Pathogens and their impacts

[viddaloo]

Strange. I always thought 'containment' meant keeping the deadly virus on at least the same continent where the infection happened? But my first language isn't English, so bear with me.

Your English is just fine! You're correct. But one must also have a fallback position.

Then we just have to wait for the first oh-so-qualified-and-important Western leader to suggest (and implement) containment. Seems like the only solution used in the 20th century, some sort of higher level decision must have been made this time around, probably with the intention to spread this out a bit before containment is (again) ordered as the #1 remedy for disease control.

Can we hope for containment to be applied on all affected continents by the end of November, or is that too early according to the Western plan for this ebola pandemic?

[ccgwebmaster]

If this is the case, the main threat is to the countries along the way, since anyone who was infected would likely be dead or too sick to travel further before they got all the way to South Africa.

Maybe the main threat is, but you still couldn't be sure someone couldn't export the disease that way - overland - even with slower modes of transport. I thought about it with respect to boats, if one was 21 days travel time from anyone, wouldn't it pretty much guarantee you isolation - but no, not if a group is travelling, and they don't all fall sick at once. Worst case someone is just infected at the start - takes three weeks to become symptomatic. Then the second group member becomes infected within say a week - so far they've had a month... repeat as many times as you care to speculate upon.

That said I expect movement of the virus overland to mostly be to nearer places, though as the case load climbs, one can expect the more statistically improbably scenarios to become probable (albeit rarer) ones.

[wili]

"not if a group is travelling, and they don't all fall sick at once"

Good point. And of course as populations get infected further south by the first wave of dying immigrants, they, too, will likely take up the attempted exodus, probably in the same general direction for the same general reasons. Thus a second 'wave' is formed--and on and on.

[ccgwebmaster]

Some interesting stuff here - a map showing air transport volumes by country from the affected region in Africa - and projections showing what to expect in the recipient nations.

http://www.forbes.com/sites/jvchamary/2014/10/13/ebola-travel/

How accurate the projections turn out to be is up in the air, but the transport data is indicative. Interesting that the US had an import before the UK - but that's statistics for you...

[EDIT] I see now, they're including Nigeria and it's connections to the UK, which seems questionable at this time as Nigeria has probably contained Ebola (for now) and certainly doesn't have an ongoing outbreak from which to derive mathematical information.

[viddaloo]

This seems perfectly under control.... Not.

2nd Dallas nurse with Ebola flew with 132 passengers day before showing symptoms

[ccgwebmaster]

This seems perfectly under control.... Not.

2nd Dallas nurse with Ebola flew with 132 passengers day before showing symptoms

The affluent nations have been far too complacent all along. It is possible (and even probable provided there isn't a festering section of disease spreading in an underclass of society that we don't know about yet) for the affluent nations to contain this - Nigeria managed it after all.

However the disease is far easier to catch and far harder to avoid catching than people believe. It doesn't take African conditions to propagate and some things actually work to the advantage of the disease in affluent nations - much greater and more frequent travelling for example.

To contain it requires near perfect adherence to a rigid protocol. The US has now permitted as many of their healthcare workers to become infected dealing with one case as Medicin Sans Frontieres has so far in the whole outbreak.

We're seeing protocols evolve however and there is still a good chance I think for containment.

Nigerian contact tracers interviewed almost 1000 people for each case they had, by the way. That's a major effort - they weren't complacent, took it seriously from the outset, and stopped it in its tracks - that time (clearly there is a very significant risk of more exports and statistics is not your friend when you keep rolling the dice).

[Milret2]

Yeah, here I am in America where we are so very technological and sophisticated and where we do not need to worry about ebola epidemics or outbreaks ... and we have a city and hospital that appears to be unable to prevent an outbreak or keep someone who had direct contact and gave care to a patient with ebola from getting on a commercial aircraft a few days after said patient died to get ready for her wedding and then develops fever and a positive ebola titer a few hours AFTER she flies back to Dallas. As a retired military medical person I am appalled and not at all unalarmed.

[ccgwebmaster]

Yeah, here I am in America where we are so very technological and sophisticated and where we do not need to worry about ebola epidemics or outbreaks ... and we have a city and hospital that appears to be unable to prevent an outbreak or keep someone who had direct contact and gave care to a patient with ebola from getting on a commercial aircraft a few days after said patient died to get ready for her wedding and then develops fever and a positive ebola titer a few hours AFTER she flies back to Dallas. As a retired military medical person I am appalled and not at all unalarmed.

Personally I think it's I think it's nice to see reality creeping in. America is showing true colours for a change now, by finding that assumptions and complacency don't offer protection, and it actually has to take the threat seriously (or else of course it will fail, but Nigeria managed to contain their export, so... er...?)

Shades of climate change response (or lack thereof) here too.

While people like to feel "exceptional" and superior to Africa, they're forgetting that while hygiene may be (a bit, but not as much as people think) better in an affluent nation, there are other risk factors not present to the same extent in Africa. For instance, many more people travel far more often and further in affluent nations. That gives the scope to greatly increase the exposure pool and geographically distribute a disease in a way not present so much in Africa.

