WHO Timeline for Ebola Containment Proves Hard To Meet

The Associated Press, as carried by Salon, reports that the World Health Organization's intended timeline for limiting the spread of Ebola in the several West African countries where it has claimed thousands of lives has proved to be too optimistic. According to the article, Two months ago, the World Health Organization launched an ambitious plan to stop the deadly Ebola outbreak in West Africa, aiming to isolate 70 percent of the sick and safely Ebola 70 percent of the victims in the three hardest-hit countries — Guinea, Liberia and Sierra Leone — by December 1. Only Guinea is on track to meet the December 1 goal, according to an update from WHO. In Liberia, only 23 percent of cases are isolated and 26 percent of the needed burial teams are in place. In Sierra Leone, about 40 percent of cases are isolated while 27 percent of burial teams are operational.

Comments

Plans made by politicians not working out?

[gweihir]

This outcome has zero surprise value and is the _expected_ outcome. Pretty speeches and reality have this nasty tendency to diverge. This outbreak will be contained when there is a working cure or a working vaccine, not before. Anything else is only possible with a working medical and civil infrastructure, which does not exist in the affected areas and cannot be established in reasonable time.

Re:Plans made by politicians not working out?

[amorsen]

A lot more could be accomplished by just throwing (not very much) money at the problem. Like Sierra Leone where ambulance drivers are only on half pay due to government budget cuts. It is ridiculous that we (first world countries) cannot find the money to make sure that health care workers in the affected countries are paid reasonable wages.

Re:Plans made by politicians not working out?

[fuzzyfuzzyfungus]

I'm not inclined to optimism; but it is worth noting that all previous outbreaks were successfully contained without either a vaccine or a cure, in no small part because of how little infrastructure their was. Just a village or two in the sticks dropping off the map and not reporting back.

The trouble this time is that the outbreak has landed squarely in the worst-of-both-worlds intermediate position, where the victims and potential victims are far too thickly settled to be more or less automatically isolated; but it's not the sort of dense settlement that has managed to develop the sort of relatively strong structures you'd need to do something unpopular and technocratic to halt the disease progression. (That said, given how popular quarantines aren't, and wishful thinking is, the list of places where people would actually line up and do whatever the socially optimal solution required might be pretty damn short.)

Re:Plans made by politicians not working out?

[fuzzyfuzzyfungus]

It's a fairly classic collective action problem. We would all be better off if it were to be done; but maybe if I drag my feet you'll flinch and do it first, so I get all the benefits at zero cost. It is fairly unimpressive, though, because it isn't even some charitable exercise, it's totally pragmatic self interest. Augment the wages of some people in an area with fairly low wages and cost of living in order to reduce the odds of a nasty hemorrhagic fever making it to somewhere where I might get it, or have to pay for its containment at first world wages? That's a hell of a bargain.

Re:Plans made by politicians not working out?

[ColdWetDog]

Slippery slope. Pay the ambulance drivers. Then pay the nurses, docs, staff, pay for the building, pay for water treatment plant, pay for security to keep the water treatment plane from being disassembled. Pretty soon, you've taken over the country.

I think most Americans and Europeans have little idea how bad the situation is vis-a-vis a basic, functional government. Until you have one, you can't really do much systematically. Should we take over Western Africa? Probably - if we want the situation to improve. But that is a huge commitment in time and money and has a lot of sticky morality issues attached.

Re:Plans made by politicians not working out?

[beelsebob]

We can't even find the money to make sure that everyone in our own countries are treated without bankrupting them, what makes you think we'd be able to pay another country's medical bills too?

Re:Plans made by politicians not working out?

[sound vision]

I'm of the opinion we should be getting our own people healthcare before going out to save the world. Saving the world is great, but on a limited budget priorities are needed.

Re:Plans made by politicians not working out?

[amorsen]

We can't even find the money to make sure that everyone in our own countries are treated without bankrupting them, what makes you think we'd be able to pay another country's medical bills too?

a) Of course we can. Practically the entire Western world has universal healthcare, and the one country which does not pays more than average on health care per capita.

b) We are not talking about actual treatment. Only about finding a few hundred million dollars to keep existing medical personnel paid while governments in the affected countries are in deep trouble.

