Homeland Security Watch

News and analysis of critical issues in homeland security

September 1, 2015

“Devastating consequences if the current trend lines continue”

Filed under: Biosecurity,Catastrophes,Climate Change,Futures,Resilience,Risk Assessment,Strategy — by Philip J. Palin on September 1, 2015

Thanks to the Alaska Dispatch News, here’s a transcript of the speech President Obama gave Monday evening (9PM Eastern) in Alaska.

The phrase “homeland security” was never uttered.  But I perceive a considerable connection.  One excerpt:

We also know the devastating consequences if the current trend lines continue.  That is not deniable.  And we are going to have to do some adaptation, and we are going to have to help communities be resilient, because of these trend lines we are not going to be able to stop on a dime.  We’re not going to be able to stop tomorrow. 

But if those trend lines continue the way they are, there’s not going to be a nation on this Earth that’s not impacted negatively.  People will suffer.  Economies will suffer.  Entire nations will find themselves under severe, severe problems.  More drought; more floods; rising sea levels; greater migration; more refugees; more scarcity; more conflict. 

That’s one path we can take.  The other path is to embrace the human ingenuity that can do something about it.  This is within our power.  This is a solvable problem if we start now. 

 

August 20, 2015

Conflicting or complementary?

Filed under: Biosecurity,Climate Change,Futures,Preparedness and Response,Resilience,Strategy — by Philip J. Palin on August 20, 2015

Each month the National Oceanic and Atmospheric Administration releases a review of weather data.  What the accumulating data demonstrates are increasing departures from historic means, much more extreme weather of every sort.

While some continue to argue the cause for this shift, there is more and more consensus that the data confirms an emerging climate much different than that experienced by recent generations. (Monday I received a briefing on the so-called Kankakee Torrent of 14,000 to 19,000 years ago.  This suggests that even extremes are relative).

So far the impact of the extended California drought on agricultural production — and prices — has been modest.  According to a late-June analysis by the USDA Economic Research Service,

The current outlook for 2015 is for slightly lower than average retail food price inflation, with supermarket prices expected to rise 1.75 to 2.75 percent over 2014 levels. Despite drought conditions in California, the strength of the U.S. dollar and lower oil prices could have a mitigating effect on fresh fruit and vegetable prices in 2015. As of June, ERS predicts fresh fruit prices will rise 2.5 to 3.5 percent and fresh vegetable prices 2.0 to 3.0 percent in 2015, close to the 20-year historical average. 

But if the current drought would extend for another several years, and especially if drought in one agricultural region is combined with destructive extreme weather in other agricultural regions (e.g. the 2010 drought in Ukraine, Russia, China, and Argentina), the combined consequence can be dire.

While an understanding of cause is usually crucial to prevention and many kinds of mitigation, it is possible to disagree as to cause and develop plausible projections of consequence. In most of life there is a “cone of uncertainty” of some sort, but even when we cannot precisely predict, we may be able to reasonably anticipate.

Over the last several months a UK-US team has attempted to anticipate the impact of extreme weather on global agricultural capacity.  They recently released a report, concluding:

... the global food system is vulnerable to production shocks caused by extreme weather, and… this risk is growing. Although much more work needs to be done to reduce uncertainty, preliminary analysis of limited existing data suggests that the risk of a 1-in-100 year production shock is likely to increase to 1-in-30 or more by 2040. Additionally, recent studies suggest that our reliance on increasing volumes of global trade, whilst having many benefits, also creates structural vulnerability via a liability to amplify production shocks in some circumstances. Action is therefore needed to improve the resilience of the global food system to weather-related shocks, to mitigate their impact on people.

I find the binational report especially interesting for reasons that go beyond the explicit factual analysis.  The organization and rhetoric of the report seems a bit bipolar… unable to resolve a persistent tension between two policy/strategy perceptions.  One angle tends toward greater redundancy and centralization.  The other tends toward greater diversity and decentralization.  The authors do not seem self-aware of the tension.  It would be interesting, at least to me, to see a principled strategic process for engaging these two alternatives… or possibly complementary approaches.

March 14, 2015

Watch carefully, explain frequently

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on March 14, 2015

According to the World Health Organization, deaths from the year-plus outbreak of Ebola now exceed 10,000.  But as of Friday, March 13 it has been three weeks since a new transmission was confirmed in Liberia.

A team of Reuters reporters — or their headline editor — summarize Liberia’s key lessons-learned as watch carefully and explain frequently.  Both depending on (and potentially contributing to) trust-building community engagement.

Liberia was hit hard and, the nation’s President admits, slow to react.  But what seems to now differentiate Liberia’s — tentative — eradication from continuing (if much slowed) transmission in neighboring Sierra Leone and Guinea has been the accuracy of “contact-tracing” — essentially a mapping of personal relationships and movement related to any confirmed transmission.

This is classic public health practice. But to actually do it depends on a shared sense of solidarity… community… common cause… and community-oriented organization that cannot be taken for granted.

