8 ms·

Ebola Cases Could Reach 1.4M in 4 Months, C.D.C. Estimates

103 points by ghshephard 12y ago

zvrba 12y ago
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.
- herge 12y ago
  Because invading Western Countries would be more effective in doing that than local African authorities?
- seren 12y ago
  This is probably posted with good intentions, but invading a country is not the best way to increase confidence in a crumbling healthcare systems and it would create its own set of chaos. For previous well meaning attempts, see "Restore hope".
- swartkrans 12y ago
  No, it really wouldn't. Not even a little bit. Why? Because "invading some African countries" would destroy our relationship with other countries, give the usual aggressors an excuse to continue to pursue their own invasions and probably not actually even help anyone. You don't really even have to invade, it's not like these "African countries" would mind a horde of doctors and health care workers to help them out of this horrible situation.
- jbigelow76 12y ago
  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 12y ago
    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.
- Aqueous 12y ago
  Well, the US is sending 3,000 containment troops to West Africa [1]. Just having access to their special equipment, trained personnel, and other resources will hopefully make a huge difference. Any solution to this will probably come from co-operation and coordination between many governments. 1. http://www.nytimes.com/2014/09/16/world/africa/obama-to-announce-expanded-effort-against-ebola.html?_r=0 http://www.nytimes.com/2014/09/16/world/africa/obama-to-anno...
  - CyberpunkDad 12y ago
    The problem is that the military does not have the kind of medical containment systems on a scale that they need. They just aren't equipped for this type of mission. Battlefield triage and hospitals won't help in this situation.
    - phkahler 12y ago
      >> Battlefield triage and hospitals won't help in this situation. Have you seen the facilities they have over there now? I think battlefield hospitals are a huge step up. Logistics is also a core function of the military, so once a plan is in place they will bring in whatever that plan calls for and get stuff done. Where the military doesn't work is when politics is involved and the mission is not so clear.
- this_user 12y ago
  Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation. It could not possibly lead to any kind of resistance or guerilla warfare or additional support for Jihadists and other kinds of extremists around the world.
  - skylan_q 12y ago
    Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation. It's not about winning hearts and minds. It's about containment.
    - roywiggins 12y ago
      Containment IS about hearts and minds. If you have the trust of the people- if they trust that Ebola is real, that healthcare workers are not out to get them, that they can go to a hospital and receive care- then this outbreak might be containable. When you don't have trust, you get dead healthcare workers: http://www.bbc.co.uk/news/world-africa-29256443 http://www.bbc.co.uk/news/world-africa-29256443 Fighting ebola has been compared to fighting an insurgency, and I think the comparison is quite apt. You can't win with force alone.
      - mrweasel 12y ago
        >You can't win with force alone. Actually you can, you just need to use enough force and nobody is willing to do that. Ebola could become a threat to the point where the healthy start shooting people trying to escape quarantined areas or simply burning them down. At the most extreme you could just firebomb or nuke the areas infected. That would be excessive force, but it would solve the problem.
      - zvrba 12y ago
        > When you don't have trust, It is difficult, if not impossible, to build trust because the population isn't educated, they don't trust the government from before, and there is no infrastructure for wide-spread dissemination of information. > You can't win with force alone. You can. I think that the part of the problem is that they try to take care of the sick, but they don't have resources, the equipment, the personnel, the education... nothing. The sick can walk out (if they can), anybody can walk in, other people try to "liberate" them, etc. It's mess. Compare their conditions with how ebola-infected people are handled in the west (isolation and containment facilities). What do to instead: just write off the infected, however cruel that may seem, and transfer them to a closed isolation facility, guarded by military. Heck, I don't think that anything else would be feasible even in any western country if suddenly a few thousand people got infected.
- drivingmenuts 12y ago
  World: We have a small problem in Africa. US: You need us to invade? No sweat. World: We have two small problems in Africa. It's not actually a joke.
peterfisher 12y ago
'Could Reach', what is this Fox news?
- ceejayoz 12y ago
  These estimates come with a variety of scenarios. 1.4 million is the worst-case one.
- ambler0 12y ago
  People are downvoting you, but your comment seems fair enough to me, since the alternative scenario discussed in the article is that the epidemic could be "almost ended" by the same date. So, could be 1.4 million, could be "almost ended". Certainly seems like a misleading and intentionally sensational headline to me.
  - mhb 12y ago
    Perhaps the downvoters thought that the snark about Fox News was unnecessary and not the underlying premise.
- AznHisoka 12y ago
  what else do you want? "will reach"? This is not an exact science here
- msane 12y ago
  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=featured_ebola#t=articleResults http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...
  - basugasubaku 12y ago
startupfounder 12y ago
"...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.
- GFK_of_xmaspast 12y ago
  So what exactly are you proposing here.
- angersock 12y ago
  Boots could become infected. Sadly enough, this is a perfect place to use drones, God help us. EDIT: So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what? My point was both reasonable and succinct.
  - toomuchtodo 12y ago
    > So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what? You were probably downvoted because a little of column A and a little of column B. The situation hasn't deteriorated to the point that remote lethal force is the solution. Education and proper containment protocols would solve the problem without the need for indiscriminate murder.
    - angersock 12y ago
      Oh, of that I had no doubt, but I notice that nobody has disagreed with my point: given that lethal force (or the threat thereof) is useful in maintaining quarantine (as suggested by my parent post), use of drones makes sense, because it avoids the contamination issues seen using humans. There's a lot to be said for proper containment protocols and education, but let's not kid ourselves--the populations in question are already willfully acting against such things, supposing (in many cases) a Western bugaboo. Regardless, the meta issue here is that a bunch of HNers downvoted something merely because they disagreed with it (which is annoying but hardly the first time it's happened to this account) but also failed to contribute meaningfully to the discussion (which is sad). A lot of fools decry "oh no HN is close-minded" while spouting rubbish, but sometimes the accusation is well-founded. In our present example, there is an interesting discussion to be had: could the use of drones for quarantine purposes present as the next step down that slippery slope? What sort of precedent might that set? Were it to be wrong, what exactly would make it so? But, no; instead the users blindly downvote away and click onwards, safely avoiding that heavy burden of exploratory thinking.
deleted 12y ago
[deleted]
Pxtl 12y ago
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 12y ago
  That includes the USA, right?
  - Pxtl 12y ago
    I honestly have no idea. I really hope we don't have to find out.
  - natrius 12y ago
    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 12y ago
      How do you track all the contacts from a million infected people?
      - jonknee 12y ago
        There are no infected people in the USA. If there is a case here you ferociously follow the contacts of the first case(s).
      - trose 12y ago
        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.
FollowSteph3 12y ago
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.html?referrer= http://mobile.nytimes.com/2014/09/23/world/africa/23ebola.ht... 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 12y ago
  >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 12y ago
    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 ;)
cmrivers 12y ago
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=featured_home#results=&t=articleResults http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...
- nicpottier 12y ago
  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?
  - cmrivers 12y ago
    My suggestion is just based on the findings reported in the NEJM paper I linked, which has an incubation of 11 days and a long infectious period.
  - sliverstorm 12y ago
    what people do in Excel just blows me away It's best to think of it as a programming language unto itself :)
  - Havoc 12y ago
    >(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.
- berberous 12y ago
  I'm too lazy to input your suggestions, but I'm curious: does it make the scenario better or worse than the CDC suggests?
phkahler 12y ago
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_cid=su63e0923a1_w http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_c...
jostmey 12y ago
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.
nickthemagicman 12y ago
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.

