Homeland Security Watch

News and analysis of critical issues in homeland security

October 18, 2014

Ebola source sitrep 1

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on October 18, 2014

This is the first in an irregular update on efforts to engage Ebola’s center-of-gravity.  As noted previously, I am concerned US media is not giving sufficient attention to fighting this disease where it matters most for all of us.

If the rate of transmission can be suppressed at the source, then the risk to the United States will be substantially mitigated.  If the rate of transmission in West Africa cannot be significantly reversed in the next 60-to-90 days some epidemiologists are concerned Ebola will establish itself well outside it’s historically native range.

Data collection in Guinea, Sierra Leone, and Liberia — the current outbreak’s epicenter — is far from state-of-the-art.  But following is the best information now available from local health agencies as aggregated by the World Health Organization:

Ebola Chart

These numbers will get worse — probably much worse — before they get better.  Current projections suggest 10,000 new cases per week by December.

But there is also some encouraging news.  The Ebola transmission cycle in Senegal and Nigeria has evidently been successfully interrupted and contained.

Ebola survivors who have developed an immunity to the disease are now involved in caring for other patients and may be the source of life-saving blood transfusions.

Population behaviors, such as burial practices, are adapting to the risk.

Several new treatment centers are under construction.  Early identification, isolation, and effective treatment of those with Ebola will cut transmission rates and improve survival rates.  This week US military operations to expand local capacity got seriously underway. (Further details)

There will, almost certainly, be more cases of Ebola presenting in the United States.  The best way to reduce vulnerability is to eliminate the threat at its source.

 –+–

Editorial Note:  It has long been my personal opinion that “homeland security” is most meaningful when it offers its legacy professions, policy-makers, and the public a strategically integrated angle on risk.  The risk environment is usually complicated, often complex and even chaotic.  There are important roles for an array of specializations, threat-specific strategies, operational expertise, and tactical competence.  Homeland security will be more successful to the extent it is well-informed of these related domains.  But homeland security delivers added-value when it can stitch together these diverse elements into a coherent — ideally mutually amplifying — whole.  Strategy, at least in my use of the term, is especially concerned with how risks can be intentionally engaged in a manner that deploys the threat against itself and reduces self-generated vulnerabilities.

What is the most effective strategy for the risk of Ebola?

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12 Comments »

Comment by Donald Quixote

October 18, 2014 @ 5:24 pm

The greatest take away for this very critical Ebola outbreak is to actually and truly learn and implement the lessons for a more serious pathogenic threat that may dwarf Ebola in the United States and worldwide. A man can dream.

Comment by William R. Cumming

October 18, 2014 @ 7:36 pm

Speaking of specifics of HS what have the 200 FTE Office the Medical Director in DHS been up to in the EBOLA scene?

Has a single PAR been issued by Uncle Sugar to the public? How is rumor control setup for the current EBOLA situation? Is there a daily sitrep on EBOLA made available to the public?

Comment by Christopher Tingus

October 18, 2014 @ 9:39 pm

Today, diseases as common as the cold and as rare as Ebola are circling the globe with near telephonic speed, making long-distance connections and intercontinental infections almost as if by satellite. You needn’t even bother to reach out and touch someone. If you live, if you’re homeothermic biomass, you will be reached and touched.
—Angier, 2001

Comment by Christopher Tingus

October 18, 2014 @ 9:47 pm

Authors

Stacey Knobler, Adel Mahmoud, Stanley Lemon, Leslie Pray, Editors, Forum on Microbial Threats

Globalization is by no means a new phenomenon; transcontinental trade and the movement of people date back at least 2,000 years, to the era of the ancient Silk Road trade route. The global spread of infectious disease has followed a parallel course. Indeed, the emergence and spread of infectious disease are, in a sense, the epitome of globalization. Although some experts mark the fall of the Berlin Wall as the beginning of this new era of globalization, others argue that it is not so new. The future of globalization is still in the making. Despite the successful attempts of the developed world during the course of the last century to control many infectious diseases and even to eradicate some deadly afflictions, 13 million people worldwide still die from such diseases every year.