The recent measles outbreak in the United States demonstrates the epidemiological challenges that can emerge from a break-down of trust in communities.  I am intrigued (tempted?) with analogies to public safety and counter-terrorism challenges. Many historians of community policing trace its origins to public health models.  But I will not go there today.

It is worth noting that in this week’s Nature, respected scientists warn that the H7N9 flu virus is rapidly mutating.  The Los Angeles Times reports,

Overall, this second wave of H7N9 influenza viruses represents “a major increase in genetic diversity” compared with the viruses in the first wave, the study authors wrote. Unless live poultry markets are permanently closed, merchants stop transporting chickens from region to region, and other control measures are put in place, the virus will “persist and cause a substantial number of severe human infections.” So far, most people were sickened by handling infected chickens; cases of the virus spreading directly from person to person have been limited. That might change if the virus mutates, as happened with the H1N1 swine flu pandemic that began 2009. 

In any case, Ebola is not the only potential epidemic (upon, on, among the people) to present a risk.

This may only be a projection of preconceived bias, but in trying to discern what is different in the experience of Liberia and Sierra Leone, I perceive a bottom-up strategy in Liberia and a top-down strategy in Sierra Leone.  Trust-building has been a challenge in both countries.  But the bottom-up strategy (or emergence?) in Liberia has been much more effective.  As a hypothesis to be tested, I would suggest the top-down strategy in Sierra Leone has potentially been as “effective” in suppressing a more sustainable bottom-up approach.

And I surmise this could have implications far-beyond Ebola.

February 2, 2015

Which is harder to defeat – Ebola or ISIS?

Filed under: Biosecurity,International HLS,Terrorist Threats & Attacks — by Arnold Bogis on February 2, 2015

That is the question that Graham Allison, Director of Harvard’s Belfer Center for Science and International Affairs, tackled in a short opinion piece for Time magazine. It was originally published last December when attention on Ebola was high due to the presence of a few cases cases inside the U.S. (in contrast to the thousands in West Africa), but Phil’s post this past Thursday on “Epidemiology of Violence” reminded me of Allison’s take on the same general concept.

His conclusion:

About Ebola, the world knows a lot and is doing relatively little. About ISIS, we know relatively little but are doing a lot.

But that doesn’t answer which is the harder to defeat.  His analysis:

Finally, we should acknowledge the fact that for the foreseeable future, there may be no permanent cure for Islamic extremism. Against Ebola, researchers are racing toward a vaccine that could decisively prevent future epidemics. But the past decade has taught us that despite our best efforts, if and when the ISIS outbreak is controlled, another strain of the virus is likely to emerge. In this sense, violent Islamic extremism may be more like the flu than Ebola: a virus for which we have no cure, but for which we can develop a coherent management strategy to minimize the number of annual infections and deaths.

Not to give too much more away from the article, but it is interesting that a political scientist looks at ISIS through the lens of public health:

Over recent centuries, medicine has made more progress than statecraft. It can be useful therefore to examine ISIS through a public-health lens. When confronting a disease, modern medicine begins by asking: What is the pathogen? How does it spread? Who is at risk? And, informed by this understanding, how can it be treated and possibly prevented?

About Ebola, we know the answers to each. But what about ISIS?

I haven’t given away all the good stuff here, so if you’re interested you can read the entire article at: http://time.com/3618049/viral-threats/

January 29, 2015

Epidemiology of violence

Filed under: Biosecurity,Public Health & Medical Care,Radicalization,Strategy,Terrorist Threats & Attacks — by Philip J. Palin on January 29, 2015

About this time last year I first heard about a few cases of Ebola in the Guinea Highlands.  It was, I thought , a bit strange.  A long way from the Congo River basin, with which Ebola is usually associated.

But I was busy finishing a big project.  Infectious disease is not my specialty. The occasional human contraction of Ebola has typically produced a rapid and effective professional response.  As previously outlined, I also missed some other important connections that could have enhanced my attention.

I was not alone.

Fast-forward to today.  According to the most recent WHO situation update, in mid-January, 148 new cases of Ebola have been confirmed in Guinea, Sierra Leone, and Liberia. Compared to August and September this is good news.  At any other time and at any other place, this level of Ebola transmission would be the epidemiological equivalent of a three alarm fire.

This is not a disease we want to treat as a chronic condition.  We ought not allow it to become endemic.  It is too deadly. The current transmission cycle must be fully, wholly stopped.  Then we must each and all do better with early identification and elimination of future animal-to-human and the first human-to-human transmissions.

This is the way with networks and we are — technically and socially — increasingly a networked world.

It would be easy to move to measles or seasonal influenza.  But I want to try a more audacious analogy.

Last week Secretary Kerry spoke to the World Economic Forum.  The whole speech was better than the sound-bites I had been fed.  Following is the whiff of epidemiology I noticed in his remarks.

