Ebola Cases Surge At Record Pace As Death Toll Hits 1,145

Tyler Durden's picture

Is it any wonder that both the WHO and Doctors Without Borders appear in full panic mode, explaining that the outbreak is "moving faster" than they can manage it? As WHO reports, the death toll in West Africa has jumped to 1,145 (2,127 infections) with 76 new deaths in the last 2 days and a record-breaking pace of reported new cases (152 in the last 2 days).

 

New cases...

 

and deaths...

 

Source: Ecologically Oriented blog

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StackShinyStuff's picture

My ass bleeds for these people, no wait...

Bloppy's picture

Sorry, pumping NFLX more important, Ebola not a concern

Publicus's picture

Those who know the ways of health will survive. Those who depends on the sickness industry will die.

 

The good news, Ebola will burn itself out in a year's time.

 

Mar, 2014 – Infected: 104 Dead: 62 ROI: 1.86
Apr, 2014 – Infected: 203 Dead: 122 ROI: 1.95
May, 2014 – Infected: 417 Dead: 250 ROI: 2.05
Jun, 2014 – Infected: 898 Dead: 539 ROI: 2.15
Jul, 2014 – Infected: 2,031 Dead: 1,218 ROI: 2.26
Aug, 2014 – Infected: 4,821 Dead: 2,892 ROI: 2.37
Sep, 2014 – Infected: 12,016 Dead: 7,210 ROI: 2.49
Oct, 2014 – Infected: 31,448 Dead: 18,869 ROI: 2.62
Nov, 2014 – Infected: 86,421 Dead: 51,853 ROI: 2.75
Dec, 2014 – Infected: 249,365 Dead: 149,619 ROI: 2.89
Jan, 2015 – Infected: 755,513 Dead: 453,308 ROI: 3.03
Feb, 2015 – Infected: 2,403,461 Dead: 1,442,077 ROI: 3.18
Mar, 2015 – Infected: 8,028,264 Dead: 4,816,958 ROI: 3.34
Apr, 2015 – Infected: 28,157,589 Dead: 16,894,553 ROI: 3.51
May, 2015 – Infected: 103,695,185 Dead: 62,217,111 ROI: 3.68
Jun, 2015 – Infected: 400,969,208 Dead: 240,581,525 ROI: 3.87
Jul, 2015 – Infected: 1,627,993,821 Dead: 976,796,293 ROI: 4.06
Aug, 2015 – Infected: 6,940,388,486 Dead: 4,164,233,092 ROI: 4.26

Divided States of America's picture

Wheres the best place to try out a new bio-weapon???? of course in Guinea, Africa.

The current scenario is akin to having some mad scientists needing GUINEA pigs to test on and so just lures homeless people off the street as his lab rats. When they go missing, nobody gives a shit or even notices it.

Us Americans are oblivious to Ebola...I still get many people telling me DONT WORRY, IT WONT SPREAD OVER HERE!

Herd Redirection Committee's picture

What, they were underreporting?

Look at my *SHOCKED, SHOCKED I SAY* face.

HobbyFarmer's picture

Hard to get an accurate count when medical personnel refuse to show up and hospitals are closed down.  Nobody is walking the streets counting stacked bodies.

We will never know an accurate number of infections and deaths....just remember to panic early.

power steering's picture

Its easier to track using fruit bat futures

kaiserhoff's picture

WHO now says there are "neurological disorders" in the survivors..., translation, brain damage.

We may not be talking about the same things when we say recovery.

Expect bad news from Atlanta, if there is any more news.

espirit's picture

Hockey stick recovery!

Mother Nature wins again.

Parrotile's picture

Available information certainly indicates the "survivors" continue to need very substantial support, with a prolonged period of convalescence. Add in neurodisability, liver damage, renal damage, and how long before the "survivors" succumb to some other illness? I'd imagine that catching typhoid after "surviving" ebola is going to cut another swathe through what's left of society.

