Friday, 26 December 2014

It's Christmas time...

Below is my attempt to try an make the BandAid30 lyrics a little more relevant and specific to the West African Ebola virus disease epidemic. 

I'm not musician, or poet - as you may tell - but I like these lyrics more...and they scan for me!

I've tried to build this while listening to my bought version of the latest BandAid song from iTunes or you can watch the video for the tune - just yell these lyrics over the top!!

It's Christmas time
Sometimes it hard not to be afraid
At Christmas time
We let in light and we banish shade
And in our world of plenty
We can spread a smile of joy
Throw your arms around the world 
At Christmas time

But say a prayer
Pray for less lucky ones
At Christmas time it’s hard
But while you're having fun
Remember a world outside your window
That it's a world less safe than here
Where a farewell kiss can kill you
And that death is much more near
And muddy roads all over
Cause delays that can spell doom
Well tonight we look around
To help you

Bring health and joy this Christmas
To West Africa
A song of hope when hope seems rare tonight (ooh)
Touch now to be spared
Cause that’s how virus is spread
How can you show you want to help at all?

Here's to you
Donate funds for everyone
Here's to them
And all their years to come
Show them that it's Christmas time for all

Come on world
Let’s show them we want to help
Rise up world
Let’s help build a safer place to
Heal the world
Let all know we care for you 
Heal the world
Let them know it’s Christmas time

Come on world
Let’s show them we want to help build
Rise up world
Let’s help build a stronger place to
Heal the world
Let all know we care for you 
Heal the world

Tuesday, 23 December 2014

Christmas 2014: give the gift of help...

I wrote a little guide back in August listing some places where one could donate if seeking to help out in the battle to contain Ebola virus and try and prevent more loss of life due to Ebola virus disease (EVD). 

With Christmas day nearly upon us, and many who read this blog likely to be doing something to celebrate it involving the giving of gifts to friends and loved ones, please think about donating to help the fight. 

You can easily add a donation, in the name of your friend or loved one, to help a range of organisations help save lives. I've re-posted my earlier list below in case you need some ideas. These donations can be made online-you can even get in a little Christmas craft and make a "voucher" tells the recipient what they did to help!

And the donation does not need to be limited to EVD of course! These organisations supply aid in many ways to those in all sorts of need. They also have a good record of getting that help to where it really needs to go. In some cases you can see that these guys spend most of your donation on tangible items and real aid - not on administration - a good thing to look out for. 

Thursday, 18 December 2014

Ebola double vision is clearing...

A quick follow up from my post in October entitled "Ebola double vision".

I've adjusted that graph and it adds another view of how the Ebola virus disease (EVD) epidemic is, in terms of overall case numbers, showing consistent signs of slowing. 

The time it takes for the case total to double (the doubling time) has stretched out from doubling every month or so, to taking about a month and a half to double.

But far from breathing a sigh of relief, the numbers in Guinea, which have never appeared consistently under control, and the still very high numbers in Sierra Leone, highlight that the epidemic is not yet leashed and the need remains for continued vigilance and more of the same hard and risky work being done by those in and around the region. In Liberia, the country that supplied the highest proportion of EVD cases leading up right up until this month, case numbers were down to just 75 in the previous week (reporting week #38). For context, that's still higher than the total of about 15 past outbreaks since 1976. And of course, this entire epidemic started from just 1 case. 100% of infected people need to be isolated and looked after (hydrated given pain relief and antibiotics among other things), 100% of burials need to be safe, and 100% of contacts need to be traced. That represents a huge task ahead of the stalwart healthcare, aid and many other support workers who have been facing Ebola virus every day for months and months.

The time between total case doublings.
For 4 doublings in a row it took a month or so, but the most
recent doubling took 44-days. 

Click on image to enlarge.

Wednesday, 17 December 2014

Ebola virus disease (EVD) and the human desire to see the worst...

Criticism is easier from up here!
There are those who just seem to enjoy hoping for the worst.

Yes, I'm othering "those people" - I'm invoking a "them" category because their outlook is just too alien for me to understand. I can respect and often understand other points of view, different beliefs and skin colours, clothing styles - all manner of things. But I just cannot understand those who seem to be filled with a macabre desire to see pain and suffering triumph over efforts to defeat it. 

Some of us are lucky enough to live in a free country and write our every little thought and feeling down to share with the world. I'm doing that now. Some use that privilege to say 'I told you so'. There is no room in the lives of some people for mistake, misstep or shades of grey. It's ones and zeroes, yes or no, all or nothing. The binary belief of those so self-assured in their personal opinions that they don't need to look around or experience for themselves any of those roles they criticize; they just know. They can just tell.

