Ebola - my visual charts & projections based on WHO data

as you can see here the curves of two previous Ebola outbreaks 1995, 2000. the whole curve up peaking and down is only 10 weaks, while in current epidemic it is already 5 months and the curve still gowing up!
the current epidemic is compound of several strains of different incubation periods ranging from 2 to 23 days).
even a treatment for one strain can probably not help the other?
curves of two ebola outbreaks 1995, 2000

current time curve

a reply to: jadedANDcynical
Thank you!

Yes, the questions are how long will R0 stay consistent and how long will it be until R0 is less than 1? I asked a Physics PhD I know about the validity of the projection. He said, "Well, it won't keep going like that forever." I replied, "I mean, until something changes drastically to slow down the spread." He said, "Yeah... eventually everybody in an area will be dead...."

I didn't find that to be very reassuring.

But it does emphasize that the main problem right now is containment, at least until better treatment is widely available. If it can be contained, R0 will go down.

a reply to: Destinyone

Catholic Nun Dies From Ebola While Working In Liberia

Thanks, Des. I hadn't seen that one yet. Assuming this is included in the WHO statistics (I imagine it will be included for Liberia), it either is or will be included in the data for the graph.

What I'm doing is adding in the statistics from WHO every couple or few days as their official updates come out. The exception is for the months before WHO started doing their reports in late March. The earlier statistics come from research published in The New England Journal of Medicine into the very first cases and the very early stage of the outbreak, starting with the 2-year-old child that is the presumed first case.

Everyone pretty much knows the WHO numbers are under-reported, but they are still the ones that are considered the most 'official.' Using the WHO numbers makes it hard for anyone to argue with Charts 1 and 2, regardless of what they think of the projections.

originally posted by: ikonoklast
a reply to: jadedANDcynical
Thank you!

Yes, the questions are how long will R0 stay consistent and how long will it be until R0 is less than 1? I asked a Physics PhD I know about the validity of the projection. He said, "Well, it won't keep going like that forever." I replied, "I mean, until something changes drastically to slow down the spread." He said, "Yeah... eventually everybody in an area will be dead...."

I didn't find that to be very reassuring.

But it does emphasize that the main problem right now is containment, at least until better treatment is widely available. If it can be contained, R0 will go down.

the disease already spread by airplanes.

10% will survive the epidemic they will be immune to the disease from now on forever.

Well if this isn't confirmation of intentionally under reporting deaths, I don't know what would qualify. The risks this practice creates for surviving family is also dangerous.

Liberians ignore guidelines on testing bodies of possible Ebola victims

Liberia's government is cremating the remains of possible Ebola victims without testing whether they have the virus, leaving relations unaware if they may be at risk of the disease as well.

Current guidelines to stop the spread of the outbreak in west Africa recommend that anyone who dies from an unconfirmed illness be tested for the Ebola before the body is disposed of.

As well as helping health officials to monitor the number of fatalities, a positive result means the virus may well have been passed on to friends and relations. But, such is the chaos in Liberia's health service, ministry of health undertakers are being instructed simply to take them directly for cremation.

When The Telegraph accompanied one such team on their collection duties last week in the Liberian capital, Monrovia, the four bodies collected during the course of an afternoon were driven straight to the crematorium at the nearby town of Marshall.

[url=http://www.telegraph.co.uk/news/worldnews/ebola/11024903/Liberians-ignore-guidelines-on-testing-bodies-of-possible-Ebola-victims.html]source[/url ]

a reply to: DancedWithWolves

That's because they're too busy trying to track down the estimated 30,000 that Sawyer may have come in contact with on his escapade through 4 airports and 3 flights, before he died of a disease he insisted he didn't have up to the moment he died.

They don't have the resources to track people down, much less test them. They are just trying to get rid of the dead bodies littering the streets.

It's so insane...

Des

originally posted by: ikonoklast
a reply to: jadedANDcynical
Thank you!

Yes, the questions are how long will R0 stay consistent and how long will it be until R0 is less than 1? I asked a Physics PhD I know about the validity of the projection. He said, "Well, it won't keep going like that forever." I replied, "I mean, until something changes drastically to slow down the spread." He said, "Yeah... eventually everybody in an area will be dead...."

I didn't find that to be very reassuring.

But it does emphasize that the main problem right now is containment, at least until better treatment is widely available. If it can be contained, R0 will go down.

epidemics are self limiting because viruses or germs die in their own piss!
and epidemic does not last forever untill everybody gets immunity. it only last 2 or 3 time curves, for unknown reasons or just because they die in their own piss.

as for mutation the mutation is a mistake that happens because environment is not perfect.
mutation rate increases when the virus is in stressful situation for a prolonged period of time.
like exposure to radioactive, or staying in a toxic environment like the Pig's belly.

mutations could go both ways, good or bad (depending on who is looking at it)
to have a more virulent strain is mostly done in lab (very advanced technology and science like top 5 superpowers )

Pig eating everything encounter all possible germs who find a place to live in their bellies.

that is why Pig is considered alternative reservoire. so if ebola have only one natural reservoire the bat since infinity, the new invasive species the pig also is an alternative reservoire for any given germ as long the pig live in the area of the natural reservoire, or even away from the natural reservoire if the trash that pig eat is imported from far away (like the germ is fish from Japan found in pigs billy)

since germs live in pigs belly (not infecting ) all kind of garbage and their toxins are dumped on the virus making the virus making more mutations because of the stress that make the dna mistake (mutation increase) so that the dna doubling could be made in a deadline like time.

the time curve unable to materialize in current outbreak of 2014 comparing with previous outbraks means different strains inoclated even different first case in different times.