Raymond K Hessel's picture

 

 

 

We are in your state

We are in your cities

We are in your streets

You are our goals anywhere

Herd Redirection Committee's picture

The prevailing view in Africa has been: "You go into the hospital, and you come out dead"

The classic Post hoc ergo propter hoc (OK, I had to look that up) logical fallacy.

Citxmech's picture

You mean you don't have them all memorized?

=]

MachoMan's picture

They're only useful in academic papers...  if you try them in court, then the judge will just scratch his head and opposing counsel will look the other way until you just go on...

erkme73's picture

Finally!  Some more Ebola-based fear-porn!  I've needed a fix for the last few days.  Alas, now I have to wait another weekend for the next update.  C'mon Tyler, keep it coming!

Parrotile's picture

Ebola is a Containment level 4 pathogen: No effective cure, potential to cause widespread death / injury within a population.

In my early career (when I was younger and rather braver / more foolhardy) I worked with such organisms in a BSL4 environment. The only reason I (and my colleagues) are alive is because we took extreme (and I DO mean EXTREME) precautions to avoid personal, and environmental, contamination.

I've seen what the filoviridae can do to other mammals / primates (and very quickly). I know what Ebola, and all the other HF viruses, can do to us.

For me, as an Infectious Diseases Physician, this is NOT "Doom Porn", but a very long expected wake up call. Do we have "contingency plans"? Seeing how even basic infection control is so poor in Aussie hospitals that we regularly have widespread outbreaks of Norovirus in our wards (as well as Clostridium difficile infections), it is pretty obvious that complacency is rampant. Seems the case everywhere, especially when "Senior Management" are more concerned with budgetary savings than real (as against "window-dressing") service quality (and Patient Safety) improvements.

 

Miffed Microbiologist's picture

Thanks for posting. I know you have had extensively more experience in this realm than I. I have read so many technical papers on Ebola it has left me in despair. I see no hope in an effective vaccine ever being developed for this. The pathogenicity is just so incredibly great. When people talk of silver and vit C as therapy I just cringe. This is not Flu. And here I was predicting a novel coronavirus as the next epidemic. Silly me.

During infection, Macrophages and monocytes are releasing a cocktail of proinflammatory cytokines that destroy the vascular endothelium, but also activate the coagulation cascade. This puts your body in a paradoxical state in which you can die of hypovolemic shock from massive hemorrhage, or from catastrophic thrombosis, the formation of blood clots around the body and avoiding the human immune system. I've seen many people die of DIC by alone, I can't imagine having a virus such as this as well.

Perhaps a treatment for Ebola could involve deshielding the immune-relevant surface proteins of cells infected by Ebola, by either biochemical targeting or preventing the Ebola glycoprotein from inserting itself in the cell membrane. I don't have the necessary background to specifically propose how to do this. There doesn't seem to be an adequate formation of neutralizing antibody. Certainly if an effective one were ever developed, it must be administered very early in the infection.

All I can come up with is "run". That certainly doesn't sound professional or scientific. Help me obi wan Kenobi you are my only hope.

Miffed;-)

Parrotile's picture

Ah, DIC. Been there, seen it, HAD IT (Ps. aeruginosa sepsis, a week's stay in a very well equipped UK ICU and even with the best of the best, I had a number of close shaves (parents called, "get here quickly if you want to see your son alive" sort of close shaves)).

So, having had such a life changing event believe me when I say I'm somewhat freaked out by this. I KNOW people who work for MSF (Clinicians and RNs alike), and all I hear from them is that Africa is still the same old corrupt, unstable Continent it has always been. "Aid" goes into the pockets of the well-connected, and local warlords, PPE is re-used (and re. your earlier posting, if aseptic technique in Aussie "First World" hospitals is so bad that we spread Noro with absolute certainty, then you'd be horrified to hear the stories I've heard on what happens there. Things along the lines of washing disposables in water that will be used for human consumption (stream, not chlorinated!)).

