You don’t understand statistical reasoning. To draw a conclusion based on valid statistical arguments, you have to have a reasonably large sample to do your statistics on. You can then say something like "The percentage of people who have Ebola and who will recover from it when treated with the best modern medical care is X%, plus or minus Y%. Y is the margin of error for the percentage X. That means the true percentage is within two standard deviations from X, which means that the true percentage is 95% likely to be within that margin of error.
For instance, we might be able to conclude from a sufficiently large sample that the percentage who will recover is 13%, plus or minus 4%. This means that there is a 95% probability that the true percentage is somewhere between 9% and 17% for any very large, truly random sample. The conclusions in your post have nothing to do with statistical reasoning. You’re just making some random guesses based on what you’ve seen in news stories.
iljitsch, guilty as charged! I’ve always been a Liberal Arts guy & wouldn’t be caught dead in Statistics 101.
Wendell, again you got me! I’m a news junkie. Besides it would be kinda difficult to get Ebola 411 from any other source than news outlets being well over 5,000 miles from the hot zone as the crow flies. Could you kindly calculate for me the probability of the WHO declared Ebola free nations such as Senegal or Nigeria getting a fresh outbreak?
You are correct that the single Senagalese patient survived. It sounds a bit more impressive couched as “100%.”
However my question is not whether or not any given african country is treating Ebola competently.
My question is, “What is the survival of Ebola viral disease in capable hands?”
Is it your contention that the survival is close to 100%?
As to where those capable hands are, feel free to start your own thread. I would not personally prefer to have Ebola in an african country (including Senegal and Nigeria) were I to have the option of a US hospital (and particularly one with robust facilities), but of course that’s a personal preference. But as I mentioned earlier, that’s not my question.
I am impressed that novo cases diagnosed here in the US (and some diagnosed elsewhere) have done well. Duncan was so sick by the time he was diagnosed with Ebola that he probably already had some degree of multi-system shutdown.
But it’s looking (not nearly enough for statistical confidence) that Ebola will turn out to be a nasty but survivable virus in medically capable hands.
I think this is good news all around, both for the inappropriately paranoid of the disease and the inappropriately careless.
It will be interesting to see how soon, and whether, the hoopla around Ebola diminishes. If it’s pretty survivable, it becomes boring pretty fast.
Ramira you can’t win with the pedantic chief. Reading between the lines he’s asked a question when he already has a prejudiced (as in preconceived idea although the other usage fits as well) as to his preferred answer when he talks of “personal preference”. His conclusion is laughable. It reminds me of the true case story of a German Minister (Secretary of department of something or other to the Americans) who visited an African nation on official duty. Shortly after his return to Germany he became unwell so he he went to see his German doctor who no doubt had “capable hands” for treatment. None of the medication he was given fixed his worsening condition so he was eventually admitted in a German hospital with “robust facilities,” bells & whistles, “capable hands”…the works. By the time the German doctors realized that the Minister had malaria his condition was so far gone he eventually died of the disease that would’ve had a $5 fix at an African OTC pharmacy or clinic. Moral of the story, sometimes it takes more than robust facilities to treat a case. Oh, how could I forget, I’m not answering the OP question
question…
You are correct that I do not personally consider african countries as a group to have as capable healthcare as the US and other Western countries.
I would not infer from the fact that a common local diagnosis such as malaria is less likely to be missed that a healthcare system’s ability to deliver complex care is equivalent, but your mileage may vary on that opinion. (WRT that particular example, the clinical misdiagnosis of malaria-type symptoms as malaria has been problematic for african healthcare.)
I note that, in general, the fatality rate from Ebola virus disease over the decades has been presumed to be quite high based on the experience of outbreaks in african countries. For this reason, when the virus got exported to other continents, the hoopla has been quite extraordinary.
I am startled that the fatality rate among the US-treated cases has been so low, but it’s a very small sample.
So I wondering what data or educated opinions there are about the survival rate when Ebola patients are in capable hands.
If all that is required (and I have not seen much actual data supporting this) to drive the fatality rate down is appropriate electrolyte/fluid rehydration, what I would have expected is that caregivers working within african countries would have long since figured that out and reported that as such. Ebola would not then have had such a large fear factor associated with it. “Yes, you can die from it, but not usually, if you get early rehydration and electrolytes.”
I cannot quite figure out if Bobby6killer and Ramira are saying that african healthcare systems are perfectly capable of taking care of Ebola patients, or not. There seems to be a layer of defensiveness about any implication they might not be capable. However the current statistics given the long history of experience with Ebola patients does not seem to bear out a conclusion that african countries with Ebola experience are very cabable at managing it.
