Friday, November 28, 2014

No Rosy Goggles Here



From the UK Telegraph:
 A few months ago I read a blog of an MSF volunteer who found himself shouting over the beautiful jungled canopy of Sierra Leone “Where is everybody”?
Today, four months after the World Health Organization declared an international emergency, I did the same thing.
I had gritted teeth and clenched fists and it came out as more of a squeak than a war cry but still, my fury and incomprehension echoed his.
I always knew I would find it frustrating being unable to provide care as sophisticated as I would like for patients suffering, but this isn’t only about the unavailability of intensive care units and swishy machines that beep.
This isn’t only about watching young people die in a terrible way and being able to offer nothing but time-honored words of comfort in badly accented Krio.     This is about people dying in triage tents with no access to any kind of medical therapy as there are no beds available. 
This is about having to put desperately sick people in ambulances for five hours as that is how long it takes to get to the nearest treatment center with space.
This is about laboratory turn-around times that mean that people negative for the disease sit in beds next to patients with profuse vomiting, diarrhea and bleeding for up to eight days, waiting for their test results.
This is about how the world knew that a nightmarish plague had hit west Africa and the world waited over six months and then sang a song about it.
Of course, I know that many agencies are contributing and working as fast as they can, and that there are some on the ground who have been advocating and campaigning for action for months.
I only arrived a fortnight ago so I can’t imagine how much more furious and frustrated they must be. Perhaps during my time here progress will be made and there will be improvement.
There are many dreadful things about the Ebola epidemic - the suffering, the squalor, and the undercurrent of fear that you could be next. For me at this point, by far the most terrifying is that nothing will change and the status quo of international turpitude will continue.


Takeaways:
The pitifully few "treatment" facilities in Sierra Leone are overwhelmed.
They provide exactly no "treatment".
The labs are slow, overwhelmed, and help to ensure those uninfected on arrival are infected in short order, thus "treatment" = infection.

Given all of that, and the fact that health care workers certainly talk to people too, is it really that surprising that the epidemic continues unabated, while the infected or merely suspected infected stay away in droves from such medieval levels of "medical care"?
This is the kind of medical malpractice that put Florence Nightingale on the map in the Crimea, and the same for Clara Barton in the Civil War.

Of course the "official" numbers most places are dropping.
People in West Arica are illiterate, perhaps even backwards and stupid.
But they aren't all barking mad.

Faced with those prospects, anyone with a lick of common sense, who heard the ominous tones of "We're from the government, and we're here to help" would
RUN LIKE HELL.

Amazing how that lesson crops in in history pretty much universally.

I Guess This Means Liberia Can Cancel Christmas



(Liberian Observer) EBOLAVILLE - Dr. Atai Omurutu, head doctor at the Island Clinic Ebola treatment unit, has raised an alarm over the disturbing incidents of male Ebola survivors infecting their partners and putting entire families at risk.
Dr. Omurutu said wives of male survivors are being admitted to the facility because they have contracted the disease from their partners.
She appealed to the Ministry of Health for condoms to be given to male survivors in order to stop this mode of transmission of the Ebola virus.
She disclosed this new wave of infection to President Ellen Johnson Sirleaf when the President toured Ebola Treatment Units.
Dr. Omurutu, a Ugandan doctor, stated that once a person survives Ebola, they still have the virus in their semen for up to three months, therefore it is extremely important that male survivors abstain from sex during that period or use a condom to avoid infecting their partner.
I'm shocked! Shocked, I say, to find out that Ebola will continue to blossom for months longer in Liberia for the same reason that AIDS is endemic to Africa: lack of basic common sense or scientific reasoning skills among the population.

So much for Liberia's presidential hopes for "A Christmas without Ebola" in 2014.
But Ebola does have one small silver lining: it keeps the stupid people from breeding.
(With the unfortunate side effect of infecting and killing their spouses, and then by extension the rest of the family.)

Happy holidays from another disease that's a gift that just keeps on giving.

