Gates: Large Epidemics Need a More Agile Response

jones_supa writes: Writing in the NY Times about the recent Ebola crisis, Bill Gates says this disease has made the world realize we are not properly prepared to deal with a global epidemic. Even if we signed up lots of experts right away, few organizations are capable of moving thousands of people, some of them infected, to different locations on the globe, with a week's notice. Data is another crucial problem. During the Ebola epidemic, the database that tracks cases has not always been accurate. This is partly because the situation is chaotic, but also because much of the case reporting has been done first on paper.

There's also our failure to invest in effective medical tools like tests, drugs and vaccines. On average, it has taken an estimated one to three days for test results to come back — an eternity when you need to quarantine people. Drugs that might help stop Ebola were not tested in patients until after the epidemic had peaked, partly because the world has no clear process for expediting drug approvals. Compare all of this to the preparation that nations put into defense, which has high-quality mobile units ready to be deployed quickly.

Comments

So when's the first scrum?

[BarbaraHudson]

n/t

Moving Infected People

[Cpt_Kirks]

I don't think infected individuals should be moved, or at least not moved far.

The number one concern is to limit contamination, so quarantine should be as absolute as possible.

Hard hearted? Maybe, but definitely practical.

Re:Moving Infected People

[oodaloop]

So when they're found in an airport, they should be quarantined there instead of going to, like, a hospital or whatever? Are you going to quarantine an entire flight of people at once in an airport?

Re:Moving Infected People

[Penguinisto]

Agreed.

While yes, the act of moving someone to an advanced care facility would be preferable for the person involved, I would counter that maybe, just maybe, that advanced care facility (or as much of it as possible) should be relocated to where the infected are. The absolute last thing you want to do is to start flying infected people outside of the infection zone to other places.

I already know the problems presented: The infected area is usually in some third-world shithole with little-to-no infrastructure, much of the equipment is big, heavy, and expensive, etc... but much of it can be made portable with sufficient engineering, and a good chunk of it doesn't even have to be brought along, or can be minimized (e.g. the ventilation/filtering systems that the centers here have to keep quarantine).

If Bill Gates wants to do something with all that cash, maybe he can hire a few engineers an medical types to build a deployable care center that can be flown out to $3rdWorldShitHole in less than 24 hours, and be put to use immediately when an epidemic strikes. Hell, build a bunch of them, include a big pile of needed supplies with each, then pre-position them in or near areas that are most likely to see recurring epidemics.

Re:Moving Infected People

[Cpt_Kirks]

As I said, not moved far.

Take that as "moved as little as possible".

If they are in a city, move them to the closest hospital IN THAT CITY.

With the last ebola mess, they were flying obviously infected people all over the place.

Re:Moving Infected People

[Penguinisto]

Are you going to quarantine an entire flight of people at once in an airport?

Not to be a heartless dick, but it's not that hard to do if someone shows symptoms en route. The airplane is a somewhat sealed metal tube, and an airport has a lot of acreage that can park that plane out far enough away from everyone else....

Re:Moving Infected People

[Wycliffe]

a deployable care center that can be flown out to $3rdWorldShitHole in less than 24 hours, and be put to use immediately when an epidemic strikes. Hell, build a bunch of them, include a big pile of needed supplies with each, then pre-position them in or near areas that are most likely to see recurring epidemics.

This is exactly what the summary is talking about. We have "high-quality mobile units ready to be deployed quickly" for military but
we don't have the equivalent on the medical side. It was insane that we did not have deployable quarantine units that could be sent to
the location so instead we attempted to fly them to a quarantine unit elsewhere. To add to the insanity, the only plane that was
capable of transporting an ebola patient could only transport ONE passenger at a time. I'm pretty sure that's the definition of being
grossly underprepared for an epidemic when the solution is to fly people halfway around the world one at a time.

Re:Moving Infected People

[ShanghaiBill]

With the last ebola mess, they were flying obviously infected people all over the place.

