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Thursday, September 11, 2014

How to stop Ebola: create negative "atmospheric pressure" by paying Ebola survivors to treat the sick

Ebola rising, from Drudge today:
STUDY: Millions more at risk in Ebola outbreak... 
'Spreading like wildfire'... 
'Terrifying evolution' of virus...
The key to an effective response lies in the survivors, who are immune to re-infection (at least by the same Ebola strain, which is what would be circulating in their area). For those survivors who are undamaged enough for work, train and pay as many as are willing to tend to the sick, the dying and the dead. Non-immune people cannot do this work on a large scale. They are terribly encumbered and they still get sick, turning them into part of the problem.

Because treating the sick is so dangerous they are now receiving minimal if any care, causing mortality rates to be higher than they need to be. Using survivors to treat the sick would greatly increase the survivor rate, increasing the pool of survivors available to treat the sick. It is a self-reinforcing amelioration.

The immune would have to for the most part remain in isolation along with the sick. They couldn't touch stuff that other people touch, but supplies could be left for them and so long as they undergo rigorous disinfection before leaving isolation the sick under their care would would cease to be a source of infection.

Ditto for those who only might be sick with Ebola. These too could be tended to by Ebola survivors, whose first job would be to find out if they do have Ebola. Survivors, if they are make sure that the outsides of their bodies are as non-contagious as the insides of their bodies, can examine those with ambiguous symptoms and determine whether they need to be kept in quarantine or can be released to non-Ebola medical care.

Negative movement-pressure is critical

Most importantly, an army of survivors working to separate and treat the sick would drastically reduce transmission, which is the only way to keep the uninfected from fleeing hot zones and propelling further spread of the disease. That's the problem now. There is tremendous pressure to flee the hot zones, causing the disease to explode outwards.

No larger quarantine zone can hold under these conditions. The greater the external efforts at containment the more the pressure has to build before it explodes outwards but it will explode. Quarantine has to at least begin at the level of the individual patient. Stop local transmission from individual patients and then larger quarantine zones might work, if they are needed at all.

With an army of immune survivors to isolate and tend to the sick at the local level it becomes safer for uninfected people within the hot zones to stay where they are. Travel is dangerous because it exposes travelers to massed humanity, where contagion is amplified. Thus it would not be hard to make it safer not to flee, if a growing army of the immune were used to provide treatment-in-isolation for the sick.

Add people's interest in not losing their established homes and livelihoods the abnormal outward pressure of the infection would be eliminated. Economic devastation could also cause pressure to flee but this too would be reduced by paying survivors to care for the sick. There would be an inflow of disposable income that would keep the local economy propped up. Care for the sick would be a new industry, subsidized from outside. Somebody has to care for the caregivers, and the money would be there to do it.

Just as it takes negative atmospheric pressure to isolate an isolation room, so too if we want hot zones to remain isolated, whether or not they are quarantined, the motivational pressure for people inside to leave must be negative. Now the pressure to leave is strongly positive. Effective use of the immune-survivor resource can change that by isolating and treating the sick, stopping transmission and creating more immune survivors. Then even without formal larger scale quarantine movement would be greatly reduced.

The alternative is continued high rates of disease transmission, in which case no quarantine zone will be able to contain the epidemic. It will inevitably explode outwards, first across Africa, then anywhere else where Ebola is not dealt with rationally.

Addendum on the immunity of Ebola survivors to re-infection

From  Dr. Bruce Ribner, director of Emory University Hospital's infectious disease unit (via PBS interview):
DR. BRUCE RIBNER: The medical staff here at Emory is confident that the discharge from the hospital of both of these patients poses no public health threat. Ebola virus is a new infection on this continent, but our colleagues across the ocean have been dealing with it for 40 years now, and so there is strong epidemiologic evidence that, once an individual has resolved Ebola virus infection, they are immune to that strain, recognizing that there are five different strains of Ebola virus.

