MERS-CoV snapdate on canaries...

MERS-CoV detections among healthcare workers (HCWs)

HCWs are akin to the canary in the coal mine - when HCWs get sick with a particular bug, this can signal that the bug may well be more active in the the wider community. 

This graph looks at the canaries and suggest that there has been a relatively long period in which they have been getting infected.

Healthcare workers positive for MERS-CoV over time.
Some reported or hypothesized clusters and outbreaks are flagged.
Click on image to enlarge.

A quick look at my database shows that most of the MERS-CoV-positive HCWs reported since October have been from Riyadh in Ar Riyadh region and Taif in Makkah region. 

Just before that, in early September, there were 2 HCWs from Jubail in the Ash Sharqiyah (eastern) region. 

If we look at the new time-based occurrence heatmap I have on my MERS-CoV static page here, the recent group of HCWs come from the areas with most cases. No big surprise there. Perhaps more surprising is why these HCWs are, presumably, still acquiring there infection in hospital settings given eh attention that infection prevention and control practices had, especially (before?) during and after the Jeddah outbreak last year.

A recent paper from Profs Drosten and Memish speaks to this topic of infection control and hospital spread of MERS-CoV a little.[1] 

It reports finding a 40-year old female (40F) nurse who, despite MERS-CoV being such a wimpy transmitter between humans, became infected after attending an infected patient. 40F did not perform any aerosol-generating procedures  but also wore only a surgical mask and gloves - it reads as though she was not fully protected against droplet, and certainly not against airborne, exposure. 

The 40F HCW then went on to shed virus for a 42-day period as determined by MERS-CoV specific RT-PCR. She was not ill during this time. Hard to contain much?

So with all that in mind, it's no longer hard to imagine how spread of MERS-CoV virus occurs within, around and between hospital settings. Also helps to explain how some of the new cases might seem strange - if not testing for subclinical or asymptomatic cases as a routine. I recall that in Saudi Arabia routine testing of milder cases is not occurring, but I cannot find a source for that recollection just now so I stand to be corrected (please send if you know if a reference that alludes to that).

A couple of quick questions spring to mind:

1. Just how widespread is this lengthy shedding period?
2. What does this say about how mild a virus MERS-CoV is when comorbidities are not a factor?
3. What role do genetics play in the host's containment and clearance of MERS-CoV infection?

Heatmap of MERS-CoV detection by date and region
within the Kingdom of Saudi Arabia
Click on image to enlarge.

Reference..

1. A Case of Long-term Excretion and Subclinical Infection With Middle East Respiratory Syndrome Coronavirus in a Healthcare Worker. Manal Al-Gethamy, Victor M. Corman, Raheela Hussain, Jaffar A. Al-Tawfiq, Christian Drosten and Ziad A. Memish.
   http://cid.oxfordjournals.org/content/early/2015/01/01/cid.ciu1135.long

MERS-CoV snapdate...

MERS-CoV detections by month and year

As can be seen from the graph below, the peaks of MERS-CoV detection have been driven by humans and their infection prevention and control issues - but what maintains the virus in between those lapses? 

It seems clear that MERS-CoV is entrenched among camels in the Middle East and Africa but how is it getting to humans, and how is it dong that in such small numbers over such a wide area? These have been questions for 148 weeks. 

It's a good thing this infection transmits so poorly between humans.

Click on image to enlarge.

Case->outbreak->epidemic->publication->learn a lesson...repeat

The global cumulative curve of suspect+probable+confirmed
cases EVD cases (orange) , suspect+probable+confirmed
EVD deaths (red) and the confirmed cases (yellow dots)
Updated from last WHO data posted 10JAN2015 AEST.
Click on image to enlarge.

When looking at the PubMed database search results for 'ebola', one can have no doubt that something big must have happened lately to drive such a massive number of science doers and writers to their keyboards. 

And of course something did - the world's largest, most widespread, multinational and longest running epidemic of Ebola virus disease (EVD) which roared through Guinea, Sierra Leone and Liberia. At the end of 2014 there were 20,000 cases and 8,000 fatalities - and those were just the cases we have seen added to official lists and made public.

A tally downloaded from the PubMed search engine
based on numbers returned using the search term 'ebola'.
Click on graph to enlarge.

The adjacent image shows what the US National Library of Medicine's search engine generates when one searches for 'ebola'. The search engine, called PubMed because it makes the MEDLINE database public (MEDLINE being the Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), lists many of the world's life science and biomedical publications that meet the PubMed standards; currently >24,000,000 citations. In 2014, a lot was written about EVD.