For a disease like ebola, that is no big deal. It is important to keep a grip on reality. There was a lot of scare-mongering over ebola, nearly all of it misplaced. Ebola can easily be stopped dead in its tracks by soap and/or hand sanitizer. It spread in Liberia, Sierra Leone, and (especially) Guinea, because those three countries have basically no health infrastructure, deep mistrust of outsiders, very low literacy, and little understanding of the germ theory of disease. Ebola was never able to gain a foothold in neighboring countries, such as Senegal, Ghana, or Nigeria, which have higher literacy and at least rudimentary health care systems. To think that ebola could spread in first world countries like America, or Europe is not realistic.

Re:Moving Infected People

[ShanghaiBill]

The number one concern is to limit contamination, so quarantine should be as absolute as possible.

Many health professionals think this is one of the dumbest things you can do. Strict quarantine policies discourage people from reporting infections, and cause people to flee at the first sign of trouble, so they can get out before the quarantine cordon is in place. During the ebola outbreak, some quarantines were imposed, and, in hindsight, they are regarded as a mistake. As people flee, they are crammed onto crowded buses, deprived of sleep, exposed to the weather, and dispersed far away from the health workers that know how to treat them.

Re:Moving Infected People

[ShanghaiBill]

Depends on the symptoms. Are you going to quarantine an entire flight when a passenger has a fever or is throwing up ?

No, because you are not going to know about it. What possible incentive does a stewardess have to report that illness, when she knows that she will be quarantined along with the passengers, and possibly left to die on a sealed airplane? The problem with draconian solutions is that they incentivize counter-productive behavior.

Re:Moving Infected People

[itzly]

My question was a rhetorical one, but since it got moderated "-1 don't understand", I'll rephrase it in a more direct way.

Not to be a heartless dick, but it's not that hard to do if someone shows symptoms en route

The problem is that most symptoms that are developed en route are going to be simple things like a fever or vomiting. These aren't clear enough to be recognized as a symptom of a dangerous disease. Taking a blood or mucus sample, and running a real test could take hours, if not days, and that's too long to keep a plane full of people waiting.

Re:Moving Infected People

[jedidiah]

Running a real test will not "take days". However, a blood test may not be helpful for days. The last doctor we imported for treatment was like this. Despite the fact that he was starting to exhibit symptoms, blood tests didn't indicate he had Ebola.

Properly quarantining people is problematic enough when it's just one obnoxious nurse. Forget about an entire plane full of entitled 1st worlders.

Re:Moving Infected People

[DerekLyons]

I already know the problems presented: The infected area is usually in some third-world shithole with little-to-no infrastructure, much of the equipment is big, heavy, and expensive, etc... but much of it can be made portable with sufficient engineering, and a good chunk of it doesn't even have to be brought along, or can be minimized (e.g. the ventilation/filtering systems that the centers here have to keep quarantine)

If Bill Gates wants to do something with all that cash, maybe he can hire a few engineers an medical types to build a deployable care center that can be flown out to $3rdWorldShitHole in less than 24 hours, and be put to use immediately when an epidemic strikes.

Let's see... the existing system uses minimal investment (mainly in transportable isolation units) to transport a small number of exposed or critically ill people to locations where an existing army of people and mountain of equipment already exists and has supporting infrastructure in place. Your proposed system has us spending tens of millions of dollars (if not more) to transport a (currently non existent) army of people and (currently non existent) mountain of equipment to a place without supporting infrastructure and requiring massive (and currently non existent) logistics pipeline to maintain to support a small number of exposed or critically ill people.

Other than the clueless paranoia displayed in this sub-thread, why on earth would you propose such a back-asswards system?

You, and the OP, are confusing two different problems. The first, moving the most critically ill people to treatment and isolating exposed individuals, is largely a solved problem. The second, quarantine and minimizing the spread of disease among the local population is a very different problem... and even so, it can be largely handled with existing systems. The problem with the Ebola outbreak in Africa was failure to recognize the problem followed up by a "too little, too late" response from the West, combined with cultural issues and behaviors which facilitated the spread of disease. You can't fix either by simply throwing money at them.

Re:Moving Infected People

[ShanghaiBill]

Interesting. I was not aware that there was a debate about the practice of quarantine.

You didn't hear about the political backlash over the NY and NJ quarantines, that were imposed to deal with the zero infections that occurred there?

