Hilo del ébola: de cómo la corrupción mata...literalmente

[sincriterio]

Pasar la cuarentena en Cádiz.
http://www.elconfidencial.com/espana/2014-10-14/alerta-en-defensa-eeuu-pide-que-3-000-soldados-del-ebola-descansen-en-espana_238486/

[Currobena]

De cómo controlar el ébola: un psicólogo de una escuela médica de Reino Unido revela su experiencia con la prevención del sida y lo compara con el ébola.

One of the few perks of being a psychologist in a medical school (apart from occasionally running to a colleague to check a personal health matter) was talking to researchers about the real state of knowledge in any particular field.
The Middlesex Hospital Medical School, which started in 1746 and was subsumed into UCL in 1987, had a great talent for developing new services. In a very minor way I added to that trend by setting up, with two other colleagues, a national referral centre for post-traumatic stress disorder, which is still in operation as an NHS clinic.
However, of much greater importance was the clap clinic. At a time when the usual appellation was Venereal Disease, two clinicians got together and decided, over a glass of champagne, to move it from the dark basement to the full daylight. In 1964 Duncan Catterall established the first Chair of Genito-urinary Medicine at the Middlesex Hospital Medical School, and so when the first symptoms of a strange sexually transmitted disease showed up in the very early 80s, James Pringle House started seeing the first cases and was at the forefront of European research. I went to seminars, talked to colleagues, and sometimes met the guest speakers for a canteen lunch. The greater the expert, the quicker they were to admit that no-one knew what the hell was going on.
To my dismay, the public management of the disease quickly veered away from traditional public health concerns, and became a political battlefield. At the WHO headquarters in Geneva senior colleagues muttered that they had been criticised for saying the virus came from Africa: a colonialist perspective, they were told. Even years later, those who worked in the field in London talked sadly, and privately, of the difficulties they encountered with giving straightforward health warnings. I wanted to design a simple poster to illustrate the relative risks, but it got no further than a large page in my filing cabinet. Such, dear readers, were the difficulties of quickly disseminating an opinion before blogging became available. 
It was clear to researchers that blood was the key vector of transmission (contaminated blood transfusions had a 90% chance of resulting in the recipient getting HIV), so that shared needle drug injecting and to a lesser extent anal intercourse without condoms were high risk activities, but public broadcasts talked vaguely about icebergs, and suggested everyone was at risk. I did some research on public perceptions of risk at that time, and AIDS figured high in the public mind. The common folk knew that it was a “gay plague” but the expert emphasis seemed to be on getting heterosexuals to use condoms. The great and the good were interviewed and asked to say the word “condom” on camera which they valiantly did. The correct way of putting on a condom was demonstrated on television, using a cucumber. This led to some worried calls about whether one could catch AIDS from a cucumber.
However, it was generally agreed that the UK government had done “rather well” and had got on top of the crisis. Now, with Ebola in the news, I thought it worthwhile looking at the current situation for the HIV virus in the UK, 30 years on from the first outbreak. This might give us a possible scenario for imagining what Ebola might look like in terms of prevalence.
In fact, the UK response to HIV seems to have been at the European average. Statistics vary in different parts of the world, but I imagine that European statistics have a modicum of accuracy. Finland, Germany, Malta, Norway (and Cuba, see below) did very well (0.1 %); Denmark, Greece, Netherlands and Sweden and Israel pretty well (0.2%) and Belgium, Iceland, Ireland, Luxemburg and the United Kingdom were average (0.3%). Austria, France, Italy, Spain, Switzerland were a bit worse (0.4 %) and Portugal very much worse (0.7%). Of course, these are not sub-Saharan African levels (as high as 25% in Swaziland and Botswana) but given that the governments knew what was coming, and had resources available, they are not stellar achievements.
Greg Cochran mentioned the case of Cuba, which had forewarning of the virus in the US and two years to prepare for their first case. 
http://westhunt.wordpress.com/2014/09/28/forty-days/
They quarantined patients for 8 weeks of health education, tracked contacts in a very determined way, and used their relative isolation to put public health before private liberty, an approach which comes naturally to the regime. Their resultant prevalence of roughly 0.1% is one-sixth the rate of the United States, one-twentieth of nearby Haiti.
http://news.bbc.co.uk/1/hi/in_depth/sci_tech/2003/denver_2003/2770631.stm
http://www.nytimes.com/2012/05/08/health/a-regimes-tight-grip-lessons-from-cuba-in-aids-control.html?pagewanted=all&_r=0
HIV probably moved from monkeys to humans before the 1950s, although the first cases were recognised in 1981 in the US. About 100,000 people in the UK are infected, mostly homosexuals, and heterosexuals from sub-Saharan Africa. More than 20 per cent of them do not know it, and are several times more likely to transmit the virus to their partners than those who have a diagnosis. Half of the newly diagnosed cases in the UK seek medical help when they are in the late stages of disease. In 2012, there were 6,360 new diagnoses of HIV, which is 17 a day in case you find that more dramatic. In England the local authorities with the highest prevalence of diagnosed infections are London, Brighton and Hove, Salford, Manchester, Blackpool and Luton, and in Scotland, Edinburgh. Treatment with antiretroviral drugs reduces the risk of transmission by more than 90 per cent. The cost of these drugs is said to be £20,000 a year and given the current almost normal life spans of HIV patients, 20 years of medication seems a prudent minimum for budgeting purposes. The money spent per capita on NHS services in England was £1,979 in 2011, so each patient with HIV consumed at least 10 times the resources of an average patient every single year.
 
