Saturday, September 13, 2014

The Very Model Of A Modern Major General Public Health Disaster


The Epi Curve from Monrovia


# 9072


In two short weeks we’ve gone from viewing the World Health Organization’s warning that as many as 20,000 people in West Africa could be infected by the Ebola virus as being a worst case scenario, to that being among the more optimistic estimates. 


While no one knows for certain how bad things will become, partly because there isn’t a lot of confidence in our understanding of how bad things are now, the forecasts are becoming increasingly dire, with some estimates in the hundreds of thousands by year’s end.


George E. P. Box, Professor Emeritus of Statistics at the University of Wisconsin, famously declared that All models are wrong, but some models are useful.” , which helps to explain the huge diversity in estimatesAs does the computer programmers creed: GIGOgarbage in: garbage out.

Which means we probably shouldn’t latch too firmly to any of these estimates, but we should recognize the general (dismal) direction in which all of them are leaning.


Yesterday, Deutsche Welle carried a report - Ebola threatens to destroy Sierra Leone and Liberia – where German Virologist Jonas Schmidt-Chanasit  provides an even more apocalyptic forecast, saying the virus will likely become `endemic’ in those countries, and that most of their population could ultimately be infected.


Overnight the New York Times ran an article called Scientists present dire Ebola projection which carried this lede:

The deadly Ebola outbreak sweeping across three countries in West Africa is likely to last 12 to 18 months more, much longer than anticipated, and could infect hundreds of thousands of people before it is brought under control, say scientists mapping its spread for the federal government.

While there are mitigation efforts that could still blunt these projected impacts  and shorten this epidemic, for that to happen, it will require an unprecedented international effort, and some very good luck with the development of vaccines.  

And while the world tries to respond to this staggering Ebola outbreak, overburdened public health agencies around the globe will also be tasked with playing Whack-A-Mole against a variety disease threats with global aspirations – like Avian flu in Asia (H7N9, H10N8, H5N1), MERS-CoV in the Middle East, and of course the one we don’t know about yet . . . Virus X.

Given the the number and size of these threats, rather than cutting back on public health budgets, we really need be investing in a bigger mallet;  A global public health response team with the resources, and international backing, to investigate and coordinate a response to future emerging disease threats before they can spiral out of control.


Because the next threat that comes down the pike could make the carnage wrought by Ebola pale in comparison.

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