We have to do more to avoid an endless cycle of violent extremism, a resupplying on a constant basis. We have to transform the very environment from which these movements emerge. And that’s why we are committed to enlarging our strategy in ways that respond effectively to the underlying causes, as well as the visible symptoms of violent extremism. That’s why we’re developing an approach that extends far beyond the short term, and which cannot be limited to the Middle East or to any other region.

We need – all of us – to take these steps so that a decade or two in the future, when the economic forum meets and you hear from leaders, they’re not standing up here responding to a new list of acronyms to the same concept, but different players. We cannot have our successors come back here to face the same questions and the same challenge. The terror groups may have those different acronyms in the future and they may be targeting different countries, but if we don’t do what is required now, then I guarantee you the fundamental conflict will either stay the same or get worse.

We were very late, nearly too late, in the West African Ebola outbreak.  Thousands have — potentially will — die needlessly.  My too-simple — but not necessarily inaccurate — analysis:  When the usual professional methods were distracted and delayed, the contagion multiplied reaching an extent beyond the capacity of professionals alone.

Sierra Leone applied significant command-and-control techniques.  In retrospect, these were entirely ineffective.  Liberia — more by accident than intention — came to depend on an extraordinary network of neighbors working with neighbors. Eventually this whole community approach was adopted in Sierra Leone as well. This mostly spontaneous bottom-up engagement became the essential foundation on which current containment was achieved.

Professionals have certainly been needed at every stage.  Coordination, collaboration, communication, and clinical care have been built upon the foundation.  Spontaneous beginnings have been systematically reinforced. But until the community — really multiple communities — mobilized the deadly disease was quickly spreading.

This is the way with networks.

January 15, 2015

When the fever breaks

Filed under: Biosecurity,Public Health & Medical Care,Strategy — by Philip J. Palin on January 15, 2015

According to the most recent WHO update Ebola has caused over 8300 deaths since the outbreak began in late 2013.  New disease transmissions are occurring, but the rate of transmission has been dramatically reduced by rigorous contact tracing, early intervention, and behavioral changes.

There continues to be the risk of transmission spikes and endemic transmission cycles.  There is much still to do.  But the worst projections have been avoided and sufficient capacity now exists to contain and further reduce the risk.

For me the most remarkable aspect of this still emerging story has been the role of informal networks, neighbors, and motivated volunteers in organizing rigorous contact tracing and behavioral interventions.   In the January 19 New Yorker there is a fine piece of long-journalism by Luke Mogelson that focuses in on this “whole community” angle of the epidemic.

A few excerpts, but please read the whole story:

Neighborhoods have mobilized, health-care workers have volunteered, and rural villagers have formed local Ebola task forces. Individuals who survive Ebola are usually immune to infection, and in many places they have become integral to stemming the epidemic. “Communities are doing things on their own, with or without our support,” Joel Montgomery, the C.D.C. team leader in Liberia at the time, told me when I met him in Monrovia…

To build a network of active case-finders who could cover all of West Point, Gbessay recruited three volunteers from each of the slum’s thirty-five blocks. Most of them were young and had a degree of social clout—“credible people,” Gbessay called them. The quarantine had done little to alleviate popular skepticism of the government’s Ebola-containment policies, however, and, for a while, hostility persisted. “At first, the cases were skyrocketing,” Gbessay said. “We used to see seventy, eighty cases a day. But by the middle of September everyone started to think, Look, I better be careful. Today, you talk to your friend—tomorrow, you hear the guy is gone. So they started to pay attention.”

Please read, When the Fever Breaks.  As you read it I wonder if you will, as I did, perceive key principles that are potentially relevant to a wide range of homeland security challenges.

December 18, 2014

Ebola update

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

The December 17, WHO situation update is available here.  According to this report, some progress is being made in Sierra Leone, which has replaced Liberia as the nation reporting the most incidents of transmission.

EVD transmission remains intense in Sierra Leone, with 327 new confirmed cases reported in the week to 14 December. While there are signs from the country situation reports that the increase in incidence has slowed and the incidence may no longer be increasing, the country reported the highest number of confirmed cases in epidemiological week 50. 

A major effort was undertaken this week in Sierra Leone to alter population behaviors that are contributing to continued transmission of the disease.  The Guardian (London) reports on some of the strategies being employed.

Reuters has an update on operations as of Wednesday.

UPDATE:

On Friday the Washington Post — which has done distinguished reporting on  the Ebola outbreak in West Africa — published a big front page feature on the situation in Sierra Leone.

Also on Friday NPR interviewed the CDC Director who is the midst of a site visit to West Africa.  Dr. Thomas Frieden warns of the risk that the virus might become endemic and therefore a perpetual source of recurring spikes in transmission.

December 17, 2014

A new homeland security-related blog: The Bifurcated Needle

Filed under: Biosecurity,Media,Public Health & Medical Care — by Arnold Bogis on December 17, 2014

I fell behind on some work this week and am not likely to post anything substantial today, so unfortunately I cannot personally provide Phil reading material to go along with his (really early) morning coffee.