http://www.avert.org/uk-hiv-aids-statistics.htm
A possible explanation for the apparently lacklustre performance of the UK may be that many of the cases are imported: that is, brought in by Black Africans infected in Africa. Looking at the demographics of the UK in 2011 that shows that 55,730,000 persons are classified as White and 1,905,000 are classified as Black or Black British. Looking at the HIV figures (this is broad brush, because I have omitted the “mixed” groups) the HIV rates per 100,000 are as follows:
Whites: 93 per 100,000
Blacks: 2015 per 100,000
So, the rate seems to be 21 times higher among Africans. The fact that so many Africans have come to the UK cannot be blamed on the quality of UK public health warnings aimed at changing the behaviour of the local population. The White rate is exactly comparable with the best European nations at 0.1% 
Nonetheless, considering that about 36 million people in the world are infected by HIV and that 30 million have died, the management of HIV is hardly a global success story. Does this give us any help in looking ahead to the prevalence of the Ebola virus in 30 years’ time? Prediction will depend on whether treatments or vaccinations become available, but my impression, no more than that, is that the spread of the virus should be much slower, very much slower. HIV can be passed on whilst the carrier still looks good for sex, and sex is fun, so HIV gets an easy ride. Ebola can only be passed on (if the experts are right) when the carrier is looking pretty ill and unattractive, and dealing with ill people is a duty, and not much fun. Furthermore, Ebola is so virulent at the moment that immediate death rates are high. With simple precautions it should be contained. Even when “protocols” fail, the reproduction rate of the virus in human carriers should be low. Despite all the worrying news, it should be a simple matter to avoid the spread of the disease.
On a more speculative note, perhaps we shall be saved by stigma. By fearing all people who look as if they are ill with Ebola, stigmatising them and avoiding all contact with them, definitely not putting ourselves at risk by helping them, particularly not touching them when they are dying or dead, the virus will die out. So, in one corner we have the virus, in the other corner the uncertain public, caught in an awkward tussle between altruism and abject fear. Ebola has its best chance of spreading in societies which don’t believe it exists (like in parts of Africa), and to a lesser extent in those which don’t believe that, given the virus does exist, the absolute priority is to change our behaviour quickly (parts of the wealthy West). Informed opinion ought to be right, but with every failure of both treatment and containment in Western hospitals public belief is eroded.
Although it goes against altruistic instincts, futile attempts at interventionist treatments may be making matters worse.

Es interesante el relativamente grande éxito de Cuba con la gestión del SIDA en comparación con otros países más ricos y avanzados, demostrando que no es cuestión sólo de dinero y sí de organización, prioridades y dedicación a la salud pública por encima de todo.

http://drjamesthompson.blogspot.com.es/2014/10/ebola-in-2040-will-stigma-save-us.html

[mpt]

¿estados fallidos?

http://www.elperiodico.com.do/2014/10/13/margaret-chan-direc-oms-virus-del-ebola-podria-crear-estados-fallidos/

http://www.infolibre.es/noticias/politica/2014/10/14/la_oms_calcula_que_dos_meses_habra_190_000_nuevbas_infecciones_ebola_mes_22647_1012.html

[Маркс]

Bueno pues según comunicaron técnicos en la materia en 15-20 días tras el contagio de Teresa se irían dando más casos con toda seguridad... 