While a lot of the 'ebola' publications in 2014 were commentaries and a lot of reviews that mostly presented the same information, these were necessary to feed many different groups of readers and specialities hungering for background on EVD and the ebolaviruses and how these related to them and their roles, patients and lives. 

I had cause to scan the literature on a daily basis for a few weeks and was particularly impressed with the New England Journal of Medicine's clinical papers and the BMJ's summaries and updates. Of course Science/Sciencexpress and Nature had some beautifully informative articles as well - delving into the humanity behind the numbers and seeking answers to questions we were all asking. I thought PLOS Current Outbreaks (although I'll never enjoy reading that layout), Lancet, Lancet Infectious Diseases and Morbidity and Mortality Weekly Report also stood out in 2014. 

Some of these articles came out very quickly and many were available without the need to breach a paywall. But some of the research...I can't help but wonder how many lives could have been saved if studies detailing and reinforcing the apparent benefits to survival from the aggressive use of intravenous fluids and electrolytes could have come out sooner-through whatever venue. What if we'd talked about, researched or actually published better personal protective gear designs earlier? Imagine if the world had registered that Ebola virus seemed to be in the region years ago, when research papers suggested it. Would any of this knowledge have saved more lives? Who knows? Would the focus on what needed to be delivered to West Africa have changed because of earlier dissemination of need? Would more point of care chemistry instruments have been prioritised? Would the urgency about the need for more healthcare workers have been stepped up if more specific examples of why they were needed were out there for our leaders to be briefed on? Probably unanswerable questions.

Why can't humans ever seem to learn enough to prevent the event sneaking up and whacking us senseless? Why is it always after the event that the light dawns and processes are created for 'next time'?

There will be many more publications to come in 2015, spinning out of this epidemic and the events yet to unravel. Hopefully they will create enough memory for the world to be better prepared for next time. Prepared for a little...uooh - goober fish...

H7N9 outbreak #3 underway?

What better way to start 2015 than a snapdate!! For those who are new to them here on VDU, they were initiated here and defined here as snap updates - posts that don't have lots of detail and chat...although they almost always end up having lots of chat!

Figure 1. H7N9 cases by week of onset (or hospitalisation
or reporting dates of the preferred onset date was
not made public).
Click on image to enlarge.

This one is an update of the situation of one of the many avian influenza viruses ("bird flus" if you must) around again - avian influenza A(H7N9) virus, or just 'H7N9'.

In Figure 1, I've taken the huge liberty of adding in the start and end dates of the 3 outbreaks of H7N9 to date; and in doing so, I've said that China is in the early stages of one right now. I may well be wrong of course - this is a blog and these are my opinions - but it looks that way to me. 

Figure 2. China's northern laboratory network influenza
surveillance data up to Week 51 of 2014. [1].
Click on image to enlarge.

The case numbers for H7N9 in Figure 1 have been above zero for a little while and in particular November looked like a busy month (see weekly and monthly tallies here). Keep in mind that there is also a reporting lag - the time between date of onset (obtained from more detailed World Health Organization data) and the date the case was publicly reported (I rely on FluTrackers line list for these details). That delay can be a month or more on occasion; up to 38-days in late December. I suspect this is because China reports cases to the WHO in batches, something instigated toward the end of the 1st and 2nd outbreaks. So I suspect we will see more cases assigned to December, during reports that come out in January.

But it look like 'tis the season for influenza in humans in China (see figure 2 and the Chinese National Influenza Centre [2]) - and as some of us have discussed on Twitter, this is most probably due to the changes in weather (environmental conditions) which result in sustained viral survival on cough and sneeze-contaminated surfaces and in wet and dry propelled droplets and droplet nuclei; in both man and bird (see Hong Kong avian influenza detection report dates [3]). 

That sustained survival may well be all it takes for more of us to pick up an infectious viral dose.

Once the seasonal influenza viruses get a foothold in us, they spread well, causing disease in those who are susceptible and probably a bunch of unnoticed infections in those with previous exposure to that strain plus a healthy immune memory of that intrusion. By "seasonal influenza virus, I mean those that replicate in and circulate efficiently among humans, as opposed to the relatively inefficient avian subtypes.

So stay tuned to H7N9; it's not yet very good at spreading between humans but its established in birds and has been spilling over into humans since at least the beginning of 2013. We know how influenza can deal us a rough hand if the stars and its genetic segments align favourably (for it). Oh, and the continued reliance on fresh chicken obtained from and killed at live poultry markets. The majority of cases have very clearly had contact with poultry as defined by the WHO. 

