Obama picks EBOLA Czar.... medical superstar?

[Paprika]

Lots of people lie against their best interests. Not so many lie against what they perceive to be their best interests. A good number of people will make a somewhat-rational determination that preserving the image of chastity is more important than a quick recovery of a STD — fewer would face a doctor telling them that the difference between life and death in the next week depended on an honest statement about recent sexual activity and lie. In the case of Ebola, there is no gain whatsoever for lying; not only would the person require admittance to the hospital in any case, his life would very likely depend on immediate treatment. Notably, Thomas Duncan, the Liberian patient who died in Texas, lied about his potential exposure to Ebola when flying to the US but not when he went to hospital with symptoms.

I think it's safe to say that someone suffering from Ebola-like symptoms who knows that she has been in possible contact with an Ebola victim has little to no risk of lying about that fact. It's not only against her best interests but also against her perceived best interests.

Have you heard of the case of Patrick Sawyer, naturalised American? You complain about hypotheticals: there's a clear case for you.

[seanD]

One thing I've learned from all this is that if there ever really is a deadly pandemic that comes to the US, in the wake of a comically incompetent government and a hyper politically correct society, we're totally screwed.

[Teallaura]

One thing I've learned from all this is that if there ever really is a deadly pandemic that comes to the US, in the wake of a comically incompetent government and a hyper politically correct society, we're totally screwed.

Depends on how close the photo op is to the epicenter...

I'm channelling DE!

[Juvenal]

If there's a crisis here, I'm not seeing it.

Ebola Facts: How Many Ebola Patients Have Been Treated Outside Africa?

The current grand total of nine cases treated in the U.S. have resulted in a grand total of one death, with just two cases still under treatment as of today, including the doctor in New York who was diagnosed yesterday. As of today, there have been two cases of transmission occurring in the U.S. itself, both of which involved medical staff and occurred during the treatment of the first case, the Dallas fatality, during his most contagious phase, and both of which, as of today, have recovered.

Nina Pham, Dallas Nurse, Declared Free of Ebola and Released From Hospital

[Teallaura]

Yeah, okay, Mr Math Prof, what is the percentage increase in the number of cases in the US since July?

Ebola has a nasty history of playing pop-up. That aside, only a total idiot thinks a readily transmissible, virulent, and usually deadly disease showing an unquestionable increase in prevalence should be regarded as 'no big deal'.

It is a crisis - it is not (yet, Praise God) an epidemic. Treat it like it's no big deal and it will fast become an epidemic. Treat it like it's the end of the world - even though it isn't yet - and we still have a chance to eradicate it. The CDC needs to up its game and at the same time let the states start throwing their expertise in. The medical community needs to quit waiting for the CDC to get its act together - and frankly, so do the states. Tackle it insanely NOW and you don't bury nearly as many people then.

[Juvenal]

Yeah, okay, Mr Math Prof, what is the percentage increase in the number of cases in the US since July?

Since July? The first case was in September. Divide by zero error.

That said, there has been a change in cases transmitted inside the U.S.

-100 percent.

Zero, nil, nada, since the first two nurses.

I did leave a link, and that link is continually updated. The most recent addition is a graphic showing that of the 700 doctors from Doctors without Borders sent to West Africa, 270 are currently in the field, and 3 have contracted Ebola, "a doctor from Norway, another from France, and now, an American."

Ebola has a nasty history of playing pop-up. That aside, only a total idiot thinks a readily transmissible, virulent, and usually deadly disease showing an unquestionable increase in prevalence should be regarded as 'no big deal'.

How contagious is the virus?

I'm unlikely to waver from sticking to the facts.

It is a crisis - it is not (yet, Praise God) an epidemic. Treat it like it's no big deal and it will fast become an epidemic. Treat it like it's the end of the world - even though it isn't yet - and we still have a chance to eradicate it. The CDC needs to up its game and at the same time let the states start throwing their expertise in. The medical community needs to quit waiting for the CDC to get its act together - and frankly, so do the states. Tackle it insanely NOW and you don't bury nearly as many people then.

The real player in this game is the WHO, and the relevant medical community is Doctors without Borders. It's a crisis in West Africa, not here. And, in fact, in only three countries in West Africa: Guinea, Sierra Leone, and Liberia, which is where it needs to be eradicated. Nigeria has been cleared, and Senegal appears likely to maintain containment.

New cases are being diagnosed at a rate of c. 1000 per week, with the largest clusters centered around Freetown and Monrovia, and that rate is considered likely to increase ten-fold.

Oh, and while I'd prefer to delegate our own Captain Obvious to point it out, doing anything "insanely" is, well, insane. The CDC has already upped its game. But I do have to agree with you on this one. Dis-coordinating the effort in the U.S. would be a good example of tackling it insanely.

As ever, Jesse

[Sam]

Paul Farmer (epidemiologist & author of "Pathologies of Power" and "Haiti After the Earthquake") argues that the morality rate from Ebola should be around 10% rather than the 50% to 90% rate currently referenced. The reason for the discrepancy? Medical resources.

