Today parameter estimates were published in the NEJM [0] that conflict with the model's default settings. The Eichner incubation distribution, and an infectious duration of maybe 11 days are better inputs, in my opinion.
Thanks for the link, interesting to play with and hats off the the CDC for being so open with their modeling tools. (also, what people do in Excel just blows me away)
I played with your suggested settings and while they are indeed alarming, I'm curious why you think they are better suited. They don't seem to fit the historical curve quite as well as the default CDC ones.
>(also, what people do in Excel just blows me away)
Same. I work in Excel pretty much all day and rock at using it as a swiss army knife. But when people use it to build these hectic models then I'm still thoroughly impressed.
Agreed, sending 3000 US personnel to the area is a risky but ultimately a wise move. Some other countries have also sent people (China and the UK IIRC) but in far smaller numbers. I'm very disappointed by the limp EU response - although they've pledged E180m they're only now meeting to coordinate logistics and containment strategies, which seems really irresponsible, notwithstanding the existence of other problems like military conflict in Ukraine and the ME.
exactly. Given that ships regularly cross the mediterranean loaded to the gunwhales with passengers (or overloaded - two ships sank a few days back and about 700 people drowned, sadly), there is a lot of potential for an outbreak to impact Europe. It would probably be containable, but at great expense and would have a terrible impact upon existing immigrant communities regardless of actual infection risk.
Hell, if you listened to some people in the US you'd think the US-Mexican border was one giant hot zone. I shudder to think what would happen if Ebola turned up in France or someplace.
"WHO has stated the reported numbers "vastly underestimate the magnitude of the outbreak", saying there may be 2.5 times as many cases as officially reported. Cases in remote areas may also be missed"
Sadly enough, this is a perfect place to use drones, God help us.
EDIT:
So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what?
> So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what?
You were probably downvoted because a little of column A and a little of column B.
The situation hasn't deteriorated to the point that remote lethal force is the solution. Education and proper containment protocols would solve the problem without the need for indiscriminate murder.
Oh, of that I had no doubt, but I notice that nobody has disagreed with my point: given that lethal force (or the threat thereof) is useful in maintaining quarantine (as suggested by my parent post), use of drones makes sense, because it avoids the contamination issues seen using humans.
There's a lot to be said for proper containment protocols and education, but let's not kid ourselves--the populations in question are already willfully acting against such things, supposing (in many cases) a Western bugaboo.
Regardless, the meta issue here is that a bunch of HNers downvoted something merely because they disagreed with it (which is annoying but hardly the first time it's happened to this account) but also failed to contribute meaningfully to the discussion (which is sad). A lot of fools decry "oh no HN is close-minded" while spouting rubbish, but sometimes the accusation is well-founded.
In our present example, there is an interesting discussion to be had: could the use of drones for quarantine purposes present as the next step down that slippery slope? What sort of precedent might that set? Were it to be wrong, what exactly would make it so?
But, no; instead the users blindly downvote away and click onwards, safely avoiding that heavy burden of exploratory thinking.
Fair enough. From my viewpoint, every such judgement should be taken as an opportunity to argue, to pick apart reasoning and debate. This may be an unfair bar to hold people to, despite all the blustery talk of innovation and disruption. :|
Frankly, and succinctly, I think you got down-voted because you did not use the word quarantine in your original post. It read as if you were proposing to send drones to indiscriminately murder people in the affected areas.
Which takes us to the point of how, exactly, do you think you can enforce a quarantine using drones? Sure, you can blow up everything that moves in a perimeter... but how are you going to pick your targets if civil authorities do not close all roads/ports/air-traffic? And how do you minimize the spread within the city once they have done that? You need boots on the ground to do that effectively!
Drones are the atomic bombs of 21th century. A specific technology with extremely specific military applications that gets transformed by popular imagination into a symbol of limitless power. e.g. Drones have become the ultimate thought stoppers.
Nice paper (linked in the article) but I see one thing that looks like an error. When comparing different start dates for intervention the have 3 curves on a plot. Then for "under reporting" they have another plot which looks like the same 3 curves multiplied by a constant to compensate for the under reporting.
The problem is that the intervention consists of increasing the percent of patients getting treatment from 10 percent to 70 percent. But with under reporting by 2x that would be an actual increase from 5 percent to 35 percent, which would have a much less significant effect on the total number infected - possibly not even ending the epidemic. Perhaps they assume the intervention will include solving the under reporting problem.
Anything that exhibits exponential growth catches people off guard. Just like the exponential growth of CPU speeds that benefited society, a rapidly spreading disease could reshape our world in a relatively short period of time.
If we don't see a large-scale military-invasion-sized response in the next week or so, I don't think they're going to stop it. Western Africa is screwed, along with other any country that lacks the ability to handle the plague or close its borders.
If Ebola sticks with its current mode of transmission, stopping it is straightforward. Isolate patients, find their recent contacts, isolate them. Rinse[1] and repeat. It's easy to track down contacts in the western world: credit cards, post-paid mobile phones, formal employment, etc. It's hard to do so in developing world slums.
The entire developing world might be incapacitated by the Ebola epidemic. The western world, not so much.
The NSA has already shown this to be relatively trivial. Don't think for a second the government wouldn't harness that knowledge in an emergency situation such as an Ebola outbreak within the US.
The NSA is excellent at tracking communication contacts that establish the existence of relationships (notwithstanding the potential of false positives). And this would also work for tracking someone driving around in a car running errands in specific places.
But if someone arrives in a US city unwittingly carrying Ebola and gets on a crowded bus or subway car, that's not so easy to track. Likewise if the person goes to a nightclub or other crowded place. Suppose it's a returning American who attends a baseball or football game - the NSA may well be able to ID almost everyone who attended the event, but trying to screen/isolate tens of thousands of people who might have come in contact with an infected individual wandering around a stadium is easier said than done.