However, for his and everyone else’s reading pleasure I’d like to point out a new homeland security blog that has recently come to my attention: The Bifurcated Needle. Named for the needle used to administer smallpox vaccinations, technically it is a health security blog. Since it seems no one can agree on what means “homeland security” I’m eagerly dragging the “Needle” down to HLS Watch’s level.

It is published by the good, and very smart, folks at the UPMC Center for Health Security. Health security is not unlike homeland security in that it covers a vast intellectual space. They already have posts up covering topics such as measuring preparedness, the security risks involved in virus research, collateral benefits of nuclear power plant preparedness, and the difficulties of biological decontamination.

Very likely worth your time to check it out: http://www.bifurcatedneedle.com/

 

 

December 11, 2014

Going the wrong way in Sierra Leone

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on December 11, 2014

Eboa 12_10

Ebola concentrations in West Africa.

The map comes from the December 10 WHO Situation Update.  Also from this report is a very troublesome finding, highlighted below.

Effective contact tracing ensures that the reported and registered contacts of confirmed EVD cases are visited daily to monitor the onset of symptoms during the 21-day incubation period of the Ebola virus. Contacts presenting symptoms should be promptly isolated, tested for EVD, and if necessary treated, to prevent further disease transmission.

During the week of 1 December, 95% of all registered contacts were visited on a daily basis in Guinea, 96% in Liberia, and 84% in Sierra Leone (a steady decline since week 44, during which 94% of registered contacts were reached). However, the proportion of contacts reached was lower in many districts. Each district is reported to have at least one contact-tracing team in place.

On average, 17 contacts were listed per new case in Guinea during the week to 1 December, 22 in Liberia, and 6 in Sierra Leone.

December 4, 2014

100,000 Doors

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on December 4, 2014

Recently my non-blogging life has experienced a set of interesting, but time-consuming convergences.  As a result my engagement at HLSWatch will be constrained for several weeks, potentially a few months.  

In my judgment the task of this blog is to amplify, aggregate, analyze and occasionally advocate.  Until more time emerges from the convergence, I will mostly use this Thursday post to amplify a situation someone else has written about, but that has not gotten much mainstream attention.

The Ebola threat continues to be deadly in West Africa and despite considerable progress still presents a potential threat to global health.  Here is the December 3 WHO Situation Update.

Local (whether Dallas or Monrovia) and global engagement of this threat has also been an interesting case-study in prevention, preparedness, mitigation, response, and — we hope — recovery.  It has been fascinating, at least to me, how crucial “whole community” engagement has been to bending the transmission curve.  

For reasons that are not yet entirely clear, Liberia and Guinea have made much more progress on changing population behaviors than has Sierra Leone.  This is despite considerable efforts by the Freetown government for a period of several months.  On Black Friday the New York Times ran a related story on its front page.  The following is from Tuesday’s Concord Times, a leading newspaper in Sierra Leone. It was written by Mohamed Massaquoi.

–+–

The Disaster Management Department in the Office of National Security, with support from UNDP, will be embarking on a door-to-door campaign in new Ebola epicentres across the country, targeting 100,000 households in the next two weeks in Waterloo, Port Loko and Moyamba with specific life-saving information.

The campaign, which is expected to reach one million people, has commenced following the recruitment and training of 300 community disaster management volunteers in Moyamba last week.

The volunteers, drawn from localities in new Ebola epicentres, will disseminate information ranging from the importance of early treatment, keeping families safe from infection while waiting for help, to welcoming survivors back into the community as a way of reducing stigma associated with Ebola.

The UNDP-supported campaign is part of national efforts to engender behaviour change in order to stem the spread of the Ebola virus disease in Sierra Leone.

In the past 21 days, Sierra Leone has recorded an exponential rise in the number of Ebola infections. Latest WHO figures show that while reported case incidence is stable in Guinea with 148 confirmed cases reported in the week to 23 November, stable or declining in Liberia – 67 new confirmed cases in the week to 23 November, Sierra Leone recorded 385 new confirmed cases in the week to 23 November.

In addition to the continued rise of cases of Ebola in Sierra Leone, the epicentre of the outbreak has shifted from the east of the country (Kailahun and Kenema) to the north-west, including Bombali, iron ore mining district of Port Loko and the Western Area, especially Waterloo and Freetown.

The Western Area continues to have the highest rate of infection, with 280 cumulative cases in the past week. Port Loko is also a major area of concern, with 120 cases in the past 7 days, according to WHO figures.

Chief Alimamy Bethembeng II of Waterloo, himself a volunteer in the door-to-door campaign in his community, enthused that with the right information, using face-to-face methods and using people who are part of the community, things would hopefully change. “We have to defend our communities from Ebola,” he said as he moved from house-to-house in the Faya-Mambo neighbourhood in Waterloo, one of the worst hit areas in the Western Area.

