It is the disease of not listening, the malady of not marking, that I am troubled withal.

William Shakespeare[1]

[Last time we wrote a blog about paranoia, literary and real, and discussed an interesting novel from 1979 to illustrate a point. In the novel, senior people plotted to take over our Government. They had discovered a man-made disease, and hired former revolutionaries from the 1960’s to spread it around the country. The idea was that the plotters would find the revolutionaries before they went too far, catch them, alarm the public, and ram through legislation, regulations and the like to seriously curtail our constitutional protections. In this way the insiders would solidify their control over the nation, all in the name of keeping us safe from harm.

It’s an interesting thesis and no, it’s not about the Patriot Act, our invasion of Iraq and Afghanistan, or our seemingly endless wars in the Middle East. The book was written more than 20 years before those events. And it’s fiction, not fact. But it does make a point, i.e., that people might well accept all manner of restrictions, etc., if they think they’re genuinely at risk and the Government needs the power to protect them.

Today we have the Ebola epidemic. It’s very real, but it’s not affecting us very much, and so far there’s no evidence it’s man-made. Apparently Ebola is indigenous to Africa.  But there’s always the chance that somebody might try to exaggerate the current epidemic, to capitalize on public concern to further some agenda or other that might not be in our interest. There’s that chance, but there’s not a lot of evidence it’s happening. Granted, some people think that a crisis is too good a thing to waste. But again, I don’t think the crisis is being manipulated at this time for political purposes.

Now let’s go to today’s blog.]

Predicting Things

Well, it’s February and we’ve only written one blog in the New Year. There’s no excuse for that, except possibly indolence, or snow and the fear of snow; but the snow missed us, and we’re awake now, so it’s time to get on with life. First, however, how about a round of applause for our nation’s intrepid meteorologists? They have lots of weather models, I think they call them algorithms, and super computers to run them on, but still they managed to grossly overestimate the snow that was supposed to hit New York City last week.[2]

Frankly I wasn’t surprised. I live in the DC area and am quite accustomed to snow emergencies that don’t materialize, except when they do. And, of course, half an inch of snow is considered to be an emergency here, largely because many folks just don’t know how to drive on ice.

Still meteorologists remind me, I don’t know why, of an old joke about economists: If you look at all of them and plot their consensus over two decades, you may find that they forecasted 12 of the last two recessions, and missed the big one in 2009. Are economists influenced by their political views, or do they simply make mistakes in the math? Who knows? No doubt there are legitimate explanations. But the fact of the matter is that often their predictions are all over the place, and they can’t all be right.

Of course, even some politicians realize that their favorite economists are fallible human beings. Apparently Mikhail Gorbachev, the last leader of the old Soviet Union, was one of those enlightened ones. He famously remarked that he had 100 economists to help him, and one of them was smart; but he didn’t know which one. [3]

Predicting a Plague

But this time around we’re not going to talk about the weather, or economics; instead let’s talk about forecasting disease, the outbreaks thereof, and more specifically about Ebola. We’ve all heard of Ebola, of course, and last year this blog focused on it exclusively for a time. It’s a terrible disease; the symptoms are ghastly, and the mortality rate is very high. But while there was general agreement about this, and that there were no cures or vaccines currently available, there was no consensus on just how bad the epidemic might be. Like with the weather, the estimates were all over the place.

Here at Elemental Zoo Two we tracked 3 estimates, to see which one turned out to be the most accurate. These were: (i) an initial one from the World Health Organization (WHO); (ii) our own, based on early projections by scientists in the field when the current epidemic manifested itself; and (iii) a “worst case” scenario proposed by the U.S. Centers for Disease Control (CDC). Most definitely, there was no consensus

  • The Initial WHO Estimate. In late August WHO estimated that total Ebola cases (that’s “cases,” not fatalities) in West Africa would top out at 20,000 in early February of this year. [4]
  • Our “Geometric” Estimate. Also in late August WHO scientists reported that, as of then, Ebola cases were doubling every 35 days.[5] So we at Elemental Zoo Two did our own projection to see what might happen if Ebola cases continued to increase at that rate. Our spreadsheet showed 71,680 cases by February 8, 2015.
  • The CDC “Exponential” Projection. Obviously WHO was not expecting the early, rapid rise in Ebola cases to continue throughout the epidemic. CDC, on the other hand, had a much darker view. On September 23 it proposed, as a “worst case,” that actual Ebola cases were 2.5 times more than reported cases, and that cases were doubling every 21 days, not every 35 days. So based on this, CDC concluded that there might be as many as 1,400,000 Ebola cases in West Africa by the end of January, 2015.[6]

So What Happened?

Here it is, early February, and the results are in. As of January 28, WHO counted 22,092 total cases of Ebola in West Africa.[7] That’s about 31 percent of our projected total, and less than 2 percent of the CDC’s worst case.[8] Our projection, and CDC’s, were way too high.

WHO’s initial estimate of 20,000 cases was a bit low, but compared to the competition, was spot on. So the next time there’s an epidemic, who are you going to believe, us, the CDC or WHO?

That’s a tough question. Elemental Zoo Two isn’t entitled to any special deference, and we don’t claim medical expertise. We’re just amateurs who ask questions based on the things we uncover.  The CDC, who does claim expertise, was way off this time around. Why? Ask them; we don’t know. But they did say theirs was a “worst case” analysis, and that certainly was true.

