Worst case scenario is off the table, but where are Ebola numbers going?

[Shiloh]

Source: http://www.calgaryherald.com/health...where+Ebola+numbers+going/10399556/story.html

Worst case scenario is off the table, but where are Ebola numbers going?
By Helen Branswell, The Canadian Press November 21, 2014 9:40 AM

TORONTO - The Ebola apocalypse scenario is off the table. But where exactly is this epidemic going?

Unfortunately no one is entirely sure. But those involved in charting the response feel certain that if the world eases up on efforts to quell the outbreak, the scenery won't be pretty when the journey ends.

Then again, it isn't pretty now. The latest counts from the World Health Organization suggest there have been 15,145 reported cases and 5,420 reported deaths. To put that in context, this epidemic has killed more than twice as many people as have been infected in all previous Ebola outbreaks combined.

Official counts are known to be an underestimate, though there is no real way of gauging how much higher true totals would be. The WHO thinks the real tallies may be double the counted cases. The U.S. Centers for Disease Control multiples the known numbers by two-and-a-half to come up with its estimates.

Either method produces a figure that is within the same area code as what the WHO had projected the outbreak count would be in early November ? 21,000 cases. It is clearly not on track for what the CDC had warned might come to pass if more wasn't done to beat back transmission ? between 550,000 and 1.4 million cases by late January.

Both organizations issued those prognostications in late September. And while the WHO was more conservative than the CDC when projecting how long the explosive growth in new cases might last, both agencies share a prediction in mid-November: This epic bout with Ebola is far from over...

 

[GardenSpider]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

Interesting article. The slowing trend seems to be tenuous at best and predicated on tried and true methods of beating back ebola. A question remains in my mind as to the behavior of this disease and whether or not it will slink away only to pop up again later or whether herd immunity might be playing a role in some communities with high rates of exposure. I'm not certain anyone has adequately explained why so many children exposed to dying parents were never infected. One thing does seems likely however after reading this article: ebola is likely to drag on and on at a lower decibel hum for quite a long time in the affected areas. How it hasn't' gotten out into the neighboring countries (Mali could be dodging a bullet like Nigeria) is nothing short of a miracle.

Here is the last part of the article from page 2:
http://www.calgaryherald.com/health...mbers+going/10399556/story.html#__federated=1

snip

"We're not talking about anything like doubling (of cases) in three weeks or four weeks. It would be doubling in many months now. In other words, the whole thing has really slowed down," Dye says.

"But that is not a sign that the thing is under control."

The situation in Liberia, which in September was catastrophic, has improved. The increase in new cases there has slowed substantially, down to about 100 a week from 400 to 500 a week back then. Dye says the reason for the improvement isn't well understood. That for some makes the trend hard to trust, but still, people are grateful for the improvement.

On the other hand, Sierra Leone's situation has gone in the opposite direction, with sharp increases in some parts of the country, including the capital, Freetown. That situation is a source of much concern, and Dye says there's no way to project how long the trend will continue.

"It's possible Freetown could be a major-major disaster, instead of just a major disaster," he warns.

In Guinea, transmission persists, but the incidence — the increase in new cases — is no longer growing.

Dye says the relative stabilization of the situation has been a boost for people in the control program, confirming that while the dynamics of this outbreak are different — involving spread in densely populated urban centres and across porous borders — the virus responds to the control measures traditionally used to stop Ebola outbreaks.

"If the right things are done, district by district by district across the epidemic area, then this epidemic can be beaten," Dye says.

That means no letup in control efforts, he insists. "Even though the numbers may be flattening out in some places overall or even declining in Liberia, the response to that is not to slacken off at the moment."

Meltzer too warns that all it would take would be for people to loosen up on Ebola controls — returning to traditional burial rights, for instance — for transmission rates to explode again.

"At what point do communities say: 'We're tired of government taking away people in body bags. We want to have our traditional funerals again'?" he asks. "We don't know how long these lessons will stay embedded in people."

"Just to paraphrase Winston Churchill, this is definitely the end of the beginning, but it's not the beginning of the end."

 

[gsgs]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

check regions, not countries

the pattern is, that it goes up to a certain level and then down

...

while in the meantime it starts in other,new regions

 

[blacknail]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

This reminds me of the Spring when it was 'emergency over, everyone can go home'. This is not the kind of message that delivers long-term containment. Until there are 0 cases for 42 days we need to mount a sustained effort to eradicate the disease, as arduous as that is.

