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 to...ummm....be 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.