On April 16 and 17, 2002, the Forum on Emerging Infections held a working group discussion on the influence of globalization on the emergence and control of infectious diseases. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop.

The Impact of Globalization on Infectious Disease Emergence and Control report summarizes the presentations and discussions related to the increasing cross-border and cross-continental movements of people and how this could exacerbate the emergence and global spread of infectious diseases. This report also summarizes the means by which sovereign states and nations must adopt a global public health mind-set and develop a new organizational framework to maximize the opportunities and overcome the challenges created by globalization and build the necessary capacity to respond effectively to emerging infectious disease threats.

Comment by William R. Cumming

October 19, 2014 @ 1:12 am

Wiki Extract:

Pandemics and notable epidemics through history

There have been a number of significant pandemics recorded in human history, generally zoonoses which came about with domestication of animals, such as influenza and tuberculosis. There have been a number of particularly significant epidemics that deserve mention above the “mere” destruction of cities:
Plague of Athens, 430 BC. Possibly typhoid fever killed a quarter of the Athenian troops, and a quarter of the population over four years. This disease fatally weakened the dominance of Athens, but the sheer virulence of the disease prevented its wider spread; i.e. it killed off its hosts at a rate faster than they could spread it. The exact cause of the plague was unknown for many years. In January 2006, researchers from the University of Athens analyzed teeth recovered from a mass grave underneath the city, and confirmed the presence of bacteria responsible for typhoid.

Bubonic plague victims in a mass grave from 1720–1721 in Martigues, FranceAntonine Plague, 165–180. Possibly smallpox brought to the Italian peninsula by soldiers returning from the Near East; it killed a quarter of those infected, and up to five million in all. At the height of a second outbreak, the Plague of Cyprian (251–266), which may have been the same disease, 5,000 people a day were said to be dying in Rome.
Plague of Justinian, from 541 to 750, was the first recorded outbreak of the bubonic plague. It started in Egypt, and reached Constantinople the following spring, killing (according to the Byzantine chronicler Procopius) 10,000 a day at its height, and perhaps 40% of the city’s inhabitants. The plague went on to eliminate a quarter to a half of the human population that it struck throughout the known world. It caused Europe’s population to drop by around 50% between 550 and 700.
Black Death, from 1347 to 1453. The total number of deaths worldwide is estimated at 75 million people. Eight hundred years after the last outbreak, the plague returned to Europe. Starting in Asia, the disease reached Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in Crimea), and killed an estimated 20 to 30 million Europeans in six years; a third of the total population, and up to a half in the worst-affected urban areas. It was the first of a cycle of European plague epidemics that continued until the 18th century. There were more than 100 plague epidemics in Europe in this period. The disease recurred in England every two to five years from 1361 to 1480. By the 1370s, England’s population was reduced by 50%. The Great Plague of London of 1665–66 was the last major outbreak of the plague in England. The disease killed approximately 100,000 people, 20% of London’s population.
The third plague pandemic started in China in 1855, and spread to India, where 10 million people died. During this pandemic, the United States saw its first outbreak: the San Francisco plague of 1900–1904. Today, isolated cases of plague are still found in the western United States.

Aztecs dying of smallpox, Florentine Codex (compiled 1540–1585)
Encounters between European explorers and populations in the rest of the world often introduced local epidemics of extraordinary virulence. Disease killed part of the native population of the Canary Islands in the 16th century (Guanches). Half the native population of Hispaniola in 1518 was killed by smallpox. Smallpox also ravaged Mexico in the 1520s, killing 150,000 in Tenochtitlán alone, including the emperor, and Peru in the 1530s, aiding the European conquerors.[27] Measles killed a further two million Mexican natives in the 17th century. In 1618–1619, smallpox wiped out 90% of the Massachusetts Bay Native Americans.[28] During the 1770s, smallpox killed at least 30% of the Pacific Northwest Native Americans.[29] Smallpox epidemics in 1780–1782 and 1837–1838 brought devastation and drastic depopulation among the Plains Indians.[30] Some believe that the death of up to 95% of the Native American population of the New World was caused by Old World diseases such as smallpox, measles, and influenza.[31] Over the centuries, the Europeans had developed high degrees of immunity to these diseases, while the indigenous peoples had no such immunity.[32]

