Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

[gsgs]

Liberia: Hope - Over 1000 Survive Ebola in Liberia

Oct.16
http://allafrica.com/stories/201410161052.html
decrease in Lofa, Bomi, Margibi, Nimba and Montserrado
Dolo's Town (pop.=25K)was quarantined (~Aug.20) to eradicate Ebola.
WHO coordinator in Margibi said there are no new cases because of
community awareness
-----link to Dolo story added : http://www.thenewdawnliberia.com/in...quarantine-lifted&catid=25:politics&Itemid=59
-----weekly cases in Margibi (pop=200K) Aug.17-Oct.19: 17,134,53,103,137,79,86,???,27,22

Nimba is improving
Montserrado has a drop in new cases.

 

[sharon sanders]

Re: Liberia - Improvement: Over 1000 Survive Ebola

Re: Liberia - Improvement: Over 1000 Survive Ebola

Thanks Gsgs. I am not sure what to believe. Some numbers are hopeless. There are some articles stating some improvements. I think the entire situation is a mess.

Please see:

Officials downplay deaths in Liberia says film-maker

WHO "Stratified data are temporarily unavailable for Liberia."

 

[gsgs]

Re: Liberia - Improvement: Over 1000 Survive Ebola

Re: Liberia - Improvement: Over 1000 Survive Ebola

obviously there is underreporting.
But there was underreporting before ... so does underreporting improve ?
And the situation is still bad, but is it really exponentially increasing ??

I do see a pattern : in regions where it was bad, drastic
countermeasures are being taken and these do have an effect.

otoh it spreads to ever new regions ...

 

[Ray]

Re: Liberia Confusion over Cases

Re: Liberia Confusion over Cases

Much confusion over Liberia numbers.


The WHO reporting of Ebola cases in Liberia (Fig. 1) is showing a rapid decline in the recent weeks from mid September to mid October. The reports do not suggest that this is a success story, rather warning about the limitations of data collection during a period of widespread disease [1]. Still, it is important to note that if the prior rate of growth continued, the number of cases would have more than doubled till the middle of October. Instead, reported cases have decreased dramatically. The number of confirmed cases in particular has declined from a maximum of over 250 in the week ending Sept 7, to approximately 20 in the week ending Oct 12.

From personal communication with WHO Liberia-Monrovia response coordinator Dr. Joa Ja'keno Okech-Ojony, we have learned that this trend may indeed be real. The difference in transmission is attributed to four changes that occurred in mid September that can be responsible for this change:

http://necsi.edu/research/social/pandemics/liberiadecrease.html

 

[sharon sanders]

If things are getting better why is the government of Liberia reporting that they need 84,841 body bags for the next 6 months?

http://www.mohsw.gov.lr/documents/SITRep 148 Oct 10th, 2014.pdf


Their usual death rate is 9.9 per 1000 people on an annual basis. The population size is 4.2 million. So the need for burial boxes, bags etc. is approximately 42k annually.

The stated need for 84,841 body bags for the next 6 months is 169,682 for a year. This is roughly 4 times the average need.


https://www.cia.gov/library/publications/the-world-factbook/fields/2066.html

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=population of liberia


And then this from MSF (hat tip crof for the link):

Ebola Front-Line Doctors at Breaking Point
By Makiko Kitamura and Naomi Kresge Oct 19, 2014 6:42 PM ET 19

At 3:30 a.m. in the world’s biggest Ebola treatment center, Daniel Lucey found the outbreak reduced to its essentials: patients lying on mattresses on the floor and vomiting in the dark, visible only by the wavering flashlight beam of a single volunteer doctor.

“I don’t see a light at the end of the tunnel,” said Lucey, a physician and professor from Georgetown University who is halfway through a five-week tour in Liberia with Medecins Sans Frontieres, the medical charity known in English as Doctors Without Borders. “The epidemic is still getting worse,” he said by phone between shifts.

more...

http://www.bloomberg.com/news/2014-10-19/ebola-front-line-doctors-at-breaking-point.html?

 

[Chris]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

?I don?t see a light at the end of the tunnel,? said Lucey, a physician and professor from Georgetown University who is halfway through a five-week tour in Liberia with Medecins Sans Frontieres, the medical charity known in English as Doctors Without Borders. ?The epidemic is still getting worse,? he said by phone between shifts.[/I]

more...

http://www.bloomberg.com/news/2014-10-19/ebola-front-line-doctors-at-breaking-point.html?