103 points by ghshephard 12y ago

zvrba 12y ago

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.

herge 12y ago
Because invading Western Countries would be more effective in doing that than local African authorities?
seren 12y ago
This is probably posted with good intentions, but invading a country is not the best way to increase confidence in a crumbling healthcare systems and it would create its own set of chaos. For previous well meaning attempts, see "Restore hope".
swartkrans 12y ago
No, it really wouldn't. Not even a little bit. Why? Because "invading some African countries" would destroy our relationship with other countries, give the usual aggressors an excuse to continue to pursue their own invasions and probably not actually even help anyone. You don't really even have to invade, it's not like these "African countries" would mind a horde of doctors and health care workers to help them out of this horrible situation.
jbigelow76 12y ago
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 12y ago
  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.
Aqueous 12y ago
Well, the US is sending 3,000 containment troops to West Africa [1]. Just having access to their special equipment, trained personnel, and other resources will hopefully make a huge difference. Any solution to this will probably come from co-operation and coordination between many governments. 1. http://www.nytimes.com/2014/09/16/world/africa/obama-to-announce-expanded-effort-against-ebola.html?_r=0 http://www.nytimes.com/2014/09/16/world/africa/obama-to-anno...
- CyberpunkDad 12y ago
  The problem is that the military does not have the kind of medical containment systems on a scale that they need. They just aren't equipped for this type of mission. Battlefield triage and hospitals won't help in this situation.
  - phkahler 12y ago
    >> Battlefield triage and hospitals won't help in this situation. Have you seen the facilities they have over there now? I think battlefield hospitals are a huge step up. Logistics is also a core function of the military, so once a plan is in place they will bring in whatever that plan calls for and get stuff done. Where the military doesn't work is when politics is involved and the mission is not so clear.
this_user 12y ago
Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation. It could not possibly lead to any kind of resistance or guerilla warfare or additional support for Jihadists and other kinds of extremists around the world.
- skylan_q 12y ago
  Yes, an unprovoked military incursion into a foreign country is usually a great way to win the population's hearts and minds and ensure its full cooperation. It's not about winning hearts and minds. It's about containment.
  - roywiggins 12y ago
    Containment IS about hearts and minds. If you have the trust of the people- if they trust that Ebola is real, that healthcare workers are not out to get them, that they can go to a hospital and receive care- then this outbreak might be containable. When you don't have trust, you get dead healthcare workers: http://www.bbc.co.uk/news/world-africa-29256443 http://www.bbc.co.uk/news/world-africa-29256443 Fighting ebola has been compared to fighting an insurgency, and I think the comparison is quite apt. You can't win with force alone.
    - mrweasel 12y ago
      >You can't win with force alone. Actually you can, you just need to use enough force and nobody is willing to do that. Ebola could become a threat to the point where the healthy start shooting people trying to escape quarantined areas or simply burning them down. At the most extreme you could just firebomb or nuke the areas infected. That would be excessive force, but it would solve the problem.
    - zvrba 12y ago
      > When you don't have trust, It is difficult, if not impossible, to build trust because the population isn't educated, they don't trust the government from before, and there is no infrastructure for wide-spread dissemination of information. > You can't win with force alone. You can. I think that the part of the problem is that they try to take care of the sick, but they don't have resources, the equipment, the personnel, the education... nothing. The sick can walk out (if they can), anybody can walk in, other people try to "liberate" them, etc. It's mess. Compare their conditions with how ebola-infected people are handled in the west (isolation and containment facilities). What do to instead: just write off the infected, however cruel that may seem, and transfer them to a closed isolation facility, guarded by military. Heck, I don't think that anything else would be feasible even in any western country if suddenly a few thousand people got infected.
drivingmenuts 12y ago
World: We have a small problem in Africa. US: You need us to invade? No sweat. World: We have two small problems in Africa. It's not actually a joke.