If Ebola gets to Western countries, a few hundred million dollars are gone in the blink of an eye.

Re:Plans made by politicians not working out?

[catmistake]

Should we take over Western Africa? Probably - if we want the situation to improve. But that is a huge commitment in time and money and has a lot of sticky morality issues attached.

Excuse my hyperbole, but this is a great idea, not just for West Africa, but Canada, Mexico, Central America, South America... and why not? The World, too. Imperialism is not a bad idea for the US... we sort of do it already, but then we abandon the people and natural resources for some reason and just pay for everything. But if we would annex what we want, we would make the place better, safer, healthier, the people better educated, will live longer, be happier... and we can keep the natural resources to finance what is known as Manifest Destiny.

Re:Plans made by politicians not working out?

[Anonymous Coward]

Duncan got his infection by driving a woman with Ebola to the hospital and your proposed solution is to hire more cab drivers?

Here's a question: How many people would Thomas Duncan have infected if his family had been evacuated to a tent in New Jersey, and they razed the building after handing Duncan a lethal dose of Benzos and a glass of Vodka?

Follow up question: How much money would that have cost the state of Texas?

When treating Ebola infects 3x people, and there is a 50% mortality rate: the humane/cost effective solution is elective suicide. If you contain them for public health reasons then the contingency that they "decline the Benzos" is unlikely by itself(and even more unlikely to change the outcome). People who want to sweat and puke and shit it out will either die without infecting anyone else, or survive. Same cost to taxpayers.

People who want to risk other people's lives to improve their own probability of survival should have to buy an exponentially more expensive "stamp"/voucher for healthcare in advance so that the cost of treating them is paid for in advance like(you know: like raffle tickets).

Anyone who thinks we can afford the quality of care Duncan(and his victims) received at any reasonable scale are dreaming. There's not enough money available for 100x Duncans.

MSF gives you a saline drip, 1/10th of a nurse, $50 in Tychem/Tyvek disposable protective clothing, ~.5L of germicidal bleach concentrate, a rubber mattress that smells like chlorine, a puke bucket, a bed pan, and a body-bag transport to the furnace if you don't walk out.

They can't even afford THAT at the rate this shit is growing and you want more cab drivers?

Re:Plans made by politicians not working out?

[theshowmecanuck]

There are a lot of people who have realized that simply throwing money at problems in Africa doesn't help. Lately, a lot of them are African. People are recognizing that given one or the other, the "teach a man to fish" adage is the only effective way to help. The problem is that normally the money doesn't go where it will help the most. And from what I've seen NGOs don't always know the best places. If they did, there probably wouldn't be any more poverty there.

Re:Plans made by politicians not working out?

[amorsen]

I completely agree. In the normal situation. This is not a normal situation.

This is a situation where health is put a risk on a global scale because we cannot be arsed to pay a few thousand ambulance drivers, and so infected people are left at home to infect their community. It is complete stupidity.

Those ambulance drivers are risking their lives every day. The least we can do is pay them their normal wages.

Re:Plans made by politicians not working out?

[DNS-and-BIND]

Racist. Imperialist. Black people can't run their own countries, so the Americans have to step in and do it for them. Yeah, that worked out SO well for you in Somalia, yeah?

Re:Plans made by politicians not working out?

[gweihir]

You cannot "throw money at the problem" either. Remember what happened when that was tried with whole plane-loads of dollars in Irak? The money just vanished and never reached those it was intended for. That is one of the primary defects of the infrastructure there: No way to distribute money so that it actually reaches those it is intended for.

Re:Plans made by politicians not working out?

[gweihir]

In addition, there is no power in the world strong enough and rich enough to take over Africa. Even the US falls several orders of magnitude short.
 

Re:Plans made by politicians not working out?

