So…are the recent posters arguing that what we have here is a fairly benign disease requiring not much more than early electrolytes and hydration?
That it took african countries this many decades to figure that out?
That we don’t need more expert care in africa for the Ebola crisis–just more gatorade?
I wouldn’t call a disease with a 10-20% fatality rate even with the best of care as “fairly benign.”
Indeed. That’s 5-10 times the mortality rate of the Spanish Influenza, one of the worst pandemics in recent history.
Although thankfully, ebola is much less contagious than influenza, with an Ro of 1-2, while “in a totally susceptible population, an infectious case [of Spanish influenza] could have led to 2.4–4.3 and 2.6–10.6 cases in community-based and confined settings, respectively.” (http://ije.oxfordjournals.org/content/36/4/881.full0)
If you’re exposed to a person with ebola, you’re less likely to get it from them than if they had Spanish Influenza, but far, far more likely to die from it.
I wouldn’t call it “benign” but apparently it is much more treatable and survivable with modern 21st Century medical care and facilities than in backwoods Africa.
Africa needs both.
Chief Pendant, you say Ebola is “fairly survivable in capable (Western) hands”? How do you explain Spain’s Ebola experience? 3 cases, 2 deaths, 1 survivor. With a 66% mortality rate doesn’t that place this Western nation’s stats closer to African figures of 50-90% fatalities? I imagine early treatment aside, one has to consider the patient’s ability to fight the virus in the first place. In West Africa Ebola victims ages cover the entire population spectrum from infants to senior citizens. The two Spanish priests were elderly and clearly their bodies couldn’t handle the ravages of the disease as the nurse in Spain who contracted the disease from them could yet all had access to supportive medical assistance early on into their infection cycle. So far the US has been fortunate enough to have relatively young & otherwise healthy adults contract Ebola, save for the lady missionary who was airlifted to Georgia. Imagine how the “capable Western hands” would cope with Ebola if it emerged in the general population where kids, adults & senior citizens could be infected. How well have your “capable Western hands” the less virulent Enterovirus D-68 outbreak in your part of the world this year?
As Ramira & others have pointed out to you Africa is not a country. I’m way over in East Africa where we thankfully remain Ebola free. Western Europe is actually much closer to the affected countries than we are. No we don’t do Gatorade here & I can’t honestly recall the last time I had to swat a fly. That said here in Kenya we are told we are ready to handle any Ebola cases that may slip into our borders. This West African outbreak has been extremely uncharacteristic even for African standards considering it commenced in December last year and hasn’t burned itself out almost a year on. The five countries affected so far are all facing Ebola for the first time. Senegal & Nigeria contained Ebola and according to the WHO are free of EVD. For the first time as far as I know all the capital cities were affected by Ebola which in the past has been confined to remote areas in at least four other countries. The African Union has organized for doctors and healthcare workers to jet into Guinea, Liberia & Sierra Leone to assist in the fight against EVD at the source as it were. Kenya has dispatched 500 medics to the cause. I don’t think Gatorade and fly swatters are on the packing list though.
If you’ve read the book “The Hot Zone” (more likely than not you watched the movie with Dustin Hoffmann) you’d know that Kenya had a couple of the slightly less virulent Marburg hemorrhagic fever cases and contained them at The Nairobi Hospital a couple of decades ago. Given that we’ve had enough of a heads up from West Africa and the most likely place an Ebola case could turn up would be in Nairobi, much like you’ve had in Texas, New York, Georgia, Nebraska (have I missed a state of the union?) I predict we’ll most likely fare as well as you “capable Western hands”, if not better.
Nairobi, KENYA
Did you mean African? Amber Vinson sure looks like a black woman to me.
ETA: This was addressed a few times later in the thread.
Did anyone else notice that three of the American victims have been 33-year-old men? If I fit that demographic, and was doing relief work in Africa, I’d be more than a bit worried.
This however doesn’t explain the impression I have that the coverage for the flu some years ago here and in the USA was much more similar.
Also, do you think that TV channels actually deliberatly create hysteria to increase ratings?
This however doesn’t explain the impression I have that the coverage for the flu some years ago here and in the USA was much more similar.
Also, do you think that TV channels actually deliberatly create hysteria to increase ratings?
ETA : when I think of it, were the previous Ebola epidemics covered by American medias? It could be that “Ebola epidemic” is getting old in Europe, despite this one being more serious than the others.
