There Are Far Higher Public Health Priorities For Africa Than Ebola

[Gemineye]

Forbes
By Henry I. Miller, a physician and molecular biologist...

In a world of limited health-care resources, we need to make hard decisions that will deliver high-impact outcomes for the most people at the least cost. Spending nearly half a billion dollars on curbing Ebola virus infections would be a poor choice.

These sorts of flawed and self-aggrandizing judgments by senior UN bureaucrats are not unusual, validating the observation of the late, great economist Milton Friedman that ?very few people spend other people?s money as carefully as they spend their own...

snip

http://www.forbes.com/sites/henrymi...blic-health-priorities-for-africa-than-ebola/

 

[silylene]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

I disagree.

Ebola currently has a exponential growth rate in three West African countries, with the case count doubling every 27 days (and the case count is probably an underestimate by 2-4x), and a fatality rate of 50-70% (depending on the credibility of the cases being counted).

At this progression rate, if unabated 11 months from now, next August 2015, there will be 8 million cases of Ebola, and also 4+ million fatalities.

Ebola is and will continue to overwhelm medical care facilities for other diseases, injuries, pregnacies. Ebola will overwhelm the economic system leading to breakdowns in food supply, sanitation, employement, schooling.

This 'collateral damage' will cause additional deaths which may be comparable in number to Ebola itself.

This result will depopulate W. Africa. A regional disaster.

And this exponential progression rate, if unabated 17 months from now and able to spread throughout the continent, will infect 50% of the population of Africa. Now we are facing a global disaster, not a regional disaster.


Making hard choices
However bad the existing problems with 600,000 malaria deaths, lack of clean water, lack of adequate sanitation facilities, etc on the African continent (and they are bad, and I agree that $500M would help greatly), these existing problems and deaths still pale in comparison with an Ebola health crisis that could easily kill 5 million people within a year, and 250 million people within 18 months.

 

[Vibrant62]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Welcome Silylene and well said - I completely agree. Unfortunately there is still a deep lack of understanding of the scale and size of the ebola problem, even among some health professionals.

 

[Gemineye]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

I must disagree with silylene. If this outbreak is progressing at an exponential rate, why have there been only 20 or so confirmed or suspected cases in Nigeria? The rate of progression is a function of the country's ability to isolate known cases and quarantine contacts. Also, why is there only a handful of countries that are affected? Why isn?t the Ivory Coast or Mali reporting cases; they share borders with Ebola affected countries? I wouldn't treat the exponential progression rate as a fact until we have more data.

 

[Vibrant62]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

The WHO has identified and discussed the exponential growth rate of ebola in Liberia, Sierra Leone and Guinea, but especially Liberia in this situation report. I would recommend its reading in full.

http://who.int/mediacentre/news/ebola/8-september-2014/en/

However, with regard to the three outbreak countries the concluding paragraph spells out quite clearly the severity of the situation.

As WHO Director-General Dr Margaret Chan told agencies and officials last week in New York City and Washington, DC, development partners need to prepare for an ?exponential increase? in Ebola cases in countries currently experiencing intense virus transmission.

Many thousands of new cases are expected in Liberia over the coming 3 weeks.

WHO and its Director-General will continue to advocate for more Ebola treatment beds in Liberia and elsewhere, and will hold the world accountable for responding to this dire emergency with its unprecedented dimensions of human suffering.

This report also highlights that in these countries, traditional isolation, containment and control measures are not working, but in countries where the outbreaks are more isolated and earlier in the development cycle, they seem to be responding well.

 

[silylene]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Gemineye,


for the sake of argument here.

On the worst case scenario for Africa, I said "if unabated 17 months from now and able to spread throughout the continent". I fully realize Ebola hasn't thankfully shown the ability to spread significantly beyond the three west African countries.

On the other hand, if Ebola does continue an unabated exponential growth within the same three W African countries, these countries do have enough aggregate population (assuming 70% of the population lacks natural immunity) that there could be 8 million cases of ebola 11 months from now (count = 4000 * 2^11). This count does not require that the disease moves beyond the borders of these three countries.

And I said both times, 'unabated'. Of course we will be taking all measures during the next year to abate Ebola. That is what the $500M of funding is supposed to do! With successful abatement, the disease doubling time will increase from its current 27 days to something much longer, as the effective Ro drops, and so there would be fewer doublings of the victim count than 2^11 in the next year. With successful control measure we can keep the disease confined within its current geographic locations, and not spread further into additional countries.

This is why the $500M emergency funding should be used for Ebola abatement, instead of being spent on malaria, general sanitation and general water purification in Africa.

 

[Gemineye]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Thanks for the clarification, silylene. That makes sense to me. Also, I didn't want to give anyone the impression that I agreed with Dr. Miller. He makes some good points and I like to stimulate discussions by posting alternative points of view, e.g. the thread I started: "Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak". Happy posting!

