Ebola Getting Out of Control in the Democratic Republic of Congo

This story has been in my drafts folder for a while. I can’t get too worked up about Ebola because I don’t see how it can become a real problem for the US, though I’m sure there is some way it can. Besides, there are other diseases that are real problems today, that we could worry about. Still, lets pull it out of drafts and take a look at the situation in the DRC.

If a picture is worth a thousand words, this one is screaming that the epidemic is out of control. ‘Nothing short of terrifying’: Ebola death toll hits 1,000 as lethal virus spreads. (Click the image for a larger view.)

Mistrust has hindered efforts to rapidly contain the highly contagious disease, with a quarter of people in the region believing that the Ebola virus does not exist. Others have accused the authorities of fabricating the outbreak for political gain – voters in the region were not able to partake in national elections in February due to the crisis.

Violence is also rife. The area surrounding Butembo has been at the centre of conflict for more than two decades, and over one hundred armed groups are in operation in the region.

You can’t help people who don’t want help.

The recent spike in cases is in part because efforts to control Ebola were temporarily halted following a string of attacks on treatment centres, threats against health workers and the murder of a WHO epidemiologist.

People Are Worried About the Wrong Thing

Ebola is bad, but it isn’t likely to get here by way of illegal immigration. It takes too long for people to get here that way. 20 Illegal Aliens from Congo Being “Monitored for EBOLA” at U.S. Border.

TB on the other hand is a real problem.

“TB is an ongoing issue in the state of Texas,’ [Laredo Health Director Dr. Hector Gonzalez] explained. “Between Texas, California, and New York, we have 50 percent of the cases of TB and the border has the most. Brownsville has the biggest number of cases.”

Because there is TB, Multi-drug resistant TB (MDR-TB), and Extremely drug-resistant TB (XDR-TB). Regular TB costs about 100 bucks to cure, if you can give people medicine over time and KNOW they will take it. The other forms require hospitalization, quarantine and whole lot more drugs.

Hat tip to Wirecutter.

Never Say Hollywood Doesn’t Know How to Make Money Off a Crisis

Hundreds of people are dead. Hundreds more are sick. (The mortality rate is about 50% right now.) And the outbreak is spreading. Hollywood’s response? “Let’s make money!” See Julianna Margulies in first look at scary Ebola miniseries The Hot Zone. If there is a better example of Hollywood feeding off the tragedy of others, it doesn’t jump to mind right now.

By that description alone, you can deduce it won’t be realistic. You won’t see people die by bleeding from every orifice in their body. You won’t see them vomiting blood, losing control of their bowels, or any of the other things that go along with hemorrhagic fever. That wouldn’t be very entertaining.

21st Century Hollywood is known for its low bar on class, morality, decency, etc. But this seems like an extreme way to make money. Or at least it does to me.

UPDATE: If you behind on the status of Ebola… see this link.

I Thought We Had Learned the Lessons of Ebola

But the people of The Democratic Republic of the Congo haven’t been told or don’t believe those lessons. Ebola outbreak reaches city of 1 million residents.

The Ebola outbreak in the Democratic Republic of the Congo has spread to a city of nearly 1 million residents. There are now 30 confirmed cases and 15 deaths in the city of Butembo reported in the latest update provided by the World Health Organization (WHO). The number of cases in the city center is still low, according to Doctors Without Borders, but that number is rising quickly in more outlying districts and suburbs.

There are limited supplies of the vaccine – which is still under trial I believe. And there have been reports of aggression against the Safe and Dignified Burial teams. (Those teams help stem the spread of the disease.)

Under the “Why you should care” heading. Butembo is near Uganda and South Sudan, and not too far from Nairobi, Kenya. If it spreads to Nairobi, it will probably spread a lot farther. (International air travel anyone?)

And I was just about ready to change the Category of “Ebola” to a tag, since it didn’t look like we would have another outbreak like the last. This is looking like the last outbreak. Maybe it is worse than the last outbreak.

Liberia Declared Ebola Free

Liberia was hard hit by the 2014 Ebola outbreak, but they seem to have gotten it whipped. In Liberia, Ebola outbreak is declared officially over – The Washington Post.

Liberia, the West African nation where Ebola claimed the highest number of deaths in the largest outbreak since the virus emerged in 1976, has gone 42 days without any new Ebola cases, according to a statement released by the WHO.

The 42-day period represents double the maximum incubation period for the virus since the last victim of Ebola was buried.

The numbers in Liberia are staggering.