Thursday, November 27, 2014

Mali: Ripples Continue Outward



(WHO) - Mali’s Ministry of Health has confirmed an additional 2 new cases of Ebola virus disease. The first, confirmed on 22 November, occurred in the 23-year-old fiancée of the 25-year-old nurse who attended the Grand Imam from Guinea (the index case in this outbreak) and died of Ebola on 11 November.The young woman developed symptoms on 19 November and, on 20 November, was hospitalized in isolation at Bamako’s Ebola treatment centre, a new facility which opened last week.
Because of her association with the nurse, most of her close contacts were already under surveillance. Her case was detected early in the disease course. Her quick isolation has further reduced opportunities for community exposures.
The second new case is part of a family of previously confirmed and deceased patients. The 27-year-old man lost his mother and half-brother to Ebola.
He developed symptoms on 19 November and was admitted for treatment at the new facility on 24 November.

So they're now on tier three of infections, and the second new case was wandering around loose and symptomatic in Bamako for five additional days.

That will work out well.

Operation Dumbass Drop II



(Reuters) BOHICA - Sierra Leone appealed to the United States on Wednesday to send military aid to help it battle Ebola as it falls behind its West African neighbors Guinea and Liberia in the fight against the virus.While the outbreak appears to be coming under control in Liberia, thanks partly to a health operation run by U.S. troops, infection rates have accelerated in Sierra Leone.
The rate of transmission is also beginning to slow in neighboring Guinea, the first country to report an Ebola case, although case numbers are rising in Mali.
"I believe now that the cases are reducing in Liberia, he (President Barack Obama) will ask the Department of Defense and the State Department also to turn attention to helping the efforts in Sierra Leone," said Alpha Kanu, Sierra Leone's minister of information and communication.
He also appealed to the United States to help Guinea, and urged Britain to provide more assistance to Sierra Leone.
Guinea's President Alpha Condé said on Wednesday he is ready to authorize the use of force if necessary if anyone refuses to let doctors check Ebola suspects for signs of the disease.
"We have an agenda, which is to get rid of this disease as quickly as possible," he told a news conference.
Britain, the former colonial power, has sent military personnel to establish treatment centers in Sierra Leone, as well as three helicopters and a 100-bed naval hospital.
The U.S. response in Liberia involves 3,000 troops.
"The difference between Liberia and Sierra Leone is that the American response was faster and stronger and more robust in the beginning, using technology that was easier to put up than what the British are doing in Sierra Leone," he told reporters.
The deputy commanding general of U.S. Operation United Assistance said this week the country had the capacity to help other Ebola-hit countries but denied there were immediate plans to do so.
Sierra Leone's President Ernest Bai Koroma has introduced emergency Ebola measures. He said it might be necessary to call another three-day lockdown to remove the sick from communities and transfer them to newly built treatment centers.

Putting 3000 troops into Liberia accomplished nothing, as they notably constructed nothing for over 8 weeks, and by the time they did, people had elected to die at home instead of going into quarantine.

So Sierra Leone wants some of that, and some General Fuckdup says "Why sure, let me drop my trousers and bend over for you, sir!"

So if you're in the military, below the O-7 grade, you know what's coming next.
"The good news is, a lot of them speak English, and they're not shooting at you.
The bad news is, they'll be bleeding out the ass, there's no cure, and we won't be issuing any of you any protective gear."


But notably, things are going so well in Guinea that they're willing to "use force" on anyone refusing treatment or quarantine.
Wait, I thought Ebola was "under control" in Guinea...?
So, apparently, "under control" means everyone there as well has decided to say "Eff that!" whenever the suggestion is made that they get in the van and go to the Quarantine Death Center for their ration of NoCare and a plastic shroud.

The sheep, having noticed no one comes out of the abattoir, are declining to go inside.
"Thank you for your kind invitation to the BBQ.
Before we RSVP, we'd like to know who's on the menu?"
 

Wednesday, November 26, 2014

Ebola: Melodrama Descends To Farce



H/t to commentor geoffb for this one. We needed some comedy for the holiday weekend.

FREETOWN, Sierra Leone (AP) — The Ebola outbreak in Sierra Leone, which has been surging in recent weeks, may have reached its peak and could be on the verge of slowing down, Sierra Leone's information minister said Wednesday.