During one of the training sessions in Port Loko, Director of Disaster Management Department, Mary Mye-Kamara, said that the face-to-face campaign has proved very successful in slums across Freetown, and that it is the preferred method for effective awareness-raising on Ebola.

She said: “People in some of these communities are still suspicious of outsiders coming into their neighbourhoods and villages telling them about Ebola. Some of them think that these outsiders are the ones spreading the virus. This is why we are engaging the local people, training them so that they will do the awareness raising themselves. That is the only way forward now.”

She added: “Without community ownership this is difficult, even impossible to make any meaningful headway. The imams need to understand and accept that they cannot be doing the same burial rites like before…otherwise the virus will spread.”

Mye-Kamara noted further that denial is still very high, as is distrust and reticence in communities, thus urging everyone to get involved in the campaign.

“People said to us why should they be bothered to take their sick relatives to the hospital and treatment centres when the ones who had been taken before did not return? ‘They are going to die anyway’. But now we are saying to our compatriots that, with early treatment, there is a huge chance of survival. We are showing them evidence of people who have recovered from the virus. They are seeing it and we continue to hope things will change. Ebola will go,” she said.

Denial, suspicion about the spread of the disease, low level of knowledge and information are still very much prevalent especially among the poor in urban and rural areas. The face-to-face campaign hopes to target the hard-to-reach villages and communities with the right information in Port Loko, Moyamba and Waterloo in particularly, where the virus is spreading.

UNDP Programme Manager Saskia Marijnissen says, “Stopping the Ebola outbreak will not only depend on improved knowledge, but also on a change in attitude and practices. Our approach actively engages community members in a dialogue to motivate behaviour change.”

November 20, 2014

Ebola — no sitrep — but an update

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on November 20, 2014

One Wednesday the World Health Organization released a new update on the situation in West Africa.  The rate of new transmissions has continued to decline in Liberia and Guinea.  But the curve is continuing upward in Sierra Leone.

I have not seen a persuasive analysis to explain the difference between the three neighboring nations.  But there is some indication that too many social-networks in Sierra Leona may still be in denial.  Community engagement and organization are widely thought to be what turned-the-curve in Liberia.

On Tuesday a subcommittee of the House Foreign Affairs Committee held a hearing on fighting Ebola in West Africa.   You can see/hear a video of the hearing and read the prepared testimony at the committee’s website.

I probably will not prepare a new sitrep this weekend as I have the last few weekends.  A couple of new “day job” assignments are going to take a serious commitment through mid-February.  I may be a bit AWOL from HLSWatch.  We’ll see.

November 15, 2014

Ebola source sitrep 5

Filed under: Biosecurity,Public Health & Medical Care,Strategy — by Philip J. Palin on November 15, 2014

The number of deaths traced to the current Ebola outbreak now exceeds 5000.  The rate of transmission has not increased in Guinea and has slowed in Liberia. But the situation in Sierra Leone is continuing to worsen.  A new network of Ebola cases has emerged in Mali among health workers who were exposed while caring for a man with kidney failure.  The patient was also suffering from a non-diagnosed Ebola infection.

Ebola_November 14

The fatality rate among those exposed to the Ebola virus is falling. In June the fatality rate for this West African outbreak was estimated at 90 percent.  In September the fatality rate was still at least seventy percent.  In prior Ebola outbreaks — much smaller in scope — the fatality rate has averaged 50 percent of those infected.   There are some studies that suggest with early intervention the fatality rate is now as low as 25 percent.

These are small and still unconfirmed studies.  But on a preliminary basis it is reasonable to observe:

  • The amount of circulating viral load was higher in those who died than in survivors; those patients with the highest levels of virus were most likely to die.
  • One of the strongest determinants of survival appears to be patient age. Patients older than 40 years were nearly 3.5 times more likely to die than those aged less than 40. The association between an older age and a higher risk of death was found regardless of whether the patient had co-morbidities or not.
  • Evidence of substantial fluid loss and profound electrolyte derangement associated with severe diarrhoea appears to increase the risk of a fatal outcome. More aggressive supportive care, especially intravenous rehydration, is thought to improve the prospects of survival.

Seriously compromising the ability to provide early diagnosis and care is a public health infrastructure insufficient to conduct the necessary contact-tracing. According to the November 12 WHO update:

Between 3 and 8 November, 5301 new contacts were identified in Guinea, Liberia and Sierra Leone, compared with 4067 new contacts traced in the previouwoulds week. A total of 95% (124,214 of 130,140) of required daily contact visits were conducted. However, the proportion of contacts reached was lower in many districts. Each district is reported to have at least one contact-tracing team in place. On average, only 10 contacts were listed per case in the three countries in the past week. The low average number of contacts listed per case suggests that the estimate of 95% gives an unduly favourable view of the success of contact tracing. Active case finding teams are being mobilized as a complementary case detection strategy.

The situation in West Africa remains very bad, but it is not — yet? — as bad as some projected in September or even early October. The predictions have, in part, been disrupted by increased public health interventions, improved clinical care, and — especially — altered population behavior.  While the threat of the virus was too long underplayed, since August a creative and committed response has paid-off.