They can track your location via a cell phone that nearly everyone carry's with them at all times.
If an infection does come over, then expect people the laud the NSA's spying because it'll be the thing that makes it possible to identify, target, and quarantine.
That could change in short order - don't you remember the Liberian guy who turned up in Lagos? If he had traveled a few days earlier he would still have been infectious but might not have been identified as such on arrival.
The USA is probably the best place to be. According to the news, Ebola spreads through direct, close contact. My opinion is that people in the US live somewhat isolated lives, which would make it hard for a disease like Ebola to flourish.
No, it doesn't. I know a lot of people that work day-in-day-out on ebola at the CDC. The US (and many countries) are totally equipped to handle ebola and you really don't need special facilities to do it.
We can't stop the seasonal stomach flu because the stakes are low enough that we aren't handing out hand-sanitizer on every street corner and obsessively quarantining every gastroenteritis sufferer and every person with whom they ever interacted.
Stomach flu isn't flu. Stomach flu is a misnomer, referring to gastroenteritis, a symptom of a stomach bug - generally a virus, but not influenza (the flu). It's relevant because the infectious mechanism of stomach bugs is similar to Ebola - the disease spreads by people interacting with sufferers' copious vomit and diarrhea.
The problem with a huge ebola epidemic is that the more people infected, the more of a chance the virus has to mutate.
If the virus becomes airborne, rather than infectious via body fluids, the world has an extremely serious problem on its hands.
You are right, it is a bit sensationalized. The 1.4M-by-Jan projection from the CDC is the highest currently and also seems to be the least official. CDC has stated this as a "worst case" scenario with no intervention. It's hard to find the source material from CDC but it has been parroted since last week. I think it may have been a remark from a CDC scientist but not an official release. It's worth considering other estimates
The CDC report and the article present both worst-case and best-case scenarios for Liberia and Sierra Leone. 1.4M is worst-case (no intervention) and "almost ended" is best-case ("If, by late December 2014, approximately 70% of patients were placed either in ETUs or home or in a community setting such that there is a reduced risk for disease transmission [...] then the epidemic in both countries would almost be ended by January 20, 2015").
People are downvoting you, but your comment seems fair enough to me, since the alternative scenario discussed in the article is that the epidemic could be "almost ended" by the same date. So, could be 1.4 million, could be "almost ended". Certainly seems like a misleading and intentionally sensational headline to me.
IMO, invading some African countries, searching for sick people and enforcing quarantine would be more useful than getting involved in a new war in Syria/Iraq.
That sounds like an excellent plan for containment. Send tens of thousands of troops over to Africa to corral people, bringing them in close contact, then send the troops back to their home countries, nothing could possibly go wrong.
Send tens of thousands of troops over to Africa to corral people,
How now?
You might want to read an article or two about the proposed Liberia mission -- and about what is actually being proposed as a role for the U.S. troops there; and why this proposal has gotten the support of the World Health Organization, among others -- rather than just put out whatever fanciful speculations that might pop into your head.
This is probably posted with good intentions, but invading a country is not the best way to increase confidence in a crumbling healthcare systems and it would create its own set of chaos. For previous well meaning attempts, see "Restore hope".
No, it really wouldn't. Not even a little bit. Why? Because "invading some African countries" would destroy our relationship with other countries, give the usual aggressors an excuse to continue to pursue their own invasions and probably not actually even help anyone. You don't really even have to invade, it's not like these "African countries" would mind a horde of doctors and health care workers to help them out of this horrible situation.
Well, the US is sending 3,000 containment troops to West Africa [1]. Just having access to their special equipment, trained personnel, and other resources will hopefully make a huge difference. Any solution to this will probably come from co-operation and coordination between many governments.
The problem is that the military does not have the kind of medical containment systems on a scale that they need. They just aren't equipped for this type of mission. Battlefield triage and hospitals won't help in this situation.
>> Battlefield triage and hospitals won't help in this situation.
Have you seen the facilities they have over there now? I think battlefield hospitals are a huge step up. Logistics is also a core function of the military, so once a plan is in place they will bring in whatever that plan calls for and get stuff done.
Where the military doesn't work is when politics is involved and the mission is not so clear.
Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation. It could not possibly lead to any kind of resistance or guerilla warfare or additional support for Jihadists and other kinds of extremists around the world.
Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation.
It's not about winning hearts and minds. It's about containment.
Containment IS about hearts and minds. If you have the trust of the people- if they trust that Ebola is real, that healthcare workers are not out to get them, that they can go to a hospital and receive care- then this outbreak might be containable.
Actually you can, you just need to use enough force and nobody is willing to do that. Ebola could become a threat to the point where the healthy start shooting people trying to escape quarantined areas or simply burning them down.
At the most extreme you could just firebomb or nuke the areas infected. That would be excessive force, but it would solve the problem.
It is difficult, if not impossible, to build trust because the population isn't educated, they don't trust the government from before, and there is no infrastructure for wide-spread dissemination of information.
> You can't win with force alone.
You can.
I think that the part of the problem is that they try to take care of the sick, but they don't have resources, the equipment, the personnel, the education... nothing. The sick can walk out (if they can), anybody can walk in, other people try to "liberate" them, etc. It's mess. Compare their conditions with how ebola-infected people are handled in the west (isolation and containment facilities).
What do to instead: just write off the infected, however cruel that may seem, and transfer them to a closed isolation facility, guarded by military. Heck, I don't think that anything else would be feasible even in any western country if suddenly a few thousand people got infected.
Today parameter estimates were published in the NEJM [0] that conflict with the model's default settings. The Eichner incubation distribution, and an infectious duration of maybe 11 days are better inputs, in my opinion.
[0] http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...