
How the world’s health organizations failed to stop the Ebola disaster - rpm4321
http://www.washingtonpost.com/sf/national/2014/10/04/how-ebola-sped-out-of-control/
======
yeison
According to this article, it seems like a lot of health care workers are
catching the disease. Even the westerners who are familiar with the
transmission mechanism of the disease. Therefore, isn't possible that we are
underestimating how easily the disease can spread?

~~~
timr
_" isn't it possible that we are underestimating how easily the disease can
spread?"_

Yes, though the number of health care workers catching the disease in West
Africa is more indicative of the total lack of basic medical supplies there,
than anything else. Last that I heard, the MSF has a very low rate of
transmission to medical staff because they're properly outfitted and strict
about decontamination protocols.

That said, too many people are repeating the _" it isn't airborne"_ line as if
it has great significance. Ebola doesn't _need_ to be "airborne" \-- it's
contagious enough, simply because it's very difficult for human beings _not_
to come into contact with "bodily fluids", particularly when they're caring
for sick people.

The fact that Ebola "isn't airborne" is comforting from the perspective that
it isn't likely to spread to large numbers of people in public spaces. But
even so, it's more than infectious enough to cause an epidemic.

~~~
towski
This will be the first time humans have ever underestimated nature

------
lotsofmangos
Donation pages for Médecins Sans Frontières:

[http://www.msf.org.uk/make-a-donation](http://www.msf.org.uk/make-a-donation)

[https://donate.doctorswithoutborders.org/](https://donate.doctorswithoutborders.org/)

~~~
bainsfather
MSF are a great organisation - very efficient and clear-headed in what they do
- ~"ok, here's how much money we spend, how do we help the most people?"

And in the past they have even said ~"actually, for disaster x, we cannot
efficiently help any more people, please stop donating money" \- not many
charities would be that honest.

If you want to donate your money, MSF will likely do the most good with it.

------
powera
Sometimes I worry that the epidemics (or potential epidemics, rather) will
continue until eventually our incompetence in large-scale organization
overtakes all of the 20th century innovations in medicine.

------
tokenadult
I read through the comments here, and read through the article, and I guess
it's hard for people who mostly deal with first-world problems to wrap their
minds around what it's like to live in a much poorer place. "West Africa was
ill-equipped for an Ebola disaster because civil war and chronic poverty had
undermined local health systems and there were few doctors and nurses. Health
workers in the region had never experienced an Ebola outbreak and didn't know
what they were seeing in those first critical months." Yes. The ebola virus
had previously appeared in other parts of Africa, and previous outbreaks have
always fizzled out. There are so many urgent health problems in west Africa
that at first ebola didn't look like it needed an all-hands-on-deck response.

One part of that "there were few doctors and nurses" in west Africa has to do
with the brain drain. People with medical training in west Africa are well
positioned to emigrate to other countries. In the six years of my late dad's
life when he was completely paralyzed from the neck down, one of the long-term
care facilities where he stayed for quite a while was staffed mostly by
Liberian immigrants, with various job classifications. The Liberian immigrant
community here in Minnesota (and the Tibetan immigrant community, and several
other groups of immigrants) is mostly employed in hospital and nursing home
work, with the more skilled immigrants of course making MUCH better incomes
than they could in their home countries. Our gain is another country's loss in
the short term. (Eventually, interchange of people through immigration helps
both the sending and receiving countries, because ideas and trade ties flow
both ways, but those networks take time to build up, and freedom and stability
in the developing country to have best effect.)

The stark differences between life in a barely developing country and life in
a developed country are hard for people to imagine if they haven't experienced
them. Not many participants here on Hacker News have first-hand experience
with this.

------
danieltillett
What I want to know is why anyone think this outbreak is going to be brought
under controls anytime soon. Looking at the size of the outbreak and with with
the R0 well over 2 since August there is nothing that makes me think it is not
going to hit the predicted 1.5 million infections by January. Then what?

~~~
skmurphy
I think we will see an infected person make it out of West Africa at a rate of
one per month to one per week. We have one case in Dallas and a case earlier
this summer in Nigeria. Both were contained but as the number of infected
people goes up in West Africa the pressure to leave is going to be greater.

