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Ebola 2014 World Map with event descriptions.

This map updates with new events. It covers 1976 to 2015.

The 2014 outbreak of the Ebola virus was identified initially on March 14th by a software tool at Boston, some 7,000 kilometers from the infection locations. Normal medical services were provided in rural areas of Guinea from close to the start of the epidemic. They didn't know that quarantine was needed. Not for weeks.

What has happened and is happening to contain Ebola is predicated on models that were built to predict outbreaks in rural areas. The transfer rate is estimated to be between 1 and 2. This is not realistic for cities. As you will see, urban environments and urban dysfunctions can produce catastrophic impacts on public health efforts.

Advanced economies are atypical.

In wealthy countries the samples from hemorrhagic disease incidents go straight to a lab for tests. The victim or victims are quarantined. Investigations proceed to determine prior human contacts with victims to anticipate additional infections.

Out in the Guinea bush last March, these procedures went off slowly or ineffectively or not at all. Matters have gotten steadily worse. Ebola spread out to three additional countries so far and the system at Monrovia, Liberia, has been compromised through a criminal break in at an Ebola clinic.

World Health Organization does what it can. These experts rely on straight-line, hierarchical report systems to identify outbreaks. Up till this outbreak that system had worked well enough. Diseases had been slow enough to be controlled. Raise the R-zero transmission rate and the system fails.

There's nothing here that a quick $1-billion wouldn't help. Think of it as though it was a war.

Estimates for the R-zero transmission rates for Ebola outbreaks ran to 1.83 for Congo/1995 and 1.34 for Uganda/2000. (R-zero is the number of new infections per identified victim outside of quarantine.) In this 2014 incident the disease presents a higher R-zero, likely in the 2 to 3 range for rural African societies, outrunning the WHO system with ease.

Software called HealthMap takes a different approach from WHO at early detection of outbreaks:

HealthMap... uses algorithms to scour tens of thousands of social media sites, local news, government websites, infectious-disease physicians’ social networks, and other sources to detect and track disease outbreaks.

Sophisticated software filters irrelevant data, classifies the relevant information, identifies diseases and maps their locations with the help of experts. The site is run by a group of 45 researchers, epidemiologists, and software developers at [Boston College Hospital.]

-- from Public Health Watch,

At the same time the computer simulation community is making efforts to analyze a wide range of more-or-less-likely Ebola outbreak patterns. Here the focus is on transmission. These models start by building on lists of critical factors and then roll the dice at transmission level to see how many people get hit:
-- Societal responses that affect containment: availability of quarantine beds, openness to medical personnel on the part of the infected, education generally and of women as healthcare providers in particular, withdrawal/retreat by doctors and nurses, (commonly religious) barriers to public health measures.

-- The specific R-zero for this strain of Ebola. Recognize that R-zero varies with population density.

-- Incubation period, which has run to 6 days on average in prior outbreaks with a range of 1 to 21 days.

-- Specifics of urban environments. This is for Lagos, Nigeria and 20,000,000 residents in the region. On Western terms this is a borderline failed city.

-- Commercial and seasonal population movements. For example: AIDS was spread initially along the truck routes. Truck stop prostitution was a prime vector.

Lethality ranges 50% to 90% for Ebola. There are five major identified strains.

There is an additional problem in Nigeria. The country is sharply divided between its Muslim north and its Christian south. The north does little to educate women. Going backward toward the 7th Century is more like it. The Salafi ideal. A path you also see with the Boko Harum, Gulf States Salafi and ISIS.

Memorizing the Koran does not intersect modern biology. That is going to hurt them.

The worst of it for Nigeria's Muslims is that the men try to get together five times a day for prayers. They are good Sunnis. It is a time for peace and friendship. Inject the Ebola virus into this system and you get a transmission environment that combines aerial dispersal with hand contact. And the risks fire off at five times a day.

Christians meet once a week or for some, once a day. The traditional African religions meet for festivals and celebrations. With Ebola in the mix: the less frequently people congregate, the better.

Considering the impacts of social structure, will it be possible to quarantine new Ebola cases faster than new cases are generated? What are the right estimates for R-zero for rural, trading town and urban environments?

Results from unofficial Monte Carlo runs are not good. Go for projections based on secondary information and we're in new territory. More below the orange muffin........

At what point does a human population find itself unable to bury its dead ???

Europe went for Plague Pits during the 14th and 17th Centuries during years when three-quarters of all deaths are attributed to the one disease. Both London and Paris municipal governments issued plague orders. Bodies were picked up at night. Details for burial arrangements for most the corpses were left to the individual parishes -- even when London lost 69,000 in 1665. Public burial was used as a last resort.

About as fifth of London died from plague in 1665. At that time the city had an estimated 460,000 inhabitants.

