

Ebola Cases Could Reach 1.4M in 4 Months, C.D.C. Estimates - ghshephard
http://www.nytimes.com/2014/09/24/health/ebola-cases-could-reach-14-million-in-4-months-cdc-estimates.html

======
cmrivers
The 'tool' used to generate these results is available for download as an
excel spreadsheet here:
[http://stacks.cdc.gov/view/cdc/24900](http://stacks.cdc.gov/view/cdc/24900).

Today parameter estimates were published in the NEJM [0] that conflict with
the model's default settings. The Eichner incubation distribution, and an
infectious duration of maybe 11 days are better inputs, in my opinion.

[0]
[http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...](http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_home#results=&t=articleResults)

~~~
nicpottier
Thanks for the link, interesting to play with and hats off the the CDC for
being so open with their modeling tools. (also, what people do in Excel just
blows me away)

I played with your suggested settings and while they are indeed alarming, I'm
curious why you think they are better suited. They don't seem to fit the
historical curve quite as well as the default CDC ones.

Do you have more background there?

~~~
Havoc
>(also, what people do in Excel just blows me away)

Same. I work in Excel pretty much all day and rock at using it as a swiss army
knife. But when people use it to build these hectic models then I'm still
thoroughly impressed.

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startupfounder
"...following its current trajectory..."

"In the best-case model...would be “almost ended” by Jan. 20..."

"The current official case count is 5,843, including 2,803 deaths, according
to the World Health Organization."

It would be a very smart investment to contain this outbreak of Ebola and put
boots on the ground.

~~~
anigbrowl
Agreed, sending 3000 US personnel to the area is a risky but ultimately a wise
move. Some other countries have also sent people (China and the UK IIRC) but
in far smaller numbers. I'm very disappointed by the limp EU response -
although they've pledged E180m they're only now meeting to coordinate
logistics and containment strategies, which seems really irresponsible,
notwithstanding the existence of other problems like military conflict in
Ukraine and the ME.

~~~
segmondy
EU should be concerned the most, they will be hit hardest when Ebola gets out
of Africa.

~~~
anigbrowl
exactly. Given that ships regularly cross the mediterranean loaded to the
gunwhales with passengers (or overloaded - two ships sank a few days back and
about 700 people drowned, sadly), there is a lot of potential for an outbreak
to impact Europe. It would probably be containable, but at great expense and
would have a terrible impact upon existing immigrant communities regardless of
actual infection risk.

Hell, if you listened to some people in the US you'd think the US-Mexican
border was one giant hot zone. I shudder to think what would happen if Ebola
turned up in France or someplace.

------
phkahler
Nice paper (linked in the article) but I see one thing that looks like an
error. When comparing different start dates for intervention the have 3 curves
on a plot. Then for "under reporting" they have another plot which looks like
the same 3 curves multiplied by a constant to compensate for the under
reporting.

The problem is that the intervention consists of increasing the percent of
patients getting treatment from 10 percent to 70 percent. But with under
reporting by 2x that would be an actual increase from 5 percent to 35 percent,
which would have a much less significant effect on the total number infected -
possibly not even ending the epidemic. Perhaps they assume the intervention
will include solving the under reporting problem.

Otherwise a very nice report:
[http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_c...](http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_cid=su63e0923a1_w)

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jostmey
Anything that exhibits exponential growth catches people off guard. Just like
the exponential growth of CPU speeds that benefited society, a rapidly
spreading disease could reshape our world in a relatively short period of
time.

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FollowSteph3
That's assuming the current count is accurate which boots on the floor
consistently disagree with:

[http://mobile.nytimes.com/2014/09/23/world/africa/23ebola.ht...](http://mobile.nytimes.com/2014/09/23/world/africa/23ebola.html?referrer=)

[http://racingheartblog.tumblr.com](http://racingheartblog.tumblr.com)

Considering the doubling rate I would personally increase that number by at
least 2-5 doublings...

