Ebola: DON'T PANIC!! is a Panic Response

Contemplating His World Tour
Image source: http://halehighschool.info/pics/pandemic.jpg

 
...The systematic, rational way to control [an] outbreak, [is] by defining its outer borders and letting the pyre of cases inside burn to completion....

--From Daily Beast: Doctors Without Borders Hits Ebola Breaking point by Abby Haglage and Kent Sepkowitz... excellent article announcing end of contact tracing in three countries where ebola is epidemic.


Ebola: DON'T PANIC!! is a Panic Response

As a sailor and 'prepper', I agree that panic never helped nobody. As an EMS/VFD/SAR volunteer, I'm committed to the idea that, when 9-1-1 is called, help should be on the way.

The recent media trend to headline DON'T PANIC!! strikes me as pollyanna; misrepresenting and belittling a clear and present danger. Shouting it at the top of their considerable lungs strikes me as a form of panic.

It is (by and large) true that the present danger to the USA and other first world nations is small. The response here (contact tracing, quarantine, monitoring, training and protocol upgrades) is proceeding about as well as one might expect. Limited incursions are presently containable and contained.

Yet the threat from ebola is growing exponentially, and virtually unchecked.

Liberia, Sierra Leone and Guinea are raging out-of-control. Aid from 'advanced' nations remains too little, too late. Crucially, the number of healthcare workers on hand - both indigenous and extra-national - are too few for effective containment measures.

The tipping point is when contact-tracing is no longer possible.

Contact tracing is a fundamental tool for epidemic containment: identifying ALL victims of a disease, ALL the persons with whom they've had contact, and ALL the persons with whom those persons have had contact. Monitoring and/or quarantine and/or care follow as warranted.

This is the means by which Nigeria and Senegal contained their recent, small outbreaks, with Spain and the US hopefully having done so as well.

But exponential growth is defeating us.

Not only are cases of EVD (Ebola Virus Disease) growing exponentially in the three countries with ongoing ebola epidemic, but this exponential growth generates a doubly exponential explosion in numbers of contacts.  

Doctors Without Borders (aka Medecines Sans Frontieres (MSF)) and their colleagues on the ground have reached the limit of their ability to conduct effective contact tracing.

Shit is Hitting The Fan.

"But the First World is responding!", bleats the First World, "We have 4000 ebola beds planned for early November! They only have, what? Three hundred and fifty, now?"

Of course, at this writing that already falls short of current cases by about 15%, the number of which are expected to double by early November. Thanks a lot, First World. Oh, by the way... do you happen to have the necessary thousands of doctors, nurses and other trained health technicians ready and willing to volunteer?

"Um, no. They're standing ready to safe-guard the Homelands, though!"

So here's the problem:

As a local population of ebola infected persons grows (the three countries mentioned will do, for starters), the virus is presented with exponentially more opportunities to mutate and spread into new populations (spillover), and is exponentially harder to contain. Contact tracing becomes more difficult at a double exponential rate.

Exponential / Double Exponential Note: In Nigeria's outbreak, a single patient infected 18 others (exponential growth in two 'generations'). Successful contact tracing involved some 19,000 interviews - a thousand-fold increase over cases (double exponential growth). Success is only possible in low number outbreaks, no matter the sophistication of the health-care systems involved.

Mutation Note: Any viral replicator is selected by suppression efforts for strains which find ways to replicate in the face of those efforts. Going airborne (considered unlikely) is only one of many possibilities for a virus to enhance its reproduction success.

As the threat of infection increases, many who are able to do so will flee the 'hot zone' by any means available - legal and monitored or not. As local government fails, there will be less and less to hinder them. A certain percentage of these refugees will already be infected, and may well be presymptomatic. Spillover into geographic and transport neighborhoods becomes exponentially more likely with increasing numbers. 

Those living in poverty - around two thirds the global population, and inter-mixed in large numbers in every country - are especially vulnerable to contagion, and most often lack even basic health-care. From ebola's point of view, this means plenty of prospects, with avenues into every nation. An empire upon which the sun never sets.

We are presently giving ebola a virtually free run in three, populous West African countries. In a few, short months, outbreak has become epidemic, with pandemic a very short step away. Doubling every few weeks, how many doubling periods before 'critical mass' is achieved? Have we crossed that threshold, already?

With the exception of Cuba - who's response, proportional to their economy should shame and inspire we who are far wealthier - MSF, and WHO, our response has been token and far below the needful.

Ebola is inherently destabilizing through direct and indirect effects. 

Actual ebola, containment tactics and fear of ebola affect economies across the board, from extraction of raw materials to the delivery of goods and services.

It is deadly when left to its own devices. To attend to those stricken and counter its spread requires boat-loads of money and man-power. Restrictions on movements impede the flow of commerce. Illness and death sap labor.

All this sends economic shock waves reverberating through local and global economies. If in fact these economies are fragile, how much shock can they stand? How long can 'modern health-care systems' stand with a partially or fully crippled economy?

If ebola goes pandemic (spreads to other regions of the Third World and/or beyond), how long can we maintain our isolation?

Shouting DON'T PANIC!! in the penthouse of a building whose basement is on fire is a panic response. Come on, people, let's put this thing out! is not. Near the beginning of a conflagration, it's relatively easy; later on, the best you can hope for is a controlled burn.

So, let's stop shouting PANIC / DON'T PANIC!!  Don't panic and send immediate, massive help to West Africa. 

Now, before the whole damn neighborhood burns down.

Despite arrow shown, we are currently at Level 5 for ebola...
outbreaks in US and Spain have not been 'community level'.