When we look at the situation this week in Lagos, Nigeria, the outbreak targets twenty times the population for inner-city residents and forty times the population before you get out of built-up suburban districts. Population density runs to 20,000/sq.kilometer. for the main island of Lagos. That compares with 70,000 sq.kilometer for the multilevel island of Manhattan NYC.

By way of comparison the rural population density for Guinea runs to 40/sq.kilometer. In the area of the Congo around the Ebola River, population density runs below 10/sq.kilometer. No area that got hit before 2014 had population over 25/sq.kilometer.

All prior outbreaks were successfully limited to these rural areas. That's where the R-zero transmission ratios of 1.83 and 1.34 were recorded. No case of Ebola hemorrhagic fever had been recorded from an urban population.

Please bear with me:

Prior to 2014 no re-transmission of Ebola hemorrhagic fever had been recorded in an urban environment.
Not one case.

There are logical consequences that go with this difference. Low population densities match up with low counts for interpersonal contacts. Which means that an infected person gets a tiny fraction of the opportunities to infect a stranger that he would get in a city.

On top of the heightened contact counts, urban crime is observed to interfere with medical efforts. Over in Liberia, a news item out of @BBC:

"At least 20 suspected Ebola patients missing after quarantine center looted, [Monrovia,] Liberia police say."
Armed gangsters attacked that Ebola treatment and quartantine center. Lord only knows what they thought they were getting. Ebola starts like flu, ends like rabies. The rural R-zero estimates at 1.83 and 1.34 are pretty much irrelevant to what is happening with such social breakdowns at Lagos, Monrovia, and the cities in other outbreak countries.

R-zero, R-naught, Basic Reproduction Rate. Whatever. That's the number of people who get a disease from every person who contracts it -- excluding quarantine operations.

For Monrovia and Lagos, from what we see with local reports, there is no such thing as effective quarantine. Authorities are weak because government is weak. Taxes are low. Manpower for forceful health responses is non-existent. Education is available for a few. They are no more set up for Ebola than London and Paris were set up for plague.

Monrovia and Lagos are Libertarian Heavens.

A.k.a., Hell when confronted with Ebola.

Plus BBC and CBC have word of the criminal attack in Monrovia on an Ebola clinic.

PatSaw and R-zero at 8

"Lagos is big, it's crowded. It would make in many ways a perfect environment for the virus to spread," said Nigerian epidemiologist Chikwe Ihekweazu, who runs website Nigeria Health Watch and worked on Ebola in South Sudan a decade ago.

"In the heart of Lagos, people live on top of each other, sharing bedrooms and toilets. In densely populated communities infection control becomes almost impossible to do well."

When [Patrick] Sawyer landed at Murtala Mohammed airport on July 20, [2014] none of the bystanders, airport staff or health workers who rushed to help him understood the danger they were in.

No one had the full body protection of mask, suit and gloves that are essential to prevent contagion, so his ill advised journey gave the world's worst Ebola outbreak a foothold in Africa's most populous nation.

Sawyer died five days later, followed by one of the nurses who first treated him. Eight others are confirmed infected and receiving treatment, including a hospital doctor.

-- Tim Cocks at Reuters, August 12th

And now there are dozens of PatStaws running around in Monrovia and (more than 50:50) in Lagos and the other population centers of West Africa.

The first PatSaw generated a minimum R-zero of 8 in Lagos, Nigeria.

He did that without spending two or three days walking around half sick. He did that mostly hospitalized.

You want to understand the impact of high fatality and high R-zero, check out a copy of the movie "Contagion" from 2011. 84% rating at Rotten Tomatoes. All Star cast. Heavy CDC involvement.

Technically accurate. And the whole society goes down the tubes until a magic vaccine comes along, playing Deus ex machina.

And that's projecting a lower death rate and lower than an "8" for R-zero.

It can happen here.

Back in 1917 New York City peaked out losing 500 people a day to Spanish flu. That was from a population of 5,000,000. Today we've got 8,000,000 in the five boroughs and more than twice that in connected suburbs.

Other cities took big hits. They were clean and they had good medical systems.

Don't be afraid. There is no use to that. But learn to be careful. Learn what it will take to survive if this takes off.

You can do better than what happened with the PatSaw events. Adopting protective gear if Ebola gets here -- that can cut R-zero down by more than half. It also reduces morbidity by reducing the length of chains of invasive virus that get through. (Viruses travel in long chains, rarely individually.) The "R-100" masks with replaceable canisters and the best surgical masks are superior to alternatives.

The PatSaw prediction of "8" for the R-zero is from a sample size of one. Maybe we can dodge the bullet. For West Africa, the odds are worse than for us.

Do we really have to look at what an "8" looks like in Monte Carlo simulations ???

Watch the expansion through a poor, urban group of humans?

Watch every simulation run go nuts, unless a vaccine jumps in.

Tough problem.

Originally posted to waterstreet2008 on Mon Aug 18, 2014 at 06:37 AM PDT.

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