Update

West African Ebola outbreak death toll reaches 1,013 : WHO

DAKAR (Reuters) - The death toll from the worst ever outbreak of Ebola has reached 1,013 after another 52 people died in the three days to Aug. 9 in three West African countries, the World Health Organization said on Monday.

The largest number of reported new deaths were in Liberia, where 29 people died, followed by 17 in Sierra Leone and six in Guinea, the WHO said in a statement on its website. The total number of cases rose to 1,848, it said.

source

Again... if someone is not symptomatic, they are not contagious. If someone is running around with Ebola but has no symptoms, they are not spreading it. Stop posting stuff about people running through multiple airports infecting everyone, unless you actually KNOW that person was symptomatic and could infect others.

originally posted by: fleabit
Again... if someone is not symptomatic, they are not contagious. If someone is running around with Ebola but has no symptoms, they are not spreading it. Stop posting stuff about people running through multiple airports infecting everyone, unless you actually KNOW that person was symptomatic and could infect others.

Ebola reproduces in bodily fluids. MOST viruses take hundreds or thousands of virus cells excreted in fluids to infect a person. Ebola takes but one cell to infect. Tell me that there is not ONE single ebola cell in an asymptomatic person's fluids that can infect others?

Exactly.

originally posted by: fleabit
Again... if someone is not symptomatic, they are not contagious. If someone is running around with Ebola but has no symptoms, they are not spreading it. Stop posting stuff about people running through multiple airports infecting everyone, unless you actually KNOW that person was symptomatic and could infect others.

where is evidence ebola only contagious after symptoms appear. transportation feed contaigen



www.idpjournal.com...

Infectious disease emergence and global change: thinking systemically in a shrinking world

like ebola, highly pathogenic avian flue HPAI seems less common in small than in large flocks of chickens, for which primary transmission is respiratory.The viral trade-off hypothesis, developed by Ewald and others [102], speculates that evolutionary forces in most ecological situations are likely to drive pathogens, which trade off rapid host lethality in exchange for relatively prolonged host longevity. Over time, this is likely to favour greater opportunities for pathogenic reproduction. Extremely rapid host mortality is likely to result in a self-limiting epidemic, especially for pathogens which are not infectious until hosts are symptomatic. This is not the case for influenza, which as mentioned can be effectively transmitted when symptoms are either minor or have not appeared.

If there is a very large number of immunologically naive hosts (e.g., birds) that can be infected, and which are in close proximity, then a pathogen that causes rapid infection may be favoured, even if it causes death – as long as there are sufficient other vulnerable hosts which can, in turn, be infected before the original host dies. That is, the evolutionary penalty for pathogens that kill rapidly is lesser, even if they kill the host.

a reply to: DancedWithWolves

Thanks for the heads up that the newest data is available. I've updated charts 1 and 2 below. As with the original charts, Chart 1 and Chart 2 show the number of cases and the number of deaths for the Ebola outbreak that have actually been reported. In Chart 1, the y-axis is linear. In Chart 2, the y-axis is a logarithmic scale where divisions of the axis increase by powers of 10.

Click on either graphic to see it larger.

I didn't update the projections for two reasons. First, there wouldn't be much change yet. Second, I think it's a good sign that all the suspected cases outside the original outbreak countries have allegedly been negative so far.

Charts 1 and 2 were created and updated by me (not by WHO or NEJM) using the data from the news updates on the following WHO and The New England Journal of Medicine websites:

SOURCE: WHO website 1

SOURCE: WHO website 2

SOURCE: The New England Journal of Medicine

is R0 and R1 related to the curve in the graph

I see repeated references in all the threads on Ebola, about how a limiting factor of contagion is that the infected is only contagious while symptomatic.

As if people who have a headache, stomach pains and achyness go straight to the hospital ordinarily?

I went to work yesterday with all that, and diarrhea and nausea too. Not many people stop their lives just because they have some slight flu like (or hangover, or low blood sugar like) symptoms. Especially if they have a plane ticket they paid a lot for and have been preparing their voyage for months.

I could not find a reference that ebola only transmits after symptoms appear. can anybody get me a clue where is such reference

a reply to: fleabit

Hi Fleabit!

