Friday, August 8, 2014

Will Ebola Wipe Out the Human Race?

The Triumph of Death, by Pieter Bruegel the Elder, circa 1562

UPDATE: October 17, 2014: Send in the Clowns

Today the World Health Organization announced that the country of Senegal is now free from Ebola.

See related story: What Can We Learn From Senegal?

Meanwhile, the Obama gubmint announced it was appointing a man named Ron Klain to be the new Ebola "Czar."  In other words, Klain will be the go-to guy who will coordinate the nation's Ebola response.  

Klain is the former chief-of-staff for Vice Presidents Al Gore and Joe Biden.  That makes him a long-term Democratic Party operative, with close ties to the White House, and the ability to navigate Capitol Hill and politics in general.

He's not a doctor (he's actually a lawyer), and he's never dealt with command and control style logistics.  He has, however, been to a hospital before.  One time, as a kid, he fell on a rusty nail and had to get a tetanus shot.  Also, he had a bad cold one time and got a prescription for some antibiotics.  So it's not like he's totally unfamiliar with medicine.  

Klain is a little bit portly and he wears glasses.  That's not meant as a criticism of portly, glasses-wearing people, many of whom are dear friends of mine.  

The Obama administration was also considering appointing a 3-star general to the post, a man who is tall and strong, with a white flat-top haircut, steely eyes and perfect vision.  

However, they were concerned that if the Ebola crisis worsened, the general would soon appoint himself "Czar-Czar," or just plain "Czar," and do away with representative government altogether.  The people need a strong hand to guide them in times of danger.    

Anyway, Klain will be an upgrade from Thomas Frieden, director of the CDC, as the public face of the government Ebola response.  The sooner Klain steps into his new role, the sooner we don't have to watch Frieden's mindless pronouncements on TV anymore.  

Ron Klain, the new Ebola Czar

UPDATE: October 12, 2014: Ready?  I didn't think so.

“I’m angry about this,” said RoseAnn DeMoro, executive director of National Nurses United, the country’s largest union and professional association of nurses.  “We want the first line of defense to be the most prepared.  Our hospitals are resisting us.  The C.D.C. doesn’t say that we need hazmat suits.  If this doesn’t change dramatically, we will picket every hospital in this country.”

Once again, we're showing 'em how we do it here in the Western World.  You just get in there, son, and get after that Ebola virus.

As you know by now, a nurse at Texas Health Presyterian Hospital in Dallas somehow contracted the Ebola virus from Thomas Eric Duncan before he died.  The first unplanned Ebola patient in the United States passed the disease on to at least one other person.  So thus far, we're batting 1,000%.

What's most fun about this is no one knows how it happened.  No one but Thee Optimist.  Want me to tell you?  Okay, here:

They aren't ready.

It's that simple.  Despite weeks of confident reassurances from the CDC and other government agencies, health care workers in the United States aren't ready to deal with Ebola.  Why would they be?  They haven't been trained for it.  They're busy.  They have other patients to see.  They've never worn head to toe protective suits before. 

The newspapers are calling the incident a "breach of protocol."  It's hardly a breach of protocol when people don't know what the protocol is.  When Duncan first got sick, there were so many breaches of protocol in Dallas that they were thinking of renaming the city Breach of Protocol, Texas.

They turned the man away from the Emergency Room.  The apartment wasn't immediately disinfected, and the family continued to live there.  The ambulance he rode in wasn't disinfected for several days.

So now a health care worker has Ebola.  Is it really a big surprise?

UPDATE: October 8, 2014: Cracks appear in the facade

So Thomas Eric Duncan died today, and that's kind of sad.  I was pulling for him.  It seems clear to me that he knew he had been exposed to Ebola, lied to the guards at the Monrovia airport about his exposure, and took a plane to the United States.

He was probably hoping that if he did get sick, he would receive the best medical care on Earth, something our TV spokesmodels frequently tell us is readily available here in the land of the free.

Instead, he got what can best be described as second-rate care.  What else do you call it when a man from West Africa presents himself at a hospital emergency room with symptoms consistent with the early stages of EBOLA, and is sent home?