I’ve been asked more than once what the formula for effective action against Ebola might be. It’s often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions. What’s the ‘model’ or the ‘minimum basic package’? What are the ‘metrics’ to evaluate ‘cost-effectiveness’? The desire for simple solutions and for proof of a high ‘return on investment’ will be encountered by anyone aiming to deliver comprehensive services (which will necessarily include both prevention and care, all too often pitted against each other) to the poor. Anyone whose metrics or proof are judged wanting is likely to receive a cool reception, even though the Ebola crisis should serve as an object lesson and rebuke to those who tolerate anaemic state funding of, or even cutbacks in, public health and healthcare delivery. Without staff, stuff, space and systems, nothing can be done.

If such things were thin on the ground in Monrovia and Freetown, they were all but absent in rural regions.

[Teallaura]

Um, he's arguing that the rates would be so low if socio-economic factors weren't playing a role. Was that what you meant?

[Sam]

Um, he's arguing that the rates would be so low if socio-economic factors weren't playing a role. Was that what you meant?

No, he's not -- though perhaps one has to be familiar with Farmer's work, especially through the prism of "Pathologies of Power." Farmer is arguing that Ebola mortality rates would be that low if adequate healthcare resources were provided. He doesn't much care how those resources are allocated, I would guess. Even with socio-economic factors as they are, Farmer sees plenty of resources that could be made available if the world community had the will, or even desire, to do so. Farmer notes explicitly several times in this essay alone how a shift in thinking towards infrastructure and prevention could dramatically mitigate the crisis.

While it is true that better socio-economic factors would reduce Ebola mortality rates (see: USA), that's not Farmer's argument. He's arguing that with the right focus and resources allotted to these regions, as they are now, the Ebola mortality rate should be closer to 10% than 50%-90%. That the mortality rate is the latter is a moral failing in Farmer's mind, I would venture.

[Teallaura]

Okay.

[Juvenal]

Paul Farmer (epidemiologist & author of "Pathologies of Power" and "Haiti After the Earthquake") argues that the morality rate from Ebola should be around 10% rather than the 50% to 90% rate currently referenced. The reason for the discrepancy? Medical resources.

"Diary." Paul Farmer. London Review of Books. October 2014

I've read that quote twice now, to make sure I understand his usage of quotes. Those are definitely scare quotes; he's not just highlighting relevant phrases. Paul Farmer, with all due respect to his efforts in world health, is simply whining here. If prevention is worthwhile, its costs and effectiveness can be modeled, and return on investment calculated by measurement. This is how adults make the best use of limited resources.

The real issue in the developed world is an unwillingness to measure Africans the way we measure ourselves. Their deaths and diseases are less important than ours. The associated issues in Africa are corruption and ignorance, and the pervasive poverty that fuels them. Two dollars a day doesn't leave much left over to invest in the future.

If such things were thin on the ground in Monrovia and Freetown, they were all but absent in rural regions.

Because the resources are all but absent in rural regions, Monrovia and Freetown are acting as magnets drawing in the sick. Population gravitates toward larger flows of resources.

As ever, Jesse

[Sam]

"Diary." Paul Farmer. London Review of Books. October 2014

I've read that quote twice now, to make sure I understand his usage of quotes. Those are definitely scare quotes; he's not just highlighting relevant phrases. Paul Farmer, with all due respect to his efforts in world health, is simply whining here. If prevention is worthwhile, its costs and effectiveness can be modeled, and return on investment calculated by measurement. This is how adults make the best use of limited resources.

The real issue in the developed world is an unwillingness to measure Africans the way we measure ourselves. Their deaths and diseases are less important than ours. The associated issues in Africa are corruption and ignorance, and the pervasive poverty that fuels them. Two dollars a day doesn't leave much left over to invest in the future.

If such things were thin on the ground in Monrovia and Freetown, they were all but absent in rural regions.

Because the resources are all but absent in rural regions, Monrovia and Freetown are acting as magnets drawing in the sick. Population gravitates toward larger flows of resources.

As ever, Jesse

I doubt he'd disagree; I don't think Farmer is against modeling or cost-effectiveness. I think he's using scare-quotes in that way to typify a particular mindset, one that doesn't actually look at preventative models or broad cost-effective solutions but wants fast-acting, reactive treatments on the cheap once the crises have already begun to spiral away. That passage reminded me of his evident anger and frustration dealing with TB in Russian prisons, where appropriate epidemiological models were ignored in favor of cutting costs, while administrators still expected effective containment.

Yeah, it's a whine -- a complaint. I don't think it's an illegitimate one, however.

[Jedidiah]

The real issue in the developed world is an unwillingness to measure Africans the way we measure ourselves. Their deaths and diseases are less important than ours. The associated issues in Africa are corruption and ignorance, and the pervasive poverty that fuels them. Two dollars a day doesn't leave much left over to invest in the future.

You are surprised that America places a higher value on itself than on African countries. That is how things work, and why humanitarian efforts, mainly by Christians by the way, do not have the money that internal problems have. Do you think we should try to even things out? How?

[Spartacus]

I wonder what the response would be if I were to suggest that this wouldn't have happened under Bush, who spent considerable time and effort on aid to Africa.

[Sam]

I wonder what the response would be if I were to suggest that this wouldn't have happened under Bush, who spent considerable time and effort on aid to Africa.

I'd respond that it's highly unlikely that Bush would have continued to provide foreign aid at anywhere close to those levels after the financial crisis. The GOP attitude toward such aid soured alongside all the other spending programs that they once undertook or even championed.