That would entirely depend on (1) where you’d be based in Africa & (2) the type of relief work you’d be doing. Let’s keep in mind that Westererners living in Africa do a lot more than relief work as there are as many lines of business one can conduct here as well. Africa is a heck of a lot bigger than most people, including Africans, believe because the Mercator global maps we are accustomed to shrink its size down whilst magnifying Europe’s size up.
So far you’ve had about 8 Ebola cases in America of which Duncan the traveller & sole fatality was one. There’s been at least one photographer (the Nebraska case) while the rest have been medics or missionaries (2 dealt with Duncan in Dallas while the rest were airlifted from the hot zone (Guinea, Liberia & Sierra Leone) in West Africa. The medics and missionaries have all been fully aware of the risks involved in assisting the sick & afflicted population. They are like firemen who run to the danger to make a difference as opposed you or I who are gawking from a safe distance thousands of miles away. The photographer willingly took the risk of being in the hot zone so we could get pictures of what was going on there and be better informed. If you’re a General Motors or General Electric Executive in distant Nairobi or Johannesburg, you have little to worry about. So far the countries outside of the hot zone that have been unfortunate enough to have an infected traveller come into their country (Senegal, Nigeria, USA) & those that have knowingly airlifted infected medics/missionaries to their facilities (UK, Spain, Germany, USA) have proved that Ebola can be managed or contained once you know that it’s Ebola you’re dealing with. So why worry at all?
[QUOTE]
I left out a word. I meant “west Africa”.
A few days ago, I was doing some (for want of a better word) post-diving on some of the stories, and that this disease really slugs people is illustrated by what they look like upon discharge from the hospital vs. a couple weeks or months later. Good heavens, Dr. Brantly looked like death warmed over compared to a few days ago, when he introduced Obama at the White House (and was called “Keith”; trust me, he’s been called worse things over the past few months :smack:). I saw him climb out of that ambulance on live TV :eek: and I still can’t believe he did that.
I also found an interview with Dr. Sacra done by a local TV station where he said that yes, he was the sickest he’d ever been in his life, and did have several really miserable days, but he didn’t realize just how ill he really was until he saw his chart, and specifically his blood count: “My platelets were LOOOOOOOOOW! Wow, I really WAS sick.” He also said that the worst thing for him was being isolated, although he understood why it was necessary.
I have not read the Hot Zone, do not watch movies, and do not use popular media as the source for medical information.
I am asking a question: What is the survival rate in capable hands?
I am not interested in where those capable hands might be located, although I note that, to date, african countries have not demonstrated a very reassuring capability.
Re Spain: I do not know the general condition, presumed viral load, and complications of the two individuals who were transferred to Spain. Capable intervention includes early intervention, typically. Perhaps the progression of illness at the time of capable intervention (as with Duncan here in the US) was too advanced.
I have noted that Ebola does not seem to have exacted much of a fatality rate here in the US. For some of those who contracted it here, the course of disease seems relatively trivial. While I am not privy to details, if it were the case that extreme complications had occurred, these individuals would have had much longer and more precarious courses.
Thank you for educating me about africa. I had no idea there was more than one nation there. I did have a general sense that up to and including the recent outbreak, the fatality rate for Ebola has been suggested to be about 50-80+ percent. The US experience does not parallel that, and I have not seen medical explanations advanced that stratify the difference by age group. While it is true the US cases have been younger, I am not aware that Ebola in africa is thought to have a very low fatality rate in similar-aged patients, even if the very old and very young fare worse.
If appropriate hydration is the mainstay of treatment, I am wondering why it took so long to figure this out; over the decades of various african Ebola outbreaks such an approach (a la the one taken with cholera to reduce fatality) has not been the primary emphasis. Rehydration can be undertaken inexpensively, broadly, and with lay health deliverers. Instead, the focus has been on providing much higher levels of hospital care, which is difficult to distribute broadly where poverty and ignorance are so widespread.
There seems to be a fair amount of defensiveness above thread wrt to the approach in africa generally, but none of that helps answer my very specific question:
What is the survival rate of Ebola viral disease in capable hands?
It would appear the answer may be closer to “less than 10%” (but perhaps not, if we have more experience with cases diagnosed de novo w/ early intervention by capable caregivers w/ access to good infrastructure).
Whether that lower (putative) fatality rate will end up being due mostly to rehydration therapy is another question. We’ll probably have to wait until the therapeutic interventions here in the US are analyzed and reported.
I think so, yes. Remember, most of our TV channels are run by people looking to make a profit from advertisers. More viewers means higher advertising rates.