The idea of "moving" infected, or possibly infected people certainly seems counter-intuitive.

They idea that broad and draconian quarantines cause more people to move, also seems counter-intuitive, but it is true. Limited quarantines of actually infected people, that are being effectively treated, usually makes sense. Going beyond that is generally counter-productive.

The best way to stop ebola is soap, not draconian quarantines.

ebola

[itzly]

The major reason why ebola was able to grow was simply poor basic health care practices in some countries. Simple rules, like not touching dead or sick people, and washing your hands regularly would have helped a lot more than "databases" and "global warning and response systems".

Re:ebola

[gnujoshua]

Simple rules like not touching dead people or sick people? Simple rules, like not touching dead or sick people, and washing your hands regularly would have helped a lot more than "databases" and "global warning and response systems.

It is not reasonable to expect people to not touch dead or sick people and it is absurd to think that proper hand washing would prevent the transmission of Ebola. Ebola is primarily a caregivers disease because the people most likely to get it are those caring for someone near the end of their life. A person walking around with Ebola is unlikely to spread it to another person. And a person who is near the end of life and severely sick with Ebola is unlikely to be walking around. In most places on Earth, a person with Ebola would go to a hospital when their symptoms were very strong. When there aren't hospitals, though, then it will be family members that will help care for a person who starts to spike a fever and is becoming dehydrated due to the explosive diarrhea or projectile vomiting (or both) that they are having. And, people should care for one another, because most of the time, the symptoms of Ebola are indistinguishable from other common ailments a person might have. For some patients, at the very end of life, there might be other signs that are peculiar to Ebola, such as lesions, but this isn't always the case. But in any case, even in a hospital setting, if a person is projectile vomiting or having explosive diarrhea, then often it is not just simply a matter of properly washing ones hands to prevent infection. Lastly, if when a person dies of such conditions, they are likely covered in their own vomit and excrement and may on occassion even have open lesions on their skin. Properly cleaning the area of a sick person and preparing their body for burial is something that trained professionals with proper equipment should do. But, again, such professional services do not exist throughout much of rural West Africa, and so the job of cleaning, preparing a body, and burying a body falls on shoulders of the members of the family and household.

As Paul Farmer said: "The only formula we’ve come up with is the following: you can’t stop Ebola without staff, stuff, space and systems. And these need to reach not only cities but also the rural areas in which most people in West Africa still live."

With apologies to programming-motherfucker.com

[Anonymous Coward]

Medicine, Motherfucker

Do you practice it?

We are a community of motherfucking clinicians who have been humiliated by pseudoscientific quackery for years. Do you know what they call alternative medicine that works? Medicine, Motherfucker.

We are tired of antivaxxers, homoeopaths, naturopaths, chiropractics, acupuncturists, faith healers, and anyone else getting in the way of Medicine, Motherfucker.

We are tired of being told we're money-grubbing idiots who need to be manipulated to work in a Allopathic Medicine chain gang without any time to explore the natural healing powers of measles and whooping cough because none of the 10 insurance companies that are responding to customer demand for acupuncture coverage can do... Medicine, Motherfucker.

We must destroy these methodologies that get in the way of...Medicine, Motherfucker.

They claim to value / They really value / We fucking do:
Individuals and interactions / Tons of billable hours / Medicine, Motherfucker
Removing toxins and chemicals / Tons of pointless tests / Medicine, Motherfucker
Health Freedom / Bleeding patients dry / Medicine, Motherfucker
Fighting the Establishment / Paranoia and conspiracy theory / Medicine, Motherfucker

We think the shit on the left, is really just the con in the middle, and that we really need to just do the thing on the right... Medicine, Motherfucker.

Signed,
Anon. C. Owhard.
And the Medicinal Motherfuckers.

Re:With apologies to programming-motherfucker.com

[ColdWetDog]

You sound angry. Perhaps some nice Cognitive Behavioral Therapy.

Or just a nap.

Re:Why should we care?

[Penguinisto]

I am going to post a devil's advocate question, because there are people who will ask this:

Why should we care about an epidemic/pandemic in some other area of the globe?

