Wednesday, October 15, 2014

We'll know by Christmas

“The major difference between a thing that might go wrong and a thing that cannot possibly go wrong is that when a thing that cannot possibly go wrong goes wrong it usually turns out to be impossible to get at or repair.”
Douglas Adams

As I write this the WHO is saying that the number of cases of Ebola in West Africa is likely to ramp up to 10,000 new ones every week by December, with around seven out of ten people who contract it dying from it. “Don’t worry,” seems to be the message being purveyed down from on high “This will have little impact in the technologically advanced rich nations.”

I’m not so sure.

Straight away I’ll admit that, obviously, I’m not a doctor or a specialist in contagious diseases. A majority of people will read that last sentence and say “Therefore you have no right to talk about it.” If you’re one of them, then bye. However, I do have a firm grasp of the exponential function, and a keen sense of when people in high places are telling fibs to make themselves look like they are in control of events. Perhaps that’s all one needs at the moment. When I see the official message change in the space of a week from “There’s not a chance,” to “Only one or two people might get it,” to “A handful of people might get it,” then I naturally project forward a bit and think about expectation management and message creep.

Frankly, at this stage, it’s more or less irrelevant that we have the occasional case popping up in the West. We are able to deal with them without too much of a problem (the main threat comes later) - although it is concerning that the nurses in Spain and the U.S. who did contract the virus did so despite wearing full protective suits. We are repeatedly assured that this cannot happen, and the fact that it has happened has immediately been blamed on a ‘breach in protocol.’

But breaches in protocol are what we humans are good at. Every organisation that I’ve ever worked at has been full of people breaching protocol at every level. Usually, of course, doing so hasn’t led to them dying messily with blood gushing from their orifices and so mostly they get away with it. Are we to believe that the sprawling medical sector with its vast hordes of employees is less prone to this?

Yes, in the real world, shit happens.

Let’s face it, if you’re an official in some position of power and your job and status depends on making the right comments or being able to pass the blame for something onto someone else then you can be expected to act in such a manner. It’s what you are programmed to do in a non-holistic linear kind of way. So when, for example, a health official says it ‘impossible’ to catch Ebola from a mattress and then someone goes right ahead and does it anyway because they briefly touched a drip feed that had a viral load from some other patient who had sneezed a fleck of vomit on it as they wheeled the bed past him in a corridor, which then came into contact with said mattress and passed it onto someone else, then said official can claim that due to a clause in article 41.5b of the Code of Hospital Regulations about moving patients around then the porter had breached protocol and caused the infection. Problem solved, for you at least.

Here’s a hypothetical situation. Imagine that despite Ebola had somehow mysteriously appeared in your country and the government message had been racketed up to the point of saying “Don’t worry, only a quarter of you will get it,” but so far you had been lucky and avoided it. You’ve washed your hands all the time, avoided contact will all other human beings and animals, not touched a doorknob in six months … but despite all of this you started to come down with a fever and worried you had caught ‘it’. Several of your friends and family have already disappeared into hospital isolation wards and you have never heard from them again, and there are rumours swirling around that the hospital has run out of protective gear and that most of the staff have either died or fled, leaving it manned by untrained survivors with precious few medical supplies to work with. Would you a) Check yourself into said hospital and hope all the rumours were untrue or b) Lie in your own bed with your stash of medical supplies you had managed to amass, send out a farewell Facebook status update and hope for the best?

People who opine on healthcare programmes, just like economists, always assume that people act in a rational way — although it is they who decide what constitutes rational behaviour. They build models based on people acting in the way they are supposed to act, even though not many of them are psychologists.

As they stand, things don’t look good. With a doubling of new cases every 21 days that means every single person in the world will have or have had Ebola by September 2015. Of course, this won’t happen in such a neatly exponential way as there are many interrupting factors that will slow the disease’s spread. In any case, we probably have only a few weeks to stamp down on Ebola and eradicate it from West Africa, because as soon as it gets really out of hand there will be people fleeing to other parts of Africa and bringing the virus with them.


Over the last few days in the course of several discussions about Ebola a few truly inane points and suggestions have been raised. Here are some of the most prominent ones:

Ebola is not very contagious and it is only poor people in Africa that can get it. Well, the fact is that we don’t know an awful lot about this strain of the virus. We pretend we do, but we don’t. If we did then people wearing space suits would not be getting it. A past study has shown that it can be transmitted through the air between monkeys and pigs. The study has been attacked and defended thoroughly and, like most things on the internet, you end up not knowing what to believe. Nevertheless, if you ever come into contact with someone who has died from the disease, or if you end up caring for a family member with it, the chances are that you will get it too. Simple as. 

This is getting out of control, we should quarantine the affected African countries and shoot anyone who tries to escape. Ummm, interesting suggestion. Never mind the fact that the moment any such suggestion is raised there will be an exodus of people from those countries. Where would they likely flee to? Well, apart from fleeing to all corners of Africa they would also flee to the homes of their relatives in New York, London, Paris etc. They may try and do that anyway, as things progress. 