The other influence is that of the “24 hour news cycle”. They just need…stuff…to fill all that time, particularly those channels that literally have “news” on for 24 hours. Even in a global news culture, we don’t get 12 unique news stories per hour for 24 hours. They chose several “big stories” to cover, and report on those over and over and over. Much of that time is not spent on presenting new facts or actual developments, but in speculation, prediction and conversation about the “news”. My guess (not being in the journalism field) is that this is cheaper than, say, sending a reporter to France to tell us what’s going on in your country, and another to Liberia to tell us what’s going on there. Faced with the simultaneous pressures for ratings and filling time, we get a lot of hysteric speculation passing for “news,” while at the same time remaining largely ignorant of a whole lot of what’s going on in the world. (I can’t think of a widely covered news story involving France since the Tour de involving Lance Armstrong. I’m sure a few things have happened there since. 
)
Before this one, ebola was covered, but it was not one of these “leading” stories. It was mentioned somewhere in the newscast, in a short segment, as a story of vague interest that was happening Over There Somewhere. I’m trying to think of a possible American story that might have been similarly covered in France…maybe one of the school shootings we’ve had in the last few years? Did that merit a mention in your newscasts? I can’t imagine it was terribly loud, if so, but I’m guessing at least one reporter did something on it, possibly as a lesson in how crazy those Americans with their guns are. That’s how ebola was covered here in the past: this bad thing was happening to those poor people in Africa, and wasn’t it a shame and wouldn’t it be awful if it came here, and here’s the weather forecast for tomorrow.
Chief Pedant, your question is unanswerable at the moment and will probably never be answerable. To know reasonably precisely what percentage of people with Ebola would survive when given the best medical treatment known would require there to be a substantial number of people with Ebola who made it to a place with the best medical treatment. It doesn’t look like there is ever going to be a substantial number of people with Ebola who make it to the best medical centers. You can’t make an authoritative medical statement if you don’t have a test group that’s large enough that random variation would affect any such statement.
If there is annoyance, it is that you keep making statements like ‘African countries’ and continue to ignore references otherwise, like the Senegalese (100% recovery) and the Nigerian cases (60%) - and I made already the suggestion that for the Nigerian case that it is needed to make a difference between the initial infection round and its fatalities when they did not understand they were facing the Ebola virus, but thought it was another disease, and those who were treated after they had realized what they actually faced. It is my impression from incomplete information that the survival of the 2nd round of the transmission was much better.
It is also necessary to look at the actual localizations of the past outbreaks of the Ebola virus disease, which were entirely all in deep rural areas, mostly in the DRC (which can not be accused of having a health system outside of its major cities even), but also the Uganda.
It is very different, an outbreak in a deep rural area where even getting to a genuine doctor may take days of hard travel over pistes which not more than unprepared dirt (the DRC most particularly), and getting patients to an urban hospital, even if not the best.
Then there is the difference you can make between the case of the Liberia and the Sierre Leone, each of which had all their government systems including hospitals utterly destroyed in almost 2 decades of savage civil wars, and which were never well developed. Guinea Conakry continues to perform better in control, but not good, but they have the problem of the disease reservoires particularly in the Liberia.
These are very significant variations where the variables are very different, so to talk of Africa does not have very much meaning.
But this was already noted and you continue to make no difference between the cases.
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They were quite elderly priests who were transferred late to the Spanish treatment.
See again the above.
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You are starting by ignoring the very key factor of historical disease outbreak occurring in deeply rural areas which have had no effective access to the modern health care, even by lower income country standards. And it can be assumed that these deep rural populations have often high disease loads like the malaria etc., and weak nutrition, so they are even yet more vulnerable. It is not sensible to make naive comparison between age group when the other variables must overwhelm age.
If the reporting is correct, the Nigerians seem to have understood this and responded appropriately once their doctors realized it was Ebola and not another disease.
It is not clear it is not a known understanding.
But here again you continue to collapse Africa in to a small entity and ask questions that only make sense if you are not understanding Africa except as one entity undifferentiated.
West Africa, and these nations in particular, have never had the Ebola virus disease outbreak before and they are many thousands of kilometers away from Central Africa where the outbreaks occured before. It would not be a surprise if in the Guinea Conakry, in the Sierre Leone and the Liberia, medical professionals did not know much about the Ebola.
Nigeria, which is on the other hand, is much closer and has a regular trade with the DRC, and the professionals of the city of Lagos would have good reason to have a better understanding of the Ebola virus disease treatments.
This is a false choice and problem, and again I say you seem not to understand at all the complete absence of support in particularly the two Anglophone countries. The care needed is not all that simple if we are understanding that the persons that you call lay are in fact usually illiterate or of low literacy and not necessarily in the capacity to undertake the high risk care.
