Wednesday, October 15, 2014

We'll know by Christmas



“The major difference between a thing that might go wrong and a thing that cannot possibly go wrong is that when a thing that cannot possibly go wrong goes wrong it usually turns out to be impossible to get at or repair.”
Douglas Adams

As I write this the WHO is saying that the number of cases of Ebola in West Africa is likely to ramp up to 10,000 new ones every week by December, with around seven out of ten people who contract it dying from it. “Don’t worry,” seems to be the message being purveyed down from on high “This will have little impact in the technologically advanced rich nations.”

I’m not so sure.

Straight away I’ll admit that, obviously, I’m not a doctor or a specialist in contagious diseases. A majority of people will read that last sentence and say “Therefore you have no right to talk about it.” If you’re one of them, then bye. However, I do have a firm grasp of the exponential function, and a keen sense of when people in high places are telling fibs to make themselves look like they are in control of events. Perhaps that’s all one needs at the moment. When I see the official message change in the space of a week from “There’s not a chance,” to “Only one or two people might get it,” to “A handful of people might get it,” then I naturally project forward a bit and think about expectation management and message creep.

Frankly, at this stage, it’s more or less irrelevant that we have the occasional case popping up in the West. We are able to deal with them without too much of a problem (the main threat comes later) - although it is concerning that the nurses in Spain and the U.S. who did contract the virus did so despite wearing full protective suits. We are repeatedly assured that this cannot happen, and the fact that it has happened has immediately been blamed on a ‘breach in protocol.’

But breaches in protocol are what we humans are good at. Every organisation that I’ve ever worked at has been full of people breaching protocol at every level. Usually, of course, doing so hasn’t led to them dying messily with blood gushing from their orifices and so mostly they get away with it. Are we to believe that the sprawling medical sector with its vast hordes of employees is less prone to this?

Yes, in the real world, shit happens.

Let’s face it, if you’re an official in some position of power and your job and status depends on making the right comments or being able to pass the blame for something onto someone else then you can be expected to act in such a manner. It’s what you are programmed to do in a non-holistic linear kind of way. So when, for example, a health official says it ‘impossible’ to catch Ebola from a mattress and then someone goes right ahead and does it anyway because they briefly touched a drip feed that had a viral load from some other patient who had sneezed a fleck of vomit on it as they wheeled the bed past him in a corridor, which then came into contact with said mattress and passed it onto someone else, then said official can claim that due to a clause in article 41.5b of the Code of Hospital Regulations about moving patients around then the porter had breached protocol and caused the infection. Problem solved, for you at least.

Here’s a hypothetical situation. Imagine that despite Ebola had somehow mysteriously appeared in your country and the government message had been racketed up to the point of saying “Don’t worry, only a quarter of you will get it,” but so far you had been lucky and avoided it. You’ve washed your hands all the time, avoided contact will all other human beings and animals, not touched a doorknob in six months … but despite all of this you started to come down with a fever and worried you had caught ‘it’. Several of your friends and family have already disappeared into hospital isolation wards and you have never heard from them again, and there are rumours swirling around that the hospital has run out of protective gear and that most of the staff have either died or fled, leaving it manned by untrained survivors with precious few medical supplies to work with. Would you a) Check yourself into said hospital and hope all the rumours were untrue or b) Lie in your own bed with your stash of medical supplies you had managed to amass, send out a farewell Facebook status update and hope for the best?

People who opine on healthcare programmes, just like economists, always assume that people act in a rational way — although it is they who decide what constitutes rational behaviour. They build models based on people acting in the way they are supposed to act, even though not many of them are psychologists.

As they stand, things don’t look good. With a doubling of new cases every 21 days that means every single person in the world will have or have had Ebola by September 2015. Of course, this won’t happen in such a neatly exponential way as there are many interrupting factors that will slow the disease’s spread. In any case, we probably have only a few weeks to stamp down on Ebola and eradicate it from West Africa, because as soon as it gets really out of hand there will be people fleeing to other parts of Africa and bringing the virus with them.

***

Over the last few days in the course of several discussions about Ebola a few truly inane points and suggestions have been raised. Here are some of the most prominent ones:

Ebola is not very contagious and it is only poor people in Africa that can get it. Well, the fact is that we don’t know an awful lot about this strain of the virus. We pretend we do, but we don’t. If we did then people wearing space suits would not be getting it. A past study has shown that it can be transmitted through the air between monkeys and pigs. The study has been attacked and defended thoroughly and, like most things on the internet, you end up not knowing what to believe. Nevertheless, if you ever come into contact with someone who has died from the disease, or if you end up caring for a family member with it, the chances are that you will get it too. Simple as. 