I also find it hard to believe that a person is categorically not infectious until symptomatic as the viral load will be increasing continually from the infection incidence. It may well be much harder to contact dangerous body fluids until there are obvious symptoms - but I'd be surprised if you couldn't find dangerous levels of virus (any virus at all in this case) in at least some body fluids before symptoms emerge.

The US certainly hasn't got the best healthcare in the world - though it's arguably decent compared to most African nations (if patients can afford it at least, which many cannot). It's the human factor that's behind all these failings - watch this space? There's not long to get it right, if the outbreak continues to grow, we could reasonably expect a 50 fold increase in exports by early next year...

[Laurent]

Take bushmeat off the menu before humans are served another ebola
http://www.theecologist.org/blogs_and_comments/commentators/2594108/take_bushmeat_off_the_menu_before_humans_are_served_another_ebola.html


Small drugmakers try to scale up to meet Ebola crisis
http://www.washingtonpost.com/national/health-science/small-drugmakers-try-to-scale-up-to-meet-ebola-crisis/2014/10/09/a594dec2-4fee-11e4-babe-e91da079cb8a_story.html?wprss=rss_energy-environment

[ccgwebmaster]

Take bushmeat off the menu before humans are served another ebola
http://www.theecologist.org/blogs_and_comments/commentators/2594108/take_bushmeat_off_the_menu_before_humans_are_served_another_ebola.html

If it's what you can afford to eat, you have no choice. From what I've read it's actually thought possible to catch it from eating fruit with bat saliva on it - no need to directly consume the animal anyway.

Habitat destruction, human population pressure and international exploitation are big factors here too.

[wili]

If we weren't feeding nearly all of it to cows and cars, there would be plenty of corn (or other better stuff) to be feeding these folks so they don't have to go for bushmeat. But really it's more about human encroachment into forested areas and destruction of forest driving forest animals into more and more inhabited areas.

Meanwhile:

Drexel study questions 21-day quarantine period for Ebola

http://medicalxpress.com/news/2014-10-drexel-day-quarantine-period-ebola.html

    "Twenty-one days has been regarded as the appropriate quarantine period for holding individuals potentially exposed to Ebola Virus to reduce risk of contagion, but there does not appear to be a systemic discussion of the basis for this period," said Haas, who is the head of the Department of Civil, Architectural and Environmental Engineering at Drexel.

    Haas suggests that a broader look at risk factors and costs and benefits should be considered when setting this standard. With any scientific data of this nature there is a standard deviation in results –a percentage by which they may vary. In the case of Ebola's incubation period the range of results generated from the Zaire and Uganda data varied little. This might have contributed to the health organizations' certainty that a 21-day quarantine period was a safe course of action.

    But looking more broadly at data from other Ebola outbreaks, in Congo in 1995 and recent reports from the outbreak in West Africa, the range of deviation is between 0.1 and 12 percent, according to Haas.

This means that there could be up to a 12 percent chance that someone could be infected even after the 21-day quarantine.

    "While the 21-day quarantine value, currently used, may have arisen from reasonable interpretation of early outbreak data, this work suggests reconsideration is in order and that 21 days might not be sufficiently protective of public health," Haas said.

This is NOT good news, folks.

[ccgwebmaster]

This is NOT good news, folks.

Statistics only gets you so far in biological systems though - in reality there are boundaries not automatically encompassed by the mathematical tools statistics gives you. For example, where are the 20 feet tall people? Statistically shouldn't a very small number exist or be possible? But in reality we know it isn't ever going to happen (the health problems of growing to excess size kill you first).

In the case of Ebola for infection to take as long as 21 days is I think very rare - most cases manifest within more like 2 weeks (for now). For infection to take much longer would be very unlikely because the immune system has either successfully responded or not responded in this time. If symptoms were going to take much longer than 21 days to manifest it's more likely that actually you have an even worse scenario - a non symptomatic carrier... who will never manifest symptoms and yet remain infectious (although perhaps not strongly compared to most so as the symptoms also happen to be the primary infection vectors).

And here, we really don't know for sure what the probabilities are, just as we don't know lots of things about the disease when it's acting on these scales.

[wili]

Much as I admire most of your writing, I'm afraid I just can't follow your connections/associations here. What do the non-existence of 20-foot people have to do with the fact that about 1 in every 8 people who survive ebola are still infectious?

Are you just saying that you think anything having to do with statistics is completely bs?

It's quite a clear ratio presented. Nothing terribly tricky looking or subtle. Do you think "health problems" are likely to kill people who are non-symptomatic like they do people who get over a certain height?

Really, I'm just at a loss as to what you are trying to convey here exactly.

It touches me potentially closely, since a largish family from Nigeria that lives near us has reportedly been under 21-day quarantine till today, but now are wandering free again. So if this report is right, there is a fair chance that, if they had been exposed, one of them could still be asymptomatic but still carrying the disease. So further clarity would be most welcome.

