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The Mathematics of Ebola Trigger Stark Warnings

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Re: The Mathematics of Ebola Trigger Stark Warnings

#151

Post by ghshephard »

Padding wrote: post #104
ghshephard wrote: post #95

Earlier quoted context omitted.

"Where do you make the cutoff with your drug experiments? " I don't know where you make the cutoff, but I'm comfortable saying that its somewhere below having a disease with a 50% mortality rate in under 14 days. I'm pretty much okay taking any risk at that point.

You didn't get the point of the argument. What do you do when something with 51% mortality in 15 days comes up? And then something with 49% in 13 days .. where do you draw the line? And what do you do when people continue to cry out?

I got the point of the argument. And, I made it very clear that I don't know where to draw the line. All I know for sure, is that 50% mortality in 14 days comes below that line. Sign me up for an experimental treatment.

Re: The Mathematics of Ebola Trigger Stark Warnings

#152

Post by ghshephard »

rwallace wrote: post #124

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while,…

Your recommendations are exactly contrary to the guidance from those who have spent their entire careers studying the best way of responding to these types of epidemics.

Attempting use "force" to seal off the area, is perhaps the single most effective way to lose all control of this disease, and see it spread to hundreds of thousands, if not millions of people who (quite reasonably) decide to fight back against such an activity.

Careful Training, use of locals who have developed immunity, massive injections of beds, medicine, and supplies, can have a huge impact, and keep this current epidemic under control

Re: The Mathematics of Ebola Trigger Stark Warnings

#153

Post by ObviousScience »

cstross wrote: post #122
waps wrote: post #85

Earlier quoted context omitted.

And who pays for the, potentially unbounded fallout from that decision ? Let's say this happens : http://en.wikipedia.org/wiki/Thalidomide (First read about the advantages of the drug, then move to the crises. in particular the birth defects crisis) And please don't just say that people knowingly took the risk, read the article first to see how that played out. People won't accept the consequences of decisions made u…

There are pros and cons for both sides of this argument. The question is whether to suspend normal precautionary procedures during an extraordinary situation, not whether to ditch normal precautionary procedures which exist for very good reasons (see the Elixir Sulfanilamide disaster for why): http://www.fda.gov/aboutfda/whatwedo/history/productregulati... You're rightly concerned for the possible side-effects of usi…

> who's liable for not deploying an available experimental treatment that is later determined to work, but only after tens of thousands have died while it sits, unused, on the shelf due to lack of test data?

No one, that's exactly the point.

There's no way to sort out misdeeds, eg, fake cures from real attempts if we lift the normal trial and liability procedures. No one would use untrialed drugs if they had to take the full liability.

So the reality is that there is no good way to send only useful drugs there while skipping the filtering process.

If you're okay with some people being poisoned or lied to for money in the hope that some people will get a real drug, then we could make that work, but I'm not sure we want to go down that path.

Re: The Mathematics of Ebola Trigger Stark Warnings

#154

Post by lotsofmangos »

jfoutz wrote: post #148
narrator wrote: post #75

Earlier quoted context omitted.

The American perspective is to solve every problem with the military or money. We believe that violence and more money are the only effective solutions to every single problem the world faces. Original thinking just doesn't happen. A creative solution would be to temporarily halt all regulations on anti-ebola drug development and let them experiment on any willing person in Liberia who wishes to receive treatment. Th…

I'm from the american southwest, there's a kind of snake here who's effects of venom are remarkably similar to the effects of ebola. All the crazy regulation has been holding up any US research, but in northern mexico, a Doctor Stanley has been doing monkey trials. His unique combination of mineral oil seems to boost immune response, while the venom inures the cells to ebola's most harmful attack vectors. I realize t…

Don't listen to that charlatan, you would be much better investing the money in my range of anti-viral mist diffusers. I've had one running for a year now and nobody on my street has Ebola. It also seems to work against tigers.

Re: The Mathematics of Ebola Trigger Stark Warnings

#155

Post by rwallace »

ghshephard wrote: post #152
rwallace wrote: post #124

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while,…

Your recommendations are exactly contrary to the guidance from those who have spent their entire careers studying the best way of responding to these types of epidemics. Attempting use "force" to seal off the area, is perhaps the single most effective way to lose all control of this disease, and see it spread to hundreds of thousands, if not millions of people who (quite reasonably) decide to fight back against such…

Your argument is from authority, but authority is trumped by empirical fact. The kind of strategy you advocate was, yes, the right thing to try back in spring, when there was reasonable hope that it could work. It conclusively failed, at a time when the outbreak was far smaller and more tractable than it is now. It cannot possibly keep the current epidemic under control, because the current epidemic is already not under control, hasn't been for months. Meanwhile, hundreds of healthcare workers have, despite training, been among the dead. No amount of training can compensate for the fact that with a caseload of this magnitude you get overworked to the point of exhaustion and start making mistakes.

By contrast, the strategy I advocate has thus far been working.

Nigeria? Cut travel to the affected area. One idiot had slipped through, causing an outbreak. Because it was only one small outbreak, it was possible to contain it.