Are these personal-views-made-public all that destructive? Maddening though they may be, they probably don;t do a lot of damage, no. Nonetheless I thought it worth writing my own opinion about a related example in a recent opinion piece posted by the New York Post, addressing some aspects of that Ebola virus epidemic you may have heard about during 2014. It's the one causing>18,000 cases (and growing), >6,800 deaths, collapses of already minuscule health infrastructure, deaths of many key healthcare workers, potentially disastrous impacts on birthing, schooling and vaccination programs and bans on festive season gatherings.

The NYP article was entitled "The great Ebola lie — Outbreak hyped for funding & media attention". 

No hype there though. 

The author, Michael Fumento, seemed disappointed and a little angry about a few things. These included:
  • that EVD deaths had not reached HIV's 35 million
    That's a really good thing in case you were wondering. This use of an HIV statistic is a bit off though; AIDS is not an acute disease but an acute public health emergency was what the WHO quote referenced. Sure-I'm just playing with words. Also worth remembering that EVD acutely kills >70% of those we know have been infected during the 2014 epidemic. A bit different from the course some pathogens chart. 
    The particular choice of a citation for that WHO quote was also interesting. Firstly, the quote had been used some weeks earlier but secondly the next sentence from the original quote was not present in The Week's article source yet it adds even more context by stating that "Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long". Together, that does paint a kind of unique picture.
  • that EVD did not attain a rate of 10,000 cases per week, starting in the first week of December.
    Also, really good.
    The models have been discussed around social media and in the scientific literature for a while. For example, articles most recently in Nature and in the PNAS discuss how predictive models provide much needed guidance for planning the scale of a satisfactory intervention and predicting as well as gauging the impact of those interventions...among other things. Oh, and that 10,000 cases number was not pulled out of thin air at a press conference, it and more dire predictions can be found in other models including those discussed in Science, the Lancet Infectious Diseases, here and here, the New England Journal of Medicine, PLoS Currents|Outbreaks here and here and the CDC's Morbidity and Mortality Weekly. And elsewhere, if one asks around.
  • that 2014's EVD epidemic had already peaked by mid-October when the WHO held a media conference.
    But if you look at more recent data from WHO - their weekly numbers are plotted below - it's pretty clear nothing but Nigeria had peaked. Later data shows that cases were still adding up in Liberia and in fact still are raging in Sierra Leone. Cases in Guinea seem to wax and wane and export travelling cases to other countries fairly consistently. The US was happening and Mali yet to happen. 

Weekly Ebola virus disease (EVD) suspect+probable+confirmed cases by
WHO reporting week, and country.

Click on image to enlarge.
Most of the author's apparent anger seems directed at WHO but also other "big public health" including the Centers for Disease Control and Prevention. The main guts of the article reduce down to...
You’ve been lied to, folks. For months.
But "lie" is specific and well-defined word. Oxford defines a lie as... 
An intentionally false statement
So in the author's opinion, the WHO & the CDC and perhaps others, each conspired by making conscious decisions to lie to the world and promote hysteria in order rewarded with "billions of dollars"? BigPublicHealths' endgame was really just to make a buck from all that extra funding (much/most of which still hasn't materialized) by hyping up history's biggest ever EVD epidemic.

Or is it more realistic to see it for what it actually was; a (delayed) effort to try and light a fire under a sluggish international community? 

Perhaps all those dollars were part of a costed (perhaps using models?) proposal for a suitable response to fully shut down the epidemic and remove Ebola virus humans in West Africa before everyone gives up? Could it really be that simple? Yup. It sure could. Because a response to an outbreak, even when not in a rich Western nation, is an expensive and big deal. In rich Western nations, it's a lot more expensive and, judging by the response to a couple of cases in the United States, a much bigger deal. So I'm really stumped about the focus for the angst; perhaps there is a deeper reason in the NYP article that I simply missed by being simple. Naah, that's not it.

It's already been said, but just to repeat the point; disease modelling uses the numbers we have to predict what the numbers will be. The numbers we have are already old and cannot tell us how bad things could get. Bodies in the street give us an innate sense of bad, but models put brackets around that in order for cheque signers to get a quantifiable understanding of just how bad things will be tomorrow, next week or next year. Models predict what could be if nothing happens to change the trends extrapolated from the numbers we have in hand. Modelers have no qualms about saying they produce predictions. Models can also do some other stuff like predict how things could improve if we provide help, teach, support, learn and change our habits. In Ebolaville, the models were one part of the support underpinning a new message of urgency  that, it was hoped, would stir a slumbering international awareness - jolt it to life - and elicit the kind of response that, at least partly, eventuated. 