peterfisher 12y ago

'Could Reach', what is this Fox news?

ceejayoz 12y ago
These estimates come with a variety of scenarios. 1.4 million is the worst-case one.
ambler0 12y ago
People are downvoting you, but your comment seems fair enough to me, since the alternative scenario discussed in the article is that the epidemic could be "almost ended" by the same date. So, could be 1.4 million, could be "almost ended". Certainly seems like a misleading and intentionally sensational headline to me.
- mhb 12y ago
  Perhaps the downvoters thought that the snark about Fox News was unnecessary and not the underlying premise.
AznHisoka 12y ago
what else do you want? "will reach"? This is not an exact science here
msane 12y ago
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=featured_ebola#t=articleResults http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=fea...
- basugasubaku 12y ago

startupfounder 12y ago

"...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.

GFK_of_xmaspast 12y ago
So what exactly are you proposing here.
angersock 12y ago
Boots could become infected. Sadly enough, this is a perfect place to use drones, God help us. EDIT: So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what? My point was both reasonable and succinct.
- toomuchtodo 12y ago
  > So, do you downvote because you despise the idea of maintaining quarantine with lethal force, because you find the idea of using drones to kill horrendous, or what? You were probably downvoted because a little of column A and a little of column B. The situation hasn't deteriorated to the point that remote lethal force is the solution. Education and proper containment protocols would solve the problem without the need for indiscriminate murder.
  - angersock 12y ago
    Oh, of that I had no doubt, but I notice that nobody has disagreed with my point: given that lethal force (or the threat thereof) is useful in maintaining quarantine (as suggested by my parent post), use of drones makes sense, because it avoids the contamination issues seen using humans. There's a lot to be said for proper containment protocols and education, but let's not kid ourselves--the populations in question are already willfully acting against such things, supposing (in many cases) a Western bugaboo. Regardless, the meta issue here is that a bunch of HNers downvoted something merely because they disagreed with it (which is annoying but hardly the first time it's happened to this account) but also failed to contribute meaningfully to the discussion (which is sad). A lot of fools decry "oh no HN is close-minded" while spouting rubbish, but sometimes the accusation is well-founded. In our present example, there is an interesting discussion to be had: could the use of drones for quarantine purposes present as the next step down that slippery slope? What sort of precedent might that set? Were it to be wrong, what exactly would make it so? But, no; instead the users blindly downvote away and click onwards, safely avoiding that heavy burden of exploratory thinking.

deleted 12y ago

[deleted]

Pxtl 12y ago

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 12y ago
That includes the USA, right?
- Pxtl 12y ago
  I honestly have no idea. I really hope we don't have to find out.
- natrius 12y ago
  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 12y ago
    How do you track all the contacts from a million infected people?
    - jonknee 12y ago
      There are no infected people in the USA. If there is a case here you ferociously follow the contacts of the first case(s).
    - trose 12y ago
      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.

FollowSteph3 12y ago

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.html?referrer= http://mobile.nytimes.com/2014/09/23/world/africa/23ebola.ht... 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 12y ago
>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 12y ago
  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 ;)

cmrivers 12y ago

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

nicpottier 12y ago
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?
- cmrivers 12y ago
  My suggestion is just based on the findings reported in the NEJM paper I linked, which has an incubation of 11 days and a long infectious period.
- sliverstorm 12y ago
  what people do in Excel just blows me away It's best to think of it as a programming language unto itself :)
- Havoc 12y ago
  >(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.
berberous 12y ago
I'm too lazy to input your suggestions, but I'm curious: does it make the scenario better or worse than the CDC suggests?

phkahler 12y ago

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_cid=su63e0923a1_w http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm?s_c...

jostmey 12y ago

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.

nickthemagicman 12y ago

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.