Senegal? Same. Tougher problem because it has a land border with the affected area. In response, citizen groups have been supplementing the security forces, patrolling the border and turning back people trying to enter the country, thus far successfully.

Ivory Coast? Cut off travel from the affected area. Thus far, no Ebola detected.

Do you believe in results? I advocate abandoning the strategy that has been proven not to work and focusing on the strategy that has been proven to work.

Re: The Mathematics of Ebola Trigger Stark Warnings

#156

Post by gbrown »

wmgries wrote: post #146

I'm no expert and I'm just as frightened by the spread of this disease as everyone else, but I think people in this thread, and the media in general, are being a tad "end-of-the-world"-y about this without looking at some of the important facts. Namely: 1) The article mentions the R0 of Ebola and claims it is between 1-2 in the current outbreak. Previous outbreaks of Ebola have been as high as 2.7. But this is relati…

A basic reproductive number of two can be really really bad, provided it stays that high. If exponential growth holds long enough, it doesn't matter too much what the rate is, so long as it's above one.

With that being said it varies a LOT between different countries for exactly the reasons you mention. My initial work shows a lot of heterogeneity:

http://grantbrown.github.io/Ebola-2014-Analysis-Archive/Sep_...

I agree wholeheartedly with your last three points. Also, from the looks of things the cheapest and most effective time to tackle the disease was months ago. The second cheapest and most effective time to try to stamp it out is as soon as possible.

P.S. The ProMed daily digests are some of the best and most comprehensive updates on this situation I've seen:

http://www.promedmail.org/

Re: The Mathematics of Ebola Trigger Stark Warnings

#157

Post by gbrown »

rwallace wrote: post #124

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while,…

You have no idea what you're talking about. Sealing off the area wouldn't just be a crime against humanity, but it isn't possible. This is a region with little infrastructure and extremely porous borders.

The reason things got out of control is that the world relied on charitable organizations to fix things, but the wonderful folks at the MSF were quickly outgunned.

Re: The Mathematics of Ebola Trigger Stark Warnings

#158

Post by rwallace »

gbrown wrote: post #157
rwallace wrote: post #124

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while,…

You have no idea what you're talking about. Sealing off the area wouldn't just be a crime against humanity, but it isn't possible. This is a region with little infrastructure and extremely porous borders. The reason things got out of control is that the world relied on charitable organizations to fix things, but the wonderful folks at the MSF were quickly outgunned.

I would suggest actually reading about the facts of the case before commenting with such unfounded confidence. Empirically, sealing off the area has been working so far. The wonderful folks at the MSF were not outgunned - they had resources that seemed adequate to the task - if you read the article I linked, it explains the actual reason things got out of control. And this disease has the potential to rack up a nine digit death toll if we fail to contain it. Allowing that to happen would be the crime against humanity.

Re: The Mathematics of Ebola Trigger Stark Warnings

#159

Post by gbrown »

rwallace wrote: post #130
JulianMorrison wrote: post #126

Earlier quoted context omitted.

A cordon sanitaire won't work. You're betting against the ingenuity of every single person trapped behind it, and the inevitable infected refugees are very motivated to confound efforts to find them.

No, I'm betting the world's medical resources can contain the occasional small outbreak created by the occasional individual who gets past the cordon, particularly since such containment doesn't have to last forever. You can't put out an inferno, but you can put out scattered sparks.

We're talking about a region with more than 20 million people, and recent research indicates that the disease may become endemic rather than burning itself out. Cordons would just hamper our ability to get aid in and try to keep infected patients isolated. What's needed is immediate and large scale increases in the number of isolation beds available in field hospitals, tons of PPE, and trained personnel. Or perhaps we should ignore the consensus of the entire infectious disease and medical communities.

Or perhaps we should ignore the best advice of both the medical and epidemiological communities and throw our effort behind an impossible and inhuman military containment scheme...

Re: The Mathematics of Ebola Trigger Stark Warnings

#160

Post by gbrown »

rwallace wrote: post #158
gbrown wrote: post #157

Earlier quoted context omitted.

You have no idea what you're talking about. Sealing off the area wouldn't just be a crime against humanity, but it isn't possible. This is a region with little infrastructure and extremely porous borders. The reason things got out of control is that the world relied on charitable organizations to fix things, but the wonderful folks at the MSF were quickly outgunned.

I would suggest actually reading about the facts of the case before commenting with such unfounded confidence. Empirically, sealing off the area has been working so far. The wonderful folks at the MSF were not outgunned - they had resources that seemed adequate to the task - if you read the article I linked, it explains the actual reason things got out of control. And this disease has the potential to rack up a nine…

If you'd followed the outbreak as you seem to claim, you will have seen that they succeeded to a large extent in Guinea, but the subsequent spread to other areas overwhelmed their capacity quickly, and that efforts to contain the spread were complicated by having to work with three (unprepared and weak) governments. Oh, did I mention that Guinea did try closing the borders and was unable to?

I'm writing a dissertation on infectious disease spread, and your comments strike me as uninformed and harmful. The time for massive action is now, and pipe dreams of impossible (and downright inhuman) international quarantine cordons only confuse the issue.

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