But in a reminder of how serious the situation is in Sierra Leone, a ninth doctor became infected Wednesday and the World Health Organization said the country accounted for more than half of the new cases in the hardest-hit countries in the past week. By contrast, infections appear to be either stabilizing or declining in Guinea and Liberia. The case total includes 600 new cases in Guinea, Liberia and Sierra Leone in just the past week, according to the WHO.
Dr. Songo Mbriwa, a top military doctor who was working at a treatment center in the capital, tested positive for Ebola on Wednesday, according to Abass Kamara, a Health Ministry spokesman.
Nearly 600 health workers have become infected in the West African outbreak, many in the hardest-hit countries of Guinea, Liberia and Sierra Leone — all of which had too few of the workers to begin with.
Still, Alpha Kanu, Sierra Leone's minister of information, told journalists in an online press conference that with the imminent completion of two British-built treatment centers, the worst could be over for the country.
"We believe that now that those treatment centers are ready, the transmission of new cases will start reducing," he said. "I don't think we can get any higher than we are now — we are at the plateau of the curve and very soon we will have a downward trend, once we have somewhere to take people."
Sierra Leone has nearly 6,600 of the reported Ebola cases, with about 1,400 deaths, and the infections are increasing swiftly here.
In its release of the latest figures on Wednesday, the World Health Organization said both Sierra Leone and Liberia appeared to be far behind the U.N.-set goal of isolating 70 percent of patients by Dec. 1, with only about 20 percent isolated in each country. Guinea, by contrast, appears to have already passed that target. The agency warned that data is poor and slow to come in, so firm conclusions are difficult.
Kanu, the information minister, agreed that finding beds for patients had been a challenge in the country and predicted that the new centers would expand the country's Ebola treatment capacity to 1,000 beds and would help get the infected out of the community.
He also said that Sierra Leone would repeat its September shutdown when people across the country had to remain at home while medical teams went door to door.
 


Meanwhile, back in the Land Of Reality, Sierra Leone has chalked up 100 or so fresh Ebola cases per day for each of the 18 days of November for which figures are available, and less than 20% of those are isolated at Ebola Treatment Centers.

So you can believe this version of happygas from the currently most truth-challenged governments on the  planet, or believe your lying eyes.

Guinea and Liberia report 21 and 33 cases/day respectively during the same time span, but Liberia's numbers always seem to take a couple extra days to come out, suggesting that someone "massages" the data each week to fit the narrative, rather than releasing the known numbers, and their death toll is actually marching backward over time.
So all you have to do is wrap your head around the idea that suddenly, in those two countries, Ebola has become essentially non-lethal.

Or that the "official" numbers are such utter bullshit, that they are the product of monkeys flinging darts at a target.

Notably, none of these reports are being generated by anyone actually on the ground in Guinea or Sierra Leone, and no one is outside the capitols of any of those countries, while WHO, Medecins Sans Frontieres, and US CDC and DoD spokesholes are completely silent on what's being observed.

So if you want to sell the family cow for some Magic Beans, go right on ahead. But it won't be a giant that falls on you afterwards, nor golden eggs that goose leaves on your floor.

Monday, November 24, 2014

Denial In Mali, Not Just A River In Egypt


BAMAKO (Reuters) - Mali said on Monday that another person had tested positive for the Ebola virus, bringing the total number of cases in the West African nation to eight.
The Malian government did not provide further details about the new case and how the person contracted the disease, but it came after another case was confirmed on Saturday.
It said both cases were at an Ebola treatment center.
If you're keeping score at home, it's doubled there three times in 6 weeks. True to form, mostly among health care workers, which their nation doesn't have a plethora of to begin with. And those are just the exposures they think they know about. And their borders are still wide open to Guinea and Liberia, because they're a land-locked nation.

That works both ways, which must be a great comfort to those in the additional 5 countries they border on with no Ebola outbreak - yet.
"Wait, you're coming from WHERE?"

And The Sky In Your World Is...?


ACCRA (Reuters) - The U.N. Ebola Emergency Response Mission will not fully meet its Dec. 1 target for containing the virus due to escalating numbers of cases in Sierra Leone, Anthony Banbury, the head of UNMEER, said on Monday.
The mission set the goal in September of having 70 percent of Ebola patients under treatment and 70 percent of victims safely buried. That target will be achieved in some areas, Banbury told Reuters, citing progress in Liberia.
"We are going to exceed the Dec 1 targets in some areas.
This is like blaming 9/11 on some guy using his cellphone and causing the airplanes to hit the WTC.
It's ludicrous.

