Questionable Risk Analysis by the Obama Administration — Prioritized but Unworkable Strategy against the Islamic State — versus — Under Reaction to the West African Ebola Epidemic

19 September 2014

Theme — The Obama Administration appears to have mistakenly prioritized two competing risk assessments

In the President’s mind, ISIS/ISIL/Islamic State currently seems to pose a greater threat to our national security than the much realer one presented by the rapidly escalating West African ebola virus epidemic — which has spread from Guinea into Liberia, Sierra Leone, Nigeria and Senegal.

American media appear to prioritize the two the same way.

For example, I was darkly amused yesterday when Anderson Cooper (CNN) diverted the US Ambassador to the United Nations, Samantha Power, from talking about ebola into talking about planned American efforts against the Islamic State.

Note

Mr. Cooper’s change in topic is not part of CNN’s too short clip of the Ambassador’s ebola interview —which you can access here — probably because the jump in questioning was intrusively irrelevant and therefore (presumably) embarrassing.

You want a real problem? — Deadly ebola virus has gotten loose in Africa

Epidemiological dynamics indicate that the 55 percent fatality illness may be about to jump from that continent to others. That’s a real problem. Not a hyped, pseudo-one like ISIS.

Having such a deadly disease become endemic among the human population, as opposed to living in an animal reservoir presumed to be comprised of African fruit bats, would be a public health misfortune of genuinely significant proportion.

Something about ebola may have changed

A few days ago, Dr. Thomas House — creator of a computer model that previously successfully anticipated the scale and scope of past ebola epidemics — announced that the current West African outbreak is advancing so rapidly that his model no longer works.

He thinks that something critical about the virus or its transmission dynamics has changed:

“This could be as a result of a number of different factors:

mutation of virus,

changes in social contact patterns

some combination of these with other factors.

“It is implausible to explain the current situation solely through a particularly severe outbreak within the previously observed pattern”.

People who have been on the ground in ebola territory share Dr. House’s implied concern

Among them, no less than the CDC’s director:

Just back from a week in the Ebola hot zone, Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden had a dire assessment of the situation on the ground there.

“The bottom line is that despite tremendous efforts from the U.S. government, CDC, from within countries, the number of cases continues to increase and is now increasing rapidly,” Freiden told a press conference at the CDC today.

The virus is moving faster than anyone anticipated and that’s why we need to move now, he said.

The World Health Organization (WHO) today said that the “magnitude of the Ebola outbreak has been vastly underestimated.”

According to the latest WHO figures, 3,069 people have come down with Ebola. Of them, 1,552 have died— a fatality rate greater than 50 percent.

Dr. Frieden told Fox News that unless urgent action is taken to contain the epidemic, it may be impossible to stop.

There are not enough hospitals, wards, clinics, doctors or nurses to take care of the numbers of people who are coming down with Ebola, he said.

This “impossible to stop” interpretation is not just Fox News hyperbole

As USA Today reported about the same news conference:

I could not possibly overstate the need for an emergency response," said Thomas Frieden . . . .

"There is a window of opportunity to tamp this down, but that window is closing. ... We need action now.

"[T]he challenge is to scale it up to the massive levels needed to stop Ebola," CDC's Frieden said . . . .

"Speed is key. For every day's delay, it becomes harder to stop it."

Dr. Frieden’s public health language means more than it says

Epidemiologists and public health workers almost always try to err on the side of avoiding panic.

When a prominent one among them comes out with emergency language like Dr. Frieden’s, something really bad is happening or about to happen.

That is especially true when such a statement comes during the period after unwisely hyped pandemic forecasts (in regard to flu virus) in previous years.

In short, Dr. Frieden’s statement was a call to medical arms for the whole planet.

Yet, the Obama Administration lollygagged for two weeks before the President announced a plan to send 3,000 American troops to Africa to help with the logistics of ebola containment.

My guess is that the American commitment is still much too small to be effective. Africa does not have the medical infrastructure to deal with the scope of what is underway. Neither does any single nation in the developed world.

The United Nations appears to agree.

Thus — yesterday — the United Nations Security Council declared the ebola outbreak a “threat to international peace and security”

This is the first time ever that the Security Council has voted to do something about a health crisis:

The UN heard that the international response would need to be 20 times greater than it is now if the outbreak were to be controlled.

UN Secretary General Ban Ki-moon warned an emergency meeting of the council that the number of Ebola infections was doubling every three weeks.

The council unanimously adopted a resolution calling on states to provide more resources to combat the outbreak.

The resolution attracted 130 co-sponsors - a UN record - and calls on countries to provide urgent aid, such as medical staff and field hospitals.

The resolution also calls for travel bans imposed by some states to be lifted, saying the countries need to have access to aid instead of being isolated.