[Bruce Steele]

Pondering the notion that our technology may prove problematic. Apparently The Dallas hospital with the outbreak used a pneumatic tube delivery system like the one linked below for ( hot ) specimen samples for several days a couple weeks ago. Seems like decontamination of one of these might be difficult ?  Went back on this page to April 2 for the first posting of Ebola , 83 victims .

http://med.stanford.edu/news/all-news/2010/01/gone-with-the-wind-tubes-are-whisking-samples-across-hospital.html

[ccgwebmaster]

Much as I admire most of your writing, I'm afraid I just can't follow your connections/associations here. What do the non-existence of 20-foot people have to do with the fact that about 1 in every 8 people who survive ebola are still infectious?

Are you just saying that you think anything having to do with statistics is completely bs?

It's quite a clear ratio presented. Nothing terribly tricky looking or subtle. Do you think "health problems" are likely to kill people who are non-symptomatic like they do people who get over a certain height?

Really, I'm just at a loss as to what you are trying to convey here exactly.

It touches me potentially closely, since a largish family from Nigeria that lives near us has reportedly been under 21-day quarantine till today, but now are wandering free again. So if this report is right, there is a fair chance that, if they had been exposed, one of them could still be asymptomatic but still carrying the disease. So further clarity would be most welcome.

Well, I'm not sure precisely what your article is saying - except that it's possible a small proportion of Ebola cases (very worst case end of the range 12%) could take longer than 21 days to become symptomatic? (and since we know it can survive for days out of a host in some circumstances, I'd like to know how that was measured - one couldn't simply measure Ebola onset intervals between cases, or the onset of symptoms - how exactly DO you measure the precise moment of infection, again?).

From the point of view of the precautionary principle, I'd agree with you I think - it surely wouldn't hurt to tack a bit longer onto the quarantine period if there is any doubt over the time to onset of symptoms.

However in the bigger picture it might not make sense even if a small proportion of cases do take longer to manifest. The reasons for this are that you do not need perfect containment to stop an epidemic - you just have to play a numbers game where on average less than one person is infected per case. If a 21 day quarantine can catch even 90% of your cases and permit appropriate isolation and management, you are almost certainly going to win that game (and the virus has to work very hard to infect enough people before you catch up with any outliers).

Furthermore - there is a cost to quarantine. In the early stages of containment, which is really all you ever want to have to deal with in an ideal world, this might not be such a problem. But if you have to start quarantining large numbers of people for longer just to catch a small percentage of the case load - that has a real economic cost and problem. It might be cheaper to tolerate a small increase in case load and a few more deaths, in other words.

One final point though - I don't get what you say about 1 in 8 survivors still being infectious? I don't see anything about that in the article you linked?

It is known that the virus can be recovered from semen for up to almost 90 days, and so it seems a male survivor could potentially transmit the virus for months after recovery from the disease. This is a potentially serious problem and I think one people need to be more educated about (though the information is out there, one does wonder about other bodily fluids, if there are any other reservoirs available to the virus). Your article only seems to deal with quarantine to determine if infection will develop though? It doesn't seem to provide even any hard data detailing longer intervals to manifestation of symptoms or description of the measurement methodology given the great difficulty in determining the precise moment of infection.

Not sure if I'm making any sense?

And all that said - this large family that was quarantined - frankly if there was a solid reason for the quarantine, I'd be cautious well past the 21 day window. I would also note that I believe the timescale that must elapse for a nation to be declared free of Ebola is two 21 day intervals, or 42 days.

[ccgwebmaster]

Pondering the notion that our technology may prove problematic. Apparently The Dallas hospital with the outbreak used a pneumatic tube delivery system like the one linked below for ( hot ) specimen samples for several days a couple weeks ago. Seems like decontamination of one of these might be difficult ?  Went back on this page to April 2 for the first posting of Ebola , 83 victims

One thing bugging me personally is food handling and preparation. For example, how long could viable virus survive in frozen or chilled meat - slaughtered and packaged on industrial scale in (for example) a facility in Thailand and imported by the container load into the the UK (for example)?

Or for a more nationally worrying scenario to most here - if an illegal Mexican field worker falls ill, and contaminates lettuces being picked for national distribution - how long will viable virus survive, given the constant refrigeration? (and most people don't cook lettuce, right?)

There are, I think, so many practises in the western nations that they just don't have in Africa in the same way - so many alternative opportunities for the virus, that it's really dangerous to assume we're better placed.

Furthermore, there is this assumption of worse hygiene in Africa. This may be founded in truth to some extent in some countries (I mean, their burial traditions are a real problem specific to them), but I think if we assume they don't have - and use - things like soap, we're kidding ourselves. Look at the pictures - of even corpses lying in the street that died from Ebola - the clothes they are wearing have been laundered recently and do not suggest catastrophically poor conditions to me. Even if they washed them by hand - they still have hygiene, and, er, lots of people in affluent nations don't have a particularly high standard of it either I would suggest.

How many affluent nation inhabitants don't wash their hands after using the toilet? Eat food from the floor? Share germs with pets? Etc.

[Laurent]

That must be a nightmare to work in these suits...and the quantity of rubbish thrown away...
http://www.bbc.com/news/world-us-canada-29628834

[Laurent]

Head of Cuba's Ebola Effort Expects More Aid Soon
http://abcnews.go.com/International/wireStory/head-cubas-ebola-effort-expects-aid-26284142

[Laurent]

How many Ebola cases are there really?
http://news.sciencemag.org/health/2014/10/how-many-ebola-cases-are-there-really

[icefest]

If this is the case, the main threat is to the countries along the way, since anyone who was infected would likely be dead or too sick to travel further before they got all the way to South Africa.

