Re: Liberia


Wouldn't you think that ordinary caution, once people know what's necessary, is mostly enough to stop contagion? That the initial fast spread was among people who didn't know or hadn't fully accepted that infected bodily fluids were deadly, but that Liberians generally are now well enough informed to mostly keep themselves safe?

Posted by: LizardBreath | Link to this comment | 10-28-14 5:41 AM
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That's basically what they say in the link:

No one knows for sure what is responsible for the slow down in the disease's spread, but it seems that many Liberians, who at first denied the epidemic was real, have come to their senses and changed their behavior by avoiding direct physical contact with sick or dead people. (Whether Sierra Leone and Guinea are seeing similar declines in new cases has not been reported.) At the same time, the government in coordination with international partners such as Doctors Without Borders has set up a system to isolate and care for patients and monitor their contacts for symptoms. Questions remain about why this epidemic was so severe in the first place, but it seems that this simple set of interventions, which has worked in the past to contain twenty-five previous known Ebola outbreaks in Africa since 1976, is belatedly working here too.

Posted by: heebie-geebie | Link to this comment | 10-28-14 5:46 AM
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It can't be that hard to get people to stop touching dead people. Nobody wants to seem uncaring, but once you have a good excuse, I'd think people would be a bit relieved.

Posted by: Moby Hick | Link to this comment | 10-28-14 5:58 AM
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3: You do have to bury or cremate them. It's got to be unsanitary to just leave them in the street. Somebody has to touch them. You can wear gloves, but that's not foolproof.

Posted by: Bostoniangirl | Link to this comment | 10-28-14 6:32 AM
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Epidemiologically-speaking, having a few specialists to deal with the dead is a very different thing than having it be a family affair.

Posted by: Moby Hick | Link to this comment | 10-28-14 6:33 AM
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5: Sure. Do they burn them all up together or to they give the family some kind of remains? Because I'd think that not having access to remains (cremated even) could make the emotional trauma worse.

Posted by: Bostoniangirl | Link to this comment | 10-28-14 6:36 AM
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What's up with even serious predictions being so far off? I keep hearing the one about how, by the end of the year, we'll have 10,000 new cases per week.

When you have an exponential increase in cases, and you don't see any reason to predict anything other than a further exponential increase, that gets to be a lot of cases.

Posted by: Cryptic ned | Link to this comment | 10-28-14 7:07 AM
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I think best case scenario is that new infections are leveling, not dropping. Aggressive contact tracing is making things better, but it's a job where missing one person can be disastrous (see: Ghana, where the two year old with a bloody nose has 40 high risk contacts). Wikipedia has charts on caseload taken from government/WHO reports.

The good stuff: There are now enough survivors with immunity working in body disposal and health care that it is making a difference in the number of people with high risk contacts. MSF is no longer adding volunteers. US has both troops and public health workers there. Citizens are reporting cases, going to hospitals and treatment centers.

The bad stuff: Ebola outbreaks, because of the long incubation period,, can spike after a week or two of quiet. Leveling out new cases is not success. If all the aid and concerted effort leaves, I suspect there will be a lot of cases. I'd hate to see any media suggesting that it's under control. 400 cases in one country is a LOT. There were never that many cases at any given time, especially compared to the population of the whole country, but 400 is not anywhere near stopping the outbreak. There's still not enough equipment and workers getting to remote locations.

The worst, asmentioned in the article, is that the real cost is more than just getting through the immediate crisis. The three most affected countries have lost some of their best doctors and researchers, people who were literally irreplaceable. When the aid pulls out, I hate to think what will be left for childbirth, malaria, and parasites, not to mention simple bacterial infections.

To answer BG, corpses are incinerated. The incinerated remains are still disposed of as hazardous material (ie buried as fast as possible), even though they shouldn't technically be contagious. Cerification of this would cost time and money, though, neither of which these countries have in abundance.

Posted by: ydnew | Link to this comment | 10-28-14 7:18 AM
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3: I'd imagine the harder part is to avoid touching sick people, if they're family. Per 8.2, hopefully there are enough treatment facilities now that that can be handed off as well, but transportation is a bit of a bottleneck.

Posted by: Minivet | Link to this comment | 10-28-14 7:34 AM
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The issue as I understand it is a long tradition of funeral rites that include washing of the deceased's body. I can understand that during a time of horrifying epidemic, it would be hard to let go of a generations-long tradition, even if intellectually you knew that it was dangerous.