Ingresan en el Carlos III tres personas más por sospecha de ébola

Una viajó en la ambulancia sin descontaminar que trasladó a Teresa Romero
Hay un misionero en Liberia y un tercero llegó en un avión a Barajas con fiebre y temblores
http://politica.elpais.com/politica/2014/10/16/actualidad/1413452284_037029.html

[Saturio]

Si el de Barajas viene de Nigeria, las posibilidades de que sea ébola son muy bajas.
O tenemos mala suerte del copón o es falso que en Nigeria se esté controlando el brote.

Lo que no me deja de sorprender son cosas como esta:

Una tercera persona ha ingresado hoy en el Carlos III, según informan fuentes sanitarias. Se trata de un misionero procedente de Liberia. Estas fuentes añaden que pertenece a la orden de San Juan de Dios, la misma de los dos religiosos repatriados por ébola, Miguel Pajares y Manuel García Viejo

Si lo han ingresado preventivamente estando asintomático me parece genial. Supongo que no es tan difícil que el ministerio de exteriores tenga controlados a todos los misioneros y cooperantes en la zona y tener preparado un protocolo de actuación cuando vuelvan a España y no desayunarnos 15 días después con que tienen fiebre.

[sincriterio]

Ya han puesto en marcha una página oficial.

http://infoebola.gob.es/

[Currobena]

La corrupción en la Organización Mundial de la Salud ayuda al ébola. Los enchufados de Africa facilitan la difusión de la enfermedad. Como dice el título del hilo: la corrupción mata...literalmente.

Ebola: equal opportunity pestilence    A long time ago I decided to look at human error in the context of the risks of nuclear war. I read the published literature, including the US Congressional Record, and the work done by James Reason and others on the psychological underpinnings of mistakes. I was aware of journalistic accounts about nuclear accidents, drug-taking nuclear guards and the like, but did not give them much space. Eventually I was invited to a Pugwash Conference in Geneva, an East-West summit forum where I met US intelligence experts, Russian generals, think tank researchers and interested scientists. Chatting with senior figures about accidents they initially gave me to understand that everything was under control, but as the weekend progressed many told me that if I wanted to know what was going on then the alarmist journalistic accounts were probably closer to the reality than the official accounts I had been reading.
The official story on Ebola was that, nasty as it was, it would be controlled. Now, late in the day, courtesy of Associated Press, we have been given the internal WHO view as to why it was not controlled in West Africa. It said the heads of WHO country offices in Africa are 'politically motivated appointments' made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency's chief in Geneva, Dr. Margaret Chan.

Dr. Peter Piot, the co-discoverer of the Ebola virus, agreed that WHO acted far too slowly, largely because of its Africa operation. 'It's the regional office in Africa that's the front line. And they didn't do anything. That office is really not competent,' Dr Piot said. “What should be [the] WHO’s strongest regional office because of the enormity of the health challenges, is actually the weakest technically, and full of political appointees.” He also questioned why it took WHO five months and 1,000 deaths before it declared Ebola an international health emergency in August. 'I called for a state of emergency to be declared in July and for military operations to be deployed,' Dr Piot said.
In late April, during a teleconference on Ebola among infectious disease experts that included WHO, Doctors Without Borders and the U.S. Centers for Disease Control and Prevention, questions were apparently raised about the performance of WHO experts, as not all of them bothered to send Ebola reports to WHO headquarters. 
WHO said it was 'particularly alarming' that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and $500,000 in aid was blocked by administrative hurdles.
On 3 April, MSF first warned WHO about the outbreak, saying it was unusual because far from being in a forest village it was in an urban centre on the border of three countries, thus making control difficult because of different bureaucracies and a reluctance to admit to the Ebola infection because of the economic consequences. WHO responded by saying the numbers were still small. A dispute then broke out on social media between MSF and the WHO’s spokesman, who insisted it was all under control.
So, the West African national organisations screwed up. However, Nigeria and Senegal seem to have done well, so we need to do a discriminant function analysis sometime soon. The key patient is always Patient Zero. Nigeria seems to have had a sharp diagnostician, and sufficient toughness among key health workers to face down threats from the Liberian embassy. Nonetheless they lost 8 citizens because they tried to help an uncooperative infected Liberian diplomat. However, they have saved their fellow citizens, so far. A success story.
Next, the USA. Before launching into lamentation, we need to do a mini meta-analysis. The USA has been tested by an Ebola carrier who did not tell the truth about having been in contact with Ebola. This is the real test for the Western world. Not everyone fills in forms correctly. The US response has not been brilliant, but it might improve as they move their cases to specialist centres. What is clear is that one case can put 2 lives at risk even in supposedly competent hospitals. It can also damage the equanimity of many citizens, who are put at risk. Having worked on the Camelford water pollution case in the UK, I know that these health scares can be a source of medium term, low grade worry, even when the health authorities do their best to be reassuring. 
Spain has less excuse for its record. They knew the returning priests had the disease, but did a poor job of protecting their medical staff. Britain handled its one case well, in a super-specialised unit. (He wants to go back, imagining that his having caught Ebola in the first place is an additional qualification). Germany and other European countries have handled their pre-booked cases well, in the sense of no further infections. These figures from the BBC may be a little out of date, but the overall Western death rate is 4, with 6 recovered, and 7 in treatment. It is much better than the African experience of 70% death rate, but it is a bit early to say that the fancy drugs, blood transfusions, and close contact nursing are winning the day. The death rate might turn out to be 4 out of 17, which would be very good. Currently it seems likely that all the infected new cases might survive.
 