Maybe the main threat is, but you still couldn't be sure someone couldn't export the disease that way - overland - even with slower modes of transport. I thought about it with respect to boats, if one was 21 days travel time from anyone, wouldn't it pretty much guarantee you isolation - but no, not if a group is travelling, and they don't all fall sick at once. Worst case someone is just infected at the start - takes three weeks to become symptomatic. Then the second group member becomes infected within say a week - so far they've had a month... repeat as many times as you care to speculate upon.

That said I expect movement of the virus overland to mostly be to nearer places, though as the case load climbs, one can expect the more statistically improbably scenarios to become probable (albeit rarer) ones.

Well wili and ccg, it seems your both right!
http://www.theage.com.au/world/fears-hundreds-exposed-to-ebola-after-girl-in-mali-dies-20141026-11bx19.html

[ccgwebmaster]

Well wili and ccg, it seems your both right!
http://www.theage.com.au/world/fears-hundreds-exposed-to-ebola-after-girl-in-mali-dies-20141026-11bx19.html

I'm really watching the whole Ebola thing personally. Having seen the CDC reported caseload fluidly climb from 5k-10k, and knowing they are assuming underreporting of 2.5x (and could easily be worsening as infrastructure degrades in the affected regions), it seems fairly unlikely to me that the international response is going to be sufficient.

Bearing in mind predictions at the worst case end are 1 million+ infected in just two of the three countries that are at the centre of the outbreak for early next year (vs perhaps 25,000 total to date), and I'm reading that someone thinks they will have 1 million doses of vaccine by the end of next year...

I'm also noting irrational fear driven responses in the US with respect to quarantines for returning health care providers. While I think it still cannot be assumed that the disease will become entrenched into more affluent nations I find that interesting in the context of the irrational fear responses that really enabled the disease to become embedded so deeply in the African nations worst affected. It seems public understanding of the disease is not really so much better in the affluent nations - another poor indicator for their ultimate scope to deal smoothly with a sufficiently large situation in Africa (even presuming no massive spread further).

If the fire isn't dying down soon, I think this will be big next year and possibly beyond (and by big I mean the death toll is at least going to register on the same scale as other key killers in Africa - HIV, malaria, etc).

Just my tuppence (two cents) reading of the numbers and social dynamics that seem to be at work.

There could also be interesting medium term implications for geopolitical stability in affected regions (by "interesting", I mean "potentially unhelpful"). It isn't as though there isn't already enough of that going around...

[icefest]

There's a huge amount of irrationality here in Australia.

A bit more news about the bus-girl, she was probable infective during at least part of her bus ride. In 10 days there will be a decent size oubreak in Mali.
http://www.theguardian.com/global-development/2014/oct/28/mali-rushes-contain-ebola-first-case

Have you seen the latest jump in the number infected? It's incredible. 3.5% daily growth, the fastest in at least two months.

[ccgwebmaster]

There's a huge amount of irrationality here in Australia.

A bit more news about the bus-girl, she was probable infective during at least part of her bus ride. In 10 days there will be a decent size oubreak in Mali.
http://www.theguardian.com/global-development/2014/oct/28/mali-rushes-contain-ebola-first-case

Have you seen the latest jump in the number infected? It's incredible. 3.5% daily growth, the fastest in at least two months.

The Nigerian patient managed to infect a staggering 19 others (though Nigeria also did a phenomenal job of containing that).

Whether or not this is enough to kick off a bigger problem in Mali remains to be seen - they might contain it - this time - but the real case load right now is say around 25,000 using the CDC estimates for reported vs non reported.

Multiple the caseload up to > 1 million early next year potentially, and, well, that's a lot more buses with symptomatic children in... each one of which must successfully be fully and aggressively contained to stop the disease spreading.

This instance will actually be interesting, as it will answer the question of just how serious a symptomatic individual travelling could be (in a crowded bus anyway - if the buses there are anything like the little buses I've ridden in Russia - LOTS of people use them, many people getting on and off all the time, and often very crowded indeed inside).

Expecting efficient contact tracing in this case is probably virtually hopeless - though again - interesting answers will come from this.

An aeroplane would probably be less bad - at least presuming the symptomatic individual did not smear infectious material around the toilet area... in which case all bets are off.

In some ways I think it's worth noting that children are particularly dangerous in that they can (and will) be transported even if severely ill. A severely ill adult on public transport is likely to be self transporting, and thus once ill past a point - likely to no longer continue (though the rate of onset of ebola symptoms still makes that potentially messy).

The response of the western nations is shaping up to guarantee that this crisis explodes and becomes a real problem, so far. Even if they can lock down their borders and contain the imports of disease that will still manage to occur, people forget that the world is globally interconnected. We can't just close down all those links - not without substantial and unforeseen consequences. Once the disease speads into nations from which resources are imported (or even exported), this will become increasingly clear.