On the other hand, perhaps we’ll get enough US-side patients who crump to reverse any early optimism that somehow all you need are more capable hands to drive down fatality rates.
You have again reduced Africa to a single entity, it is not.
I point again to the history of the disease and outbreak in the remotest areas of the countries in central africa with the worst infrastructure. DRC and the Sudan outbreaks it is mostly no chance to achieve such observation. This is 100% different than the Nigerian case.
We do not have a knowledge of the rehydration development (when and how observerd) stating the problem in this fashion is silly as it is making a hidden assertion from ignorance.
It is very clear that we have said that some are some are not. There should be no doubt in this, and again it is nonsensical with the strong differences between countries to talk of african healthcase systems.
The Nigeria could manage well enough to control a small outbreak and after identifiction of the disease, had okay results.
This would not the case in most of the DRC. not one answer.
No there is annoyance with a fallacious framing of the question, which I think we udnerstand is coming from a point of view.
So, given capable anywhere based care, what’s the fatality rate of the current virus type? That’s the question I haven’t seen answered yet, in the midst of all this squabbling. I don’t personally think we have enough data points to really know yet, but I am not an epidemiologist.
Squabbling over which countries are providing “capable care” may be necessary to answer the question, but the squabble isn’t the point. Identifying/defining capable care may be needed in order to exclude the victims who haven’t received it, though.
I think the issue is that in those places that have been worst hit, rehydration and electrolyte therapy have not been practical or easy. “Lay people” can’t administer it if there is no clean water available, and, if “rehydration” includes IV therapy, the supplies simply aren’t there.
Sure, but you know there are private chanels here too. Obviously, increasing ratings is good, but… I would assume that journalists/editors can have some profesionalism and principles and wouldn’t push it so far as deliberatly creating hysteria for ratings.
Yeah. For a very long time, I had no TV at all. And when CNN, followed by other 24h news channels appeared, it seemed fantastic. News all day long. They must cover so many interesting things, and in so much detail! And when I finally had one : total disapointment. The same news over and over and over again. And I had thought I was missing out on something…
Well…previous Ebola epidemics had a significant coverage over here. I remember being worried during the first one I heard about (limited to a rural area and much less victims than this time). Then there was another maybe a decade latter. So, it might be that. The third time around, it doesn’t deserve as much coverage, and people aren’t as much worried, even though the epidemic is much more severe (“Oh! Ebola in Africa? Again? And we’re all going to die horribly if it comes here? Again?”).
In fact, there’s quite a lot of coverage when something big happens in the USA. Like a school shooting, as you say, or a big hurricane, or whatnot. It makes it to the major evening news and it’s covered for days. In fact the difference between the coverage of an event occuring in the USA and the same event occurring elsewhere is ludicrous. The same thing happening at the same time in, say, India will get no coverage on TV, and will be found somewhere in the inside pages of some papers. I will be told in great details, and over several days, that nothing is known about the cause of the plane crash in the US, while the plane crash in India won’t be mentioned at all.
Ramira I totally agree with you on the annoyance. Not to mention the condescending tone when Chief Pedant made reference to “sipping Gatorade & swatting flies.” One could easily counter that with an equally heartless jibe that the nurses who contracted Ebola from Duncan were busy sipping Diet Coke & flipping burgers /steaks to notice they breached their PPE’s.
Back to the point, capability to handle Ebola does have to be done on a country by country basis. On that note Chief Pedant ought to realize the USA realistically has fared no better than Nigeria thanks to the Presby debacle. That 2 nurses could get infected whilst fully geared up is atrocious. To make matters worse, that one of them took off to Cleveland to plan her wedding mirroring the nurse who fled from Lagos to Port Harcourt shows that even first world medicine can be prone to SNAFU. Indeed that Duncan was even sent home in the first place allowing the virus to fester on in his body was an act of negligence from a first world hospital that ought to have done better.
Chief Pedant, you’re right the malaria silver bullet treatment for all cases does happen a lot in many African countries but that’s because it’s quite prevalent in many (not all) regions. For example, Nairobi isn’t in a malaria zone so a competent doctor will always ask whether you’ve been out of the city recently before he starts zeroing in on malaria with the appropriate lab tests.