Since Liberia’s latest outbreak began in March 2014, the country has seen more than 3,000 laboratory-confirmed cases of Ebola and another 7,400 probable cases, leading to more than 4,700 deaths, according to the WHO. A total of 375 health workers were infected and 189 lost their lives.

Doesn’t mean it won’t come back. Doesn’t mean that everything is over. The worst is over, but there is a lot of rebuilding to do.

Ebola? It Is the Eeeevil Bankers Fault

Because you know, they insist on things like balanced budgets and repaying of debts. (Never mind they are providing 0 percent loans…) Those evil, evil bankers. IMF policies blamed for weak Ebola response – Telegraph.

The whole thing is completely predictable. So I won’t quote any of it. Even the IMF rebuttal is de rigueur.

But I still think all this focus on Ebola is a focus in the wrong place. Oh, yeah, it is an issue with West Africa, and they need to do something about it. But there are other diseases more likely to kill you. Like TB.

Fewer than 8000 people have died of Ebola in this latest outbreak in West Africa, including the handful that died in the US and Europe.

First, lets look at the global picture on TB.

  • In 2013, 9 million people fell ill with TB and 1.5 million died from the disease.
  • Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death for women aged 15 to 44.
  • In 2013, an estimated 550 000 children became ill with TB and 80 000 HIV-negative children died of TB.
  • Globally in 2013, an estimated 480 000 people developed multidrug resistant TB (MDR-TB).

Of those 480,000 MDR-TB cases, approximately 9 percent were Extremely drug-resistant TB, or XDR-TB.

In the US, things are better, but there were still more than 9500 cases of TB reported in the US.

There were 536 deaths from TB in 2011, the most recent year for which these data are available.

Paying attention to things that can kill you is probably important, and probably worthy of news coverage, but why the coverage of one and not the other?

UPDATE: I am not alone in my concerns… Beware The Silent Killer: Influenza.

Now that the media have finished with the luridly reported and absurdly exaggerated concerns about Ebola in the U.S., they might wish to consider a genuine imminent threat to our health: influenza.

The “flu,” which is marked by high fever, muscle aches, malaise, cough, and sore throat, is transmissible through airborne droplets and is so infectious that after an airplane sat for three hours with its engines off and no air circulating, within three days, 39 of the 54 people on board contracted the flu, infected by a single passenger.

And it can kill you.

From the 1976-77 season to the 2006-07 season, flu-associated deaths in this country ranged from a low of about 3,000 to a high of about 49,000, according to the Centers for Disease Control and Prevention. (Worldwide, flu kills about 250,000-500,000 annually.)

Ebola Virus Has Traveled to Mali – To Early to Say How Bad This Will Be

More bad news on the Ebola front. Mali’s first Ebola case, a two-year-old girl, dies – officials.

Mali is one of the poorest countries in the world, and is probably not equipped to handle an outbreak of this disease.

The girl had travelled with her grandmother hundreds of kilometres by bus from Guinea via Mali’s capital to the western town of Kayes, where she was diagnosed on Thursday. Health workers were scrambling to trace hundreds of potential contacts in a bid to prevent Ebola taking hold in Mali.

She was symptomatic for at least 3 days before being diagnosed, and was contagious during that time. That three days included the bus journey.

Médecins Sans Frontières (Doctors Without Borders) are rushing an emergency team and supplies to Mali.

This Whole Traveling Nurse with Ebola Thing Just Keeps Getting Better

Now it looks like she may have been sick as far back as Friday last. Nurse may have had Ebola symptoms longer than thought – CNN.com.

The nurse who recently was diagnosed with Ebola, has said she now didn’t feel well a few days earlier than the day she got on the flight. And since she didn’t have a fever, she didn’t connect it to Ebola and her care of the patient who died in Texas of the disease.

Frontier now says it is notifying up to 800 passengers total, a figure that includes those on last Friday’s Dallas-to-Cleveland flight, the return flight four days later, plus five subsequent trips taken by the plane used in that last flight.

And now “12 confirmed contacts of Amber Vinson in Ohio … are currently under quarantine,” according to Summit County’s assistant health commissioner Donna Skoda. They include at least two people who worked at a bridal store, where the 29-year-old nurse went as part of her wedding planning.

I get that if the average citizen walks in off the street there are certain things that would point to Ebola. (Fever, etc.) But for someone who was caring for an Ebola patient that might need to be a different set of criteria. Lower fever. etc.