On July 20 Patrick Sawyer entered Nigeria in an infected state and infected at
least 20 people, 8 of whom died. See [http://www.washingtonpost.com/news/to-
your-health/wp/2014/09...](http://www.washingtonpost.com/news/to-your-
health/wp/2014/09/30/nigerias-ebola-outbreak-may-be-coming-to-an-end/)

On Sept 20 Thomas Duncan arrived in Dallas, and was subsequently diagnosed
with Ebola. At least 15 people are at high risk for contracting the disease
and another 100 had some risk of exposure.

If you take two cases in two months it's not an unreasonable estimate that at
least one person a month will escape the quarantine protocols. The protocols
are likely to get better but the number of infected people trying to leave is
likely to be substantially higher in each month going forward for at least
three to six months. If the numbers hit the upper end the current CDC estimate
(1.5 million infected) then it's likely the "escape rate" will be much higher,
hence an estimate of one per week.

~~~
tomjen3
Right now the protocols aren't nearly strong enough, hopefully we will close
air travel for anybody who has been in west africa, which should prevent
people from escaping.

Right now the excuse is that they can't infect anybody while one the flights,
but that is not really the concern - the concern is that they end up infecting
others after they land.

~~~
ghshephard
" hopefully we will close air travel for anybody who has been in west africa"
\- CDC advises against this. It does more harm than good, and makes it
difficult for supplies, and medical staff to travel in/out of the area. Also,
once you put in travel restrictions, you enter an adversarial rather than
cooperative phase, and people start to fight you, rather than work with you.

[http://www.politico.com/story/2014/10/ebola-us-
border-111581...](http://www.politico.com/story/2014/10/ebola-us-
border-111581.html)

What I don't understand, is why don't we enhance screening for anyone who has
travelled recently in West Africa? I get pulled into secondary every time I
note I've visited a "Farm" \- you would think the impact on the system
wouldn't be that great to just ask a few questions (and take a temperature) of
people who've visited ebola impacted regions.

~~~
tomjen3
I read the story and they don't get the problem - the problem isn't saving
people in Africa, but making sure the disease doesn't spread via people who
travel on airplanes.

~~~
ghshephard
Speaking from a US centric view, the only way to protect America is to control
the disease at it's source. If you prevent air travel, you make it difficult,
if not possible to control the disease.

By putting on travel restrictions, you will lose control of the disease and
jeopardize the United States.

So, in effect, if you wanted to spread the disease and put the United States
in grave danger, you would put travel restrictions in place.

------
001sky
There was a good point made in a nother piece that ebola is highly infectious,
but not so much readily contagious. Its worth considering the subtle
distintion to appreciate how difficult it is to deal with. It spreads somewhat
rapidly nonetheless because of the problems that trace amounts of contaminats
cause. Not because the cantaminants themselves are necessarily widespred or
pervasive in the environment.

[http://www.washingtonpost.com/news/to-your-
health/wp/2014/10...](http://www.washingtonpost.com/news/to-your-
health/wp/2014/10/03/can-you-catch-ebola-from-an-infected-blanket/)

------
a8da6b0c91d
[http://atoday.org/adventist-mission-doctor-speaks-ebola-
cris...](http://atoday.org/adventist-mission-doctor-speaks-ebola-crisis-
foreign-aid.html)

This doc claims the "health organizations" and aid helped _cause_ of the
epidemic. Weird diseases happen so often in that part of the world the west
africans know how to deal with it. They quarantine an outbreak village and
have the surrounding villages drop off food until the infections burn out. But
recently everybody got so excited for the foreign goodies that materialize
when you say "ebola," traditional quarantine procedure went out the window.

~~~
HarryHirsch
You read other stuff from that website, like this [http://atoday.org/god-
create-evolution.html](http://atoday.org/god-create-evolution.html) or that
[http://atoday.org/wilson-ii-president-adventist-general-
conf...](http://atoday.org/wilson-ii-president-adventist-general-conference-
believe-earth-billions-years-old.html), and suddenly you are unsure if you are
dealing with trolls or kooks.