Posted by: Witt | Link to this comment | 10-28-14 7:35 AM
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Witt, I've read in a few places (sorry, can't find a link exactly) that religious practices aren't really the problem. From WaPo:

Despite the prevailing narrative of cultural differences presenting a dangerous situation on the ground, Jasarevic, the WHO spokesman, said that his organization believes the bigger problem that there simply aren't enough trained people on the ground in Liberia, Sierra Leone and Guinea who are capable of dealing with the daily deaths in a proper manner.
"The problem is not so much to explain to people" why some traditional burial practices are dangerous in the case of an Ebola death, he said. Instead, infected areas need teams of trained people "on call, with cars," who can respond to reports of Ebola infection or death "on short notice."
Health officials are working on improving response times, but as the burial problems in Liberia have shown, it's taking too long for trained workers to deal with dead bodies, leading to increased risk of infection and tension with officials once they do arrive.

Posted by: ydnew | Link to this comment | 10-28-14 7:52 AM
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11: It does sound like it's a logistical problem (slow/inadequate removal) that activates (if you will) the cultural problem: it's one thing to allow a sick/dying/dead family member to be taken away by proper authorities without touching the body, but it's another for that family member to lie there neglected and to refrain from the actions that you've always been told are right (see Antigone).

Anyway, I take the point that it's not time to dismiss the problem, but it's a relief that the end of the beginning seems to have arrived.

Posted by: JRoth | Link to this comment | 10-28-14 9:20 AM
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Pretend these two comments are here. minus the "||" "|>".

Posted by: JP Stormcrow | Link to this comment | 10-28-14 1:17 PM
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How delightfully topical!

Posted by: heebie-geebie | Link to this comment | 10-28-14 1:27 PM
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13: Are you complaining about his approach? I mean, it's a very typical statement for Obama at this point.

Posted by: ydnew | Link to this comment | 10-28-14 2:17 PM
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I think he should have publicly licked a Doctors Without Borders staff member who is just returning to the U.S.

Posted by: Moby Hick | Link to this comment | 10-28-14 2:19 PM
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That's not really an exchange of fluids. French kiss?

Posted by: ydnew | Link to this comment | 10-28-14 2:25 PM
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There are times when I really do appreciate Obama.

Posted by: Eggplant | Link to this comment | 10-28-14 2:43 PM
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Did he kiss you?

Posted by: Moby Hick | Link to this comment | 10-28-14 2:50 PM
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Fluids were exchanged.

Posted by: Eggplant | Link to this comment | 10-28-14 3:22 PM
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15: The "joke" to the extent there is one is entirely without a political point. The "defeat Ebola with science" phrase merely triggered the song in my mind and so I posted it, the subtext is that I am an undisciplined idiot with poor impulse control.

Posted by: JP Stormcrow | Link to this comment | 10-28-14 5:31 PM
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Seriously, my sister (MD, MPH, ex-EIS, ex-PHS) is over there and the reactions of assholes like Christie pisses me off greatly. Unheated tent with a port-a-potty! Fuck you. The people running that hospital should be ashamed of how they treated a professional colleague. My sister, out of an abundance of caution (perhaps over-reaction) has dropped social media and purged her accounts. From her point of view in Monrovia, she'd rather be cautious than have her family in LA get caught up in some passing panic.

Posted by: md 20/400 | Link to this comment | 10-28-14 7:23 PM
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Unheated tent with a port-a-potty!

Rick Perry is offering a tarp and a bucket.

Posted by: Moby Hick | Link to this comment | 10-28-14 7:35 PM
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There must be a petition for quarantining returning health workers in luxury. Heck, why aren't the Burners on it? Airlocked pleasure domes with great internet, and if someone dies, a pyre.

Posted by: clew | Link to this comment | 10-28-14 8:04 PM
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The quarantine thing was so typical of Christie, and a good reminder (now that the bridge scandal has fallen off the front pages) that he's a terrible governor.

Posted by: teofilo | Link to this comment | 10-28-14 8:17 PM
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21: Got it. I thought there was a subtle suggestion that his policy (or its announcement) was underwhelming.

22: That's just sad. I hope her time there is safe and she gets the welcome home she deserves.

Posted by: ydnew | Link to this comment | 10-29-14 4:02 AM
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24. Mickey Kaus suggested doing that. I assumed he was trolling.

Posted by: DaveLMA | Link to this comment | 10-29-14 5:47 AM
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The American Public Health Association has just thoughtfully reminded me, and presumably its entire membership plus everybody who has submitted an article to one of its journals, not to touch the body of somebody who may have died of Ebola.

Posted by: Moby Hick | Link to this comment | 10-29-14 12:09 PM
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