I'm sure the personal injury lawyers are circling this case like a school of great white sharks.

In the meantime, the CDC and most public health officials continue to say that the virus is not airborne, cannot be spread by people who are not symptomatic, and that precautions taken at West African airports are enough to catch sick people before they board an airplane to the United States.  

If you've been following this post, I suppose it's obvious that Thee Optimist has been skeptical of these ideas since they were first uttered.  

Turns out he's not the only one.  An article in today's Los Angeles Times relays the thoughts of real-live disease experts, whose opinions are at odds with those of the CDC.

Read it here: Some Ebola experts worry virus may spread more easily than assumed

Here's a sample:

One issue is whether airport screenings of prospective travelers to the U.S. from West Africa can reliably detect those who might have Ebola. [CDC Director Thomas] Frieden has said the CDC protocols used at West African airports can be relied on to prevent more infected passengers from coming to the U.S.

"One hundred percent of the individuals getting on planes are screened for fever before they get on the plane," Frieden said Sept. 30. "And if they have a fever, they are pulled out of the line, assessed for Ebola, and don't fly unless Ebola is ruled out."

Individuals who have flown recently from one or more of the affected countries suggested that travelers could easily subvert the screening procedures — and might have incentive to do so: Compared with the depleted medical resources in the West African countries of Liberia, Sierra Leone and Guinea, the prospect of hospital care in the U.S. may offer an Ebola-exposed person the only chance to survive.

A person could pass body temperature checks performed at the airports by taking ibuprofen or any common analgesic. And prospective passengers have much to fear from identifying themselves as sick, said Kim Beer, a resident of Freetown, the capital of Sierra Leone, who is working to get medical supplies into the country to cope with Ebola.

"It is highly unlikely that someone would acknowledge having a fever, or simply feeling unwell," Beer said via email. "Not only will they probably not get on the flight — they may even be taken to a 'holding facility' where they would have to stay for days until it is confirmed that it is not caused by Ebola. That is just about the last place one would want to go."

UPDATE: October 3, 2014: What's the matter with Dallas?

“This is not Africa. We have a great infrastructure to deal with an outbreak.”  -- Zachary Thompson, Director of Dallas County Health & Human Services.

The people at the CDC must want to pull their own teeth out.

They've been telling us for weeks how if an Ebola case ever made it to the United States, the health care is so good here, the disease would be nailed down, isolated, and utterly eradicated in about a nanosecond.

I guess they didn't imagine it would happen in Dallas.  

When Thomas Eric Duncan, America's newest Ebola poster child, first appeared at Texas Health Presbyterian Hospital in Dallas, he told them he had a fever and was vomiting, and oh, by the way, he'd just come from Liberia.  

So they sent him home.  

They only admitted him when he returned to the hospital in an ambulance two and a half days later, vomiting blood and too sick to walk.  

At first, they said he was only in contact with family members.  Then they changed the story to say he might have been in contact with a handful of people.  Now, the story is he was probably in direct contact with 100 people while he was contagious.  

And the New York Daily News is reporting that his girlfriend and various family members are quarantined in the apartment where he was staying, along with his sweat-stained sheets and the towels he was using.  

Ebola is spread through contact with bodily fluids.  

“We have some hygiene issues that we are addressing in that apartment,” said Dallas County Judge Clay Jenkins, who also serves as director of the county’s Homeland Security and Emergency Management.

Man, it's a beautiful thing to witness when professionals are on point like this. 

Thomas Eric Duncan.  Don't hate.  Someone was bound to bring Ebola here.  It just happened to be him.  That's really a nice shirt.  I don't wear light green well, but he does.  I hope he lives to wear it again.

UPDATE: October 2, 2014: Inspiring Confidence

The man in Dallas with Ebola is a Liberian named Thomas Eric Duncan.  I know these strange African names are hard to pronounce, but give it your best shot. 