~~~
ams6110
Maybe, but it's hard to argue logically against the notion that strict
quarantine would be effective, if brutal way of containing the outbreak.
Building large central makeshift treatment centers only encourages sick people
to travel and infect new populations.

~~~
HarryHirsch
_strict quarantine would be effective, if brutal way of containing the
outbreak_

With a lengthy incubation time, and in an area that's just emerging from
several decades of civil war quarantine isn't going to happen. The best hope
is that there will soon be a vaccine, preferably before the plague reaches
Calcutta, Karachi, Jakarta or Johannesburg. It's not unrealistic, the virus
mutates only slowly, and India did get on top of smallpox; there is historical
precedent for this approach to work.

Quarantine has never been successful during wartime. The Attic plague happened
in the middle of a war.

------
q2
Couple of points: ( If there are any downvotes, please provide reasons for
downvote, Thanks.)

1\. I understand this is an article about the impact of Ebola virus. But why
does the article highlighted the religious beliefs of the doctors/persons
involved? If we remove that religious aspect from the article, how the
integrity/message of this article's content will be impacted? I think, there
is subtle religious propaganda in the article which is unnecessary to convey
the virus, its impact and required global effective response.

2\. Effectiveness of Govt. organizations (excluding armed forces who are
trained) in majority of nations, especially in developing countries is
doubtful.Organizations like WHO, UN, World bank, IMF also have similar
characteristics on effectiveness, unfortunately but with no other
alternatives.

3\. I am not sure about testing arrangements at US airports. Since US hosts
people from majority of nations who may have travel plans to other nations,
i.e. some sort of hub, virus can reach other nations quickly, if US
authorities fail to respond properly. Hope arrangements are made to test
people who are coming into US. My guess is, testing doctors/nurses, checking
customs/security officials ...etc i.e. _all employees_ at the interfaces i.e.
shipping ports, airports need to be wearing spacesuit sort of dresses as
mentioned in the article so that they themselves won't be infected and become
carriers of virus. This applies to all other countries including in Europe,
China ...etc. Is it happening?

4\. What about the effectiveness of other forms of medicine like
Homeopathy/Ayurveda ...etc on this virus? I think we need to have alternative
options of medicines/treatments, given the danger and magnitude of the problem
to humanity ...etc.

~~~
ghshephard
You might be downvoted because your suggestions are a little overboard at this
point, in particular, "Hope arrangements are made to test people who are
coming into US. My guess is, testing doctors/nurses, checking customs/security
officials ...etc i.e. all employees at the interfaces i.e. shipping ports,
airports need to be wearing spacesuit sort of dresses as mentioned in the
article so that they themselves won't be infected and become carriers of
virus."

The Risk/Reward of spending money on hazmat gear for every screener who has to
work secondary (presumably you are suggesting that we would only screen people
who had just come from an ebola active area) is pretty weak.

~~~
q2
I agree that I am suggesting screening of only those, who are coming from
Ebola active area. As this article mentions, incubation period to see symptoms
by other humans is between one week to three weeks after infection. But tests
may catch before. Since we are living in globalized world, where people move
across borders, I am worried about people carrying virus unknowingly. Many
parts of Asia are very dense and it may be overnight catastrophe if this
happens. So authorities at the hubs of human activity (US/Europe/China/Japan
...etc) need to be more vigilant than normal humans outside.

Please note that "prevention is better than care". Thanks.

Edit: small grammar change.

~~~
ghshephard
Vigilant, yes. But full hazmat gear to screen asymptomatic individuals is
going overboard.

------
fractallyte
Liberia has a government. It receives vast amounts of foreign aid. So when the
article says: _" West Africa was ill-equipped for an Ebola disaster because
civil war and chronic poverty had undermined local health systems and there
were few doctors and nurses"_, this is missing the point.

 _Corruption_ undermined the health systems, and much more besides.

Those responsible for this disaster are the Liberian officials who collect a
_minimum_ of $449 million annually from overseas donors, but somehow can't
seem to manage their nation with it. (But their personal bank accounts are
probably very healthy.)