This is getting out of control, we should quarantine the affected African countries and shoot anyone who tries to escape. Ummm, interesting suggestion. Never mind the fact that the moment any such suggestion is raised there will be an exodus of people from those countries. Where would they likely flee to? Well, apart from fleeing to all corners of Africa they would also flee to the homes of their relatives in New York, London, Paris etc. They may try and do that anyway, as things progress. 

Our country can cope with an Ebola pandemic. Don’t make me laugh. When Britain’s health minister appeared on TV a few days ago proudly proclaiming that there were two specialist beds in isolation wards in London to cope with Ebola patients I did a double take. Did he say two? TWO? To be shared between the 20 million people living in the southeast? Will they be taking it in turns or what? At what point, after the epidemic becomes a pandemic, do we manically start trying to build more isolation wards over here rather than building hospitals in Africa? So many questions …
 
It’s just a media fabricated panic to distract us from war, global warming, financial meltdown etc. If anything the media is under reporting this. When the staid folks at the WHO say that “this is the most severe health emergency in modern times,” then it takes a peculiarly asinine person to pretend that it’s unimportant. 

This is nature’s revenge … bring it on. Fine, ecologically speaking that may be so, but you have to be willing to be one of the statistics rather than merely wishing it on other people who are less fortunate.
It’s all a global conspiracy by the Koch brothers/One World Government. Yes, whatever. If you believe that it’s a conspiracy that’s fine but it won’t do you any good. 

Nigeria has eradicated it, so can we. Hurrah! Nigeria has had a few isolated cases of wealthy individuals. Furthermore, there is a lot of oil wealth at stake in that country and the last thing they need is news of an Ebola outbreak. Do you really believe everything you read coming out of the world’s most corrupt nation? 

***

So, what do I think is likely to happen? Well, I think there are two likely outcomes, and we can only hope it is the former.

Outcome 1. We throw everything we’ve got to help states in West Africa get on top of Ebola and contain the disease. It won’t be easy and it will entail a lot of ethical dilemmas, such as choosing who gets priority treatment and who does not. Many of our best doctors and nurses will have to go there and a lot of them will not come back. It will cost a fortune, just when we can least afford it, but in the end it will be worth it. As a follow up, deforestation will have to be halted, the spirits of the fruit bats appeased and a huge Marshall Plan like effort to lift Western Africa out of poverty will have to be put into action to prevent Ebola taking off yet again.

Outcome 2. The cases in West Africa continue to multiply and the disease increases exponentially, really taking off at the start of 2015. Chaos ensues as people flee disease centres and bring the virus with them. Overworked and demoralised healthcare workers abandon their posts as they realise they are at the highest risk of contracting the virus, further complicating the situation. Instead they go back to their own families and do their best to make sure that least they will get the care they need. The diseased, and quite a few non-diseased, are rounded up and put in warehouses that double as isolation centres where they are kept at gunpoint. East Africa, with its crowded slums becomes a new hot zone, and from here it is a hop, skip and jump along the busy trade routes to the overcrowded virus-friendly conditions of India. As pharmaceutical companies frantically try to find a vaccine or a cure the disease spreads like wildfire across Asia and to the world beyond.

By February 2015 half of all air traffic has come to a stop. Airlines go bust and people who are stuck on the other side of the world suddenly find out how large it is. By May there is practically no international air travel apart from private jets and military aircraft. International supply chains are shattered and disorder and chaos break out everywhere as people struggle to get food, fuel and medicine. In some countries, national armies hand out food in the streets but there’s never enough.

By late summer a few island states have quarantined themselves to try to keep the disease out, but word spreads about these ‘healthy’ zones and people desperately try to reach them, bribing officials to gain entry and bringing the disease with them.

By now, the torrent of people pouring across borders by any means available has overwhelmed the tiny capacity the richer nations have to deal with an outbreak. People stop going to work and school, and avoid public transport and gatherings. People live and die in their own homes.

After a handful of years the disease has burned itself out, although distributed pockets remain in far away places. A huge chunk has been taken out of the global population — mostly in the poorer nations that lie in the tropics — with richer nations faring somewhat better due to more elaborate healthcare systems, less overcrowding and a greater access to experimental vaccines. Some of these worked and some of them did not. Everyone still alive will breathe a great sigh of relief and look back with sadness as they think of the loved ones they lost in the Great Ebola Pandemic of 2014-18. Economies are broken and people’s faith in science and progress lies in tatters — but at least they are alive. Life will go on, as ever, but everything will have changed.