In recognition of the continuing high risks, Médecins Sans Frontières (MSF), an NGO with deep experience in the region, has recommended a new strategic approach, “Agile and well-equipped rapid response teams should be deployed quickly to actively investigate hotspots wherever they occur, and mount a comprehensive response.” This approach would depend much less on the construction and operation of isolation-and-treatment centers.

The rainy season is coming to an end in West Africa.  Typically the dry season sees a substantial increase in population movements.  This increased mobility will threaten the fragile progress that has been made.  The current ten-day forecast for Monrovia predicts almost daily rain and thunderstorms.  But early December is predicted to be bright and sunny.

Meeting early today in Brisbane the G20 affirmed and expanded commitments to fight Ebola in West Africa.  The world’s leading economies also signaled that more needs to be done to prevent and mitigate infectious threats much worse than Ebola: “This outbreak illustrates the urgency of addressing longer-term systemic issues and gaps in capability, preparedness and response capacity that expose the global economy to the impacts of infectious disease.”

November 8, 2014

Ebola source sitrep 4

Filed under: Biosecurity,Public Health & Medical Care,Strategy — by Philip J. Palin on November 8, 2014

This series of sitreps was initiated in midst of a media frenzy over the mishandling of an Ebola patient in Dallas. Yesterday Dallas was officially declared Ebola free.

In mid-October the nation seemed transfixed by symptoms and almost entirely distracted from their source.

In the intervening weeks there has been distinguished original reporting of the Ebola crisis by the New York Times and National Public Radio.  I have been less impressed with television news coverage.  But this Sunday, Sixty Minutes, the CBS news program, has scheduled a special report on The Ebola Hot Zone (2 minute video preview). Check your local listings.

As reported last week, the transmission growth rate in West Africa has slowed for hardest-hit Liberia.  It is increasing in Sierra Leone and Guinea.  There has — apparently — been successful containment elsewhere.  According to Friday’s special update by the World Health Organization the total numbers for Liberia, Sierra Leone, and Guinea are 13,241 confirmed cases and 4950 deaths.

Ebola Comparison

Click to open larger image.  Source: WHO November 5 Update

I have not seen a credible explanation for the recent divergence between Sierra Leona’s and Liberia’s transmission rates.  Guinea’s so far less virulent outbreak is probably a matter of geography, population density, and transportation networks.

As noted below, progress is being made on several aspects of the Ebola response strategy.

Ebola Mesures

Later today the USAID-US Army mission in Liberia will open its first Ebola Treatment Unit.

But clearly there remains much to be done.  The European Union has pledged over 1 billion Euros, but other than the Brits in Sierra Leone and the French in Guinea, actual engagement has been slow. On Thursday a Dutch ship departed Rotterdam loaded with ambulances, mobile hospitals, laboratories and other equipment. The cargo has been provided by nine EU Member States and UNICEF.

On Wednesday President Obama requested a special appropriation of $6.1 billion to address both domestic and international response to Ebola.  The Senate Appropriations Committee will begin hearings on the request on November 12.  The House Appropriations Committee is expected to follow suit before the end of the month.

November 6, 2014

Local conditions, globalized consequences

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on November 6, 2014

The following appeared in the November 3 edition of FrontPageAfrica, a leading Liberian news outlet.  The story was reported by Stephen D. Kollie.

As previously noted in Ebola Source Sitrep 3, there seems to have been an unexpected slowing of the Liberian rate of transmission. There are new reports this week, however, of increased transmission rates in neighboring Sierra Leone.  Here is the most recent WHO update.

There has been a remarkable absence of US broadcast media attention to Ebola as most of those treated for the disease in the United States have survived.  The “press” — digital and paper — has been much more attentive.

Late yesterday, President Obama requested a $6.18 billion special appropriation to combat Ebola.  According to the White House website, the funds will be used to

  • Fortify domestic public health and health care systems
  • Contain and mitigate the epidemic in West Africa
  • Speed the development and testing of vaccines and therapeutics
  • Establishing the capacity of vulnerable countries to prevent, detect, and respond to disease outbreaks before they become epidemics that threaten the American people.

–+–

Vahun, Lofa County – Barely seven months after the deadly Ebola Virus hit Lofa County, Liberia’s fourth most populated county (2008 national census) life seems to be returning to normal, but fear that the disease will resurface, exists among residents of the county. Schools remain closed, nonessential staffs working for the government; continue to remain home, while the culture of handshake, hugging and all forms of bodily contact is still prohibited.

At the crossing point, which connects Lofa and Bong counties, travelers are compelled by security officers to get of vehicles, wash their hands and undergo temperature screening. Those with high temperature levels are prevented from entering the Lofa County and refer to the local health authority for additional medical checks.