[ccgwebmaster]

For those interested, I think the CDC guidelines for what counts as low risk are interesting:

http://www.cdc.gov/vhf/ebola/exposure/risk-factors-when-evaluating-person-for-exposure.html

These low risk transmissions are probably actually the hardest to contact trace or keep track of as they are the most innocuous. The low risk ones I highlight especially as some of the things mentioned there haven't really been informed to people via the media - for example, shaking hands with a person in the early stages of symptoms.

[Bruce Steele]

Man quarantined in Delhi !  I don't know what percentage of "cured Ebola patients" still carry Ebola but I think we need to know . Also if you test negative does that mean negative ?  Gotta be worrying
some epidemiologists.

http://timesofindia.indiatimes.com/india/Man-tests-positive-for-Ebola-in-Delhi-kept-under-isolation/articleshow/45194610.cms

[ccgwebmaster]

Man quarantined in Delhi !  I don't know what percentage of "cured Ebola patients" still carry Ebola but I think we need to know . Also if you test negative does that mean negative ?  Gotta be worrying some epidemiologists.

Negative doesn't mean negative for sure, at least in the earlier stages of symptoms - and I'm not sure one can test properly at all before symptoms are expressed?

http://abcnews.go.com/Health/wireStory/surgeon-ebola-died-nebraska-hospital-26964965

Dr. Martin Salia was in the 13th day of his illness when he reached Omaha on Saturday. It took three days for him to be formally diagnosed after an initial test for Ebola came back negative and then another five days to be flown to the United States.

I think it's worth reiterating that it's already known the disease can survive in the semen (and perhaps other bodily fluids hard for the immune system to reach?) of survivors up to 3 months. It would be entirely possible for a secondary epidemic to be kickstarted by one careless person in the wrong place and time in that context - or theoretically even a cluster of them.

I haven't seen anything yet to suggest people can carry the virus indefinitely, presumably if that's even possible we'll find out in due course. I do think it's fair to assume if it is possible at all it would be a tiny proportion though - and anyoyne able to carry it would probably not be very infectious as the symptoms relate to the process of dying (at which point you won't carry it indefinitely) and it's hard to see how you'd sustain a high viral load without symptoms.

Some viruses are able to go dormant and re-emerge years after initial infection though, I suppose one cannot assume that is zero risk. I think it's a little academic though inasmuch as the natural reservoir of the virus is still out there and infections crop up from time to time anyway? This was just a matter of time really. So is a global pandemic of some sort (not necessarily Ebola, there are plenty of other candidates). As impoverisation and resource depletion bite against rising population (particularly in densely packed infrastructure stressed cities of the sort more and more are living in now) you can expect to see these sorts of events increasing in frequency - I'm not making any statements attributing this outbreak to the collapse process - but I think it's a fair general observation.

The big question this time is whether or not the virus breaks out of the current regions, or can it be contained and burn itself out, albeit on a larger scale than previous outbreaks. Clearly it's possible for it to become pandemic if vigilance is insufficient...

... and clearly the progression of the factors driving collapse will raise the risks of pandemics, at least up to the point that global travel infrastructure is compromised (where the risk won't go away, but potential spread would be slower).

Interesting though it is, Ebola is somewhat of a sideshow I think - and would be even if it went truly pandemic (civilisations have survived high rates of attrition from diseases before, when that factor has acted in relative isolation).

[ccgwebmaster]

... and clearly the progression of the factors driving collapse will raise the risks of pandemics, at least up to the point that global travel infrastructure is compromised (where the risk won't go away, but potential spread would be slower).

And by global travel instructure I mean fossil fuel powered transport in general, not just air travel (though that is a specific factor of interest here).

[ccgwebmaster]

http://timesofindia.indiatimes.com/india/Man-tests-positive-for-Ebola-in-Delhi-kept-under-isolation/articleshow/45194610.cms

I ought to have read the link before posting as it's exactly that scenario - someone testing positive for Ebola in semen - something the US seems to have failed to pick up on (though their whole response has been about as high quality as the national understanding of science these days in that country would suggest arguably).

Statistically it is perfectly possible there are others, and handling them is a complex issue as you cannot realistically test all travellers for all body fluids, and there is already reasons people wouldn't self declare a prior infection - not to mention theoretical situations where people wouldn't even accept they had prior infection (even when they had - one must consider low probability cases such as mentally ill people, for example).

EDIT: At least we haven't seen a bioterrorist attack using it. I think if that happened, unless it was amateur hour - it would be unmistakeable. Due to the media frenzy around both Ebola and terrorism in general (again in certain western countries), no doubt it would be highly effective as a terrorist weapon (while not necessarily resulting in mass fatalities).

[Bruce Steele]

That line at the airport is gonna get kinda long when after you take off your shoes and belt you get a magazine and a little private room before you can finish the boarding process. 

[ccgwebmaster]

That line at the airport is gonna get kinda long when after you take off your shoes and belt you get a magazine and a little private room before you can finish the boarding process. 

I dunno, the TSA are half way there already - just swap agent genders and ditch the little private room (nobody really needs privacy these days, right?)...

[I feel I ought to note for the benefit of those not familiar with air travel in the US, that the US experience wins all the awards for hostility and inappropriate unpleasantness out of any country I've travelled in - and by a graph axis breaking margin at that. Whole other irrelevant topic though...]