As noted here Saturday, even the NYTimes has WHO admitting that they're so far from their goal they don't expect to come close until the middle of next year (at which point they'll probably tell us a new fairytale story).

Baghdad Banbury obviously hasn't been paying attention.
Which probably has more to do with why this outbreak hasn't been and won't be controlled than the number of Quarantine Death Centers they have or haven't built in Ebolaville.
The bloom is off that rose, and the people aren't going to them. They're sitting in their hovels and passing Ebola around the neighborhood, because they realize can do nothing just as well as the governments can, except that doing it at home takes out their whole family, and the one next door.

Even illiterates in Monrovia aren't lining up to go die alone in a government plastic-sheet hospital for the good of humanity.

The WHO and UNEERM missed their goals because to little too late, and there probably aren't enough available resources in the entire world to catch this outbreak there now.

And we expected blithering idiots like this clown to know what they were doing.
"Hey, you fucked up: you trusted us. I'd advise you to start drinking heavily."
 

Top. Men.

Remember these @$$clowns, doing the clean-up on Doctor Dickhead's digs after he went bowling?



(Buzzfeed, via Fox News) New York City paid a con man who defrauded distressed homeowners out of millions of dollars during the housing crisis nearly $50,000 dollars to decontaminate the apartment of its first Ebola patient, BuzzFeed News is reporting.
The city awarded Sal Pane and his Bio-Recovery the emergency contract to disinfect Dr. Craig Spencer’s Harlem apartment after the physician was diagnosed with the deadly disease in October.
 
But Pane’s clean-up truck bore permit numbers that belonged to a dead man, Buzzfeed said Thursday in a lengthy report. The website said the dead man’s grieving sister was duped by Pane into selling him the truck and the company’s name.
The dead man, Ron Gospodarski, ran a reputable company that had years of experience cleaning up anthrax sites and other danger zones. Buzzfeed said its investigation showed that at the height of the Ebola scare in New York, Pane went on TV claiming that experience as his own.
“Twenty-seven years” of experience he told one radio station. “Not my first rodeo.”
Buzzfeed said that 27 years ago Pane was 4 years old.

 
In 2008, Pane ran a Long Island company that took upfront fees to obtain mortgage loan modifications for homeowners seeking to avoid foreclosure. He was sued by then-New York Attorney General Andrew Cuomo, who accused Pane of running off with fees without helping any homeowners. A judge ordered him to pay $12.5 million in fines and restitution to his victims. He’s only paid back $62,000.
Buzzfeed said Pane also did a nine-month stretch in prison three years ago after a jury on Long Island found him guilty of driving drunk and impersonating a prosecutor.
Pane’s contract with the city to clean Dr. Spencer’s Harlem apartment reportedly paid him and his company $48,000.
The city Health Department said it was unaware of Pane’s background but defended Bio-Recovery’s work.
Buzzfeed said in a brief phone interview Pane denied running Bio-Recovery.  He also told the website, “Enjoy your smear campaign."

$50K from the NYFC Health Department to a bunch of shmoes with a truck and some blue barrels.

So, the obvious follow-up question is where sociopath Pane took the stuff his henchmen removed from Doctor Dickhead's apartment, and what they did with it.

NYFC officials haven't asked, and nobody's telling.

Splendiferous. If you thought pressure-washing the vomit was good, how about looting the doc's apartment, tossing the stuff in some vacant lot, and probably hocking the good stuff at local pawn shops, and then collecting a city check for burglary in plain sight?

I couldn't make this kind of stuff up if I tried. But I think I've seen it somewhere before...

Sunday, November 23, 2014

Why Ebola Is Different



(Reuters) - An outbreak of the plague has killed 40 people out of 119 confirmed cases in Madagascar since late August and there is a risk of the disease spreading rapidly in the capital, the World Health Organization (WHO) said on Friday.So far two cases and one death have been recorded in the capital Antananarivo but those figures could climb quickly due to "the city's high population density and the weakness of the healthcare system", the WHO warned.
"The situation is further complicated by the high level of resistance to deltamethrin (an insecticide used to control fleas) that has been observed in the country," it added.
Plague, a bacterial disease, is mainly spread from one rodent to another by fleas. Humans bitten by an infected flea usually develop a bubonic form of plague, which swells the lymph node and can be treated with antibiotics, the WHO said.
If the bacteria reach the lungs, the patient develops pneumonia (pneumonic plague), which is transmissible from person to person through infected droplets spread by coughing. It is "one of the most deadly infectious diseases" and can kill people within 24 hours. Two percent of the cases reported in Madagascar so far have been pneumonic, it added.
Which, on the surface, would appear almost 10 times worse than Ebola in Mali.