References...

1. http://www.cnic.org.cn/eng/show.php?contentid=738
2. http://www.cnic.org.cn/eng/surveillance.php
3. http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf

Influenza A (H5N6) virus in humans...

Provinces hosting human cases of H5N6
Adapted from [8]
Click on image to enlarge.

After late December's announcement of a human infection with another avian influenza subtype, H5N6. The tally of human infections by this subtype of FluA stands at 2 - that are reported anyway.

The ever vigilant @FluTrackers (and their line lists, news posts and commentary) and the always alert @Fla_Medic (and his Avian Flu Diary blog) have these cases well covered.

I just wanted to make a summary here for my own reference in making some slides for a talk next month.

1. ~23-April-2014. [1,4,5] 49-year old male (49M) from Nanchong City, Sichuan Province.
   Acute severe pneumonia, died 5-May-2014
   Exposed to dead poultry
2. 3-December 2014. [2] 58M from Guangzhou City in Guangdong province.
   Critical condition in hospital since 9-Dec-2014
   Exposed to live poultry but not ill contacts [3]

There have also been plenty of lethal animal infections by this and other highly pathogenic avian influenza (HPAI; referring specifically to the bird's outcome) subtypes and strains [7], including:

From an OIE Report 21-Oct-2014. [6]

1. 12,000 quails in Quang Nai Province, Vietnam in 18-Dec-2014
   http://en.vietnamplus.vn/Home/Quang-Ngai-destroys-12000-AH5N6-infected-quails/201412/59394.vnplus
2. 1,338 birds on a farm in Nanbu, Nanchoing City, Sichuan Province, China
   http://www.oie.int/wahis_2/public%5C..%5Ctemp%5Creports/en_fup_0000015698_20140731_162951.pdf
3. 20,550 (17,790 fatal) birds on a farm in Shuangcheng District, Heilongjiang Province, China, 23-Aug-2014
   http://www.oie.int/wahis_2/public%5C..%5Ctemp%5Creports/en_fup_0000016060_20141024_193420.pdf
4. Birds in Muang Nan and Muang Xayabouly Districts, Luang Prabang and Xayabouly Provinces, Laos in 12:14-Mar-2014
   http://wwwnc.cdc.gov/eid/article/21/3/14-1488_article#r4

No sign of anything like sustained human-to-human transmission of this viral subtype to date. But another for the influenza virus Rubik's cube.

References..

1. https://flutrackers.com/forum/forum/china-h5n1-h5n8-h5n6-h5n3-h5n2-h10n8-outbreak-tracking/164419-china-man-49-with-acute-severe-pneumonia-died-from-h5n6-nanchong-city-nanbu-county-sichuan-province?t=222782
2. http://www.who.int/csr/don/28-december-2014-avian-influenza/en/
3. http://news.xinhuanet.com/english/china/2014-12/23/c_133874590.htm
4. http://afludiary.blogspot.com.au/2014/05/sichuan-china-1st-known-human-infection.html
5. http://www.promedmail.org/direct.php?id=2451125
6. http://www.oie.int/wahis_2/public%5C..%5Ctemp%5Creports/en_fup_0000016060_20141024_193420.pdf
7. UPDATE ON HIGHLY PATHOGENIC AVIAN INFLUENZA IN ANIMALS (TYPE H5 and H7) from the Office International des Epizooties (OIE), otherwise known as the World Organisation for Animal Health
   http://www.oie.int/animal-health-in-the-world/update-on-avian-influenza/2014/
8. http://en.wikipedia.org/wiki/File:China_administrative_claimed_included.svg#filelinks

Bats in a tree...

Meliandou and the burnt tree that
once housed a bat colony (from Fig 3, [1]).

While not snakes on a plane, I'm fairly sure the level of swearing has at times been at least as bad among those suffering from and dealing with the possible fall-out from these bats - if in fact they were the source for the biggest Ebola virus disease (EVD) epidemic on record.

A recent animal counting, trapping and testing study in Guinea included sampling in and around the village of Meliandou.[1] This village is, to the best of our knowledge, the site of the first animal-to-human, or zoonotic, transmission of the Ebola virus variant called Makona.[2]

The study team, made up of researchers affiliated with Germany, Sweden, Core d'Ivoire and Canada, did not find any decline in numbers of usually susceptible larger mammals around the index village; a sign during other outbreaks, of active local ebolavirus "activity". The team also found that primate hunting was not a big thing in this region, which is rather devoid of these and other Ebola virus mammalian host animals (including few of the Duiker, or forest antelope). Fruit bat hunting was common though.