Two words: Global Travel. Some dude wanting to flee that epidemic may have just enough resources to hop a plane ride or two, to get to safety with his relatives in the US... ...and we get to find out that even he didn't know he was infected until he landed and started spreading the love on US soil.

It's already happened once (that we know of) during this last one.

FDA-as-disease-process

[Impy the Impiuos Imp]

"partly because the world has no clear process for expediting drug approvals."

The vast majority of drugs should be fast track. The number of deaths that occur with letting a drug out early (before full problems are realized) is vastly smaller than the numbers of deaths that occur because drugs are held up ten years.

The FDA is built on a mathematically false premise. But you konw, a dead guy from some drug, boy can those politicians decry "unconscionable profits".

How many are standing up to decry the ten million worldwide not saved becaise some good heart drug was delayed 6 years?

W. Africa needs: hospitals, physicans, equipment

[gnujoshua]

One way to be more agile is to have more hospitals, equipment, and trained acute care physicans and nurses available to respond. It is much easier to have digital record systems if you have properly equiped hospitals and clinics that are connected to each other. Every nation should have properly equiped hospitals and on-site training programs—facilities that can emergency and critical care type situations, as well as mortuaries. Here are a couple of quotes from a recent article by Paul Farmer, one of the founders of Partners in Health that explains a little about the health systems of countries in West Africa:

Both nurses and doctors are scarce in the regions most heavily affected by Ebola. Even before the current crisis killed many of Liberia’s health professionals, there were fewer than fifty doctors working in the public health system in a country of more than four million people, most of whom live far from the capital. That’s one physician per 100,000 population, compared to 240 per 100,000 in the United States or 670 in Cuba. Properly equipped hospitals are even scarcer than staff, and this is true across the regions most affected by Ebola. Also scarce is personal protective equipment (PPE): gowns, gloves, masks, face shields etc. In Liberia there isn’t the staff, the stuff or the space to stop infections transmitted through bodily fluids, including blood, urine, breast milk, sweat, semen, vomit and diarrhoea. Ebola virus is shed during clinical illness and after death: it remains viable and infectious long after its hosts have breathed their last. Preparing the dead for burial has turned hundreds of mourners into Ebola victims.

He concludes the article stating:

Fifth, formal training programmes should be set up for Liberians, Guineans and Sierra Leoneans. Vaccines and diagnostics and treatments will not be discovered or developed without linking research to clinical care; new developments won’t be delivered across West Africa without training the next generation of researchers, clinicians and managers. West Africa needs well-designed and well-resourced medical and nursing schools as well as laboratories able to conduct surveillance and to respond earlier and more effectively. Less palaver, more action.

Nor will we ever be

[ilsaloving]

We will never be prepared for a global epidemic as long as anti-scientific morons are able to influence and/or dictate policy.

For example: The vaccination efforts of the last century have effectively been wiped out thanks to the idiotic anti-vaxxer movement, causing measles cases to surge, and are continuing to increase. I'm planning on talking to my doctor about the possibility of a measles booster just to keep my family safe.

And then there's the whole Thimerosol thing, which single-handedly destroyed our ability to easily distribute vaccines en masse. All because some assholes with zero chemistry knowledge freaked out because there was a mercury atom in the molecule. It doesn't occur to these people that if they took common table salt and consumed their component elements, your body would dissolve, punctuated by explosions.

So no, I expect that we are going to see more and more small epidemics of various diseases, and it's probably going to get significantly worse, all thanks to uneducated morons who think their ignorance has the same weight as hard-won knowledge.

Re:Gates?

[Wycliffe]

Perhaps because gates primary focus has been charity and philanthropy for almost as long as he was in the microcomputer game.

Why was this flagged -1? Bill Gates is president of one of the largest organizations helping to fight disease in the world.
He has as much validity as the president of Red Cross or any other large relief organization. This is why his opinion
matters. He's also uniquely positioned where he can help bankroll what is needed if necessary where most other large
relief organizations would have a much harder time changing their focus.

Re:Bill Gates sponsors quackery

[MrL0G1C]

And he's a giant hypocrite, he invests his money into bad companies that f**k the world up and then acts the saint trying to make the world a better place with the interest.