The problem as you know is the mode of budding. The coat is derived from the host cell, and although some specific surface proteins are expressed, the immune system sees "mostly host", and so the response (humoral and cellular) is at least delayed. Note also the lymphoid target cells. We just don't have the technology or facilities to do what you suggest (and we certainly don't have the time). I've no idea how host acclimatisation will proceed, but a certainty is that acclimatisation will "improve" infectivity, not necessarily host survival. With the bad news from WHO and elsewhere re. organ damage (liver, kidneys, lungs, and now CNS) "survivors" are pretty much a sitting duck for anything opportunist, and if we have any kind of services disruption, typhoid would be my next big concern (assuming I'm still around, and that's not at all certain.)

I've mentioned further on down the need to not place too much reliance on the "official" figures.  I prefer to use the "Margaret Chan" factor - i.e. multiply it all by 20. Then we get a real feel for what's going on, and the news isn't good M'am!

Ethical dilemma: do we attempt to treat patients who will probably die (and probably kill HCWs along the way), or do we "palliate" as best as possible? When does "Palliation" become Euthanasia, and when does Euthanasia become "Shoot on Sight"?

Do we preserve the unpreservable, or do we conserve what resources we have for effective management of the aftermath? Will there be anything worth conserving anyhow?

Right now Run Like Hell seems as good a strategy as any. We're planning a trip to Pitcairn Island . . . . . .

erkme73's picture

Me too, me too!  I had an 8-day stint in the ICU with sepsis - with full DIC - renal, pulmonary, and hepatic failure.  Activated c-protine (Xigris), along with a boatload of pressors returned my MAP above 40 on the 4th day.  Close shaves a plenty.   Sadly, none of the countless doctors assigned to my case were ever able to determine the cause of the infection.  

Parrotile's picture

You do know that Drotecogin alpha (Xigris) actually killed more than it saved (hence global withdrawal a few years ago!) You're one of the survivors!

Mine was well before such pharmacotherapy existed, and maybe that was a good thing. My colleagues freeze-dried a sample of "my" organism, and I still keep it in the desk drawer (safely sealed in a glass vial), as a reminder of how fragile life can be.

 

Miffed Microbiologist's picture

Egads! My guess would be GNR sepsis like Parrotile. That is the classic way and the most frequent cause of DIC deaths I see. My typical day. Blood Culture positive for a GNR. I go to Coag. PT and PTT high, fibrinogen low and a shit load of split products. Fuck, I've got to call the dr fast. Before I can. Blood Banks phone is ringing. We need 4 units of FFP thawed STAT!! Nights from Hell I'll never forget. Many died. Hard to stop DIC when it starts. Only easy ones were the placenta ruptures. Minutes after an emergency c section it usually stops.

Miffed;-)

Parrotile's picture

M'am, you'll know that FFP is hardly  a "bulk item" that you can easily restock!

Imagine how quickly your service would collapse if you had, say, even ten Patients needing JUST 4 bags? But they won't of course, and that's when the Red Cross start to call other centres (who also suddenly need FFP and LOTS of it, and RIGHT NOW!)

Panic. Leads to bad choices / disorganisation, leads to service collapse. No matter what other volume expanders / crystalloids you have, you NEED the components in plasma. Succinylated gelatin or hydroxyethyl starch just ain't the same!!

No FFP - "bye, bye Patient" Can't use whole blood since too many RBCs lead to sludging, and the clotting factors are absent (so useless for the purpose intended).

Maybe a little too late to rethink the "JIT delivery schemes" much loved by the bean counters!!

Miffed Microbiologist's picture

Absolutely. My record was 100 FFP when a liver transplant went bad. A friend at another hospital topped that. I wreaked several once trying to squeeze the ice out I precipitated the cryo. Just as I was going to toss it in the trash, the surgeon ran in the lab covered in blood, grabbed it out of my hands. I TOLD YOU I NEEDED IT NOW he shouted at me and ran out. We all just gave each other WTF looks wondering who was doing the surgery. That was a severe auto accident with multiple crushing injuries, another DIC fatality.