It won’t do for the entire health-care community to become hypochondriacs, but a bit of paranoia about their own health – especially if they have been working in an Ebola treatment facility – might actually be healthy. And relying on the .gov for guidance is clearly a losing proposition.

Another Nurse Has Ebola – Flies from Ohio to Texas

I wondered if they would call this another breach of protocol. They can’t, because it wasn’t. It was perfectly OK to allow a nurse who had cared for the now-dead Ebola-patient in Texas to fly on a commercial airliner even though she had a fever. She had the sense to ask the CDC, but the not sense to ignore them. U.S. health official allowed new Ebola patient on plane with slight fever | Reuters.

And here I thought fever was one of the early indications of Ebola. Especially in people you suspect might have been exposed to Ebola. Silly me.

A second Texas nurse who has contracted Ebola told a U.S. health official she had a slight fever and was allowed to board a plane from Ohio to Texas, a federal source said on Wednesday, intensifying concerns about the U.S. response to the deadly virus.

A few days ago I compared the Secret Service to the Keystone Cops. The CDC makes them look like a Mensa convention by comparison.

Even the golfer-in-chief can’t ignore this one. He cancelled a bunch of political trips.

Chances that other passengers were infected were very low because Vinson did not vomit on the flight and was not bleeding, but she should not have been aboard, CDC Director Dr. Thomas Frieden told reporters.

Just like chances were low that we would have cases of Ebola in this country. Because of the level of competence of the CDC/NIH/EIEIO in charge of this clusterfuck.

They are currently running around trying to find everyone on the flight with this Ebola patient. But what about folks in the airport? Rental car bus? Diner? Wherever? How will they notify them?

If we don’t have an Ebola outbreak in this country it will be only due to shear dumb luck. We have reporters too good to stay in quarantine in New Jersey, we have the CDC letting folks we suspect were exposed to Ebola (suspect may be too strong a word) get on a commercial flight. We have the Texas DOT holding up decontamination efforts because the transport permits aren’t in order. “I’m from the government and I’m here to help” – still the scariest phrase in American English.

Because You Can’t Expect Journalists to Live by the Rules

They are special. They do important work. NBC’s medical correspondent ‘violated Ebola quarantine’.

An NBC News crew was ordered under mandatory quarantine for possible Ebola infection after the network’s chief medical correspondent was allegedly spotted on a food run to a New Jersey restaurant, according to a report.

Dr. Nancy Synderman and company were supposed to be on voluntary quarantine after a cameraman contracted the disease. But they decided that they needed take-out.

Because the food in quarantine is just so plebeian. And besides, they are Journalists™, they are better than everyone else.

A spokesman for the .gov says there is no cause for alarm. “Keep calm and carry on.” The quarantine was violated but there is no reason to worry. All is well. Nothing to see here. Move along.

With people like this on the front lines of reporting about Ebola in Africa, it will be no time at all before they are reporting on Ebola in New Jersey, or New York.

The CDC (and Politicians) Love to Say We Are Prepared for Ebola

Nurses have a different view… and the recent events in Texas make me even more apt than usual to believe the politicians are lying. U.S. nurses say they are unprepared to handle Ebola patients | Reuters.

The hospital had completed Ebola training just before Thomas Eric Duncan arrived in their emergency department on Sept. 26. But despite being told that Duncan had recently traveled from Liberia, hospital staff failed to recognize the Ebola risk and sent him home, where he spent another two days becoming sicker and more infectious.

The problem is that not everyone has been trained, even the hospital environment. In that Dallas hospital, only the emergency room nurses had been trained, and not everyone was available on the day training was offered. But that is only a small part of the puzzle.

“When an Ebola patient is admitted or goes to the intensive care unit, those nurses, those tech service associates are not trained,” she said. “The X-ray tech who comes into the room to do the portable chest X-ray is not trained. The transporter who pushes the stretcher is not trained.”

If an Ebola patient becomes sick while being transported, “How do you clean the elevator?”

Even the basic supplies – like the correct masks and eye-protection – are not always available.

So everyone from the President on down is telling us to “remain calm, and carry on.” And that everything is under control. But is it, or are they just being politicians and lying about it?

How do you battle ignorance?

Ignorance has always been the biggest killer, but I will say it again: You can’t help people who don’t want your help. Sierra Leone burial team attacked despite lockdown | Reuters.

A team burying Ebola victims was attacked in Sierra Leone’s capital on Saturday, a member of parliament said, as a small group defied a three-day lockdown aimed at halting the worst outbreak of the disease on record.