Our country can cope with an Ebola pandemic. Don’t make me laugh. When Britain’s health minister appeared on TV a few days ago proudly proclaiming that there were two specialist beds in isolation wards in London to cope with Ebola patients I did a double take. Did he say two? TWO? To be shared between the 20 million people living in the southeast? Will they be taking it in turns or what? At what point, after the epidemic becomes a pandemic, do we manically start trying to build more isolation wards over here rather than building hospitals in Africa? So many questions …
It’s just a media fabricated panic to distract us from war, global warming, financial meltdown etc. If anything the media is under reporting this. When the staid folks at the WHO say that “this is the most severe health emergency in modern times,” then it takes a peculiarly asinine person to pretend that it’s unimportant. 

This is nature’s revenge … bring it on. Fine, ecologically speaking that may be so, but you have to be willing to be one of the statistics rather than merely wishing it on other people who are less fortunate.
It’s all a global conspiracy by the Koch brothers/One World Government. Yes, whatever. If you believe that it’s a conspiracy that’s fine but it won’t do you any good. 

Nigeria has eradicated it, so can we. Hurrah! Nigeria has had a few isolated cases of wealthy individuals. Furthermore, there is a lot of oil wealth at stake in that country and the last thing they need is news of an Ebola outbreak. Do you really believe everything you read coming out of the world’s most corrupt nation? 


So, what do I think is likely to happen? Well, I think there are two likely outcomes, and we can only hope it is the former.

Outcome 1. We throw everything we’ve got to help states in West Africa get on top of Ebola and contain the disease. It won’t be easy and it will entail a lot of ethical dilemmas, such as choosing who gets priority treatment and who does not. Many of our best doctors and nurses will have to go there and a lot of them will not come back. It will cost a fortune, just when we can least afford it, but in the end it will be worth it. As a follow up, deforestation will have to be halted, the spirits of the fruit bats appeased and a huge Marshall Plan like effort to lift Western Africa out of poverty will have to be put into action to prevent Ebola taking off yet again.

Outcome 2. The cases in West Africa continue to multiply and the disease increases exponentially, really taking off at the start of 2015. Chaos ensues as people flee disease centres and bring the virus with them. Overworked and demoralised healthcare workers abandon their posts as they realise they are at the highest risk of contracting the virus, further complicating the situation. Instead they go back to their own families and do their best to make sure that least they will get the care they need. The diseased, and quite a few non-diseased, are rounded up and put in warehouses that double as isolation centres where they are kept at gunpoint. East Africa, with its crowded slums becomes a new hot zone, and from here it is a hop, skip and jump along the busy trade routes to the overcrowded virus-friendly conditions of India. As pharmaceutical companies frantically try to find a vaccine or a cure the disease spreads like wildfire across Asia and to the world beyond.

By February 2015 half of all air traffic has come to a stop. Airlines go bust and people who are stuck on the other side of the world suddenly find out how large it is. By May there is practically no international air travel apart from private jets and military aircraft. International supply chains are shattered and disorder and chaos break out everywhere as people struggle to get food, fuel and medicine. In some countries, national armies hand out food in the streets but there’s never enough.

By late summer a few island states have quarantined themselves to try to keep the disease out, but word spreads about these ‘healthy’ zones and people desperately try to reach them, bribing officials to gain entry and bringing the disease with them.

By now, the torrent of people pouring across borders by any means available has overwhelmed the tiny capacity the richer nations have to deal with an outbreak. People stop going to work and school, and avoid public transport and gatherings. People live and die in their own homes.

After a handful of years the disease has burned itself out, although distributed pockets remain in far away places. A huge chunk has been taken out of the global population — mostly in the poorer nations that lie in the tropics — with richer nations faring somewhat better due to more elaborate healthcare systems, less overcrowding and a greater access to experimental vaccines. Some of these worked and some of them did not. Everyone still alive will breathe a great sigh of relief and look back with sadness as they think of the loved ones they lost in the Great Ebola Pandemic of 2014-18. Economies are broken and people’s faith in science and progress lies in tatters — but at least they are alive. Life will go on, as ever, but everything will have changed.

There is, of course, a third scenario — Outcome 3 — the Hollywood one where we find a miracle cure just in time that can easily and quickly be mass-produced and distributed across the globe without any political interference. The likelihood of this happening in the timeframe that we have is pretty small though and it would not address the cause of the problem, meaning we’d likely get a new and even deadlier strain in a few years’ time.

So which of the above scenarios is the more likely and why? Do you have a survival strategy if Outcome 2 kicks in? If you do, pray tell.


We’ll likely know by Christmas which one we're going to get. In the meantime you might want to read up about natural antivirals, wise up on sanitation and basic medical procedures such as oral rehydration, make friends with your immune system and start building up a stock of things that will likely be gone in a flash if a full-blown panic does break out.