We only routinely stocked about 25 units of FFP in all blood types back then. I'm sure it's more now but I haven't worked BB in years. Even with proper facilities, can you imagine the amount of FFP needed for just one Ebola case? And consider the panic during the outbreak. Who is going to go down to the neighborhood blood drive to donate? Yeah, I can see the lines waiting for pheresis. We are so doomed if this gains traction.

Would you like some company on Pitcairn? My mother-in-law had a trip on Easter island and had a wonderful time. Kinda wish I was invited. A remote quiet island has a strange attraction for me now.

Miffed;-)

Parrotile's picture

One bag per donation, and a far lower safety margin than even cytotoxics. Although the screeing processes are very comprehensive, blood products always carry the risk of accidental infection, and as the infusion count rises, the "chance" of being unlucky rises too.

 As an ex BB Scientist, you'll be aware of the cost per session - the Haemonetics "disposable centrifuges" were not budget, then add in post harvest processing, freezing, storage, and supply logistics (dedicated transport, 24/7 availability), and the costs mount.

Pitcairn, though attractive, may well be "pie in the sky".  Even though retirement (and NOT "Early retirement" by any means) beckons, I do have a moral and professional responsibility, and I feel I should do as much as reasonably possible to mitigate "the problem" if things progress as an Epidemiologist colleague cheerfully predicts. If we're told "Nothing you can do any more, do your best to look after yourselves" then off we will both go, and we'll find out what fate has in store for us on the deep blue seas.

You both need a crash course in blue water sailing, and astronavigation (since the GPS constellation will be unreliable). GPS time data should remain adequate for a long while, so you don't immediately need an accurate onboard clock, but you will need a good sextant and sight reduction tables.

Pitcairn's 25 deg 0.3' South, 130 deg 06' West. Currency is Kiwi $s, and for us Aussies, our passport allows visa-free migration. Maybe if it does go "T***s up*, we'll see you there???

P.s. - just heard THIS on the radio. http://www.abc.net.au/news/2014-08-15/ebola-outbreak-vastly-underestimated2c-says-who/5674068 NOT the sort of news I prefer to hear right now.

Ionic Equilibria's picture

Thanks for this summary.  I haven't read up on the mechanisms.  So the coat is mostly derived from the host cell?  OMG!  If so, it will make immune surveillance problematic to say the least.  Well, then, the big question more  than ever is just how infectious this sucker is.  Stay tuned for the next exciting episode of How Contagious is Ebola?  Is it more like flu or more like HIV?

BTW, are you aware the Aussies inavertently invented a biological weapon of mass destruction over 10 years ago when they were fooling around with overexpressing IL-4?  They considered not publishing but decided to go for it anyway.  Very interesting.  The mechanism was like AIDS on wheels.

Parrotile's picture

Yes, and that's just another example of us thinking we know how the "system" works, but having an incomplete picture. I still remember the fanfare when Centocor developed Centoxin (an anti-TNF antibody) that "would revolutionise sepsis survival". It sure did - Clinical trials showed it to be better than placebo at killing those with GNR sepsis!!

The entire humoral surveillance system is very finely balanced, after ages of development. Then we come along and think we can "fix" the problem without any thought of downstream consequences.

The same mind set as trying to fix a pocket watch using a hammer, in a darkened room . . .

Parrotile's picture

Whilst ebola seems pretty effective in circumventing host defences (e.g. tetherin, usually effective in inhibiting retroviruses), it is nevertheless a retrovirus, with essentially the "same machinery" as HIV, and I'm wondering whether our existing toolkit for management of that other retrovirus - HIV-1, might provide some mileage?

Whilst the "anti-HIV" drug classes are all trialled specifically with HIV Patients, there might (should?) be some cross-over efficacy, maybe in higher than usual doses, that may give the host some time to mount an effective response against ebola? Do we have the resources? Funding, availability, Government approval for such an "off-label" use?  Could our Pharmacies even get hold of sufficient supply in a hurry, with a reliable re-stock capacity?? With so many "invisible links" in the Healthcare supply chain, guaranteed supply becomes uncertain.