Duncan is 42 years old.  On September 15, while still in Liberia, he helped carry a pregnant woman with Ebola, who had been turned away from a local hospital, back to her house.  He probably became infected at that time.

He left for the United States on September 19.  He flew to Brussels, then Washington DC, then Dallas.  On the night of September 25, he presented himself in the emergency room at Texas Health Presbyterian Hospital in Dallas.  

He told them he was from Liberia.  He had a low-grade fever and was vomiting.  He told them he had recently been in Liberia.  Ready?  Here comes the fun part.  

They sent him home.  

"Oh, feeling a little under the weather, huh?  Well, you look okay.  Go on home.  Liberia?  Where's that?  Is it nice?"

Only when he came back in an ambulance, very sick, on September 28 did they admit him to the hospital.  

When Thomas Frieden, Director of the Centers for Disease Control, says in reference to Ebola, "there are core, tried and true public health interventions that stop it," is this the kind of intervention he has in mind?

Or would it have been even better if the hospital had asked Duncan to man the fundraiser Kissing Booth for a few hours before he went home?

"Slip the customers a little tongue from time to time, give 'em a thrill.  They're paying for this."

The public health system is only as strong as its weakest link.  While there are hospitals in this country that are among the best in the world, there are also some very bad, very incompetent ones.  

Which ones do you suppose immigrants from West Africa are likely to turn up at?

Artist's rendering of Thomas Eric Duncan, infected with Ebola and highly contagious, after being sent away from a Dallas hospital.

UPDATE: October 1, 2014

"It's a severe disease, which has a high-case fatality rate, even with the best of care, but there are core, tried and true public health interventions that stop it," said Dr. Thomas Frieden, Director of the US Centers for Disease Control and Prevention (CDC).  "I have no doubt that we'll stop this in its tracks in the U.S."

Well, well, well.  Ebola finally made it to the United States on its own.  Certainly, we've knowingly brought a few of our people back from West Africa, on planes that were designed for isolation.  And in these cases, the victims were brought directly to isolation units at major medical centers.  

But as of Sunday, September 28, an unidentified person, not in isolation, was brought by ambulance to a hospital in Dallas.  That person has Ebola, and has been in the United States since September 20.  Now, the CDC is scrambling to isolate everyone the person may have come in contact with.

Thomas Frieden sounds confident he knows what he's doing.  That's good.  Confidence is good.  

The Ebola victim flew to the United States from Liberia on September 19.  According to Frieden, there's no chance that this person gave anyone on the plane the virus.  

See, because our understanding of the disease is it can't be transmitted when a person has no symptoms, and they wouldn't have let the man on the plane if he had been showing symptoms.  

"There is zero risk of transmission on the flight," Frieden said. "He was checked for fever before getting on the flight."

I like confidence, and I like can-do American optimism.  But I'm a funny guy, and a funny thought occurs to me when I read quotes like this.  The funny thought is:

What if you're wrong?

What if the virus has mutated and can be spread before a person shows symptoms?  Better yet, what if the man was showing symptoms before he got on the plane and paid off the guards to let him on?  That's what I would do.

What if the guy took 20 Aleve tablets before he went to the airport in an effort to reduce his fever?  I would try that, too.  If I was a guy in Liberia with early-stage Ebola, I would do anything, bribe anyone, take any insane concoction, that might get me on a plane to the United States.  

I suspect Thomas Frieden doesn't think about things like that.  He's a very smart man who went to good schools and has been on top his entire life.  He's never been desperate, so he doesn't know what desperate people are capable of.

Frieden is in charge of the outfit that just a month ago thought sending 50 people to West Africa was going to be enough to quell the spread of the disease.  That was wrong.  

That was really, really wrong.  

He was wrong once.  He could be wrong again.  I hope not, but I guess we'll see.
Your life is in this man's hands.  Feel good about that?  Thomas Frieden, an optimist, and Director of the CDC.

UPDATE: September 29, 2014
"There is no argument the disease is out in front of the response," said Ken Isaacs, vice president of programs and government relations for Samaritan's Purse (an organization that has been involved in the Ebola response since the beginning).  "Where we are today is where we should have been 60 to 90 days ago."