UPDATE:  The day after put up this post there is an Op-Ed in the NYT warning about mutation and spread of Ebola and calling, among other things, for using survivors to tend to the sick. From Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota:
The United Nations should provide whatever number of beds are needed; the World Health Organization has recommended 1,500, but we may need thousands more. It should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. Many countries are pledging medical resources, but donations will not result in an effective treatment system if no single group is responsible for coordinating them.
I would leave the U.N. completely out of it. The U.N. is nothing but corruption. It is a well developed machine for siphoning off all monies that are channeled through it, maximally diverting every Dollar and Euro through its vast networks of sycophants, sinecures and profiteers. The U.N. is one gigantic "french drain," where pouring a flood in achieves at best a trickle out. Instead use the same Christian organizations that have been instrumental in fighting AIDS.

PEPFAR, the successful AIDS-fighting project that President Bush established in 2003, did not partner only with Christian organizations, but it did not discriminate against them, and in some ways favored them, because part of PEPFAR's mission was moral education, emphasizing that there would be no sexual transmission of AIDS at all if people were not having sex outside of marriage.

The resulting distribution of funding can be gleaned from PEPFAR's partner pages. Here, for instance, is the page for Nigeria in 2007. Maybe half of the partners, receiving half of the funding, are Christian (hard to tell because much of the money that went to secular organizations was distributed by them to Christian sub-partners). These groups actually try to deliver as much AIDS-fighting effect per dollar as they can. Similarly for the secular aid groups, which should also be employed, but U.N. is the worst. Maybe they will have to be paid off in some instances where they would otherwise use their reach to block aid, but there is unlikely to be any role in which the U.N. can do more good than harm.

UPDATES 9/20/14:  As predicted above, attempts at quarantine are motivating people inside the hot zones to flee. Instead of negative "atmospheric pressure," the attempt to impose quarantine on an out-of-control hot-zone is causing a powerful positive "atmospheric pressure" that will only get stronger until it explodes outwards like pressure-bursting pustule.

Also predictable, Obama is jumping on the chance to kill some U.S. troops and possibly bring Ebola to America by sending U.S. troops to the Ebola outbreak sites where there is nothing useful that they can do. Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, explains:
“What African troops are doing is shooting people who cross borders or violate quarantine,” Orient told WND, reacting to news of the U.S. troop deployment. “Is that what we plan to support?” 
She added, “Africans are already very suspicious of us. How will they react to an army setting up hospitals?” 
Orient called the planned U.S. deployment a “dubious mission,” warning that the nightmarish scenario could bring Ebola to America. 
“There is definitely a risk,” she said. “It seems irresponsible to send more people there when the ones already there are having trouble leaving. Probably anyone who has been exposed should be quarantined for 25 days since the last exposure.”
No, our troops will not shoot fleeing residents. They will instead deal with them up close and personal, and become vectors themselves:
“You can see that these doctors, who are highly trained people, got themselves infected,” said Dr. Lee Hieb, former president of the Association of American Physicians and Surgeons. “So sending troops into an area, if they’re dealing one-on-one with a patient, they’re not going to be able to protect themselves very well. It’s not easy to [prevent transmission], because you get tired and you get careless and you make some simple mistakes. All it takes is one virus particle.”
The only way to stop the spread is to mobilize the Ebola survivors. Pay them to isolate and treat the sick in the hot zones so that transmission within the hot zones can be extinguished, making it safer to stay put than to flee, creating the necessary negative "atmospheric pressure" and saving a lot of lives inside the hot zones as well as outside.

If any quarantine enforcement is to be applied, Ebola survivors should be used for this to, unless the quarantine is to be enforced the African way: by shooting anyone who tries to approach the quarantine boundary. That leaves no role for the U.S. military, never mind that, in the words of Lt. Gen. William G. Boykin Ret., this mission would in any case be “an absolute misuse of the U.S. military.” But then Obama wants to find any mission for U.S. troops that will keep them away from the "new Caliphate" he has spent five-plus years creating.

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