[gweihir]

Actually, African people cannot run their own countries well in most instances. The evidence is more than just compelling and there are no valid excuses for them anymore. Skin-color and race does not play a role. Culture and education does. On the other hand, looking at some tendencies in western countries, the devolution into kleptocracies and totalitarian regimes is well underway, with the US leading the charge downwards.

Re:Plans made by politicians not working out?

[gweihir]

You do not understand. That is not possible. No, really not. The infrastructure and mind-set for that to be possible are not in place.

Re:Plans made by politicians not working out?

[gweihir]

Indeed. The outbreaks before burned themselves out. This one will not.

Re:Plans made by politicians not working out?

[amorsen]

It was possible in July. Why is it not possible in December?

Re:Plans made by politicians not working out?

[gweihir]

It was not possible in July either. Some people might have been kidding themselves about the effect their efforts had, but that is all there was.

Re:Plans made by politicians not working out?

[amorsen]

The ambulance drivers were being paid then. They are not being paid now. Fixing that is trivial.

Re:Plans made by politicians not working out?

[gweihir]

No. You have no clue how these borderline-failed states work.

Re:Plans made by politicians not working out?

[amorsen]

You have no clue how these borderline-failed states work.

Wow, your eloquent debating skills really showed me there. I shall immediately change my opinion.

Re:Plans made by politicians not working out?

[RockDoctor]

This outbreak will be contained when there is a working cure or a working vaccine, not before.

The last time that I checked the laws of the universe, there was no guarantee that any particular disease had a cure. Or, for that matter a vaccine.

But that (probably undue) pessimism aside, if an acceptable design for a vaccine becomes available on the (optimistic) time scale discussed a month or so ago, then it'll only become widely deliverable late in 2015. By that point, deaths will have reached the point that the rate of growth will be decreasing because the population will have significantly decreased. Potentially around a million dead by late January - or 5% of the population.

Treatments are not going to be available on a much shorter time scale. The ZMAPP material is horribly production-limited. There are other treatments in trial - so expect them to take around another month to complete the trials, then make decisions. Then start production, which will take months to ramp up. Of course, you could probably accelerate production of treatments if you stopped producing, say, influenza vaccine. How many deaths from that cause?

Re:Plans made by politicians not working out?

[RockDoctor]

in no small part because of how little infrastructure their was. Just a village or two in the sticks dropping off the map and not reporting back.

It might help if you did a little research. The first recorded outbreak was, surprisingly, communicated to the Belgian microbiology labs who dispatched a team to Yambuko. Coincident was an outbreak in Sudan which actually started earlier. The cotton factory that was the centre of infection there didn't exist in a vacuum, but it processed locally-grown cotton and exported it. Third outbreak may fit your description, but wasn't identified until after the event. Fourth outbreak was a recurrence of the Sudan leg of the first outbreak at the same factory. 5th, 6th, 7th and 8th were the Reston virus outbreaks in the Philippines exporting monkeys to America and Italy (not normally described as areas of little infrastructure) ; 9th was a a range of gold mines in Gabon ; 10th was a scientist working in the Tai National Park (also not particularly associated with absence of infrastructure) and the next was in the city of Kikwit, a university town of ~400,000 population.

Of course, we don't know how many minor outbreaks there have been in previous centuries and millennia. But the cases recorded since identification of the disease don't match your characterisation very well.

You may not have noticed it, but when the Kikwit outbreak was going on, there was a lot of concern about the disease breaking out to the capital Kinshasha. Indeed, people fleeing the quarantines did get to the capital and die there (similarly to the Nigerian outbreak of this current cluster) but with the strength of the Congolese response, they managed to contain it. Otherwise, we'd probably not have been having this problem today.

The numbers are still being under-reported...

[Anonymous Coward]

The Ebola cases/deaths are vastly higher (2x-3x higher min) than what WHO is reporting. This is easily verifiable from WHO and others.

When the disease is multiplying week after week, the reality and false reported numbers will diverge more and more. At what point in time will the "false fact" numbers repeated worldwide, and the cases/deaths reality on the ground be reconciled in the media?