And it would be, except for one thing:

You can hand somebody with bubonic plague about $25 worth of doxycycline, and send them home, (presuming they're not already on death's doorstep) and they'll be fine in about 10 days or so.
Problem solved.

Ebola, OTOH, requires a bit more in terms of resources for maybe 4 chances out of 5 to survive.

Plague:
$25/patient
 
Ebola:
$500,000 and up/patient


This is why the US has saved 8 out of 10 Ebola patients (and will, as long as we don't get more than a paltry few at a time) and why West African nations lose about 75% of theirs, which is just about how many would live and die if they did absolutely nothing.

Because absolutely nothing is the amount of resources they have there 24/7/365/forever.

That's how Liberia, with a population half the size of NYC, has already lost more people to Ebola this year than the total casualties we suffered in 10 years of war in Iraq and Afghanistan combined.

And if the number of our victims ever starts to cut into the resources we can devote to their care, our death toll is going to start looking a lot more like the ones in Africa.

Saturday, November 22, 2014

Taking Out The Trash


 
As any good fan of shows like The West Wing knows, every White House administration has a desire to spin the news in a favorable light, and one of the ways they can do this is by letting information out in certain ways. When there are stories they have to talk about, however little the y wish to do so, they simply lump that information into the weekend information dump, downplaying it by burying it amongst a ton of other garbage released Fridays and over the weekend, in a process that became known on that series, as in real life, as "taking out the trash". Reporters like weekends too, and no one watches the news on the weekends.

So with that background, imagine my surprise, after the second solid week of essentially nothing but fluff regarding the ongoing Ebola outbreak, when the NYTimes elected to burp out this latest coverage late on Friday afternoon:
The leaders of the United Nations and the World Health Organization expressed renewed alarm on Friday about Ebola’s tenacity in Africa and, in particular, its potential to ravage a fourth country, Mali, where they said hundreds of people had been exposed to an infected cleric who died last month.
At a webcast news conference from the World Bank offices in Washington, the United Nations’ secretary general, Ban Ki-moon, and the W.H.O.’s director general, Dr. Margaret Chan, also appeared to reset their schedules for containing the Ebola virus, which has sickened at least 15,351 people and killed 5,459, according to a W.H.O. update posted earlier Friday.
Mr. Ban said nothing about the goal of safely burying 70 percent of the dead and treating 70 percent of the sick by Dec. 1, and instead expressed hope that the outbreak could be contained by the middle of next year.
Mr. Ban’s special envoy on the Ebola crisis, David Nabarro, also expressed doubts about achieving the Dec. 1 treatment goal in comments at the United Nations. “Confident? No,” he told reporters outside the Security Council, which was holding a meeting on the Ebola crisis.
While the effort to halt the virus has made progress, with strong indications that the worst-case outcomes might be avoided, the tone of the remarks by Mr. Ban and Dr. Chan was cautious.
“The international response is outpaced by this Ebola spread,” Mr. Ban said.
Warning against any complacency, Dr. Chan added, “We must not forget: Ebola is a formidable enemy.”
Most of the cases have been in the three most afflicted countries: Liberia, Guinea and Sierra Leone.
Yet the focus of the message of Mr. Ban and Dr. Chan was their concern about Mali, a vast country where the government does not have full control and where a United Nations peacekeeping force is deployed. At least six people in Mali have died of Ebola.
A successful effort to halt Ebola infections in Mali last month, prompted by an infected 2-year-old from Guinea, has now been overshadowed by a second and far more serious source of infection, from an imam who also had come from Guinea. His symptoms had been misdiagnosed as a kidney problem after he traveled to Bamako, the capital, to seek treatment.
Dr. Chan said nearly 500 people in Mali and Guinea had come into contact with the imam.
Mr. Ban said that a team led by Dr. Chan was headed to Mali and that a new support center would be established there. Dr. Chan was blunt about the potential for a worsening situation in Mali.
“We are scaling up our action,” she told reporters, adding, “We must smother this little fire, little smoke, before it gets out of control.”
The W.H.O.’s own figures tell a worrying story about the progress in containing the virus. Only 26 percent of the necessary Ebola treatment centers were up and running this week, and barely a fraction of the smaller community care centers that health experts now say are more needed. Fewer than one-fourth of reported cases were isolated, with Sierra Leone reporting only 13 percent. At the Security Council meeting on Friday afternoon, it became clear that two months after the world promised to rally to help the affected countries of West Africa, there remained significant shortfalls, even as diplomats said international aid had made a difference.
“It would be reckless to think that just because we hit some of our benchmarks, we have contained the virus’s deadly spread,” said Samantha Power, the United States ambassador.
Thomas Mauget, an aid worker speaking by video link from Conakry, the capital of Guinea, raised the alarm about new hot spots emerging in the country, saying “international mobilization must be intensified.”
The Security Council nudged the United Nations Ebola response mission to more quickly expand its operations.