[Bruce Steele]

Damn it Ccg we are a democracy !  As such I demand a choice between the little room or the  TSA hospitality agents advertised in the new "coffee tea or me? " campaign.   

[JimD]

Ebola is certainly scary in some fundamental way, but this article is about something far more likely to result in very large numbers of deaths.  And it is building fast over the last few years.

A deadly epidemic that could have global implications is quietly sweeping India, and among its many victims are tens of thousands of newborns dying because once-miraculous cures no longer work.

These infants are born with bacterial infections that are resistant to most known antibiotics, and more than 58,000 died last year as a result, a recent study found. ...

....“Five years ago, we almost never saw these kinds of infections,” said Dr. Neelam Kler, chairwoman of the department of neonatology at New Delhi’s Sir Ganga Ram Hospital, one of India’s most prestigious private hospitals. “Now, close to 100 percent of the babies referred to us have multidrug resistant infections. It’s scary.”

These babies are part of a disquieting outbreak. A growing chorus of researchers say the evidence is now overwhelming that a significant share of the bacteria present in India — in its water, sewage, animals, soil and even its mothers — are immune to nearly all antibiotics......

http://www.nytimes.com/2014/12/04/world/asia/superbugs-kill-indias-babies-and-pose-an-overseas-threat.html?_r=0


The Third - soon to be 4th - world will eventually get devastated by this effect.  And it will eventually sweep across the world.  Just contemplate for a time the type, scope and scale of the tidal waves of problems rushing towards India.  There is just no probable way for them to impactfully deal with issues related to Climate Change.  So Mother Nature will take up that burden for them.  Thus the tides of civilizational collapse flow onwards.

[Laurent]

In a statement issued Monday, the World Health Organization echoed these findings, warning that Ebola "can persist in [survivors'] semen for at least 70 days" and that some research even "suggests persistence for more than 90 days."

How Long Does the Ebola Virus Survive in Semen?
http://www.motherjones.com/politics/2014/10/how-long-ebola-sperm

The resistance to antibiotic is here in France also...we clearly have a problem...
The reasons are well known, too much antibiotics for humans who do not need them  and more surely for animals who cannot survive in confined spaces without them. We have to stop this insanity in order for futur generations to live. we may invent a few more antibiotics but if we do not change the way we deal with the diseases, theses chidren are doomed. We also need to control our births otherwise bacterias will control them...

[JimD]

The true cost of antimicrobial resistance (AMR) will be 300 million premature deaths and up to $100 trillion (£64 trillion) lost to the global economy by 2050. This scenario is set out in a new report which looks to a future where drug resistance is not tackled between now and 2050.....

http://www.scientificamerican.com/article/antibiotic-resistance-will-kill-300-million-people-by-2050/

[ccgwebmaster]

The Third - soon to be 4th - world will eventually get devastated by this effect.  And it will eventually sweep across the world.  Just contemplate for a time the type, scope and scale of the tidal waves of problems rushing towards India.  There is just no probable way for them to impactfully deal with issues related to Climate Change.  So Mother Nature will take up that burden for them.  Thus the tides of civilizational collapse flow onwards.

But we can at least be cautious optimistic that this will only be a major problem during the period of elevated population density which will come to an end, for two reasons:

1. Transmission of disease in general peaks in overcrowded and stressed populations, destroy the population, disease transmission drops
2. It's possible evolving antibiotic resistance carries a cost to bacteria, and thus removing the antibiotics for some time may in some cases cause the bacteria to return to non resistance

So disease is a big actor during collapse potentially but of much lesser long term concern - though of course surviving populations might be well advised to try to manage and contain it. Even there, it's worth the noting that immune systems of populations evolve resistance in the long run (note the difference in mortality rate to smallpox amongst europeans and the original americans).

[JimD]

This is very interesting.  Still 5-6 years out but still...

Antibiotics: US discovery labelled 'game-changer' for medicine

http://www.bbc.com/news/health-30657486?

Tests on teixobactin showed it was toxic to bacteria, but not mammalian tissues, and could clear a deadly dose of MRSA in tests on mice.

[Laurent]

Hidden Population Structure and Cross-species Transmission of Whipworms (Trichuris sp.) in Humans and Non-human Primates in Uganda
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003256

[Laurent]

Genetics of malaria drug resistance revealed
http://www.bbc.com/news/science-environment-30886419

[Laurent]

White House plans big 2016 budget ask to fight antibiotic resistance
http://news.sciencemag.org/funding/2015/01/white-house-plans-big-2016-budget-ask-fight-antibiotic-resistance

[Laurent]

Ebola outbreak: Virus mutating, scientists warn
http://www.bbc.com/news/health-31019097

[Shared Humanity]

White House plans big 2016 budget ask to fight antibiotic resistance
http://news.sciencemag.org/funding/2015/01/white-house-plans-big-2016-budget-ask-fight-antibiotic-resistance

When I slide into my most cynical moods, (these are happening more frequently) I can't help  but feel that antibiotic resistant pathogens are our last best hope against AGW.