 

[MedStudent_18]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

The 'worst-case scenario' estimates were always absurd barring 1) a major change in how ebola is transmitted within populations and 2) spread to more populous regions of Africa or Asia.

My concern is how the virus seems to spread like wildfire in an area and then burn itself out before moving to another area.

We've also seen a slowing trend in some countries before, only to have a reintroduction.

Ebola seems to be very dependent on super-spreaders, particularly dead super-spreaders. Meaning that one missed contact could reignite an outbreak.

 

[LaurentQuebec]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

i would have to disagree... ebola is everything but dependent on super-spreaders. it is a very old bug that managed to evolve to be asymptomatic in animals endemic to large portions of Africa and Asia, and perhaps deep in the Amazon, i'm thinking bats and probably some other species.

the only reason we're seeing "outbreaks" is because we dig deeper and deeper into mother earth's garden. for instance, a good deal of outbreaks occured near or at mines deep in the forest, woodcutter camps, hunting parties coming back. it comes and goes like you said, but it's been around way before the "urban humans" appeared and managed to stick around. http://www.buffalo.edu/news/releases/2014/10/041.html . there is probably a link between that and the fact some african populations were said to have a genetic footprint related to ebola, from being exposed over millions of years to sporadic outbreaks.

whether a cluster is missed or not, regarding reigniting an outbreak, it won't change the inevitability that unless the local populations take "ecological" measures to avoid as much as possible the carriers of ebola (i.e. cutting off mangoe trees inside the village), it will pop again.

the worst case scenario is not off the grid sadly. india is the worst case scenario, with 100-200 million people defecating 1855 style and immensly dense megacities. imagine it sparking up in Mumbay, or worse, next door in Bengladesh. also, what comes with ebola's moving into densely populated areas are environnement-based mutations for better means of infection, like going airborne, or moving into urban-dwelling species like rats. asymptomatic ratus ratus... aie

 

[Sharky]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

This reminds me of the Spring when it was 'emergency over, everyone can go home'. This is not the kind of message that delivers long-term containment. Until there are 0 cases for 42 days we need to mount a sustained effort to eradicate the disease, as arduous as that is.

Agree.

I also suspect that the number of cases and deaths are not just under-reported; there's evidence that they are being manipulated -- active government censorship in Liberia is one indication of that. I also think the fact that the depth of Ebola-related reporting dried up so abruptly following the cases in Dallas and New York and the appointment of an "Ebola czar" is suspicious.

The limited field reports we are seeing clearly show that people in the affected countries are changing their behaviors; secret burials, bribes to not show Ebola as the cause of death, actively avoiding treatment clinics, and so on. In a country recently ravaged by civil war, with a serious distrust of government, this shouldn't surprise anyone.

It could be a long time before outsiders have a good understanding of what's really happening.

 

[gsgs]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

this up and down made me wonder, whether it's a real "wave",
like flu-waves, which go down (mainly) because of immunity.
But with ebola we have only a very small proportion of the population
infected, less than 1%. Could there already be enough immunity then ?

Maybe only a small fraction are susceptable.
Maybe only a small fraction spread it efficiently.
Maybe many get low levels of immunity by
asymptomatically contacting low doses,
or contacting dead viruses, or contacting viruses
at bodyparts where they are hardly infected

 

[AlaskaDenise]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

..........My concern is how the virus seems to spread like wildfire in an area and then burn itself out before moving to another area....

Some writers say it does the same thing within various bat colonies - they refer to "waves", as GS mentions. Perhaps its genes are programmed to modify themselves when it senses its in danger of wiping out its prey within easy reach (i.e., one community).

.

 

[gsgs]

Re: Worst case scenario is off the table, but where are Ebola numbers going?

I should have added, that the other explanation, usually given, which makes
some sense, is, that, once there is a certain level of ebola in a region,
then countermeasures are done.

The most prominent of these was the 3-day-curfew in Sierra-Leone.
No effect of this was seen in the cases-chart.

And now, that these regions (Gueckedou,Lofa,Kailahun,Kenema,
(Montserrado,Margibi,Conakry partially) were almost cleared of ebola,
aren't they susceptible again to new introductions and it could start
again ? Didn't happen yet.


Western Sierra Leone should be near that peak, where it starts going down...