Now back to Ebola and in a rural setting without a medical lab nearby it’s plausible hot zone patients were treated for malaria thereby allowing the virus to thrive. That said since we now know you’ll probably see a lot more Senegals and a lot less Texas’ in the rest of Africa should Ebola turn up. In Kenya at least, all passengers arriving from the hot zone are followed up for at least 21 days after arrival. Tunisia in North Africa has a similar protocol and even gives them a free cellphone…to track them easier with. I for one would prefer that whatever measures the authorities have put in place here don’t get tested, but if it comes to that we are definitely in a much better place than Texas was when Duncan came calling. If Ebola does come we want to be New York not Texas.
Dr. Brantly and Nancy Writebol had both been ill for 10 to 14 days when they were brought here. I’m still amazed that either of them survived - never mind that Dr. Brantly climbed out of the back of the ambulance and walked into the hospital. I still can’t believe he did that.
This article says that they were both treated at home, where conditions were probably MUCH safer than in the hospital, and that Dr. Brantly would have been put on a ventilator at one point before coming back here - had one been available. She too was moribund at some point.
TL : DR - ZMapp was there in Africa, not because anyone anticipated its use, but because the lab wanted to test its stability in the place where it would be most likely to be used, where conditions would be erratic at best.
And that people present with widely variable symptoms was proven a few weeks ago when Anderson Cooper was interviewing Ms. Writebol. She was describing some very unpleasant symptoms, with one glaring omission, and you could almost see the question mark over Cooper’s head as he asked her, “Did you throw up?” Her response? “No, I never did!” :eek: Afterwards, he sheepishly said, “That’s the first time I’ve ever asked someone in an interview if they had ever vomited.”
:o
BTW, Dr. Brantly was awfully close to being a Patient Zero himself. Yes, he sent his wife and kids away a few days before he got sick, but they had all planned to come back because they were headed back home to visit relatives and attend a wedding, and he was scheduled to join them on furlough a few days later. Imagine what might have happened had he gotten sick on an international flight, or at that wedding, and exposed who knows how many people who weren’t expecting anything like this. It could have been disastrous on so many levels. He said on the “Dateline” special that at first, he wished they were around, but later on, when he found out what was really wrong with him and got very sick, was glad they weren’t, especially his kids, who didn’t need to see Daddy doing some of the things that he was doing before he was sent back.
My point of view is that african countries that have dealt with Ebola are not capable hands. I’m not interested in knowing the survival rate of Ebola in less competent hands.
If you want to advance a particular african country as very capable hands, feel free to do so.
I’m interested in what the survival rate of Ebola is in countries where healthcare is capable. If you think any particular african country has capability equal to the US, just let me know what you think the survival rate of Ebola is there, and why.
In that case your question is moot and can’t be tested in “battle” conditions so to speak. That’s because all the Ebola cases that have already surfaced or may emerge in the West will be (1) controlled imports of known cases, such as the various air uplifts of citizenry who’ve been infected whilst assisting at the hot zone, or (2) the odd traveler or citizen returnee slipping past the thermometer patrols at JFK & the like whilst they are asymptomatic, such as Duncan & Dr Spencer. All these Western type scenarios are not outbreaks but one offs which won’t test whether the medical establishment you work at can handle a combat ambush type outbreak as seen in West Africa. Were the Enterovirus outbreak to morph overnight into Ebola for example that could then answer your question. The likelihood of that occurring is obviously nil. Since you lack whatever fruit bat that happens to be Ebola’s natural host at Yosemite or any of your nature reserves the likelihood of a general outbreak just doesn’t exist. As we have learned from the “compromised” health care at Nigeria or the less than capable hands at Senegal is that even in West Africa the one offs are relatively simple to deal with. If it can be stomped out in Nigeria and Senegal (without even a single Texas style accidental infection case here as we saw with your nurses) then surely your first world medical establishments should expect a stellar performance.
I’m not interested in testing treatment of Ebola in battle conditions. I understand some of the issues in african countries, and you are right that a widespread outbreak in the US is less likely. We don’t rub up against our viral-laden dead and we don’t machete health workers trying to help us.
I’m just not that interested in what the survivability is where healthcare delivery is marginal or the populace is undereducated.
Those seem to be your obsessions, apparently with the idea of defending what has happened in african countries.
I’m just interested in how survivable Ebola is in capable hands.
Thanks for your comments on what has happened in african countries and some options for explaining the grim experience there. Those comments just don’t do anything to address my fairly focused question.
as he asked her, “Did you throw up?” Her response? “No, I never did!” :eek: Afterwards, he sheepishly said, “That’s the first time I’ve ever asked someone in an interview if they had ever vomited.”