Last week, the United States Centers for Disease Control (CDC) abruptly announced that the Ebola virus is spreading exponentially, and if something doesn't change, there will be as many as 1.4 million cases of Ebola by the end of January, 2015.

This is a rather dire prediction, wouldn't you say?  

The CDC is suddenly alarmed because the number of Ebola cases is more than doubling every month.  

Who's in charge over there at the CDC?  I'm just a guy with an oversized laptop, and I brought up this very thing back on August 5th, and again on August 8th.  Indeed, it was nearly seven weeks ago when I first asked the question, "Will Ebola wipe out the human race?"

At that time, the CDC announced they were committed to sending 50 people over to West Africa to handle the epidemic.  Because, you know, no big deal, 50 people ought to do the trick.

What's cool about this is it means I'm smarter than the whole CDC.  What's not cool is if their 1.4 million cases figure is anywhere near accurate, I might need to revise my estimate for when Ebola will, in fact, have wiped out the human race.

The estimate I made back in early August was June 1, 2016.

If that's why you clicked here, for the answer to the question, then yes, the answer is yes.  Ebola is going to wipe out the human race. 

By the way, the US military has finally started landing the first of the 3,000 troops they are sending.  

Liberian health care worker checks the temperature of American troops stepping off an airplane in Monrovia, Liberia.  It's a good idea to check their temperature on the off chance any of the troops are, you know, bringing the Ebola virus with them from the United States.

UPDATE: September 16, 2014

In the five weeks since I made this post, things have happened.  Things always happen.

First, the good news.  Although the virus did break out of Lagos, Nigeria, it hasn't spread abroad, and the Nigerian government has done a good job of clamping down on it in-country.  As of this writing, there are still only 22 reported cases of Ebola in Nigeria.

Now, the bad news.  Overall, the disease's rate of spread has increased.  Since August 1, the overall number of cases has tripled, and the World Health Organization (WHO) believes that Ebola cases are vastly under reported.  

In Liberia, the number of reported cases is up five-fold since August 1.  The real numbers are probably much higher than that.  The medical system has collapsed.  There are no beds available for Ebola patients.  There are precious few beds or doctors available if you have anything besides Ebola.  

The United States announced today it's sending 3,000 troops to West Africa.  Make no mistake: this isn't to save the lives of people who are already sick, but to enforce quarantines.  Better late than never. 

The WHO has estimated that as many as 20,000 people may catch Ebola before the outbreak is over.  This is pulling numbers out of the air by an organization that's been badly behind the curve since Day One.  

There are already at least 5,000 people who have caught Ebola.  At the current rate of spread, there will be about 40,000 by Christmas.  And more than 100,000 sometime in early February.  The spread of the virus has only sped up, in the face of all efforts to stop it (or even slow it down) so far. 

With all this virus replicating going on, the new worry will soon be whether the virus mutates or not.  Viruses are funny like that.  They mutate a lot.  The more they replicate, the more chances they get to mutate.

Ebola currently spreads from contact with bodily fluids.  If it ever becomes airborne, June 1, 2016 will start to look like an optimistic estimate for our date with extinction.

Original Post: August 8, 2014

Leave it to Thee Optimist to ask (and answer) the hard questions.

Before we begin, let's get one thing out of the way: I don't want Ebola to wipe out the human race.  In my opinion, humanity has been responsible for a whole lot of awesomeness, and we're liable to come up with even more awesomeness in the years ahead.  

I mean, have you see the iPhone 5?  Just stupidly awesome, am I right?

The old Mercedes SL-class convertibles?  Awesome.

Lance Armstrong climbing the French Alps like a man possessed by demons, hopped up on EPO?  Crazy awesome.

Thee Optimist = Humanity's #1 fan.

And it's clear that I don't want us to be wiped out.

But let's try a little mind experiment, shall we?  If Ebola were to wipe us out, how and when would it happen?
Skeleton of Black Plague victim unearthed by archeologists in England.

