Ebola could kill 90,000 in Liberia by year-end

[hawkeye]

Re: Ebola could kill 90,000 in Liberia by year-end

I will hunt for the study. I read it a long time ago. It was conducted on American middle school children. The study showed that children who did not know conjunctive adverbs (i.e. subsequently, however, thereafter) could not understand the concepts they illustrate. Because these words have no synonyms, it was found that people who do not understand them can not access the type of thinking that they produce. Once the middle schoolers were taught these words their abilities to deduce, write papers and think critically went from one of the worst in America to a much higher percentile.

The ability to reason is not innate to human beings. It is an acquired skill and without the correct tools in language people can not unlock even basic reasoning.

I recall reading/seeing something similar. It was really fascinating. I'm trying to recall it as well.

 

[Sharky]

Re: Ebola could kill 90,000 in Liberia by year-end

field reports are only local.
The total numbers describe the whole problem.
And in all the locations.

I was under the impression that WHO, CDC, MSF and Samaritan's Purse were operating more than just locally. I think it was CDC that said their estimate was the numbers were low by a factor of 2.5x. Samaritan's Purse has also described significant under-reporting.

Do we have any facts to support the idea that trend has reversed?

A few facts I'm aware of:

1. The Liberian government has increased press censorship, so the limited visibility we used to have from the outside has now decreased considerably.
2. Reports of hospitals not being as full as they once were.
3. Reports of more people caring for sick people at home or in their community.

All three of these would very likely result in under-reporting -- effectively increasing the previous 2.5x factor, not decreasing it.

And with growing numbers the data becomes more reliable.

Mathematically, growing numbers from the same distorted sources would actually make the data less reliable over time.

Or can there be a conspiracy, everyone systematically
increasing underreporting ...

No conspiracy needed. Under-reporting can happen as a result of systemic and cultural behaviors, with no knowledge or cooperation between the sources.

 

[JJackson]

Re: Ebola could kill 90,000 in Liberia by year-end

I think the 2.5 times undercount is based on the NEJM paper which used the data available up to the 16th of Sept. and is consequently of only historical significance.
The latest road map update gave unadjusted CFRs of 37, 29 & 52% for L, S.L & G respectively. I appreciate that this is raw deaths over cases but it still seems an unreasonable variance if all three are counting the same thing. The disease is the same as is the treatment so something is awry with the numbers.
With that caveat I think gs may be right about Liberia. I still don't trust their numbers but looking at the model (linked to in my last post) the projections for Liberia have been reduced almost every week so the earlier estimates are now nowhere near the more recent forecasts.
Liberia, the fainter lines show the old projects. Each one is anchored on the week for which they were the projection.

Sierra Leone seems to be on an upswing, as does Guinea (35% of the total cases in the last 7 days). The sudden spurts, and then declines, have been a feature of the outbreak and have caused rapid changes in the 4 week rolling Ro in all three countries.
The Graph below has the same settings as the one for Liberia but this one is for Guinea.

Both graphs were generated today at http://cpid.iri.columbia.edu/ebola.html :tiphat:

 

[gsgs]

Re: Ebola could kill 90,000 in Liberia by year-end

what I had read, the press censorship was only about reporting from the hospitals,
interviewing stuff and patients. Not about reporting about the prevalence of cases
in some regions.

> Do we have any facts to support the idea that trend has reversed?

* the daily published numbers from the ministry of health, as collected from
the counties,
* the data from their VHF-database where they collect
all the contacts-checkings. I assume WHO has access to that database
* the reports about admissions and deaths and releases from the treatment centers
* the number of calls, ambulances, disinfection requirements, burials


and again, underreporting by itself does not change the weekly trend, unless the underreporting
changes over time. No evidence for this was presented here.
With election polls we only have a sample of some 1000, still they very reliably
predict the result.

 

[Emily]

Re: Ebola could kill 90,000 in Liberia by year-end

http://www.liberianobserver.com/editorials/all-our-might-liberians-guineans-and-sierra-leoneans-must-fight-who-and-cdc-pessimism

With All Our Might, Liberians, Guineans and Sierra Leoneans Must Fight WHO and CDC Pessimism!
Tue, 10/28/2014 - 23:45 admin

Even as reports from throughout Liberia, including some of the epi-centers of the deadly Ebola virus, say it is rapidly receding, the World Health Organization (WHO) and the Centers for Disease Control are still making alarming and apocalyptic ?predictions? that Ebola will continue to spread by massive proportions well into January 2015.