So, we do not have a good estimate of how many new infections will be caused in the West by each unannounced Ebola carrier, but 2 per case seems likely, in line with the African estimate. There is evidence from Ng and Cowling (2014) that the virus lasts longer in cooler and moister climates, which might be relevant in the US and Spanish cases. 
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20892 
What now for the Western response to Ebola. Health services have not always made life easy for whistle blowers. On the contrary, the UK experience is that they can be ostracised. The airline industry was on top of this years ago. They allow pilots to admit errors anonymously, which means they can confess a mistake which acts as a warning to other pilots, and gives guidance to systems engineers as to what needs to be improved. We should have a similar system for health workers (and for car drivers, no doubt). 
http://www.chirp.co.uk/ 
Above all, estimates of human-to-human transmission of any virus need to take into account human foolishness. For every “public awareness” health campaign predicated on average intelligence and average public spiritedness we have to apply a realism coefficient: an allowance for human error in following protocols, plus selfishness, indifference, egotism, deluded altruism and occasionally downright malevolence. Human stupidity is infection’s fifth column. From the viewpoint of any virus, we serve as useful fools. The stupider the human carriers, the higher the eventual human cost. So, every measure of the infectiousness of a disease is also a measure of our intelligence. Adjust the Ro calculations for the IQ calculations.
Finally, what are we to make of the view that the key to solving Ebola is to rush to Africa with trained staff and resources, in order to put out the fire at the source? From a global point of view, given the ubiquity of the wide body jet and the apparent political imperative to keep borders open at all costs, Ebola is being given a free ride, as if it were only fair that it should take hold across the planet: an equal opportunity pestilence. In that sense, going to Africa is an understandable policy, simply because it is the one way left to control the disease. However, health colonialism runs up against some contradictions. If local governments block the prompt rollout of resources, or refuse to publish the true death rates, or fail to pay their health workers, how should the Western health colonialist respond? Should these powers edge towards to imposing good governance, or should they try to battle to bail out the ship of failed nations while corrupt and incompetent local strongmen keep drilling holes in the hull of the sinking ship?
This probably a problem Western government should leave to the Chinese Politburo, who have taken over the colonialist mantle in Africa. 
Leading indicator: watch how many Chinese in Africa get Ebola. If all threats are the ultimate IQ tests, then the Chinese should have a low rate of infection. Equally, the virus should be controlled easily if and when it reaches the Chinese mainland.

Por cierto, España el peor país de Europa en gestión del ébola, por el momento. Y China el mejor del mundo, por el momento. Con muchos chinos en trabajando en Africa, ni un solo caso por ahora.

http://drjamesthompson.blogspot.com.es/2014/10/ebola-equal-opportunity-pestilence.html

[breades]

Teresa Romero da por primera vez negativo de ébola en un análisis

• La auxiliar se someterá a una segunda prueba para confirmar que está libre del virus

No hace ni dos semanas teniamos dos positivos y hoy parece que tendremos dos negativos.