It looks as though WHO understood the situation in West Africa better than anyone else, and we should give them credit for that. That doesn’t mean you have to believe everything they say in the future. That’s a bad approach to life, no matter who you trust. Everybody makes mistakes. But while I always look for corroboration, no matter who’s talking about what, it’s obvious that WHO’s professional judgment in health matters, is entitled to a great deal of respect. At least until they lose it in some botched program or another.

Are We Out of the Woods?

Probably not. The Ebola virus first appeared in 1976, and broke out 22 times from then to 2012, infecting a total of 2,315 individuals. The outbreak of 2014-2015, some call it an “explosion,” is more infectious and deadly than all of the earlier ones combined.[9]  Seemingly the current outbreak is beginning to fade, but that’s not a foregone conclusion. Our efforts to contain it have consisted almost solely of finding and isolating patients, and providing palliative care until they either recovered or died. At present there are no vaccines to prevent the disease, or cures to treat it. So even if the disease fades in one infected area or another, there is no guarantee that it won’t recur if infected people return to areas thought to be safe, or it spreads in some other manner. [10]

There are five strains of Ebola known to us.[11] The one that figures most prominently in the current outbreak is Ebola Zaire, and the good news is that we have a program to test the efficacy of a vaccine against it.[12] The bad news is that it may take up to a year for trials to be completed and, of course, the vaccine may fail. The other bad news is that Ebola viruses are thought to be mutating.[13]

We live in uncertain times. Nature has warned us with this last, most vicious outbreak. As Shakespeare says, we need to listen and mark it down. Nobody should relax. If money is needed for more research, the Congress should appropriate it. Stop the disease before it returns or there’s a more virulent 24th, 25th etc. outbreak. Principlis obsta; sero medicina pataturcom mala per longas convaluere moras.[14]

[1] Most quotes are taken from the Oxford Dictionary of Quotations (6th Edition) (Oxford, 2004), which we will cite as ODQ at ___. See ODQ at William Shakespeare, p. 691, n. 24.This one’s from Henry IV, Part 2.

[2] As predicted, New England got a lot of snow in late January, but parts of NYC (especially Manhattan) were spared. That left politicians scrambling because they had pretty much shut down NYC in fear of the weather. “But in the New York City area, the snowfall wasn’t all that bad, falling short of a foot. By Tuesday morning, buses and subways were up and running again, and driving bans there and in New Jersey had been lifted…The glancing blow left forecasters apologizing and politicians defending their near-total shutdown on travel.” See Huffington Post,  Salsberg, East Coast Snow Storm Shuts Down New York City, Snarls Travel Plans (January 27, 2015), available at http://www.huffingtonpost.com/2015/01/27/east-coast-snowstorm_n_6552018.html

[3] It was a joke. You can find a version of it in Rec.Humor.FunnyJokes at http://www.netfunny.com/rhf/jokes/90q4/smartadv.html We heard the same story years ago, but it involved 1000 terrorists, lovers and economists, not 100. Anyway, the joke is apocryphal, i.e., based on hearsay and third-hand reports, but funny nevertheless.

[4] See World Health Organization, Ebola Response Roadmap (28 August 2014), available at  http://apps.who.int/iris/bitstream/10665/131596/1/EbolaResponseRoadmap.pdf?ua=1

[5] See Sciencexpress Reports, Gire et al., Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak (28 August 2014) (hereafter cited as Genomic Surveillance at __), available at http://www.sciencemag.org/content/early/2014/08/27/science.1259657.full.pdf

[6] See The Washington Post, Sun et al., CDC: Ebola could infect 1.4 million in Liberia and Sierra Leone by end of January (September 23, 2014), available at:   http://www.washingtonpost.com/national/health-science/cdc-ebola-could-infect-14-million-in-west-africa-by-end-of-january-if-trends-continue/2014/09/23/fc260920-4317-11e4-9a15-137aa0153527_story.html

[7] This is from the WHO Situation Report of 28 January. It’s available from WHO, Ebola Situation Report (28 January 2015) at http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-28-january-2015  WHO also shows with 8,810 deaths. You can download the raw data from WHO, Ebola Data and Statistics, at http://apps.who.int/gho/data/node.ebola-sitrep.quick-downloads?lang=en

[8] That’s 22,092/1,400,000 or 0.01587, i.e. 2% (rounded up).

[9] See Scientific American, Fischetti, The Steady Rise of Ebola (February 2015) at p. 88. This is a nifty, one-page depiction of what happened between 1976 and 2012.

[10] See BBC, News Africa, no author listed,  Ebola: Mapping the outbreak (23 January 2015), available at http://www.bbc.com/news/world-africa-28755033

[11] See HHS, CDC, National Center for Emerging Zoonotic Infectious Diseases, Ebola Hemorrhagic Fever Information Packet (2009). The document is available as a pdf download from HHS. You can find it at http://www.cdc.gov/vhf/ebola/pdf/fact-sheet.pdf . (Henceforth we’ll cite it as 2009 Information Packet at __.) : “Four of the five have caused disease in humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo. The fifth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans.”

[12] See BBC, News Africa, Doyle, First Ebola large-scale vaccine trial starts in Liberia (2 February 2015), available at http://www.bbc.com/news/world-africa-31100450

[13] See BBC, News Health, Mazumdar, Ebola outbreak: Virus mutating, scientists warn  (29 January 2015), available at  http://www.bbc.com/news/health-31019097

[14] See ODQ at Ovid, p. 580, n.16. The translation is: “Stop it at the start. It’s late for medicine to be prepared when disease has grown strong through long delays.” No doubt Ovid was speaking of the disease someone already had caught, and was counseling early treatment. Nevertheless, it’s good advice as well for people preparing for an epidemic.

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