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UN: After Dec there is no plan

R

Ray

Well-known member
“We either stop Ebola now, or we face an entirely unprecedented situation for which we do not have a plan.” -Anthony Banbury UN

UN & WHO 70-70-60 plan

70% safely buried. 70% isolated in treatment facilities. Within 60 days. (By Dec)

On the first number. UN says they have 50 burial teams. They need 500.

On the second 70 in the plan (please correct if math wrong):

CDC Ebola numbers use multiplier of 2.5 (due to underreporting) on official WHO figures (UNMEER says cases will go to 10K this wk thx Liz) so that what I'm going to use.
Assuming cases double every 30 days (although I've seen estimates of 10-21)

Mid-Oct
25K infected now.
70% of 25K = 17K.
Total beds available: 1100 beds.
Needed beds: 17,000.

Mid-Nov:
50K infected.
70% of 50K = 35K.
Staffed beds available: 1,100.
Staffed beds needed: 33,900.

Mid-Dec (end of UN plan)
70% of 100K = 70K.
Staffed beds available: 2,800 (US 1700 staffed beds become avail)
Staffed beds needed 67,200.

UN Statement
http://www.nytimes.com/2014/10/15/w...demic-who-west-africa.html?smid=tw-share&_r=0

WHO/UN Plan
Plan: http://online.wsj.com/articles/up-t...ses-could-occur-each-week-says-who-1413293490
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Ray said:
?We either stop Ebola now, or we face an entirely unprecedented situation for which we do not have a plan.? -Anthony Banbury UN

UN & WHO 70-70-60 plan

70% safely buried. 70% isolated in treatment facilities. Within 60 days. (By Dec)

On the first number. UN says they have 50 burial teams. They need 500.

On the second 70 in the plan (please correct if math wrong):

CDC Ebola numbers use multiplier of 2.5 (due to underreporting) on official WHO figures so that what I'm going to use.
Assuming cases double every 30 days (although I've seen estimates of 10-21)

Mid-Oct
25K infected now.
70% of 25K = 17K.
Total beds available: 1100 beds.
Needed beds: 17,000.

Mid-Nov:
50K infected.
70% of 50K = 35K.
Staffed beds available: 1,100.
Staffed beds needed: 33,900.

Mid-Dec (end of UN plan)
70% of 100K = 70K.
Staffed beds available: 2,800 (US 1700 staffed beds become avail)
Staffed beds needed 67,200.

UN Statement
http://www.nytimes.com/2014/10/15/w...demic-who-west-africa.html?smid=tw-share&_r=0

WHO/UN Plan
Plan: http://online.wsj.com/articles/up-t...ses-could-occur-each-week-says-who-1413293490
Click to expand...
Clearly the reported case number of roughly 8000 is too low. But where are you getting 25,000? That's three times the known number. The most pessimistic estimates I've seen (of actual numbers, not forecasts) weren't more than twice the number of known cases.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

UNMEER rep Dr. Aylwar said yesterday in press conference in Geneva that number of infected would reach 10K this week. CDC uses 2.5 multiplier (specifically based on Sept. calcs. available beds vs. needed beds) 10K x 2.5 = 25K

From today's WHO sit rep: A total of 8997 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been
reported in seven affected countries (Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the
United States of America) up to the end of 12 October. There have been 4493 deaths. http://apps.who.int/iris/bitstream/10665/136508/1/roadmapsitrep15Oct2014.pdf?ua=1

Even using WHO numbers (which they acknowledge are off 2-4 fold) the gaps are huge.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

OK - so we have defined the problem.

What ideas do we have for solutions?
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Vibrant62 said:
OK - so we have defined the problem.

What ideas do we have for solutions?
Click to expand...

To truly work, they should probably neighborhood & community run with the assumption there will be NO outside help.

.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

The numbers in basic math are clear.
The variable is how many of the denominator are now the deceased and/or have been cured.
The cured and deceased numbers need to be removed from the current total infected then percentages deducted.
The actively infected vs. the all inclusive numbers should be used.
Incubation and infectivity periods present significant variability. Unless, you assume that 30 days after infection an Ebola case is either cured or dead, regardless of the different and individual responses.

i.e. (I will use the number 10 because I am not very math savvy) -
10 people become infected
20 people will become infected in 20 days
total is 30 people infected

Of the original 10, five are dead and five are cured.
In 20 days, the number of people actively infected are 20.
Simulate 50% need isolation - then 10 people need to be isolated.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

curiosity said:
The numbers in basic math are clear.

10 people become infected
20 people will become infected in 20 days
total is 30 people infected

Of the original 10, five are dead and five are cured.
In 20 days, the number of people actively infected are 20.
Simulate 50% need isolation - then 10 people need to be isolated.
Click to expand...

CFR at least 70%: Of the original 10, 7 are dead, 3 recovered.
UN says 70% need to be isolated to bring R0 from 2 to 1 which will turn tide.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

The who Oct 15th number for infections in the past 21 days is 2816. If we assume actual infections are 2x greater then 5632 is the number of cases in the past 21 days. 70% of 5632 is 3943 beds needed right now to stem the outbreak.

Does anyone know the current bed counts?
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

I hate to say this, but it may be that Africa is going to undergo what Europe did in the 14th century. This didn't need to happen. We let it happen when we didn't pay attention in March which is when the news first broke internationally. The response from governments around the world was weak and half-hearted.