This does not mean that ebola will (for sure) break out of its previously regional suspected endemicity among fruit bats into the human population

But the statistical dynamics of infectious disease mean that it increasingly might.

The base of infection among humans is now large enough that ebola is in wildfire mode. Each day, the size of the ebola epidemic increases the probability that an as yet not ill, but already infected, traveler is going to:

(i) land someplace else,

(ii) eventually become visibly ill (when the disease begins its contagion),

(iii) expose other intimates to the illness —

under spatial and situational circumstances in which,

(iv) the nature of the illness is not recognized quickly or reliably often enough to keep it from spreading further.

Consequently, ebola may be on the verge of getting loose on a continental scale. Or worse.

Once there, it will almost certainly become endemic in the human population. That is Drs. House and Frieden’s unspoken concern. As it is mine. In infectious disease, numbers combined with virulence are the enemy.

Developed world complacence

There is a huge difference between:

(a) flying an already diagnosed doctor or missionary back to the United States (and taking precautions against disease transfer in route and during hospitalization)

and

(b) trying to detect and treat tens or hundreds of previously unrecognized cases that may eventually already be a back home already spreading the illness.

The more African cases there are, the more likely someone infected by them will return to his and her nations of origin — before anyone (including Customs) recognizes that they are carrying replicating ebola virus in their bodies.

How to deal with the West African ebola outbreak? — Just as the CDC and the UN recommend

The answer is for us to plunge whole-heartedly into helping the affected African nations contain ebola by offering up our money, personnel and logistical support.

Closing borders and trying to isolate West Africa is the wrong reaction. That merely guarantees ebola’s probably permanent foothold among humanity via a now human reservoir in West Africa (or wider).

How did the Obama Administration get its prioritization of these two risks wrong?

First, some premises about proper risk assessment and management.

Properly prioritized risk assessments and responses should depend on weighted evaluations of their:

(i) likelihood of occurrence,

(ii) the amount of damage they might cause,

and

(iii) our currently or potentially available means to counter them (before or after they strike).

Applying these premises to the ISIS versus ebola risk tree

In the Islamic State’s case:

(i) The threat ISIS/ISIL directly poses America is actually comparatively trivial and only an aspect of an overall centuries old Middle Eastern context that we significantly aggravated and now cannot control.

(ii) The way to combat the Islamic State’s depredations is primarily economic and political.

(iii) A militarized response worsens the situation by attracting more radicals.

(iv) Implementing any conceivably workable response to pseudo-Islamic and Islamic terrorism will take decades, enormous patience and determined restraint.

In contrast:

(i) The West African ebola epidemic poses a direct and imminent medical threat to world health.

(ii) The epidemic’s increasing numbers of patients is rapidly growing toward a tipping point that will likely spill the disease out into the world at large.

(iii) Once tipped into endemicity among humans, ebola will potentially — but not certainly — result in numbers of “casualties” far more impressive over the long term than anything the Islamic State could ever generate on a worldwide basis, at least without our bone-headed help.

(iv) If we do something both massive and immediate about ebola in Africa, we can probably still prevent a public health problem of genuinely bad physical and economic proportion worldwide.

Panic, however, is not the right response either

Ebola, though deadly, is not nearly as contagious as respiratory viruses. Ebola will probably never kill as many people as they do:

Ben Neuman, a Reading virologist who has been monitoring the Ebola epidemic since it began in Guinea, noted that under carefully controlled laboratory conditions, scientists have shown it is feasible to make Ebola transmit through air [like respiratory viruses], but added:

"So far there is no solid evidence that it actually happens out there in the real world."

"Compared to this Ebola outbreak, the H1N1 swine flu had already spread to an estimated 10,000 times as many people in its first 10 months."

That's not to say the Ebola virus isn't mutating. It is, rapidly, all the time.

In a study published in the journal Science late last month, a team of researchers sequenced 99 Ebola virus genomes isolated from blood samples of 78 patients in Sierra Leone -- one of the four countries at the heart of the epidemic.

They found what they described as "a rapid accumulation of interhost and intrahost genetic variation" -- in other words, a large number of frequent changes in the virus -- even in the initial few weeks of the outbreak.

The moral? — We have mistaken priorities

We should be attacking the more real and more soluble ebola threat first. Instead, we prioritized the lower and less counterable ISIS threat over the greater but more actionable ebola one.

Now, we are at risk of getting screwed by both.

Politically motivated grandstanding hyped a pseudo national security problem at the expense of a real and imminent one.

PeteFree.com

Questionable Risk Analysis by the Obama Administration — Prioritized but Unworkable Strategy against the Islamic State — versus — Under Reaction to the West African Ebola Epidemic