The middle of a crisis is probably not the time to address issues of public education. But then I have to ask, if this disease broke out in an American city, would the results be that much different? Can we really handle it, or are we just kidding ourselves?

You Know the Manure Has Hit the Rotating Air-moving Device When…

When a major news organization (NPR in this case) makes reference to mathematics. And not just reference to second-grade mathematics, but actually uses the term “exponentially.” Things must really be bad, if they have to stretch their tiny little minds around 6th-grade math. A Frightening Curve: How Fast Is The Ebola Outbreak Growing? : Goats and Soda : NPR.

Of course when their hero and chief, uses the word, they don’t have a lot of choice – even if they feel like their heads are about to explode.

“It’s spreading and growing exponentially,” President Obama said Tuesday. “This is a disease outbreak that is advancing in an exponential fashion,” said Dr. David Nabarro, who is heading the U.N.’s effort against Ebola.

Then of course they feel compelled to give a reprise of 6th-grade math to define what ‘exponentially’ means without actually using the word ‘exponent.’ That is quite a bit of legerdemain, even for a group of journalism professionals who couldn’t balance their check-book, if they ever bothered to try. (I’m sure there is an app for that.) They don’t get it quite right. Are you surprised?

Of course the math-challenged at NPR didn’t want to believe it.

When we first heard about these numbers, they sounded a bit alarmist. But then a few other modelers published their own models. The forecast is consistent: There’s exponential growth with somewhere around 15,000 cases by mid-October.

But then epidemiology is really a branch of statistics. And besides, math is hard. And science involves a lot of math, so can’t we go back to covering stories about Scotland? (Braveheart was such cool movie!)

I expect the next major story to be that this Ebola outbreak will spread somewhere – the near east, or Asia perhaps. Or even to the west, though we have a better chance of containing it than people who kill the folks disinfecting public spaces.

You Can’t Help People Who Don’t Want Help

This doesn’t give me hope that “the authorities” can do anything to stop this epidemic. Eight reported dead in attack on Ebola workers in Guinea – LA Times. (And who are the people in charge? The UN? What exactly is the UN track record of stopping regional crises, let alone regional pandemics? Their involvement after the tsunami in Indonesia was laughable, and in many deployments the UN only manages to make things worse – remember Srebrenica?)

It started with the simple (and laudable) goal of educating people about Ebola, its transmission and ways to stop its transmission. It was a simple, if a bit simple-minded, goal.

But it all went disastrously wrong.

Villagers responded furiously, pelting the delegation with stones and beating the visitors with clubs, according to Guinean radio. The delegation, which included doctors and journalists, fled into the bush after the attack Tuesday.

When the dust had settled eight members of the delegation had been killed. (The London Telegraph is reporting that the bodies were dumped in a latrine.)

And why would these “simple villagers” do such a thing?

A local police officer, Richard Haba, said the villagers believed that Ebola “is nothing more than an invention of white people to kill black people.”

Given that state of affairs in West Africa, I don’t believe we can do much to help. You can’t help people who don’t want your help, and these people don’t want our help. (This wasn’t the first aid group to be attacked in a village, and it probably won’t be the last.

Ebola Worse than You Thought: Westerners to Blame

Or that is the position of the Doctors Without Borders (or Medecins Sans Frontières or MSF) WHO warns of 'shadow zones' and unreported Ebola cases | Reuters.

The head of MSF, which has urged the WHO to do more, told Reuters in an interview on Thursday that the fight against Ebola was being undermined by a lack of international leadership and emergency management skills.

It is always good to blame “international leadership” except of course when they are doing things you don’t approve of…(I assume they are casting blame on the US and the Europeans, but I could be wrong.)

The real reason that Ebola continues to be a problem is superstition, ignorance, and a little bigotry thrown in for good measure.

The stigma surrounding Ebola poses a serious obstacle to efforts to contain the virus, which causes regular outbreaks in the forests of Central Africa but is striking for the first time in the continent’s western nations and their heavily populated capitals.

“As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home,” the WHO said in a statement detailing why the outbreak had been underestimated.

“Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death.”

Corpses are often buried without official notification. And there are “shadow zones”, rural areas where there are rumors of cases and deaths that cannot be investigated because of community resistance or lack of staff and transport.

I am not sure what “international leadership” can do in the next few months to combat centuries of mistrust.

The interesting thing about that quote is that it implies Ebola is a constant problem. Just not one the West usually hears about, because the victims are those unimportant people in the “forests of Central Africa.”