Éso es que hay vacuna ¿o no?

[R.G.C.I.M.]

Esta semana hay madrid barsa .

Sds

[sudden and sharp]

Esta semana hay madrid barsa .

Sds

Y para ese suplicio no hay vacuna, ni se la espera.

[mpt]

....... no hay vacuna, ni se la espera.

passienssia, que va a haber pa tos y patas; espera que aumente un poco la exportacion de fulanos, solo es cuestion de rebajarles un poco los ingresos recurrentes (y los black, claro);

que feo se le esta poniendo la cosa a la morena del ebook


al sr rabago se le parecen cada dia mas "el roto" y ops

[wanderer]

Estudio que muestra cómo la cepa de la presente epidemia de Ébola está mutando tan rápido como la gripe estacional -.uno de los virus con mayor tasa de mutación de los que nos afectan.-. Es bastante técnico, pero de muy recomendable lectura (no lo citaré entero, pero sí destaco los dos escenarios extremos que manejan):

Ebola 2014 Is Mutating As Fast As Seasonal Flu
[...]
Best Case Scenario:

WHO immediately deploys contact-tracing teams on the ground in West Africa.  The US Military is deployed as well, and constructs hospitals sufficient to care for the sick. The hospitals are staffed by qualified (read: well trained) caregivers. Teams on the ground  track down and care for Ebola-infected patients across West Africa, distributing self-treatment kits, food, medicine, and expertise.  An effort is made to involve local authorities and community leaders.  These efforts cause measurable reductions in the basic reproduction number of the virus by the end of 2014.

Within 3 months to 9 months, the outbreak in West Africa peaks, levels-off, and begins to fade.  The Ebola virus never has the opportunity to acquire any significant mutations, due to its limited host pool. Ebola is fully under control by early 2015.  Sporadic cases in other countries are dealt with by treatment and contact tracing.  By Q4 2015, multiple Ebola vaccines and drugs are in the pipeline limiting the overall threat Ebola poses.

Worst Case Scenario:

The international response is perpetually behind the curve. Every response action is 8 to 12 weeks too late.  Statistics from the WHO become volatile and are unreliable as the lack of deployed personnel make hard numbers impossible to pin down. By  2015 the number of infections is in the hundreds of thousands in West Africa. The West African region exports 'asymptomatic infectives' which go undetected by basic screening. These individuals  'seed' outbreaks in other countries.

As more people become infected, a significant mutation arises that allows for a longer asymptomatic but infectious period, increasing the R-0. Globally, cases continue to double every 16 days, contact tracing infrastructure outside the West becomes saturated, and hospitals are overrun. By early-to-mid 2015, the global pool of Ebola-infected patients are in the millions, mainly centered in West Africa and Southeast Asia with multiple strains of varying virulence. A sudden change in the outbreak epidemiology caused by a recombinant Ebola strain causes confusion about how to respond. Efforts at developing treatments/vaccines become logistically complex and ineffective.
[...]

http://www.zerohedge.com/news/2014-10-21/ebola-2014-mutating-fast-seasonal-flu

[traspotin]

El hecho de que mute no necesariamente debe ser malo. Imaginad que muta y consigue transmitirse por el aire...pues igual esa mutación elimina su virulencia...esperemos

[wanderer]

El hecho de que mute no necesariamente debe ser malo. Imaginad que muta y consigue transmitirse por el aire...pues igual esa mutación elimina su virulencia...esperemos

Error: de hecho, el peor escenario posible es que mute para disminuir su mortalidad, al tiempo que aumente su morbilidad (y para ello, el que mute para poder ser transmisible por vía aérea es fundamental). En tal caso, pasaría de ser una enfermedad muy grave y localizada, a una meramente grave (o incluso leve), pero con dimensiones de pandemia.

[Currobena]

El hecho de que mute no necesariamente debe ser malo. Imaginad que muta y consigue transmitirse por el aire...pues igual esa mutación elimina su virulencia...esperemos

Error: de hecho, el peor escenario posible es que mute para disminuir su mortalidad, al tiempo que aumente su morbilidad (y para ello, el que mute para poder ser transmisible por vía aérea es fundamental). En tal caso, pasaría de ser una enfermedad muy grave y localizada, a una meramente grave (o incluso leve), pero con dimensiones de pandemia.

¿Como la gripe o un catarro fuerte?