Were we lied to by bigPublicHealth so they could get a huge payday? No, of course we weren't. But we were shown what could come to pass if no funding appeared. Keep in mind that "funding" also includes resources-in-kind such as:

  • labs
  • vehicles
  • planes
  • food
  • antibiotics
  • oral (nasogastric and intravenous) rehydration solution
  • pain relief
  • personal protective equipment
  • awareness & advertising campaigns
  • phones and better comms for reporting results
  • bleach
  • water
  • treatment units
  • healthcare workers 
And despite the assurances of the author of the NYP article, there are a few past epidemics that have been contained, not by simply disappearing, but because of the heroic efforts of many in public health and patient care roles all over the world....and often with lots of money. Some epidemics have been nipped in the bud before they could bloom beyond an outbreak, thanks to dedicated people...and money. 

Wouldn't it be great if our public health could be protected for free? Sorry. Never gonna happen. The truth about Ebola in 2014 is that we may well have avoided the loss of many of the thousands of souls gone too soon, if we had just got the messages, awareness and money flowing sooner. But we'll never know that for sure.

Anyway, this is my opinion piece.  

Friday, 12 December 2014

WHO Media Release: Sierra Leone reacts swiftly in the face of desperate need

I am reprinting in full, with permission, what I think is a really well written "story behind the numbers". These stories provide invaluable context around the various individual human and community tragedies that are constantly occurring during this epidemic. They also highlight the many difficulties faced by those trying to help people, track and contain spread and and collate all the numbers. Those numbers may be dispassionate in their quantification of aspects of the epidemic, but they are so important to guide timely aid to the right areas and at the right scale

Freetown 10 December 2014 - Racing to fact check an ominous spike in Ebola cases from the remote diamond district of Kono in eastern Sierra Leone, bordering Guinea, a World Health Organization rapid response team found a worse-than-expected scene. WHO and the U.S. Center for Disease Control (CDC) joined forces with the Sierra Leone National Ebola Response Center (NERC) and Ministry of Health and Sanitation (MoHS) to sound the alarm and are now rallying all-comers in a massive build up to contain this burgeoning Ebola outbreak which ran the risk of continuing to grow and remaining hidden as world attention focuses on urban centers.

“Our team met heroic doctors and nurses at their wits end, exhausted burial teams and lab techs, all doing the best they could but they simply ran out of resources and were overrun with gravely ill people,” explains Dr Olu Olushayo, WHO National Coordinator, Ebola Epidemic Response. “In districts like Kono, with moderate transmission confined to limited villages and chiefdoms, the best chance of eliminating transmission is through aggressive and comprehensive case investigation and contact tracing,” he said. Scattered villages in 8 of the 15 chiefdoms are affected.

Reacting on intel from the Ministry of Health of Sierra Leone, WHO sent a seasoned field epidemiologist to Kono 10 days ago to tease out whether reported Ebola cases told the whole story. Cases go unreported for a variety of reasons and are exacerbated when overwhelmed and under-resourced frontline workers are unable to reach remote areas to get the truth from reluctant villagers. The surveillance officers had no vehicles. WHO and CDC quickly sent more investigators and rugged trucks.

They uncovered a grim scene. In 11 days, 2 teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor drafted into removing bodies as they piled up at the only area hospital, ill-equipped to deal with the dangerous pathogen. In the 5 days before the team arrived, 25 people died in the hastily cordoned off section of the main hospital serving as a makeshift Ebola holding center.

As of 9 December 2014, this district of over 350 000 people officially has 119 reported cases. Upon hearing the WHO findings, Dr. Amara Jambai, MoHS Director of Disease Prevention and Control harkened a local saying to describe what remains yet to be discovered, "we are only seeing the ears of the hippo."

Help is arriving daily. The NERC and MoHS for the Government of Sierra Leone and UNMEER with WHO support are connecting ready-to-help partners with an all-out multi-agency response to critical needs on the ground. WHO field staff are sharing their expertise with surveillance investigators, community mobilizers, infection controllers, and coordinators. The doctors from Partners in Health and Wellbody Alliance who supported the overwhelmed holding center, are willing to stay on board to support care at the source in outlying health posts. The International Federation of the Red Cross will build a new Ebola Treatment Center on a tight timetable, while they disinfect the hospital with MoHS and create a temporary safe holding unit. The IFRC Kenema Ebola Treatment Center will take Kono patients until these solutions are in place. CDC has staff on the ground. UNMEER has lent it’s helicopters to the effort in support of the UN family (WHO, UNICEF, UNFPA, WFP, and others) engaged in building up capacity for staff and volunteers through training, materials and logistical support. International Rescue Committee is supporting infection prevention activities in the district. Funders such as DIFD and USAID are making much of the fast response possible. The race is on in this frontier fight against the virus, as Ebola responders dash to get ahead of the epidemic rather than chasing its tail.