Our job now is either to stop civilian air travel to these areas, or in some other ways, prevent this from happening in other areas of the world that have similar health problems: India, Mexico City, parts of Latin America, etc. And to keep control of the situation in the first world, because if that comes into danger, we (globally speaking) are in a world of trouble simply because that is where the training and the money and the technology exists to stop it before it finally rolls to a halt by some natural mechanism.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

alforddm said:
The who Oct 15th number for infections in the past 21 days is 2816. If we assume actual infections are 2x greater then 5632 is the number of cases in the past 21 days. 70% of 5632 is 3943 beds needed right now to stem the outbreak.
Click to expand...

The tricky part of this equation is that if we assume that we need 3943 beds today and it takes 3 weeks to build those beds, by then the number will have doubled to be 7886. So if we have 1100 beds now then we need to build (and staff) 6786 in the next 3 weeks.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

The numbers all point to the same conclusion: demand drastically outstrips supply and it is doubtful that will change dramatically. That is why CDC, WHO, USAID are distributing home hygiene kits and starting national education programs on how to use them.

.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

beds.webp
From today's WHO Roadmap update

What ideas do we have for solutions?
Click to expand...
The beds have to go in and we need as many and as fast as we can manage. However we will never be able to install them as fast as Ebola can infect people, that is unrealistic given the head start it has and the speed it is causing new infections.
The beds can only be one part of the strategy for them to become effective the rate of transmission must be slowed so doubling times are more manageable. Not much transmission is occurring in ETCs it is going on between the sick and the un-PPEd family member trying to look after them. If you can get a little training and some very basic PPE to the carers you could significantly reduce the rate of transmission. Then the doubling rate slows and the bed installers can begin to get the beds divided by patients % to at least stabilise.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Any details on when the other beds will become available? The only thing I see in media reports are the 1700 being built in Liberia.
Also, are these planned beds able to be staffed with hcw?
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Ray here we get into murky territory. A number of countries have publicly announced commitments but I have not found any comprehensive list of promises or when they will become functional.
Off the top of my head.
Cuba: ~460 HCW
US: Liberia lead. C&C, comms, Logistics hub, 4000 Military for setup, 7000 beds, labs and an online site for volunteers (unknown number)
UK: Sierra Leone lead. C&C, comms, Logistics hub, Military for setup, 700 beds, lab, NHS volunteers (~120 initially) & RFA Argus.
Russia and China have put in labs. Most of the EU countries seem to be doing something and the EU is giving cash.
And a big thank-you to the French for they gave us MSF who have done the bulk of the work to date.

You can pick up quite a lot of data from this site but you have to dig for it.
https://www.internationalsos.com/ebola/index.cfm?content_id=397&language_id=ENG
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Here is a thought. ETU beds are going to outstrip supply for some while, whilst cases escalate. Home care is becoming essential BUT it risks whole family continued exposure, keeping the R0 above 1. There are also the issues of supply logistics so that families do not have to go out to collect food and water and other essentials - multiple locations in hard to reach territory will make this very, very difficult to keep supply lines open. If isolated families start starving families will flee, fearing forced isolation where they could starve (their perception), and/or they will flee fearing infection if housed in the same building as their infected relatives.

So - an idea...

Disaster relief NGOs have many thousands of tents and ancilliary requirements for the construction of tent cities when a major natural disaster strikes or for constuction of refugee camps.

Each tent is designed to provide housing for a family.

How about mobilising these NGOs to set up small isolation units per 10 villages or to service individuals who cannot get beds in an ETU (treatment Unit) from a population of say 10,000 or 20,000, which in turn can be seperated into 'probable cases'and close contacts for isolation? Probable cases can be isolated in a tent with a designated care giver who is provided with home PPE kits and training, pending a free bed in an ETU and/or after testing. Family members are housed in the isolation area (one tent per family), and seperated from the probable cases. If an individual develops ebola then they are moved to the probable section family tent with the original case. One family caregiver should be able to manage the two cases in terms of providing the basics etc.

It is then one drop point for logistics aid i.e food, water and other supplies, which can be delivered to the 'community' center and collected by caregivers, or families in isolation. Required kit (tents etc) should already be inexistence and would just require transport from the respective charities. The NGOs should already have systems in place for logistics management with a little adaptation, and additional staffing could come from those in isolation provided they pass a fever check, or if that is considered too risky, from the communities themselves. It is also one collection point for medics doing testing, body removal etc. Survivors could be employed here to assist.

Once a family in isolation has passed a 21 day point where NO member of their family has become sick, the entire family can return home to their village or town.

Do we think this could work? Problems?
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Vibrant62 said:
How about mobilising these NGOs to set up small isolation units per 10 villages
Click to expand...

I think that any way we can get Ebola contacts isolated is a great idea. From what I have heard, WHO has very little idea what is going on in rural areas where there are small villages. The bulk of the relief effort is directed at big cities (and their "slums"). Certainly local solutions are the best solutions and a network of tents that are supplied with PPE, chlorine, food, clean water and toilet facilities with someone trained to train each family on how to use their PPE and spray the toilet with chlorine after each use could be part of the solution.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Ray said:
?We either stop Ebola now, or we face an entirely unprecedented situation for which we do not have a plan.? -Anthony Banbury UN
Click to expand...

The plan is to hope that one of the vaccine candidates works.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Another similar alternative would be to designate one house as the quarantine area, moving non-infected or asymptomatic family members to another house. This plan could be implemented immediately.

.
 
Re: UN: After Dec there is no plan.

Re: UN: After Dec there is no plan.

Another similar alternative would be to designate one house as the quarantine area, removing non-infected or asymptomatic family members to a different house. When the outbreak is over, disinfected then burn down the house.

This plan could be implemented immediately.

.
 
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