Smallpox devastated the native population of Australia, killing around 50% of Indigenous Australians in the early years of British colonisation.[33] It also killed many New Zealand M?ori.[34] As late as 1848–49, as many as 40,000 out of 150,000 Hawaiians are estimated to have died of measles, whooping cough and influenza. Introduced diseases, notably smallpox, nearly wiped out the native population of Easter Island.[35] In 1875, measles killed over 40,000 Fijians, approximately one-third of the population.[36] The disease devastated the Andamanese population.[37] Ainu population decreased drastically in the 19th century, due in large part to infectious diseases brought by Japanese settlers pouring into Hokkaido.[38]

Researchers concluded that syphilis was carried from the New World to Europe after Columbus’ voyages. The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions of Europe.[39] The disease was more frequently fatal than it is today. Syphilis was a major killer in Europe during the Renaissance.[40] Between 1602 and 1796, the Dutch East India Company sent almost a million Europeans to work in Asia. Ultimately, only less than one-third made their way back to Europe. The majority died of diseases.[41] Disease killed more British soldiers in India than war.[42]

As early as 1803, the Spanish Crown organized a mission (the Balmis expedition) to transport the smallpox vaccine to the Spanish colonies, and establish mass vaccination programs there.[43] By 1832, the federal government of the United States established a smallpox vaccination program for Native Americans.[44] From the beginning of the 20th century onwards, the elimination or control of disease in tropical countries became a driving force for all colonial powers.[45] The sleeping sickness epidemic in Africa was arrested due to mobile teams systematically screening millions of people at risk.[46] In the 20th century, the world saw the biggest increase in its population in human history due to lessening of the mortality rate in many countries due to medical advances.[47] The world population has grown from 1.6 billion in 1900 to an estimated 7 billion today.

Comment by Philip J. Palin

October 19, 2014 @ 5:58 am

Bill and Mr.Tingus: Many thanks. Very helpful strategic context. The impatience with — even dismissal of — such context is an aspect of most current media coverage that ill-serves everyone.

Donald Quixote: I have personally seen evidence in two states and at least one private supply chain that your dream is coming true.

Fundamental to this happening — at least in these three cases — is an ability to view the risk environment strategically in contrast to tactical treatment of the immediate threat. Using a network-behavior model, these folks are able to identify systemic issues that emerge in a range of problem-sets.

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” Sun-Tzu

Comment by Philip J. Palin

October 19, 2014 @ 8:04 am

As I complain about how US media is focusing on symptoms rather than sources, it is appropriate that I acknowledge many of the links in this and previous posts depend on US media coverage. There is detailed and often distinguished reporting. Because of the Web this reporting is accessible. But front-pages and headline broadcasts often neglect these resources.

Comment by Donald Quixote

October 19, 2014 @ 10:23 am

The dream will be realized when the changes are sustained and measurable years from now, not just when we are caught up in the 24 hour news cycle. As we go through the motions, new funding will be found and grant writers will incorporate the new buzz words. The true test shall be when we have moved on to the next crisis that we did not prepare for and a more serious novel pathogenic one comes a calling.

Comment by Philip J. Palin

October 20, 2014 @ 5:07 am

Donald Quixote: Agreed. And even the best trends are not yet assured of sustainment. But most of the best trends are measureable… so sustainment may be more likely.

A piece which suggests what is brewing and how the dream might be fulfilled:

http://www.scmworld.com/Columns/Beyond-Supply-Chain/Ebola-could-teach-us-how-to-sync-capacity-with-need/

Comment by William Cumming

October 20, 2014 @ 11:22 am

NIGERIA announcing it is EBOLA FREE! IMO doubtful and close to the AIDS Free announcement at one time by South African officials. Truth is the first victim in PANDEMICS?

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October 20, 2014 @ 1:15 pm

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