There is, of course, a third scenario — Outcome 3 — the Hollywood one where we find a miracle cure just in time that can easily and quickly be mass-produced and distributed across the globe without any political interference. The likelihood of this happening in the timeframe that we have is pretty small though and it would not address the cause of the problem, meaning we’d likely get a new and even deadlier strain in a few years’ time.

So which of the above scenarios is the more likely and why? Do you have a survival strategy if Outcome 2 kicks in? If you do, pray tell.

***

We’ll likely know by Christmas which one we're going to get. In the meantime you might want to read up about natural antivirals, wise up on sanitation and basic medical procedures such as oral rehydration, make friends with your immune system and start building up a stock of things that will likely be gone in a flash if a full-blown panic does break out.

19 comments:

  1. It's not just Nigeria, but Senegal as well. We'll get an official announcement from WHO on Friday, but it appears that the Ebola outbreak is over in Senegal.

    http://crofsblogs.typepad.com/h5n1/2014/10/who-are-the-ebola-outbreaks-in-nigeria-and-senegal-over.html

    Your point about bureaucrats and protocols is well taken. However, given what happened in Dallas, caregivers in this country will be following droplet isolation control protocols to the letter going forward. And they do work; Médecins Sans Frontières (MSF) has been very active during this outbreak with over 3,000 staff on the ground (258 international and 2,800 national) and they have lost 3, none of whom were infected in the course of their professional activities.

    As to that 2012 study with pigs and monkeys. It did show that Ebola could be transmitted from pigs to monkeys. It did not show, as you claim, ". . . that it can be transmitted through the air between monkeys and pigs." In fact, the authors of this study specifically noted in their report that the design of the experiment was such that they could not distinguish between transmission via aerosols (airborne), small or large droplets (propelled) or droplets created during floor cleaning that ended up in the cages (fomites). Also, even if there can be airborne transmission from pigs to monkeys, that tells us nothing about airborne transmission from primate to primate. This is explained in more detail in the following link, which also addresses your plaint that ". . . you end up not knowing what to believe." I know who to believe, actual experts in epidemiology, virology and emerging infectious diseases (not press releases from politicians).

    http://www.pathogenperspectives.com/2014/08/ebola-stop-madness.html

    And we do know a lot about this strain of Ebola. Here's a start:

    http://virologydownunder.blogspot.com/2014/08/behind-naming-of-ebola-virusesnot-yet.html

    So I propose Outcome 0.

    Spearheaded by the Norwegians and Médecins Sans Frontières, the international aid effort finally takes off. Supplies of gloves, disposable syringes, respirators and isolation suits flood into West Africa. Deaths of healthcare providers plummet. It's an incredible struggle, but the outbreak is declared over in Guinea in late December, in Liberia in January, and in Sierra Leone by mid-February.

    If you or any of your readers want to help Outcome 0 come about, here's a link to a list of relief effort resources:

    http://www.pathogenperspectives.com/p/blog-page.html



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    1. Let's hope that you are right about the possibility of an Outcome 0. Even in this scenario, however, the conditions will still be in place for an even more deadly outbreak in the future unless the whole system is addressed.

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  2. Honestly, AS LONG AS I reasonably have access to a fully functional healthcare system, I will not be taking any serious precautions to avoid Ebola. The only sure protection against Ebola is already having survived it, and I think the chances of doing so actually will be best towards the beginning of a pandemic, before the resources of the healthcare system get stretched too thin.

    ONCE hospitals start refusing to treat Ebola patients and they get sent to internment camps, then it's time to get serious about total isolation from all other human beings.

    For a fourth scenario, you might want to check out Dmitri Orlov's http://cluborlov.blogspot.com/2014/10/ebola-and-five-stages-of-collapse.html

    His main suggestion is training the survivors to care for the sick, a solution which grows exponentially with the problem.

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    1. Dmitry's point about training survivors is a good one. I'm surprised though, given that it was Dmitry writing it, that he hadn't also considered the possibility that survivors will be selling their blood to the highest bidder. Whether that's a multi-national pharmaceutical company, or a crooked character in a backstreet clinic would remain to be seen.

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  3. I'm not sure us Westerners will fare any better. I mean the people in Africa are tough, fit and healthy individuals who have strong immune systems from being exposed to bugs all the time. Westerners are already weakened by conditions like diabetes, obesity, and generally have a lower much more sedentary lifestyle. Our extreme obsession with cleanliness means that our immune systems have had less practice at dealing with bugs.