In Voinjama, the provincial capital of the county, posters of Ebola awareness messages are prevalent. Community radio stations still boom with anti-Ebola songs and messages. This, they say, is to remind residents that Ebola epidemic is not over yet. Many, including non-government agencies believe the disease spread because people did not believe in the existence of the virus.

“No one could listen when it was announced that Ebola is in town,” said Isaac Ballah, a local NGO worker in Voinjama City. Ballah told FrontPage Africa that nearly everyone in the city came to terms with the disease when a man showing signs and symptoms of the virus was seen lying at the entrance of the Lofa County Community college.

Ballah narrates that the suspected Ebola patient was lying helpless, vomiting and openly defecating as locals went to take a glimpse at the first apparent case, which signaled the coming of dark days. “After that morning, we all went home silently, with so much worried. The next day everyone picked up their clorax bottles and we stopped shaking hands and touching each other,” he said. “Few weeks later you could only hear the sound of ambulances everywhere and at the same time, see two to three pickups filled with dead bodies.”

All this epitomized the agony the people of the county were subjected to for months said Ballah. But for several weeks now, not many cases relating to the Ebola virus have been reported in the county. But residents are still taking safety seriously to prevent any widespread occurrence of the disease. They are skeptical in ruling out a new outbreak considering the county’s closeness to neighboring Guinea and Sierra Leone with which it shares borders.

Nationwide, the numbers in Ebola cases seems to be declining as has been acknowledged by the World Health Organization (WHO). The WHOs Bruce Aylward on Wednesday confirmed the decline in the number of Ebola cases in Liberia.

“The actual number of newly reported cases is beginning to decline in Liberia and the government is driving a multi prone investigation, looking at multiple strands of evidence to try and understand, is this real, is this reporting phenomenon or is this care seeking phenomenal that’s changing? So far based on the information received today… it appears that the trend is real in Liberia,” he said.

Despite this good news authorities and citizens of Lofa are taking the good news with a bit of caution. In Voinjama, all general markets remain closed to prevent public gathering. Residents are forced to sell their produce during regular weekdays instead of Fridays, which is recognized as the official market day.

Zangota’s Patient zero

In Zangota, a small town just 45 mins from Voinjama City, where over thirty deaths were reported, the Ebola nightmare began with Krubo Mamaie, who traveled to the town for medication, says 33 year-old Luana Korvah, a mental health supervisor who was actively working with the county’s Ebola task force.

According to Korvah, Mamie had cared for her sick husband in Voinjama who died of Ebola and later left for her town when she also fell ill. She was referred to the Konia Health Center by local officials in Zangota, but died en route to the Foya Ebola Treatment Center because her condition had turned for the worse.

Said Korvah: “She and her husband had burial activities in Guinea, when they went back into the community the husband fell sick.” “She was then caring for the husband and later the man died. They took the man to Letisu for burial and those that took part in the burial ceremony, who did the bathing and all the other traditional things died.”

Korvah said many residents in the area did not believe it was Ebola rather they held the general opinion that their wells were poisoned and thus causing them diarrhea and other illnesses. The residents’ failure to accept the virus existence left nearly 70 persons dead in Zangota and the numbers continued to increase spreading to nearby towns and villages.

Now, after nearly eight months battling the deadly virus, it seems Ebola has taught many lessons in the county. Precautionary measures are the order of the day. Hand washing, no handshake is just a few preventive methods that are still being religiously practiced even though infections have slowed in a County which has lost nearly 200 persons.

Careful barbing

At a local barbing shop in central Voinjama, barbers use hand gloves, bleach and other disinfectant before barbing. Not many people are allowed to sit in the barbing shop to avoid bodily contact. “We are still scared and are doing everything possible to ensure that no one get infected in this shop,” Mohammed Sore, owner of the two brothers barbing shop told FPA.

He says while there has been no case of Ebola reported in the county for the past few weeks, he and his colleagues have not stopped the preventive measures and will continue until the country is declared Ebola free. “We will stop using the gloves and chlorine when we hear that Ebola is not in the country again,” said one of our fears is that we are close to the border and people are still coming in from Guinea,” he said Sow.

At the over 80-bed facility run by the medical charity group Medicines Sans Frontieres in Foya, all patients have been discharged with zero cases reported so far. All schools in the county remain closed as part of President Ellen Johnson Sirleaf’s directive on the prevailing state of emergency in the country.

Non-governmental Organizations such as the Pentecostal Mission Unlimited (PMU Liberia) is moving in to help with preventive materials and support to many health facilities, as residents wait quietly to see a total eradication of the deadly disease. Residents of Lofa have seen hell; Ebola killed and obliterated entire families. Cultural and religious practices helped to rapidly spread the disease among community members who were also in strong denial of the virus according to residents.

Now, the numbers of cases being reported are few and no much news of suspected deaths in Lofa County. Hand washing buckets are still placed in nearly every household and those that cannot afford the bucket travel with a bottle of chlorine water just for protection against the deadly virus, which has killed a total of 2413 persons and infected 6535 individuals in Liberia alone.