The team captured 169 bats representing at least 13 different species and 6 families. But in the house of the 2-year old boy considered the epidemic's index case, fruits bats were not eaten and no bat hunters resided there. No Ebola virus RNA was detected in any bats and antibody screening results from bat blood were inconclusive. 

These findings led the authors to study Meliandou, resulting in an hypothesis that a nearby hollow tree that once housed a large colony of free-tailed bats [locally described as lolibelo - small and smelly bats - otherwise known to belong to the species of insectivorous bat, Mops condylurus of the family Molossidea; [3], may have been the source of  infection. Why only one child was infected this way when the tree was a site of frequent play by many children is not known. The tree was burned out in March 2014 which caused many bat deaths, some of which were collected for consumption. Sequencing of a PCR-amplified mitochondrial DNA segment found that in 5 of 11 ash and soil samples from around the tree, contained traces of Mops condylurus genetic material. So that species was at least there.

So, this is all quite far from a conclusive link between the 2-year old boy and these bats. But it does read as though every avenue has been tested in this village, perhaps apart from better animal antibody testing (serology), and some serology on the blood of those villagers who remain alive in Meliandou. 

Serology testing is going to be very important for answering many questions around EVD and this outbreak and epidemic. 

Of course this will raise the usual question of whether we cull all bats to prevent this from ever happening again. Don't be ignorant! Bats have very important roles in pollinating and thus in keeping our ecosystem going. Should we kill all bees because they sting us? I'm pretty sure I've been stung by a bee more times than I've had Ebola/Hendra/SARS/Nipah/MERS/Lyssavirus or any other bat-hosted virus infection. Killing off everything to prevent a very rare zoonotic event when better knowledge can resolve the problem is just a typically short-sighted and knee-jerk human reaction (not a fan-can you guess?).

One question that does still remain, and one that is of extreme interest to me, is how often mild disease results from an Ebola virus infection? Good, robust serology methods to the rescue.


References...

1. Investigating the zoonotic origin of the West African Ebola epidemic. EMBO Molecular Medicine(2014). http://embomolmed.embopress.org/content/embomm/early/2014/12/29/emmm.201404792.full.pdf
2. Nomenclature- and Database-Compatible Names for the Two Ebola Virus Variants that Emerged in Guinea and the Democratic Republic of the Congo in 2014. Viruses 2014, 6(11), 4760-4799.
   http://www.mdpi.com/1999-4915/6/11/4760
3. Mops condylurus via the IUCN Red List of threatened species (listed as of least concern)
   http://www.iucnredlist.org/details/full/13838/0

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

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. 

• Médecins Sans Frontières (MSF)They are meticulous, fastidious and well trained so they don't needlessly risk themselves. They are on the front lines everywhere. They have been all over this outbreak from early one. They warned us.
  http://www.msf.org/
• Direct ReliefThey can (and have) mobilize the personal protective equipment (PPE) and other material. They have contacts with others in industry. They are a nexus for getting this done.
  http://www.directrelief.org/
• International Federation of Red Cross and Red Crescent Societies.They are one the ground helping keep locals informed about Ebola virus
  http://www.ifrc.org/
• United Nations International Children's Emergency Fund (UNICEF)
  Always finding way to help children. There is a large orphaned population in West Africa due to EVD this year.
  http://www.supportunicef.org
• Ebola Response Fund, United Nations Foundation 
  The UN created this fund as way to allow individuals, corporations and civil society organizations to directly support UN entities in their efforts to respond to the Ebola virus disease outbreak.
  https://secure.globalproblems-globalsolutions.org/site/Donation2;jsessionid=5A0017918CF67B11BD1FA907C0DE8C70.app246a?9260.donation=form1&df_id=9260
• Africare
  Among other things, they are helping to outfit health care workers with PPE in West Africa
  http://www.africare.org/
• globalgiving
  Among other things, they help to educate and provide medical supplies to the countries under Ebola virus assault
  http://www.globalgiving.org/
• actionaid
  Spreading awareness about Ebola through village visits, music, explanation, drama...and some pretty cool dancing!
  http://www.actionaid.org/videos/ebola-door-door
• USAID
  Has a link to a range of agencies seeking funds to help stop the EVD epidemic
  http://www.usaid.gov/ebola
• Australia Red Cross: Ebola Outbreak 2014 Appeal
  Providing education, care and aid with burial
  http://www.redcross.org.au/ebola-outbreak-2014-appeal.aspx

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.

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.