There have been previous outbreaks of Ebola in the region, so no one is
unfamiliar with it. With a growing and expanding population, it was not a case
of 'if', but 'when'; there is no excuse. When this is all over, a number of
individuals - from Liberian government _and_ donor nations - should be
prosecuted for corruption, negligence, and possibly even crimes against
humanity.

~~~
swombat
Liberia population: ~4m

Budget you declare: $449m

UK population: 63m

Budget of the NHS: £109b = $174b

People employed by NHS: 1.35m people

To match the NHS, Liberia would need $11b, almost 25 times the amount of aid
it's receiving. Hell, that's 5 times the GDP of Liberia at the moment. It
would also need to train 85,000 medical professionals (doctors and nurses
mostly) - all that in a country that's just emerging out of war (basically 20
years of civil war ending 9 years ago), has low education levels (60% literacy
- 4 in 10 people you meet can't read and write), zero infrastructure, etc.

Let's not forget that the NHS has been receiving that sort of funding for many
decades - today's infrastructure builds on yesterday's infrastructure, etc.

I put it to you that the NHS would be brought to its knees by 3000 Ebola cases
to deal with. If we ever let it get that bad in the UK, the only way we're
getting out of that is through a complete country shutdown (if that's even
possible in our supermarket-driven world - people would starve; starving
people tend to do stupid things to get food).

Blame corruption all you want (though ironically, Liberia had elections that
were widely regarded as fair, and that resulted in electing a highly
qualified, female president, in 2005), but I think in Liberia's case it is
totally fair to say that with or without corruption this country is extremely
ill-equipped to deal with an Ebola epidemic.

Links:

[https://en.wikipedia.org/wiki/Liberia](https://en.wikipedia.org/wiki/Liberia)

[http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.asp...](http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx)

~~~
fractallyte
No, this is about basic readiness for a number of contagions that are endemic
to the region, which should be prominent on a list of healthcare priorities.

Nine years is a considerable time to be able to fix many of the problems you
mention. After all those billions of dollars in aid, where is the
infrastructure? Education? Compare to post WWII Japan or Korea...

And a comparison to the NHS behemoth - a model of mismanagement, waste, and
inefficiency - is not a good one.

~~~
lotsofmangos
Ebola isn't endemic to Liberia and on health outcomes for money spent per
head, the NHS is considered to be one of the most efficient health care
systems in the world, according to the people who actually measure these
things rather than just spouting off stuff they think might be true.

~~~
fractallyte
The people who measure these things would probably disagree with you. A small,
random, selection:

[https://www.openrightsgroup.org/blog/2007/system-failure-
pri...](https://www.openrightsgroup.org/blog/2007/system-failure-private-eye-
report-into-nhs-it)

[http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/arti...](http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1298986.ece)

[http://www.bbc.co.uk/news/health-12338984](http://www.bbc.co.uk/news/health-12338984)

~~~
lotsofmangos
One computer system overspend, the opinion of Jeremy Hunt, and a report saying
half a percent of the budget could be saved by being more careful when buying
stuff like office supplies.

I note that none of those things is a comparison of NHS with other health
systems.

These are though:

[http://www.telegraph.co.uk/health/healthnews/8877412/NHS-
amo...](http://www.telegraph.co.uk/health/healthnews/8877412/NHS-among-best-
health-care-systems-in-the-world.html)

[http://www.washingtonpost.com/news/to-your-
health/wp/2014/06...](http://www.washingtonpost.com/news/to-your-
health/wp/2014/06/16/once-again-u-s-has-most-expensive-least-effective-health-
care-system-in-survey/#)

[http://www.bbc.co.uk/news/10375877](http://www.bbc.co.uk/news/10375877)

[http://eprints.lse.ac.uk/42050/1/How_the_NHS_measures_up_to_...](http://eprints.lse.ac.uk/42050/1/How_the_NHS_measures_up_to_other_health_systems_%28LSERO%29.pdf)

[http://shr.sagepub.com/content/2/7/60.abstract](http://shr.sagepub.com/content/2/7/60.abstract)

The worst recent estimate I could find was Bloomberg, who had the UK as 10th
out of 51 countries studied, with the US coming in at 41st.

[http://www.bloomberg.com/visual-data/best-and-worst/most-
eff...](http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-
health-care-2014-countries)