Harvard Public Health School and Reuters: Ebola fear, not science, driving policies

Filed under: Biosecurity,Media,Public Health & Medical Care,Risk Assessment — by Arnold Bogis on November 6, 2014

The news agency Reuters and the Harvard School of Public Health have a partnership to produce “Health Watch,” which according to the School’s website is: “a web series featuring expert analyses and comments about the latest developments in health news. This series is presented by The Forum at HSPH and the Harvard School of Public Health in collaboration with Reuters.”

In this episode, “Dr. Paul Biddinger, Associate Director of the Harvard School of Public Health Center for Public Health Preparedness, tells Reuters that fear is driving certain non-science based policies like the involuntary quarantine of health workers.” Dr. Biddinger also directs the School’s Emergency Preparedness and Response Exercise Program.

 

November 5, 2014

RIP Former Boston Mayor Thomas Menino: The Public Health Mayor

This week Boston laid to rest it’s longest serving mayor, Thomas Menino.  He served as mayor in Boston for 20 years.  Yes. That’s right.  Twenty years.

To his admirers he was known as the “Urban Mechanic,” as the Boston Globe describes, “leaving to others the lofty rhetoric of Boston as the Athens of America, he took a decidedly ground-level view of the city on a hill, earning himself a nickname for his intense focus on the nuts and bolts of everyday life.” To some of his detractors (and even his supporters) he was referred to as “Mumbles,” for his less than soaring rhetorical skills.

This humble man from the Hyde Park neighborhood of Boston rose to national prominence, with former President Bill Clinton paying his respects before the funeral procession and Vice President Joe Biden attending the ceremony. Impressive for a politician recognized to have no political ambition beyond running his city.

What does this have to do with homeland security? For some time I’ve heard from various colleagues that preparedness, particularly health-related preparedness, had an unusual amount of political support in Boston. Public health and EMS were not simply the minor leagues to law enforcement and fire service major league players. But it became vivid when I read the following description from a food-orientated homage to Mayor Menino from The Atlantic food critic Corby Kummer:

But aside from the coddling and special treatment any mayor who shows up gets, Menino cared about food for exactly the reasons today’s food-movement activists do, and long before it was fashionable to embrace what food can and should mean: access to fresh produce for everyone of every income level; gardens as ways to unite and repair communities; and, most importantly, fresh food as a route to better health. The mayor told everyone, including his biographer, longtime Atlantic senior editor Jack Beatty, that he wanted to be remembered as “the public-health mayor.” That made him work particularly closely with my spouse, John Auerbach, who served 10 years as Boston’s health commissioner. 

So….apparently I missed this self-appointment.  After the fact it was easy to find further evidence of Menino’s interest in public health.  See the videos I’ve posted below.

Again, how is this related to homeland security? Two points that at least I think of are interest. 

 

A lot, if not the majority, of public health work does not seem to fall into the category of homeland security. Expanding access to fresh produce in low income communities, anti-smoking efforts, childhood vaccination campaigns, etc.  It’s not always about responding to the next Ebola outbreak.  Yet when taken as a whole, improving the health of the community in general improves overall resilience.  Healthy people fare better during and following disasters than unhealthy ones.  People with access to health insurance are more likely to visit a primary care doctor than the emergency room for common maladies, thereby not taking up vital resources during events like the Boston Marathon bombing. A healthier community is a more resilient community.

Menino’s attention to public health underscores the importance of political leaders in homeland security. I have often heard professionals complain about meddling politicians (along with the annoying press) and how events can be run more smoothly when they are absent.  Yet not only do they play an important role in communicating with the public during and following disasters, they make or influence the choices made in a community before there is a bad day.  Menino’s focus on public health not only improved the overall health of Bostonians, but contributed to the competence exhibited during the response to the Marathon bombing, from the existence of a Medical Intelligence Center to the cooperation between city agencies such as Boston EMS and Public Health with the private hospital systems.

It is comparing apples and oranges, but in thinking about this I could not help but contrast Boston’s situation with that of New York City.  Size and resource issues aside, NYC has spent the most energy on security instead of general preparedness since 9/11.  I am not arguing that there has not been a lot of resources directed towards preparedness and response activities and organizations, only that it is lacking when compared with the radical changes enacted in the NYPD and other agencies charged with preventing a terrorist attack. I think I could make the case that Boston, under Menino’s leadership, took a more all hazards approach while NYC, under Mayors Giuliani and Bloomberg, remained primarily focused on terrorism. That is not a value judgement, but simply an observation.

If you are interested, the following video highlights many of Mayor Menino’s accomplishments in public health.  From the Boston Public Health Commission (which Menino created in 1996):

 

If you have a little more time, here is a longer discussion held at Harvard’s School of Public Health with Menino shortly after he left the Mayor’s office.  For those more security minded, at the beginning of the discussion he is asked and replies with a lengthy description of his point of view about the events surrounding the Boston Marathon bombing.

 

 

 

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