The question that readily comes to mind is, What are these two global organizations up to? After taking a full six months to respond to this deadly emergency in three West African countries where people were dropping dead in their thousands, WHO is still insisting that Ebola deaths could exceed 20,000...

 

[gsgs]

Re: Ebola could kill 90,000 in Liberia by year-end

This is not a question of "Might". Use data and statistics and logics.
Post your data and analysis and charts to the reports, to the internet blogs and newsgroups
and forums and wikies and webpages.
And to the journals to counter the existing papers.

 

[Emily]

Re: Ebola could kill 90,000 in Liberia by year-end

WHO could lead the way instead of speculating that what looks positive must be negative:

Reporter Jackson said people were very upset that WHO and others were saying the reason the numbers in ETUs were down was that ?infected? people were staying away for fear of Ebola stigma and cremation. He said he found no one in the several communities visited who held that view. Many were upset with the WHO and CDC for giving these alarming predictions.

There is that one county that seems to be having a problem, but nobody in Liberia is covering that up.

 

[JJackson]

Re: Ebola could kill 90,000 in Liberia by year-end

.. underreporting by itself does not change the weekly trend, unless the underreporting changes over time.

Therein lies the rub.
It is the nature of the beast that the contact tracing and monitoring is going to be of those who are in the system. If they are outside the system, either because there was no room at the ETC or they did not present for treatment for any other reason, then they would not be counted or traced. Even when all the beds were full the road map updates were still claiming 80% plus contact tracing (of those within the system).
What is unclear to me is what monitoring is going on to quantify the numbers outside the system. If a radical change in the general population's behaviour occurred which caused a marked drop in transmission in the un-counted part of the population would we have seen it? If the 2.5 undercount estimate was correct 6 weeks ago might it have reduced to near zero without anyone really noticing until the ETCs could not fill their beds? If so then the method of data collection has a big hole in it as only counting those who show up to be counted is never going to provide an adequate picture on which to base containment decisions.

Do any of you know how, and if, the undercount is being tracked and updated?

 

[gsgs]

Re: Ebola could kill 90,000 in Liberia by year-end

they have the 2 systems : county-email-reports and VHF-database for
contact tracing, you can check whether they go somehow parallel.
See report #146

I think, there were teams running from house to house and searching for cases.
Their reports should give an estimate of the amount of underreporting, even if only
a small percentage of households were checked.
Then you have institutions, schools, companies, offices where they take records
of missing employees or pupils.
Then there were people dying in the streets.
I don't know whether they write death-certificates, but they must keep some sort
of tracing for the causes-of-death-statistics ?!




I don't think you can hide the deaths so well. People have contacts, friends, family.

 

[Chris]

Re: Ebola could kill 90,000 in Liberia by year-end

I don't think you can hide the deaths so well. People have contacts, friends, family.

This is exactly right.

I'd like to add that the slope of the epidemiological curves from Columbia/Princeton, Healthintelligence, and Healthmaps as they were presented in mid December all had "improved" conditions too. Liberia's improved results were modelled and Liberia's improved results are, for the most part, do to behavioural changes.
Also, I have thought for a week now that in many parts of Liberia ,sensitization campaigns have succeeded reducing the 2.5 multiplier significantly, perhaps to 0.

For the most part Liberia's people did this.

My evidence for this is the data, such as it is, as well as media sources from the region. Many here, and elsewhere, have suggested a draconian clamping down on Western values of freedom of speech, but as gsgs points out the actual law was targeted. If the disease was really moving to the "no improvement" or "degraded" models, I submit we would be hearing about it. I have some little expertise in this field so I'm confident of my assessment.

But the disease is tricky and seems to flare up, so more studies are needed as well as hyper awareness. Here I believe Lofa County is an example of success and almost immediate failure with a few additional cases after 0 patients (if I recall correctly, please correct me if my numbers are wrong) in treatment centres.

Yeh Liberia is improving, but it might be a pyrrhic victory when next door seems to be getting worse.