TL;DR summary:
*>  The UN wishful thinking Dec. 1st 70% containment date has been pushed to the middle of next year.
IOW, they see no hope in hell that this thing is anywhere close to being controlled for months and months, at which time they'll probably conclude that mid-2015 was a pipe dream as well.
*> The number of exposures in Mali is no longer 327, it's now "over 500".
IOW, Ebola is officially off to the races in Mali (they're already isolating the third tier of infectees from the second Index Patient), and probably about to leap to where things were in Guinea, Liberia, and Sierra Leone last May, and it will make the jump in Mali in one great leap forward. The UN and NGOs are scrambling to pitch in, but it's probably far too late for that, and they don't have any reserve capacity to deal with this latest front. Look for the next report to tell you that they're now tracking "over 1000" exposures, and the latest confirmed case has exposed other people as well, as Ebola just keeps doubling apace ahead of all efforts to stop it in Mali, just like it did in the first three countries of outbreak. And Mali is more populous, medically under-served, and generally illiterate than any of them.
*> The prior "Ebola is slacking off, we're winning" happygas has been replaced by the cold hard realization that they are so far from screwed they can no longer see it receding into the distance.
They have nowhere near the number of centers they think they need, they cannot even isolate 25% of confirmed cases (which means they're isolating precisely 0% of unsuspected cases), but they're absolutely certain that they've succeeded in scaring people enough that they'll no longer report their infections nor arrive at Ebola Treatment Centers (AKA Quarantine Death Camps), which is the only way you have that many opening beds even as the disease spreads unrestrained.
In short, their entire efforts thus far, precisely like everything they've done prior, remain a complete, unmitigated, and unvarnished failure when they admit the truth to themselves, and look at their own available data.

In WWII, there was a brief period known as the "Phony War", when things seemed hopeful, as the conflict failed to catch fire after war was declared, mainly because the Germans took pause to consolidate their gains, and re-deploy their forces for the next round of attacks, mostly during the quiet winter months when campaigning wasn't so favorable anyways.

That's where this lull is now, especially when the press and government here have belatedly decided, for mostly partisan reasons, coupled with the sincere desire not to look like the clueless bunch of lackwits they've both demonstrated themselves to be on crisis after crisis, have co-operated (if not outright conspired) to underplay, downgrade, and simply ignore the common sense implications of this crisis, spike the stories about it, and refuse to cover or comment about it.

It's bad enough when you catch a government spokeshole lying.
But when the "journalists" covering them give them a stage wink as they do it, expecting either of them to tell you anything useful, let alone truthful, is a forlorn hope.

That isn't going to change on this story unless or until people start dropping in the streets in NYFC, if then.

You have from now until that time - which could be any amount of time at all - to get yourselves and your preparations together. You can plan ahead, or you can go shopping after Thanksgiving, and imagine everything is just fine, and this Ebola thing isn't coming to us anytime soon, even as we make plans for rotating thousands of troops into and out of the hot zone there, while the disease spreads across four countries unchecked.

Use your time wisely.