Another major problem, is that ebola infection is so subtle initially - how many Patients do we turn away from ED every day, with "minor viral infections", those with headache, arthralgia, mild pyrexia? Common Cold, mild viral URTI, non-specific viral illness? "Go home and rest for 24 hours, plenty of fluids, and paracetamol. If there's no real improvement after 2 days, return, or see your GP" Early ebola mimicks these symptoms exactly, and not every case has the high fever. Even if they do, we'll do an l.p., (comes back "normal parameters"), so we might send them to a short-stay ward (Medical Assessment Unit usually) for a few days of IV Aciclovir pending blood cultures, then off home. Aciclovir doesn't work against ebola, so we could easily have an infected, infective patient in a general ward, with no known need for special contact precautions. Open visiting too, so plenty of visitors to spread "it" far and wide.

Do we turn away ALL Patients who might have bacterial meningitis? Doing that would be a Public Health catastrophe in the making, and we cannot "assume" that every patient coming in with mild photophobia / headache / neck stiffness has viral meningitis. So we HAVE to at least consider treatment for a few days, and by then we could have a major problem, including a major Staff Health problem.

No Nurses / Clinicians / everyone else in the "Service Chain", no Hospitals, and no effective infection management.

This is the concern. We really need a VERY fast and VERY reliable test. As far as I'm aware, this does not exist, so we really don't know if that patient coming in during the "evening rush hours" is our "index case", and that's where it starts to get scary, especially when you consider the usual ED workload, often junior staff getting ED experience, always a bed management issue, and always pressure to "get them to a ward, or get them out".

Ionic Equilibria's picture

"Whilst ebola seems pretty effective in circumventing host defences (e.g. tetherin, usually effective in inhibiting retroviruses), it is nevertheless a retrovirus, with essentially the "same machinery" as HIV, and I'm wondering whether our existing toolkit for management of that other retrovirus - HIV-1, might provide some mileage?  Whilst the "anti-HIV" drug classes are all trialled specifically with HIV Patients, there might (should?) be some cross-over efficacy, maybe in higher than usual dose..."

My guess, and it is just a guess, is that counter measures will need to be more specific than this if ebola doesn't respond to antivirals.  Have retrovirus inhibitors besides tetherin and Aciclovir been tried?  If both fail, as you've indicated, it looks bad for antivirals in general.  Hmm...  Why doesn't ebola respond to antivirals?

Am I missing something?   Where is the full court press to determine the exact mechanisms and put a spanner is their works?

HIV infects TH1 cells wiping out cell-mediated immunity.  What cell type(s) does ebola target?

Parrotile's picture

Tetherin's endogenous, so we can't (directly) use this. "The Wife" is a Pharmacist (Ph.D. in formulation) and she pointed out to me that many of the HIV toolkit were developed specifically to target HIV components, development being along the lines of computer-aided molecular design, intended to provide the "best possible target affinity".

So unless we're really lucky and the targets in ebola are REALLY similar to the targets in HIV - 1, this line of thought may not gain much traction. Aciclovir has been shown to inhibit HIV-1 in vitro, and some trials have shown a benefit (slowing rather than stopping disease progression), so, since this drug is (relatively) cheap, and (relatively) safe, even in high doses, this could be one possibility of many. In view of the strategies we have to use with HIV-1, I'd be happier if we knew we had a range of "reasonably effective" drugs we could use as a group. That way we'd hopefully maintain efficacy, since past experience has shown "single drug therapy" to be a sure (and fast) way to guarantee resistance development.

ss123's picture

shows we still have almost 2 years to Paaaaaaaarrtaay!

SofaPapa's picture

I have to say, Tylers, I am getting tired of your "red arrows at the end of charts" schtick.  It cheapens whatever message the actual data might be sending, and these charts are a perfect example.  The most recent data points do not confirm your "doom arrows".  Doom porn gets tiresome.

yogibear's picture

Not if it spreads.

With a 90% kill rate it will decimate demand in the western countries.