Without disrespect, but there were witnesses that saw Sawyer with diarrea on the plane, which would make him symptomatic. Destinyone was referring to him. Furthermore, according to one African newspaper (I will try to find the link after work) he denied having had contact with ebola patients (his sister died of ebola) and, apparently, he and another doctor decided to try to break in to two different isolation wings in two different hospitals before jumping into those planes.

originally posted by: reletomp
as you can see here the curves of two previous Ebola outbreaks 1995, 2000. the whole curve up peaking and down is only 10 weaks, while in current epidemic it is already 5 months and the curve still gowing up!
the current epidemic is compound of several strains of different incubation periods ranging from 2 to 23 days).
even a treatment for one strain can probably not help the other?
curves of two ebola outbreaks 1995, 2000

current time curve

From what I can tell is that we are currently in uncharted waters then...
Those two outbreaks peaked at 5-8 weeks and ending at 7-18 weeks. I honestly doubt that this has peaked yet. I feel that this is going to continue for a LONG time.

originally posted by: fleabit
Again... if someone is not symptomatic, they are not contagious. If someone is running around with Ebola but has no symptoms, they are not spreading it. Stop posting stuff about people running through multiple airports infecting everyone, unless you actually KNOW that person was symptomatic and could infect others.

Here ya go Fleabit. Considering other articles also quoted airline employees that Sawyer was vomiting and had diarrhea on his last flight, and he died 2 days after his flight. The Government of Nigeria issued an unprecedented alert.

News / Health
Nigeria Tracking 30,000 People at Risk of Contracting Ebola

Last updated on: July 30, 2014 4:01 AM

Nigerian health authorities are in the process of tracing more than 30,000 people who could be at risk of contracting Ebola, after the virus surfaced in Lagos.

The authorities have confirmed that a Liberian man who died in Lagos last Friday tested positive for Ebola, Reuters reported.

After the discovery, the hospital that dealt with Nigeria's first known Ebola victim was closed.

Professor Sunday Omilabu, from Lagos University Teaching Hospital, told Reuters the health authorities are now tracing everyone who may have had contact with the victim.

"We've been making contacts. We now have information about the manifest. We have information about who and who were around. So, as I'm talking, our teams are in the facility, where they've trained the staff, and then they [are] now asking questions about those that were closely in contact with the patient," said Professor Omilabu.

'We're actually looking at contacting over 30,000 people in this very scenario. Because any and everybody that has contacted this person is going to be treated as a suspect," said Yewande Adeshina, a public health adviser.

Nigeria's government has implemented a state of "red alert" at all border crossings and initiated a media campaign to alert the public
www.voanews.com...

If you choose not to believe the whole damn Nigerian Government...not my problem.

Des

a reply to: viibird

is R0 and R1 related to the curve in the graph

Yes and no.

No in that charts 1 and 2 are simple graphs of the actual numbers reported in the New England Journal of Medicine for dates prior to March 23, 2014 and by WHO for cases for March 23, 2014 and after.

I am not an epidemiologist or a doctor, but I understand that R0 represents the Basic Reproduction Number, the average number of people that one patient spreads an illness to. I have been trying to find a good definition of R1, but I am finding many different sources who use R1 in many different ways relating to epidemics.

So I'm not sure about R1 (perhaps someone else can address that), but yes for R0 in that the numbers which make up the graph are a result of R0. As I understand it:

If R0 is less than 1, the number of cases will diminish and the outbreak will eventually end. If R0=1, the number of cases would stay relatively constant. If R0 is greater than 1, the number of cases increases. So although the graphs are not calculated based on R0, what you see on the graphs is because of R0 as well as other factors.

At a slightly educated guess, I think the main reason the curves are currently relatively linear when plotted with the y-axis being logarithmic is because R0 is staying relatively constant currently. So the outbreak numbers continue to increase exponentially based on R0. If the outbreak(s) can be controlled so that each patient spreads it to fewer people (hopefully on average to no more people), R0 would effectively go down and the graphs would go down.

This is what happened in past outbreaks, although they have all been smaller in numbers and in affected areas and population densities. Hopefully it will in this outbreak as well. WHO apparently thought originally that it would happen with this outbreak months ago. There has never been an outbreak quite like this, so any projections are at best an educated guess.

I would have liked to have been able to factor in R0 more directly, but there isn't really enough data publicly known about the generations. For the first few generations, there is a surprising amount known (or believed to be known) about which cases spread it to which cases in each generation (thanks to this information published in The New England Journal of Medicine. But now all you see are numbers of new cases and deaths and new totals, either as a whole or per country.

Based on what is known about the incubation period (from a few days up to about 3 weeks), I think R0 is probably as previously cited by jadedANDcynical in a previous post about R0.

We estimated the basic reproduction number (R0) to be 2·7 (95% CI 1·9–2·8) for the 1995 epidemic in DRC, and 2·7 (95% CI 2·5–4·1) for the 2000 epidemic in Uganda.

jadedANDcynical noted that this quote was from Understanding the dynamics of Ebola epidemics

I created a new graph, Chart 6, that has a logarithmic y-axis that is in powers of 2. If R0 is approximately 2, give or take a little, and if there is a new generation about every 2 or 3 weeks, I think this graph shows what you would expect. The outbreak doubled almost 11 times in slightly more than 8 months. Click the chart for a larger graphic.

in the article "understanding ebola" it says that fourth of cases in Congo were infected by needles in hospitals. could it be that the remaining three fourths were infected from the needle infected ??
that Hospitals were the cause of spread.