    If you think we have more chance of surviving because of our healthcare systems, then I would disagree. Out of the people treated in the West so far 4 have died and 6 have survived, but that is with expert treatment from the top specialists, and these patients were all working age adults. If vulnerable groups were included the survival rate would not look so good. There is no cure at present so the healthcare system can't help much, and would be very quickly swamped. Hospitals are already proving to be a place where Ebola spreads.

    I think air traffic should be shut down now to help slow the spread. Quarantining West Point with 50,000 residents was never going to work, as the vast majority were healthy and would break out once the people around them started dying. But some kind of quarantining may help slow the spread. I think Ebola will spread really quickly when it reaches places like London.

    I agree with you, that now is the time to ensure you and your family are fit and healthy.

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    1. There is some debate going on at the moment as to whether Ebola piggy-backs on the immune system rather than just plain confronts it. If this were so it would mean that having a healthy immune system would be no better than having an unhealthy one. It might even make it worse. But I have no idea whether this is the case or not but it would seem prudent to make sure you and your immediates are as fit and healthy as possible.

      Last year I got flu and was *really* sick with it for over a month. I tried every flu cure known to Boots, but nothing had the slightest effect. Eventually I dragged myself down to a Chinese traditional healer — a 90 odd-year old woman with her daughter acting as translator — and she sold me a whole carrier bag full of medicine.

      I have no idea what it was because the writing was all in Chinese but I had to take up to 300 of these little pills every day, hourly with some warm water. She said I would be '60% better that afternoon, and 100% better in two days' time'. And the amazing thing was, she was absolutely right. Since then I have not been dismissive of herbal remedies.

      But, yes, panic would be a big problem here - at least in the first few months of an outbreak. Let's face it, if people freak out about having their flight delayed then how would those same people react to a deadly epidemic that halts their lives?

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    2. The Dallas patient died. The facts on the ground in relation to system responses have been proven in the field. The results are in and they're not good. Nuff said!

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    3. Hi Jason. Interesting. Remember not to mention herbal remedies to a General Practitioner or you'll get the same lecture I had to deal with... It sounds like some sort of dodgy 70's BBC sitcom: "Don't mention the war!" ;-)!

      Still, I grow a huge number of medicinal and culinary herbs here and find myself wandering around eating this and that whilst doing the rounds. Do they have a noticeable affect - yes. However, whilst you have both systems use both. Shame the industrial medical profession feel that they are superior to alternative therapies and are dismissive.

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  4. I wonder, too -- the contagion level doesn't seem too bad in Africa: if it were really as infectious as it's reputed to be, wouldn't every person exposed to it -- every single person, in fact! -- catch it? Yet it often seems to be just one or two of an extended family, rarely every single member of that family, who gets it, and four of ten of those, with essentially no treatment (palliation of symptoms is all there is, apparently....) recovers from it. BUT -- the infection has been localised in the affected areas of Africa for long enough that many/most people there must have at least some resistance to it. In the West, in Asia, all other parts of the world, no antibodies at all! What I wonder is how the virus is going to infect a wholly unprepared 'collective' immune system. Think measles and Maya, eh. This would be an appalling sort of cultural historical justice.

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  5. I have been thinking of this too. My professional history is in biotechnology, public health, scientific analytic software. In various ways, I have been studying statistical modelling of pathogens, transmission, disease life cycles, and treatment for over a decade as part of my job.

    All I can say to the idea that Ebola will remain in West Africa is that there are not too many highly contagious viruses that remained local rather than global. Malaria...

    Anyway, it will happen. I would avoid western medicine like the plague, and certainly not get into any hospital situation. As a doctor friend of mine said, if you stay in a hospital for any length of time, the chances of you getting sick from something there goes up to 100%.

    Best of luck

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    1. Even if ebola doesn't have the calamitous effect on us directly, many will still die due to the health systems being overloaded and unable to deal with formerly routine problems. If hospitals become hotbeds of disease then who in their right mind is going to want to go into one?

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  6. There are two points I have been making about this on other blogs, and I will repeat them here.

    The first is that if you ramp up the world population from 2 billion in 1937 to 7 billion in 2007 seventy years later, among other things you have just set yourself up for a pandemic that lowers the world population to a more sustainable level. This has historically happened every time there has been a population explosion. So something alot like Ebola breaking out of Africa or some other place that is unusually overcrowded or with an unusually rapid population increase is inevitable. The best medical system in world history will not be able to contain every one of these cases.