Matt's picture

This strain is closer to 50%, in exchange for being more communicable, it seems.

viahj's picture

which is why it is so much more dangerous to the world at large.  it can spread faster than it burns out. 

sushi's picture

And as it spreads it replicates and mutates and will likely become more communicable. MIffed likely understands this muchbetter than I do but as it spreads it mixes genetic material with that of its host organism.

So if the host has a common cold at time of Ebola infection then there is a possibilty Ebola will acquire the capacity for airborne transmission.

I'm sure that ISIS, or some other mad-hatters, will figure out that Ebola represents a perfect means of payback for all those drone strikes. You the impregnable super power? Sneeze this!!

 

Parrotile's picture

Aquisition of host information is unlikely (ebola uses RNA as its genomic material). The big concern is "host acclimatisation" via repetitive passage (i.e. infection), in mind of the 3% transcription error rate per kilobase pair (ebola is about 19 kbp). Many of the errors will prove fatal for the virus, but occasionally there will be a beneficial change (for the virus!), and that change will propagate favourably providing the host does not change. With 7 Billion + potential hosts, all of whom are pretty much genetically identical (in the areas where ebola and others prefer to grow and bud happily) that's something that keeps me awake at nights.

So, transmission horizontally within a community is never good news. The virus will change slightly person - to - person, and there is the high likelihood that any vaccines developed using "lab" virus, may have reduced efficacy against repetitively - passaged "wild" virus, so even "effective" (Primate trials) vaccination might not be the "great cure" that the MSM seem to be peddling just now.

sushi's picture

Thanks for that clear explanation. The MSM should provide those forms of clarification but they don't.

Ionic Equilibria's picture

Parrotile "Aquisition of host information is unlikely (ebola uses RNA as its genomic material). The big concern is "host acclimatisation" via repetitive passage (i.e. infection), in mind of the 3% transcription error rate per kilobase pair (ebola is about 19 kbp). Many of the errors will prove fatal for the virus, but occasionally there will be a beneficial change (for the virus!), and that change will propagate favourably providing the host does not change. With 7 Billion + potential hosts, all of whom are pretty much genetically identical (in the areas where ebola and others prefer to grow and bud happily) that's something that keeps me awake at nights.

So, transmission horizontally within a community is never good news. The virus will change slightly person - to - person, and there is the high likelihood that any vaccines developed using "lab" virus, may have reduced efficacy against repetitively - passaged "wild" virus, so even "effective" (Primate trials) vaccination might not be the "great cure" that the MSM seem to be peddling just now."

Hmm...  Yes, but be that as it may, how has this worked out in the real world.  E.g., did smallpox evolve to become more deadly or infectious?  Or can we say smallpox was already so bad it couldn't get worse?  Might that already be the case with ebola?  Insuffucient data.  Only time will tell.

Eyeroller's picture

And the Fed are rumored to have the first interest rate rise in March 2015, eh?

Redneck Hippy's picture

As Einstein said, the most powerful force in the universe is compound interest.

fedupwhiteguy's picture

So, is ROI "return on investment" or "recovered of infection" or "rate of increase"? If you guessed #1, you are a numbers guy and only think of the bottom line, if you  guessed #2 you're an wishful optimist, and if you guessed #3 then yo is 1 very shmart dude!

ZerOhead's picture

< Ebola has already topped out...

< Ebola is just warming up...

If you remove the arrows telling you what to think... it looks to me like the rate of new ebola cases may have topped out 20 days or so ago...

StackShinyStuff's picture

On deaths it appears that way but there is a lag and reported cases appear to be breaking out to the upside.

ZerOhead's picture

Information is improving which will help reduce the rate of new infections... as are survival rates as new infectees seek medical help where before they just hid and spread it to family members as they died.

Too early to call yet but looking good I think.

In any event Barry should go down in a show of solidarity... roll up his sleeves (real high like) and help out by digging in and getting his hands dirty...

debtor of last resort's picture

'If it was my son i would kick his bleeding ass out of the White House's back yard'