That is why both things are needed.
But this is about the worst hit countries.
That is not the same situation for the Nigeria or the Senegal - to understand this you need to stop thinking of one undifferentiated Africa.
I believe it is in finding the data of the Nigerian case as I have said earlier and looking at the outcomes from the 2nd round of infections, when they understood what they were dealing with and were responding. This will show what a moderate capability African hospital setting will achieve with an earlier response.
Since the Senegal case is only one person, it is hard to say this makes a case, as that one person had complete recovery and speedily. I believe the treatment was the same and it was the rehydration.
So your answers need to stop being sought in “Africa” which is not an entity that makes sense for the analysis, but in finding if it is available what the data of the Nigerian case says or maybe the Nigerian and the Senegalese cases together.
Chief Pedant please be serious. You wouldn’t have put the word Western in brackets next to the phrase “capable hands” if you didn’t care where those capable hands were. You claim on another thread that you have years of experience in an Emergency Department, so let me break down for you what I said earlier and what Ramira has repeated again for you yet you choose to ignore it.
Apart from the three hot zone countries which share contiguous borders, if you want to determine what capable hands have achieved so far across the globe then study each separately. Looking at the mortality rates outside of the hot zone, all nations that have had Ebola patients have performed better than the 50-90% fatality rates associated with Ebola in all outbreaks since DRC in 1976 except for Spain, a Western nation. Working off memory the fatality rates look something like this:
UK: 1 case, no deaths or 0%
Germany: 1 case no further information
USA: 8 cases, 1 dead or 12% remains an active Ebola zone!
Spain: 3 cases, 2 deaths or 66%
Senegal: 1 case, 1 cured or 0% declared free of Ebola after 42 days
Nigeria: 20 cases, 8 dead or 40% declared free of Ebola after 42 days so 12 presumed cured
Mali: 1 case, 1 fatality 147 contacts being monitored
Now Spain requires closer scrutiny since it’s…ahem…a Western nation & ought to have “capable hands”. The Spaniards dispatched a jet to pick up the priests who received Western standard medical care all the way to Madrid. Since they were taken ill at the treatment centers they worked at, we can safely assume they had all the electrolytes & hydration, sans Gatorade, prior to their airlift. So Spain, a Western nation is doing rather poorly with a 66% fatality rate when compared with African nations such as Nigeria or Senegal. The 3 other Western nations also airlifted their nationals save for Duncan, the hapless Liberian who traveled to Dallas, & sole fatality on US soil. So it can be argued that even with the very best of Western medicine available, the US not only managed to allow a jet set traveler in with Ebola, but also allowed him to die. In this regard the Dallas experience is closer to the Nigerian one, but has played out better so far (ie, less fatalities beyond patient zero). Also note that all Western countries, save for the US with Duncan, have knowingly imported Ebola patients so they ought to have zero fatalities.
The Nigerian experience shows what that particular country managed to do once they realized they were dealing with Ebola. They activated the Smallpox tracking protocol that already exists and used that to successfully contact trace individuals who came into contact with the first cases beyond Liberian-American Patrick Sawyer, aka patient zero.
To compare the 3 hot zone countries where the outbreak was (1) The first in history for West Africa and (2) in rural areas to previous outbreaks in DRC, South Sudan or Uganda really doesn’t help much.
DRC notoriously has an extremely poor road system so outbreaks there tend to peter out where they start. The only thing one can infer given the spread of the West Africa outbreak is that there is a lot of movement and trade between the 3 countries. Like you advocate for the US no doubt the outbreak here will be analyzed once it burns out. I hope you watch documentaries since National Geograhic’s future take on the West African Ebola outbreak promises to be a nail biter!
So what is the survival rate in capable hands? It depends on the country. But rest assured that those of us who are fortunate enough not to share borders with the hot zone only need to monitor those who jet in properly. Since we have all been forewarned, surely we must all now be “capable”, n’est pas?
I think it must be noted for the Spanish priests I understand not only were they very elderly, they were not promptly moved. I do not think we can think they had good care given where they were.
I make again the point that it seems that the Nigerian case results must not be looked at as one thing, but must be examined for ‘before’ they realized it was the Ebola virus. and After they realized. It appears most of the mortality falls in the initial transmissions.
It is also again necessary to point out the great difference in geography. The Nigerian situation is they are much physically closer, by direct kilometers and by trade connections with the central africans, and the Nigerians trade a great deal with the Congos. They have had reason to pay attention to the Ebola virus more than a Guinea Conaktry which is 5, 6 hours flight from the DRC, almost like going to the USA or Europe.
