, worse than - it did in 2014. Which is well within the possible likely course of action.
https://raconteurreport.blogspot.com/2018/08/nothing-good-to-see-here.html