CAPTCHA: culpable!

Re:The numbers are still being under-reported...

[Bengie]

When Ebola made land-fall in the USA, we had something like 9 cases reported. Of those cases, 1 death, 1 still sick, and the rest recovered. Small sample set, but that seemed a lot better than the large death percentages happening in Africa. From what I understand, most deaths are cause by dehydration. A simple IV drip could save a lot of lives.

Re:The numbers are still being under-reported...

[theshowmecanuck]

This weekend I think I heard that they ar rreporting 7000 died so far. I think they owe it to everyone to tell us what they really think the number is. Otherwise what are we paying them so much for. We could hire monkeys if all we wanted was to report numbers from countries in "image damage control."

Changing the infection defination ..

[MonsterMasher]

The 'big drop' was in good part because of changes in the 'definitions'.
.
Here is someone with some details:
        http://youtu.be/XIDmK5qwarU
(Worth the time if you care about future .. and things.)

Re:Changing the infection defination ..

[wonkey_monkey]

If you make deadlines attainable, people slack off.

Re:Here is an idea:

[Anonymous Coward]

I hope you didn't patent that, because I'm going to tell the WHO and the CDC about that idea, and claim it was my own idea. And then when Ebola is no more, I will take all of the credit.

I invented a new word to describe the procedure: Quarantine.

I thought of it first. Not the WHO or the CDC.

What I want to know is...

[Otome]

How do you "safely Ebola" somebody? It sounds pretty dangerous to me.

Salon fails at logic

[Anonymous Coward]

You are surprised at the witless Voxsplaining morons at Salon failing to write coherently?

Re:safely Ebola the victims?

[Anonymous Coward]

salon

Really? I'm less surprised when Slashdot fucks it up than when Salon does it.

Re:safely Ebola the victims?

[Anonymous Coward]

You fail reading comprehension. Also, critical thinking. Salon is a rag.

Re:safely Ebola the victims?

[BarbaraHudson]

safely Ebola 70 percent of the victims

This typo was accurately transcribed from the article. I think it was meant to say "savely bury 70 percent of the victims".

More than half those with ebola aren't dead yet. Isn't that being just a tad premature? Even if it would work?

(welcome to English 101, where "victim" means "dead" for ebola, "injured" in a car accident, and "stupid" for Nigerian scam emails, and the average sarcasm detector is b0rked.).

Part of the problem is that you can't have the average Joe or Jane go over there and help with things like burial teams. Takes training, equipment, and a support infrastructure for the volunteers (they have to eat, put on protective gear, new gloves - in short supply, and be protected from those who want to prepare their dead in the traditional fashion).

Re:safely Ebola the victims?

[93 Escort Wagon]

safely Ebola 70 percent of the victims

The original article was written by Smurfs.

WHO estimates that WHO's estimate is way low?

[raymorris]

> The Ebola cases/deaths are vastly higher (2x-3x higher min) than what WHO is reporting. This is easily verifiable from WHO and others.

WHO estimates that there are twice as cases as WHO estimates there are? Something doesn't smell right in your post.

However, if in fact WHO is reporting numbers 2-3 times higher than WHO is reporting, someone should report WHO. Who is reporting WHO to who?

Re:WHO estimates that WHO's estimate is way low?

[Anonymous Coward]

You are confusing the terms 'report' and 'estimate' and using them interchangeably. WHO is *reporting* numbers fed to them by local governments and labs. They are *estimating* that the *reported* numbers are too low based on a number of factors. It's science.

Read for yourself, it's true

[Anonymous Coward]

http://www.independent.co.uk/news/world/africa/ebola-outbreak-number-of-deaths-are-massively-underestimated-warns-who-9686662.html

http://www.reuters.com/article/2014/08/15/us-health-ebola-idUSKBN0GD1US20140815

http://www.huffingtonpost.com/2014/10/03/ebola-west-africa-underestimated_n_5926634.html

The WHO itself talks about this problem in those articles, and on it's own website:

Why the Ebola outbreak has been underestimated
http://www.who.int/mediacentre/news/ebola/22-august-2014/en/

The reporting situation has been bad, and is getting worse as more people/villages/structure are wiped out by Ebola.