The note on the DRC and the roads is important, it is the same in the South Sudan. The extremely poor transport infrastructure is a key and it is much worse than almost any other region in Africa.
The case now in the West African countries you also see strong differences from economic and internal governances capacities, so the idea to say there is an African result is nonesense.
It is necessary to understand the great variability between the countries - to keep saying Africa, Africa, Africa is ridiculous. But also within the countries. Nigeria is not in some ways a impoverished country, and the really terrible conditions of the Liberian and Sierre Leonnias are among the worst in infrastructure in all of the West Africa region. It is already clear that Guinea Conakry, among the weakest in terms of the government administration of all the francophone zone, but still much stronger than the two anglophone countries - it never went through a civil war although there was a revolution just recently, is doing better than the other two, and it could be that if the Liberia upland had not been so badly neglected and administered that maybe it would not have turned into the pumping heart of reinfection. This is a great scandal. But it shows lumping all the countries into one category is ignorance, blindness or something sinister.
I note for bobby6killer that he can search on the poster and africa to understand some things.
You can’t draw any conclusions based on low single digit case numbers per country.
Actually you can. I’ll go out on a limb here and predict that low single digit case numbers per country will be the norm for those countries far enough from the hot zone to require an infected person to hop on a jet in order to start a new outbreak in a distant land. At most we’ll see double digit cases as happened in Nigeria. Here’s why. In spite of all the doom and gloom scenarios, which are somewhat understandable given the unprecedented number of cases in the hot zone, Ebola has left the bulk of the African continent relatively intact almost a year on since it emerged in rural Guinea. Within the hot zone itself it’s clear that the disease had ample time to spread virtually unchecked from December 2013 before it was identified. Although I agree with Ramira on most points, I disagree that Nigeria’s experience should be looked at with the view that they didn’t know they were dealing with Ebola. By the time Patrick Sawyer boarded that flight to Lagos it was already very clear that Guinea, Sierra Leone & Liberia were swamped. Someone dropped the ball. Protocols of handling passengers disembarking from direct flights from the HZ should’ve been place. Trusting the authorities in Monrovia to monitor departing passengers was naive on their part. As Reagan once said, trust but verify. That the Nigerians quickly and focused well enough to keep Ebola in check in both Lagos and Port Harcourt where one of the nurses who treated Sawyer had fled to just before a quarantine was placed on the medics who treated him & contact tracing of hundreds of people commenced.
For those countries where infected individuals can’t simply walk across the border, the Senegal (infected by road), Nigeria & US (Duncan does Dallas & Dr Spencer takes a bite out of the Big Apple by plane) scenario will be the norm. Duncan stayed with a Liberian family in Texas and Dr Spencer had contact with his fiance and at least two friends all of who have been monitored. The Dallas family are clear of Ebola and so far Spencer’s friends haven’t come down with the virus. So as we have seen, these can be easily contained. That’s not to say we may not have anymore Duncan’s. We most likely will. It’s entirely possible that Nigeria may be “reinfected” again. But apart from the unfortunate people at the HZ’s epicenter where only time and a few brave medics can battle it out, the rest of us need to be vigilant enough to isolate each case as and when they emerge, whack-a-mole style, without resorting to the extremes that have been adopted by Canada & Australia.
The rest of the story doesn’t support what you’re saying here.
The point is that if out of 3 people 2 die you can’t conclude that the mortality rate is 67%. If it’s 40% you still have a 20% chance that two out of 3 people die and a 6% chance that all three die.
Statistics 101.
The utilization of the basic statistics, as the americans say the statistics 101 is fine for the situations where we have large and robust data sets.
It is not appropriate for any other situations, and reflects if so used, *naiveté *and unsophistication about the data issues outside of the developed markets.
It is true, from small and also from biased sample sizes one can not have strong statistical conclusions.
However, initial qualitative observations that can be rigorous without being statistical are quite valid and usual. It is not possible to make strong, statistically valid conclusions about treatments as the clean and valid data is probably too low.
This does not, however address horrible data problems. The data collection now is not viable except under the controlled circumstances. Already there are reports from MSF that their teams working without the air conditioning can not reliably register any data.
So, do not talk to statistics 101 if one does not know about applied statistics and evaluation in low information environments, please. Even for the private sector this is a significant area of work and research and to talk 101 is naive and useless. The public health sector analysis for lowest income countries has been struggling here and has methods. I am not expert in these