Front Page Africa has the good news stories too, with some qualifications:

http://frontpageafricaonline.com/in...hs-drop-a-lot-of-empty-beds-fewer-pickups-now

So what's the real picture I wonder?

 

[Vibrant62]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

I think Sirleaf may be trying to maintain domestic stability. In her defence, social unrest at this time would be disasterous.

Not reporting numbers to WHO gives her room to say what she likes .... but all these good news stories merely need to be contrasted with the recent appeal speaches she has made to the international community for help.

This was only yesterday

Liberia's Ellen Johnson Sirleaf urges world help on Ebola

 

[Ronan Kelly]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

Excerpts below, but go read the whole piece here; http://news.sciencemag.org/health/2014/10/how-many-ebola-cases-are-there-really

How many Ebola cases are there really?

Martin is a contributing news editor and writer based in Amsterdam

By Martin Enserink 20 October 2014 5:30 am
...
Is there any good news in the recent numbers?

There is. The number of new cases in some areas at the epicenter of the outbreak-- Kenema and Kailahun districts in Sierra Leone and Liberia?s Lofa county--has been dropping, and that?s not a result of underreporting, says Dye. ?It has happened for a sufficiently large number of weeks now that we are confident that it's a real reduction in incidence on the ground, probably related to control measures,? he says. ?Our colleagues working on the ground believe it is too.?

One important factor has been the increase in safe burials, Dye says. (The bodies of Ebola victims are very infections.) People in the affected areas have resisted abandoning traditional burial practices that carry a high risk of infection, but in these three areas, local leaders, supported by WHO and others, have come to advocate a change. If that happens elsewhere, says Dye, ?we expect to be able to cut out a substantial amount of infection in the community.?

http://news.sciencemag.org/health/2014/10/how-many-ebola-cases-are-there-really

 

[gsgs]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

Kailahun,Kenema,Lofa are quite clear

but the main thing is Montserrado County (Monrovia)

or in Sierra Leone : "Western Area"

--------------------------------------------------

Enserink: They clearly show that the number of cases has roughly doubled every 3 to 4 weeks
and that this trend is continuing

[I think it's not continuing]
-----------------------------------------------------

---------edit--------------
Liberia just uploaded updates, increasing again

 

[JJackson]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

I think we are seeing the inevitable pattern caused by a contact transmission disease. It is analogous to a fire throwing out sparks seeding new fires rather than a rolling fog spreading more evenly as you would get from an airborne or droplet disease.

In areas where the disease burden is not so great patient confidence in treatment centers is higher and the higher HCW to patient ratio allows for effective contact tracing and containment. For those areas near the tri-country boarder they have had more time to adapt and a greater disease burden engendering more fear. This has aided in communication of risk factors and adaption of contact behaviour and burial practices.

In dense urban environments the picture is likely to be different. Contact tracing is a nightmare and the numbers of patients outside the system form a ready pool of new cases throwing out showers of fresh sparks. The traditional isolate/trace method works it is just being overwhelmed by numbers. IMO we are only in the early stage of this outbreak and no where near the point where we will see a significant change in doubling time. For this we need sufficient boots on the ground to -
1] Improve messaging and stop high risk activities, like contact with corpses.
2] Provide basic PPE and advice to those caring for EVD patients for whom their are no ETC places.
3] Stamp out small clusters - as in Nigeria, Senegal and, hopefully, Dallas & Madrid.
4] Then begin to attack the root of the problem in the areas where control has been lost.

The first two are absolutely critical with out them the rapid doubling time will continue to absorb all the new capacity being added rendering it ineffective in slowing growth.

Each new area infected will have to develop its own level of fear to the point where changes in traditional ways of interacting are adapted.

While viewing the situation from a far it is sometimes difficult to remember that most of the country is unaffected. That may seem a strange statement when you look at a Roadmap update map and see almost every county showing cases within the last 21 days but the reality is if you drive to most of these counties there are 10s of cases in and around one or two towns or villages everywhere else has nothing. With a combined population of a little over 20 million the three MRU States would need to have 200,000 cases for 1% of the population to be affected. Disease burden is much more granular that we are used to with other infectious diseases.