Re:Read for yourself, it's true

[iggymanz]

you can put the phrase "in Liberia and Sierra Leone" after each of your posts. In other words, no reason for alarm seen for cases outside those countries.

Re: Read for yourself, it's true

[iggymanz]

no evidence it is spreading globally at all, WHO is only concerned out what is happening in those countries. If they'd quit munching on bats and fondling infected dead corpses and breaking people out of quarantine the disease would die out. you can't help stupid

Re:Here is an idea:

[Anonymous Coward]

What is "moral" and what is "immoral"?

Is it "immoral" to quarantine Africans because that is "racist"?

Is it "moral" to let infectious diseases run rampant throughout the world in order to avoid being "politically incorrect"?

Is it "immoral" to want the human species to survive?

Is it "moral" to want to keep introducing defective genetic material into the pool? Is it "moral" to not tell people to mind their Rh factors when choosing a mate? Is it "moral" to lower the standards in schools to meet the standards already met by the lowest performing students? Is it "moral" to let a cop kill an innocent African-American without burning down your own city?

Re:Timeline?

[catmistake]

Ah, no. Where have you been? We decided to take efforts to save all the minorities, (Why? Blues. Jazz. Hip Hop. Dub Step. Morgan Freeman. etc.) and kill all the racist idiots, slowly and painfully. See, racists have never contributed anything to society, ever, so its really a method of survival that we cull this pointless group from our herd.

Best possible scenario for you: if you get a chance, you should kill yourself immediately.

Containing Ebola?

[lippydude]

"State House frustrating efforts of the Mayor of Freetown to curb Ebola"

"Exploring Safe and Dignified Burial Public Response"

"How Muslims Wash, Bury Their Dead"

"Taking Care of Someone with Suspected Ebola"

Re:safely Ebola the victims?

[ultranova]

safely Ebola 70 percent of the victims

The original article was written by Smurfs.

Fun fact: one of the first Smurf stories was about a disease-type zombie apocalypse nearly destroying the Smurf civilization.

Quite good

[Zorpheus]

They got it under control in one country, which is quite good I think, considering the situation in these countries, and the high number of unregistered cases.
The WHO plan has cost just 71 million, while Obama's Ebola plan costs 6.2 billion. Maybe that will work out.

Re:Quite good

[Zorpheus]

Actually it is also more or less declining in Liberia, making it two countries.

Re:Quite good

[Zorpheus]

And I don't get the "expert's" comment int he article:

“You want to isolate 100 percent of patients with Ebola and have 100 percent safe burials,” said Sebastian Funk, director of the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene and Tropical Medicine. “Getting to 70 percent doesn’t really mean a lot.”

70 percent is enough to bring the epidemy to a decline. 100 percent is not achievable with reasonable effort, and can only come from a theorist.

Re:Timeline?

[dave420]

"We", or "polite society" as it is commonly called, decided that allowing anyone to die a needless death is abhorrent (regardless of any single characteristic you can pin on them), and in a separate move, decided that people who discriminate based on superficial qualities such as race are clearly not functioning rationally (owing to the simple fact that one can't rationally come to the same conclusions using only evidence and critical thought).

Trying to spin it into some "them vs. us" thing where you're the poor guy caught up in the middle for simply being honest is only serving to highlight how woefully irrational you are, or how startlingly ignorant you are of the history of western civilization. Either way you end up looking like a knee-jerk buffoon who is quite happy to fester in his own two-dimensional, black and white world, where nothing more than a cursory glance is required to accurately appraise very complicated situations, and anyone who says otherwise is saying so simply to be PC.

Your parents and society failed you massively.

I thought Ebola was inherently dangerous...

[sribe]

So how you safely Ebola people?

Re:I thought Ebola was inherently dangerous...

[gelfling]

Declare it racist then all problems are solved.