[JimD]

White House plans big 2016 budget ask to fight antibiotic resistance
http://news.sciencemag.org/funding/2015/01/white-house-plans-big-2016-budget-ask-fight-antibiotic-resistance

When I slide into my most cynical moods, (these are happening more frequently) I can't help  but feel that antibiotic resistant pathogens are our last best hope against AGW.

I agree with that.  I think we are far too cowardly to actually act in our own best interests in this situation.  It does seem that our only hope is the intervention of Mother Nature or one of the other Four Horseman.

[AbruptSLR]

The linked article discusses how climate change is helping to spread infectious diseases:

http://phys.org/news/2015-02-infectious-diseases-emerging-climate.html

[Laurent]

Mutant Superbug Has Been Discovered In The U.S.
http://www.huffingtonpost.com/entry/mutant-superbug-us_us_57474a21e4b055bb11719d35?ir=Green&section=us_green&utm_hp_ref=green

A mutant strain of E. coli, resistant to even the toughest antibiotics, has been found in the United States, federal health officials said Thursday.

The bacteria, discovered last month in a 49-year-old Pennsylvania woman with a urinary tract infection, contains a gene known as mcr-1, making it resistant even to colistin, a decades-old antibiotic that has increasingly been used as a treatment of last resort against dangerous superbugs.

The discovery — the first time the strain has been found inside the U.S. — “heralds the emergence of truly pan-drug resistant bacteria,” according to a report released Thursday by Department of Defense researchers. The woman, now recovered, has a military connection, authorities said without elaborating.

[Anne]

In response to that HuffPo article it's worth reading this rebuttal

No, this isn’t the start of the antibiotic apocalypse, just bad reporting

<Snip>Here's the quick take-away

Thursday’s report of a mcr-1-based colistin-resistant bacterial infection in a US patient is concerning, but unsurprising. The plasmid based resistant gene threatens to spread to other bacteria, potentially to ones that are already resistant to last resort drugs, such as CRE. However, the trajectory of mcr-1's emergence and its contribution to drug resistant infection trends is not yet clear. For now, the case serves mostly to highlight the ongoing crisis of rising antibiotic resistance and furthers the need for better stewardship of old antibiotics and development of new ones.

Antimicrobial Agents and Chemotherapy, 2016. DOI: 10.1128/AAC.01103-16

More at the link:
http://arstechnica.com/science/2016/05/everybody-be-cool-a-nightmare-superbug-has-not-heralded-the-apocalypse-yet/

[vox_mundi]

It's Winter. The ice is returning. Its time to curl up by the fire, have a drink, and worry about something else. (More methane and less ice will be there next year)...

This Mock Pandemic Killed 150 Million People. Next Time It Might Not Be a Drill.
https://www.washingtonpost.com/news/to-your-health/wp/2018/05/30/this-mock-pandemic-killed-150-million-people-next-time-it-might-not-be-a-drill/

... This past May, the Johns Hopkins Center for Health Security (CHS) led an exercise involving current and former high-ranking U.S. government officials on how the country would respond to an international outbreak of an engineered pathogen. In this fictional scenario, a terrorist group constructed a virus that was both deadly and highly contagious. More than a year into the made-up pandemic, the worldwide death toll was soaring past 150 million, the Dow Jones had fallen by 90 percent, and there was a mass exodus from cities amid famine and unrest.

... The advisers were asked to give recommendations to a fictional president (who remained offstage). They received briefings and news reports as the exercise progressed. Their consensus advice was repeatedly ignored and overridden by the president for short-term political reasons.

The fictional outbreak kept getting worse.... “We didn’t want to have a Disney ending,” Inglesby said. “We wanted to have a plausible scenario. We did know it would be jarring.”

... The Johns Hopkins pandemic exercise, as some of the audience members noted, took place one week after the top White House official responsible for leading the U.S. response in the event of a deadly pandemic left the administration and the global health security team he oversaw was disbanded under a reorganization by national security adviser John Bolton.

Exercise: http://www.centerforhealthsecurity.org/our-work/events/2018_clade_x_exercise/clade-x-resources

Definitely check out the scenario slides - It gives one pause... http://www.centerforhealthsecurity.org/our-work/events/2018_clade_x_exercise/pdfs/Clade-X-exercise-presentation-slides.pdf

Exercise Video: https://www.youtube.com/watch?v=tqa7NHq73xM&feature=youtu.be&t=2675

RealTime Outbreak Map: http://outbreaks.globalincidentmap.com/

[Ktb]

One of the most interesting reads on the ASIF. Thanks for posting Vox.

Does raise some serious concerns about how we would handle a true global epidemic like Clade X. Recently read The Year of the Flood by Margaret Atwood, very similar concept but the manufactured disease in the book has a much higher virulence and lethality resulting in true collapse.

[Sebastian Jones]

I actually spent 4 hours or so watching the entire thing- something I would not ordinarily do. I suppose that alone is a testament to the value of the series .
I found it to be authentic, so far as I could tell.
It being American, it took a fairly dismissive attitude towards international institutions -this was definitely a feature.
Unfortunately the group failed to grasp the seriousness of the situation and failed to take the kind of action required.
The situation they did not grasp was that the entire system of civilization was probably going to collapse and the action required was not just dealing with the (comparatively) simple situation of the pandemic, but how best to situate the nation- and the world- to best survive the aftermath.
In  this, it is reminiscent of how most countries are addressing (or not) the climate and bio-diversity crises.