 

[Pathfinder]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

Ebola Doctors at Breaking Point: 'This Constant Feeling That the Boat's Sinking'

By Makiko Kitamura and Naomi Kresge Oct 20, 2014 12:23 PM CT

At 3:30 a.m. in the world?s biggest Ebola treatment center, Daniel Lucey found the outbreak reduced to its essentials: patients lying on mattresses on the floor and vomiting in the dark, visible only by the wavering flashlight beam of a single volunteer doctor.

?I don?t see a light at the end of the tunnel,? said Lucey, a physician and professor from Georgetown University who is halfway through a five-week tour in Liberia with Medecins Sans Frontieres, the medical charity known in English as Doctors Without Borders. ?The epidemic is still getting worse,? he said by phone between shifts.
...
?They are at the breaking point,? said Vinh-Kim Nguyen, a professor at the School of Public Health at the University of Montreal who has volunteered for a West African tour with MSF in a few weeks. MSF has already seen 21 workers infected and 12 people die, and ?there?s a sense that there?s a major wave of infections that?s about to wash everything away,? Nguyen said.
...
http://www.bloomberg.com/news/2014-10-19/ebola-front-line-doctors-at-breaking-point.html

 

[gsgs]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

http://www.liberianobserver.com/new...-nationwide-ebola-declines-says-dorbor-jallah
> Less Than 400 Ebola Cases Nationwide as Ebola Declines, Says ...
> Liberian Daily Observer‎ - 9 hours ago

> the coming dry season might help
contagiontracker.com

it could be however that people are more and more reluctant to go into the centers
with bad conditions and strikes


this comes just at a time when the most recent numbers
are going up again - still not as bad as in mid-Sept., though


---------------------------------------------------
Liberia: Margibi Health Workers Threaten Strike Action Monday, If...
AllAfrica.com‎ - Oct 12, 2014

Liberian Elections Commission to Unveil Midterm Candidates
AllAfrica.com‎ - 18 hours ago

http://allafrica.com/stories/201410202741.html
Ebola Deaths Drop? A Lot of Empty Beds, Fewer Pickups Now
AllAfrica.com‎ - 18 hours ago

-----------------------------------------

why are the numbers going down in Margibi now ? nothing in the news,
while all the measures, quarantine etc. since Aug.20 didn't help
now since 2 weeks the numbers are lower. immunity ?

 

[BoomerCoop]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

It's hard to know what's really happening on the ground. I would be happy if cases were really decreasing, but we don't really know. In the MSF's latest report they say:

"More and more reports suggest that families are choosing to keep suspect cases at home and are also practicing burials through various means, to circumvent the mandatory cremation policy enacted by the government."

Also, don't know how many stories I've read about patients going into a treatment centre, and that's the last they are seen, especially if the treatment centre is far from home. This may tie into the Liberian government stopping the press from filming/reporting inside treatment centres. If you were Liberian, and saw some of those pictures from inside of treatment centres, you might very well want to keep your loved one at home, instead of them dying alone in a treatment centre.


http://www.msf.org/article/ebola-crisis-update-16th-october-2014

 

[gsgs]

Re: Liberia - Ebola Improvement? - Not According to MSF & Gov Request for More Body Bags

http://allafrica.com/stories/201410211595.html
Ebola Cases Dropping From 10 to 3 Daily
AllAfrica.com‎ - 17 hours ago

Reduction About the Case of Ebola - Good News, But...
AllAfrica.com‎ - 2 hours ago

Liberia reports growing Ebola cases
Shanghai Daily (subscription)‎ - 14 hours ago
Liberia reports growing Ebola cases. Oct 22, ... Sumo named Montserrado,
Bong and Margibi as red flag counties where the virus is concentrated




> daily press briefing at the Information Ministry

[can we get these daily press briefings ?]

Ministry of Information Culture and Tourism regular Ebola press briefing yesterday, Dr. Brown said

http://www.micatliberia.com/
http://www.micatliberia.com/index.php/ebola-update.html


http://webtv.un.org/watch/daily-pre...-bahrein-press-conference-today/3851119918001