    The second point is that I don't think the current Ebola outbreak itself is IT. It seems to kill its victims too quickly and is not contagious enough. I suspect the real pandemic will spread with alot less mainstream medial coverage, most likely with no medial coverage at all. Also, through hard experience I have come to disbelieve every piece of information I receive where the only source is essentially talking heads on television. That means I half suspect that the entire "Ebola" outbreak has been completely made up out of whole cloth.

    I also would not be so quick to dismiss quarantines and travel bans, because quarantine has been a key tool in defeating just about every successfully contained plague/ pandemic in history, and one of the reasons health experts think that the world today is unusually vulnerable to pandemics is the high rate of people traveling about.

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    1. Too true. We have created a huge biomass that must look like a princely feast to a virus.

      Dismiss quarantine and travel bans? I didn't say that ... I think they should be enacted immediately, but they will lose their effectiveness as time goes by and more people have it.

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  7. One of the principals told me this story one time:

    At the height of the SARS panic a student returned from Hong Kong to an fairly exclusive boarding school in England. At some point she had accidentally scalded herself but hadn't had it treated. The scald got infected and she started to run a nasty fever. The school called the local hospital for an ambulance to pick her up, describing the situtaion as best they could. The ambulance crew refused to drive out. All the other ambulance crews refused to drive out.

    Eventually the local Director of Public Health got called, by this time it was late at night and the situation was fairly confused. He was a doctor who hadn't actively practiced in 10 years or more but he got some kit, located a braver-than-average nurse and drove out to the school. Once he was there in person he quickly diagnosed the problem and called for an ambulance to bring some anti-biotics and some other basic supplies. They complied, but only on condition that they didn't have to enter the school grounds: they could throw the supplies over the school wall.

    So, everytime I hear that Ebola doesn't pose a threat to western countries with advanced healthcare systems I think about that doctor standing by a school wall in the middle of the night, waiting for a package to land at his feet.

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    1. Advanced healthcare systems are only as effective as they are planned to be. When something unexpected happens it really throws a spanner in the works.

      I imagine there will be plenty of lobbing healthcare supplies over walls soon. Also, I read the other day that doctors in the UK are preparing to deal with ebola patients via Skype!

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  8. Predicting the future has no downside to it unless you are putting up money in which case the game is to make the majority bet on the wrong horse.
    You've trotted out three horses and offered up odds.
    But there is a fourth horse, which is that speculation on ebola drives up readership of your blog. That's the horse that is guaranteed to bring in money. And I've seen Orlov and the Archdruid trot out that same horse and it will bring in money regardless of how the other horses do. But as you've said, we will know how the other horses do by Christmas, maybe Easter at the latest. It's so hard to be patient.
    By the way, speaking of predictions, someone called Jim Kunstler in the comments to this morning's blog post on predicting financial collapse in the third quarter for three years running now.
    By the way, I enjoy the doomer blogs. The only one that that has become tiresome for me is Guy McPherson's Nature Bats Last. Perhaps it is because he has a race with only one horse in it, to wit, Near Term Extinction.
    My advice to blog writers would be, give them more than one horse to bet on. And you've done that, so I wish you continued growth in you readership.

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  9. Things have been quiet on the ebola front for a few weeks now. No new cases in the US and the people that were sick have either died or recovered and the people that might have been exposed have apparently not caught the disease. So I searched the internet for ebola statistics and found that as of October it seems that infections are still going up at an exponential rate in the three African countries where the disease is currently concentrated.
    So yes, it appears that we still have to wait until Christmas to see whether the disease stays contained in its present territory or manages to escape and spread to the rest of the world. In the meantime, here in the US, the attention of bloggers has turned to the victory of the Republicans over the Democrats. For the time being, in the blogs that I read, this is treated as a more serious threat to civilization than ebola. But Christmas is only six weeks away and we shall see who ultimately gets credit for destroying civilization.

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  10. Interesting post but I don't see any of the 3 outcomes happening. Outcome 1 where Ebola will be contained is happening but deforestation halted, and many of our best doctors not coming back and a new Marshall plan? I don't think so ).In terms of outcome 3 - a cure will be found but it will take time and then getting it to who needs is a different story. However in the medium term it will be contained - already changes in human behaviour, safer burials, and an influx of medical resources to the region is having positive impacts in reducing its spread. In 6 to 12 months we will see this more clearly. Pandemics like the plague and the Spanish flu cost millions of lives but in those days health systems were effectively non-existent or basic, there was little education and public awareness of how to contain their spread - but this won't happen with Ebola - different world completely.

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I'll try to reply to comments as time permits.