[bbr2314]

Reposting from what may have been the wrong thread --

The Ebola outbreak in DRC continues to worsen.

Today's sitrep shows 542 confirmed cases, 96 suspected cases, and 319 deaths.

That is a weekly increase (12/10->12/17) of 44 confirmed cases, 23 suspected cases, and 34 deaths. Or, +67 versus one week prior.

So, we are at approximately 636 total cases and 319 deaths, with a weekly increase of 67 cases and 34 deaths.

11/19: 444 / 217
11/26: 495 / 241 (+51 / 24)
12/03: 516 / 260 (+21 / 19)
12/10: 569 / 285 (+53 / 25)
12/17: 636 / 319 (+67 / 34)

At the same stage of the West African outbreak, the below numbers were occurring -- a weekly increase of +137 cases, and 94 deaths.

6/22: 567 / 350
6/29: 704 / 444

However, there are several major differentials between the current outbreak and the 2014 outbreak.

1) We have an effective vaccine, albeit in limited supplies. Out of an estimated 300,000 total doses, almost 49,000 have now been used.

2) The current outbreak is in a single nation, and seems to be more geographically contained (for now). However, it is also an active war zone with ongoing civil strife that has repeatedly hampered medical efforts.

Considering these two factors, it is apparent that if not for the vaccine, the current outbreak would be easily outpacing 2014's numbers. Unfortunately, even WITH the vaccine, this is now the second largest outbreak on record, the largest in DRC's history, and is spreading within urban areas. The number of new cases and deaths each week, WITH vaccine, are still rising exponentially.

Archived reports:

https://us13.campaign-archive.com/home/?u=89e5755d2cca4840b1af93176&id=aedd23c530

This is a very bad situation. The week-over-week increases in new cases have been sustained for the past month after briefly dropping at the end of November. I would imagine there are higher numbers than what are being reported as well due to the fact that guerilla rebels have actively been attacking Ebola clinics and kidnapping patients (.... not the brightest bunch).

At the current pace of the epidemic, there will be over 1,000 cases by 2/1. And if it accelerates in the next few weeks, that number could be reached by 1/15. I would anticipate Western media fervor over the epidemic to begin ratcheting upwards at that point. By the time we reach 2/1, the vaccine supply will likely be substantially exhausted, with ~150,000 doses remaining

So, buying stock in MERCK is probably a good bet, as they are the only producers of the current vaccine, and there is likely to be substantial media hysteria as the current outbreak seems to be spreading even WITH the substantial containment efforts. And as weekly new case counts potentially surpass 100+ (we are now 2/3 of the way there), the number of contacts / vaccinations will also increase exponentially.

On a final note: I am beginning to suspect Ebola is now behaving much more like an STD than it has traditionally. Rape and pillaging are still the norm in parts of the DRC where the outbreak is spreading wildly, and it would not surprise me if there are infections occurring in the latency period AFTER symptoms have abated for some of those infected with the virus. This is very troubling and potentially allows a much higher r-naught compared to areas where rape and pillaging are not the norm. Beyond the civil strife, perhaps this is the confounding variable influencing the current trajectory of the disease? Because nothing else really makes sense at this point.

Monthly numbers, BTW:

08/17: 103 / 50
09/17: 148 / 66 (+45 / 16) +43%
10/17: 234 / 109 (+86 / 43) +58%
11/17: 432 / 214 (+198 / 115) +84%
12/17: 636 / 319 (+204 / 105) +47%

vs. West Africa 2014

3/29: 103 / 66
4/29: 248 / 157 +140%
5/29: 309 / 204 +24%
6/29: 704 / 444 +127%
7/29: 1323 / 729 +87%
8/29: 3116 / 1607 +136%

It appears we are currently at a "make or break" moment for transmission. We shall see what happens next. It is interesting to note that the monthly numbers in the West African outbreak experienced an up-and-down see-saw from month to month. DRC's outbreak has seen lower overall spread but more consistent growth, which is potentially more alarming in the long-term if containment is not achieved. The West African "see-saw" would also argue that January is probably going to be a very bad month.

Also re: vaccine -- after doing more digging it appears stockpile is now running out rather quickly in the outbreak region.

On 12/5, there were 4,290 doses available. After delivery of 2,160 new doses, the stockpile still decreased to 4,060 doses. This is down from 4,530 doses available as of two weeks ago, and in the past week alone, there have been 4,421 vaccinations.

Week 49 report: http://apps.who.int/iris/bitstream/handle/10665/276677/OEW49-0107122018.pdf

Week 50 report: http://apps.who.int/iris/bitstream/handle/10665/277186/OEW50-0814122018.pdf

[bbr2314]

As of today's SITREP, we are now at 574 confirmed cases and 161 suspect, for a total of:

735 cases / 347 deaths

UP from 617 / 313 as of 12/16

A 7-day increase of +118 cases / 34 deaths

And the hotly-contested "election" in a war zone now riddled with Ebola is happening today.

Happy New Years....