 

[silylene]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Ebola currently has a exponential growth rate in three West African countries, with the case count doubling every 27 days (and the case count is probably an underestimate by 2-4x), and a fatality rate of 50-70% (depending on the credibility of the cases being counted).

At this progression rate, if unabated 11 months from now, next August 2015, there will be 8 million cases of Ebola, and also 4+ million fatalities.

New estimates http://healthmap.org/site/diseaseda...tality-2014-west-african-ebola-outbreak-91014
"The lag-adjusted PFC - about 80-85% - is significantly higher than the unadjusted PFC but is consistent with recent fatality estimates by Médecins Sans Frontières [6]. This finding reiterates the magnitude of this outbreak – not only in terms of scale, but also lethality. In light of this new estimate, a stronger global effort is all the more imperative."

Indeed, this was published today and is discussed in another thread in FluTrackers:

Thursday 11 Sep 2014

The terrifying mathematics of Ebola
...
Given the rate at which the virus is spreading, it says the virus will soon be having an “apocalyptic” impact on the country and its neighbours unless there is a dramatic increase in international assistance.

“It could get very bad indeed,” said Prof John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine. ”And I mean you can’t rule out some sort of nightmare doomsday scenario.”
...
The leading epidemiologist is studying the spread of the virus in Monrovia, where the outbreak is now most intense. He has told Channel 4 News that based on the current rate of spread and lack of power to control it, it has the potential to infect the majority of the population of the country.
...
“The doubling time of this epidemic is about two weeks, so if we are overwhelmed with our resources right now, it’s going to be twice as bad in two weeks’ time.”
...
http://blogs.channel4.com/tom-clarke...ics-ebola/1329

 

[JJackson]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

It is becoming difficult to do any meaningful math with the published numbers now the clinics are full. The confirmed/probable case count numbers are based on lab test/clinical evaluation of patients.

The catch 22 is that new patients do not get tested or evaluated unless a new bed becomes available. Either a patient recovers, dies or some one builds a new facility. If we are not careful we are going to be counting added beds not new EVD cases. The cases will just merge back into the general population and seed more cases ready to mop up treatment capacity as it is bought on-line.

 

[erruve]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

I don't understand.

Let's assume there's no chance of it spreading outside West African nations, but the exponential rate of increase is real and will continue until sometime when it burns out...

Why is it wrong to direct $500 mil towards the effort of saving lives? Should we have ignored the earthquake in Hait? The cyclone in the Phillipines?

What's wrong with people?

 

[Donners]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

It's interesting; there was such a push for more attention to be given to the outbreak for months, and now that it has that attention, some are starting to push back against it.

This article cites a comment referring to Ebola as the Kardashian of viruses:

http://www.theage.com.au/world/is-e...es-that-kill-more-people-20140909-10e5vb.html

 

[newuser]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Forbes
By Henry I. Miller, a physician and molecular biologist...

In a world of limited health-care resources, we need to make hard decisions that will deliver high-impact outcomes for the most people at the least cost. Spending nearly half a billion dollars on curbing Ebola virus infections would be a poor choice.

These sorts of flawed and self-aggrandizing judgments by senior UN bureaucrats are not unusual, validating the observation of the late, great economist Milton Friedman that ?very few people spend other people?s money as carefully as they spend their own...

snip

http://www.forbes.com/sites/henrymi...blic-health-priorities-for-africa-than-ebola/

I think the fact that the health system has been completely overwhelmed by Ebola spells out the truth of its impact. There will be no care for Malaria or other more common/widespread, but not as deadly, diseases until Ebola is under control. And they need huge amounts of money to get there, partly because of how nonchalantly the international community has been treating this until recently (in large part because of arguments like the author's.)

 

[silylene]

Re: There Are Far Higher Public Health Priorities For Africa Than Ebola

Comparing the statistics of the toll of malaria deaths to the toll of ebola deaths, ebola is currently killing 4x times as many W. Africans as Malaria per month, and that ratio is increasing.

Link to analysis, Greg laden's Blog

Then we have the August-only monthly number of deaths. Here we dee that Ebola is huge compared to Malaria. So, back when people were saying ?Malaria is worse,? in late July and early August, Ebola was starting to prove them wrong.

The last two numbers are calculated for all three countries combined. Here we are going out on a limb, and it is better statistically to crawl out on a thicker limb than a thinner limb. I made some estimates here, and those numbers conform to what is being talked about by WHO and others. If Ebola continues to spread at its current rate the daily number of new cases could be between 150 and 300 by the beginning of January. I state these as low vs high estimates, but actually, they are both conservative. Multiplying this by 30 days in a month, and dividing by 2 to approximate the ca 50% mortality rate, we have conservative numbers for Ebola that leave Malaria in the dust. Even if the doubling of estimated Malaria death rates should be doubled again, Ebola will be a bigger factor than Malaria.