Here's How

Thus far, the Ebola outbreak has largely taken place in three relatively small, Third-World countries in West Africa, namely Guinea, Liberia and Sierra Leone.  

As I described in an earlier post, the outbreak has reached a dangerous phase, especially in two of those countries, Liberia and Sierra Leone.  You probably didn't need me to tell you this.

See Related Article: Zombie Apocalypse Just Weeks Away in West Africa

What's even more dangerous is that in late July, an American citizen named Patrick Sawyer, who was working in some governmental capacity in Liberia, came down with the disease and flew to the airport in Lagos, Nigeria, before collapsing from the symptoms.  

News reports say he was shedding the virus aggressively before he collapsed, coughing up blood, vomiting and having diarrhea.  Sawyer died, as did one medical personnel who cared for him.  Thirteen other people in Nigeria are now confirmed cases.  Sawyer may have been in contact with 70 people or more while he was contagious.

Actually, there's no way of knowing how many people Sawyer interacted with before he died.  There's also no way of knowing where they went.  In all likelihood, some of them have already left Nigeria.  They may have the disease, they may not. 

We do know this:

People in Lagos were exposed to the disease.  

The city of Lagos has 21 million people, which is slightly more people than the countries of Liberia, Sierra Leone and Guinea combined.  Lagos is teeming with people, and much of the city is shantytown slums, with poor or nonexistent sanitation and healthcare.

Because the disease has an incubation period of two to three weeks, there is no way to know whether it is spreading in Lagos.  There is also no way to stop it from getting loose among the population.  It's either loose already, or it isn't.  The horse is out of the barn, so to speak. 

If it turns out the virus is loose in Lagos right now, quietly spreading from person to person, that's going to be a game changer.  There will be no way to quarantine a city that large.  And there will be panic.

Lagos is a major port, a major hub of transportation, and an international city.  If Ebola breaks out, people are going to start heading for the exits, by land, by sea, and by air, carrying the virus with them.  From Lagos, you can go pretty much anywhere, and people will do exactly that.    

Here's When
A couple of days ago, we talked about how the total number of people known to be infected with Ebola has doubled every month since April.  It was probably quietly doubling for a few months before that, but it wasn't really on too many people's radar at that point.  

Let's assume, for a minute, that the 2X rate of growth continues into the future.  That seems like a reasonable assumption at the moment.  Up until now, nothing has put a dent in that rate despite the efforts of the three governments in question, Doctors Without Borders, Samaritan's Purse, and a number of smaller aid organizations.  

In fact, the rate of spread may be quite a bit faster than that in Liberia and Sierra Leone.  And First World governments aren't really doing much to impact it as of this writing.  The U.S. Centers for Disease Control (CDC) are sending 50 people.  They should start arriving in West Africa sometime this month. 

Thanks, guys.

Further, a CDC spokesmodel was quoted in the New York Times today saying that it will be "many months, if not years" before an Ebola vaccine or cure will be available.

With these things in mind, earlier today I did something you will find helpful.  I ran a little spreadsheet that assumes the number of people infected with Ebola continues to double every month going forward.  

Simplistic?  Sure.  No one has ever accused me of being overly-sophisticated in my thinking.  Something is bound to happen that will change that growth rate.  Right?

Right.  And depending on what that thing is, the disease could die out.  Or it could accelerate its spread from 2X to 4X to 8X to 10X.  You don't know what it's going to do, and I don't either.  

So I assumed it will continue as it's been going these past four months.  What did I come up with?

On June 1, 2016, more than 6.7 billion people will have the disease, effectively wiping out the human race.  Just less than two years from now. 

If I were you, I wouldn't worry about catching Ebola, however.  Long before we ever get to that point, most of the systems that keep civilization humming along will have broken down.  

In the event that Ebola makes it out of Africa and spreads around the world, you're more likely to die of things like dehydration, hunger, exposure to the elements, or murder than you are to catch the disease.

Might as well enjoy yourself in the meantime.   

Danse Macabre (the Dance of Death) by Michael Wolgemut, 1493

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