~~~
roywiggins
>These figures take into account the fact that many cases go undetected, and
estimate that there are actually 2.5 times as many as reported.

~~~
FollowSteph3
Even at 2.5, which to me is low, that 1.4x2=2.8 times another half doubling
and were looking at 4.2 million. That's quite a difference.

If the under estimation is by a factor of 5 then you're looking at 44.8
million.

The exponential value is really important, especially in the early and end
games ;)

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Pxtl
If we don't see a large-scale military-invasion-sized response in the next
week or so, I don't think they're going to stop it. Western Africa is
_screwed_ , along with other any country that lacks the ability to handle the
plague or close its borders.

~~~
AznHisoka
That includes the USA, right?

~~~
natrius
If Ebola sticks with its current mode of transmission, stopping it is
straightforward. Isolate patients, find their recent contacts, isolate them.
Rinse[1] and repeat. It's easy to track down contacts in the western world:
credit cards, post-paid mobile phones, formal employment, etc. It's hard to do
so in developing world slums.

The entire developing world might be incapacitated by the Ebola epidemic. The
western world, not so much.

[1] with bleach

~~~
awakened
How do you track all the contacts from a million infected people?

~~~
trose
The NSA has already shown this to be relatively trivial. Don't think for a
second the government wouldn't harness that knowledge in an emergency
situation such as an Ebola outbreak within the US.

~~~
anigbrowl
The NSA is excellent at tracking communication contacts that establish the
existence of relationships (notwithstanding the potential of false positives).
And this would also work for tracking someone driving around in a car running
errands in specific places.

But if someone arrives in a US city unwittingly carrying Ebola and gets on a
crowded bus or subway car, that's not so easy to track. Likewise if the person
goes to a nightclub or other crowded place. Suppose it's a returning American
who attends a baseball or football game - the NSA may well be able to ID
almost everyone who attended the event, but trying to screen/isolate tens of
thousands of people who might have come in contact with an infected individual
wandering around a stadium is easier said than done.

~~~
natrius
Crowded places aren't currently a significant source of Ebola infections.

~~~
anigbrowl
That could change in short order - don't you remember the Liberian guy who
turned up in Lagos? If he had traveled a few days earlier he would still have
been infectious but might not have been identified as such on arrival.

[http://news.yahoo.com/liberian-ebola-symptoms-dies-
nigeria-o...](http://news.yahoo.com/liberian-ebola-symptoms-dies-nigeria-
official-132822550.html)

------
nickthemagicman
The problem with a huge ebola epidemic is that the more people infected, the
more of a chance the virus has to mutate. If the virus becomes airborne,
rather than infectious via body fluids, the world has an extremely serious
problem on its hands.

------
peterfisher
'Could Reach', what is this Fox news?

~~~
msane
You are right, it is a bit sensationalized. The 1.4M-by-Jan projection from
the CDC is the highest currently and also seems to be the least official. CDC
has stated this as a "worst case" scenario with no intervention. It's hard to
find the source material from CDC but it has been parroted since last week. I
think it may have been a remark from a CDC scientist but not an official
release. It's worth considering other estimates

\- WHO says 21,000 by mid January

\- NEJM says ~10,000 by mid January
[http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...](http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_ebola#t=articleResults)

~~~
basugasubaku
The article links to the CDC report:
[http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_c...](http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_cid=su63e0923a1_w)

The CDC report and the article present both worst-case and best-case scenarios
for Liberia and Sierra Leone. 1.4M is worst-case (no intervention) and "almost
ended" is best-case ("If, by late December 2014, approximately 70% of patients
were placed either in ETUs or home or in a community setting such that there
is a reduced risk for disease transmission [...] then the epidemic in both
countries would almost be ended by January 20, 2015").

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zvrba
IMO, invading some African countries, searching for sick people and enforcing
quarantine would be more useful than getting involved in a new war in
Syria/Iraq.

~~~
jbigelow76
That sounds like an excellent plan for containment. Send tens of thousands of
troops over to Africa to corral people, bringing them in close contact, then
send the troops back to their home countries, nothing could possibly go wrong.

~~~
dreamweapon
_Send tens of thousands of troops over to Africa to corral people,_

How now?

You might want to read an article or two about the proposed Liberia mission --
and about what is actually being proposed as a role for the U.S. troops there;
and why this proposal has gotten the support of the World Health Organization,
among others -- rather than just put out whatever fanciful speculations that
might pop into your head.

