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posted by martyb on Thursday October 16 2014, @11:34PM   Printer-friendly [Skip to comment(s)]
from the connecting-the-dots dept.

Pamela Engel writes that Americans need only look to Nigeria to calm their fears about an Ebola outbreak in the US. Nigeria is much closer to the West Africa outbreak than the US is, yet even after Ebola entered the country in the most terrifying way possible — via a visibly sick passenger on a commercial flight — officials successfully shut down the disease and prevented widespread transmission. If there are still no new cases on October 20, the World Health Organization will officially declare the country "Ebola-free". Here's how Nigeria did it.

The first person to bring Ebola to Nigeria was Patrick Sawyer, who left a hospital in Liberia against the wishes of the medical staff and flew to Nigeria. Once Sawyer arrived, it became obvious that he was ill when he passed out in the Lagos airport, and he was taken to a hospital in the densely packed city of 20 million. Once the country's first Ebola case was confirmed, Port Health Services in Nigeria started a process called contact tracing to limit the spread of the disease and created an emergency operations center to coordinate and oversee the national response. Health officials used a variety of resources, including phone records and flight manifests, to track down nearly 900 people who might have been exposed to the virus via Sawyer or the people he infected. As soon as people developed symptoms suggestive of Ebola, they were isolated in Ebola treatment facilities. Without waiting to see whether a "suspected" case tested positive, Nigeria's contact tracing team tracked down everyone who had had contact with that patient since the onset of symptoms making a staggering 18,500 face-to-face visits.

The US has many of these same procedures in place for containing Ebola, making the risk of an outbreak here very low. Contact tracing is exactly what is happening in Dallas right now; if any one of Thomas Eric Duncan's contacts shows symptoms, that person will be immediately isolated and tested. “That experience shows us that even in the case in Nigeria, when we found out later in the timeline that this patient had Ebola, that Nigeria was able to identify contacts, institute strict infection control procedures and basically bring their outbreak to a close”, says Dr. Tom Inglesby. “They did a good job in and of themselves. They worked closely with the U.S. CDC. If we can succeed in Nigeria… I do believe we will stop it here.”

Related Stories

Contact Tracing in the Real World 52 comments

Ross Anderson, a researcher at the Security Group at the University of Cambridge Computer Laboratory, has written about contact tracing in the real world enumerating in detail some of the many shortcomings with and false assumptions about contact tracing as means of fighting a pandemic.

There are also real systems being built by governments. Singapore has already deployed and open-sourced one that uses contact tracing based on bluetooth beacons. Most of the academic and tech industry proposals follow this strategy, as the “obvious” way to tell who’s been within a few metres of you and for how long. The UK’s National Health Service is working on one too, and I’m one of a group of people being consulted on the privacy and security.

But contact tracing in the real world is not quite as many of the academic and industry proposals assume.

First, it isn’t anonymous. Covid-19 is a notifiable disease so a doctor who diagnoses you must inform the public health authorities, and if they have the bandwidth they call you and ask who you’ve been in contact with. They then call your contacts in turn. It’s not about consent or anonymity, so much as being persuasive and having a good bedside manner.

He is not alone in pointing out that claims of being able to anonymize personal data have largely been proven to be bunk. The rules we set in place now will be with us for a long time and have far-reaching effects. The need to be given an appropriate level of consideration.

Security researcher Bruce Schneier posted his concerns on the same contract tracing story.

Previously:
(2020-04-11) Apple and Google are Launching a Joint COVID-19 Tracing Tool for IOS and Android
(2020-04-08) Senators Raise Privacy Questions About Google's COVID-19 Tracker
(2014-10-16) How Nigeria Stopped Ebola


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  • (Score: 4, Insightful) by khallow on Friday October 17 2014, @12:38AM

    by khallow (3766) Subscriber Badge on Friday October 17 2014, @12:38AM (#106856) Journal
    As was noted on the crappy Green site, the strategy used in Nigeria works great when there are only a few cases. That's currently the case in the US and elsewhere outside of Africa. Those infections will probably be contained without much further incident.

    BUT infections continue to grow at an exponential rate in the three primary countries affected. It's not "we're all dead by X-mas". But every month that exponential increase happens, the amount of suffering greatly increases and the risk of greater problems increase. For example, about a quarter of all Ebola cases have happened in the last month (corresponding to an increase of a third in total cases every month). That's been true for most of the duration of the epidemic. Eventually, it will saturate (forming a logistics curve), but it's not close to doing so.

    Will these societies remain stable to that point and contain Ebola to themselves? I don't think so. Will Nigeria remain Ebola-free when a wave of Ebola-carrying refugees comes over from Benin (which is not currently affected by Ebola) or elsewhere? Of course not and the contact tracing method discussed in this article will be near useless when large numbers of infections are introduced into neighboring countries.

    My view is that this is the last window of opportunity before a significant fraction of Africa dies from Ebola or before an epidemic which could last a few months instead lasts many years and affects most of the world.

    PS, all the health care officials making noise about the need to continue commercial air traffic in the face of Ebola will change their tune after a few more infections make their way to the developed world. Quarantine isn't perfect (as my discussion of waves of refugees above indicate), but it works better than screening uncooperative passengers.
    • (Score: 2) by kaszz on Friday October 17 2014, @01:09AM

      by kaszz (4211) on Friday October 17 2014, @01:09AM (#106863) Journal

      "Will Nigeria remain Ebola-free when a wave of Ebola-carrying refugees comes over from Benin (which is not currently affected by Ebola) or elsewhere?"

      Erect wall, use drones and patrols that shoot on sight?

      • (Score: 0) by Anonymous Coward on Friday October 17 2014, @02:20AM

        by Anonymous Coward on Friday October 17 2014, @02:20AM (#106872)

        Erect wall, use drones and patrols that shoot on sight?

        yeah genius, make them all into large ebola infected blood splats. it's morons like you that are making things worse.

        • (Score: 0) by Anonymous Coward on Friday October 17 2014, @03:54AM

          by Anonymous Coward on Friday October 17 2014, @03:54AM (#106886)

          I'm the one around here who usually misses the sarc tag.

          -- gewg_

      • (Score: 1) by khallow on Friday October 17 2014, @12:33PM

        by khallow (3766) Subscriber Badge on Friday October 17 2014, @12:33PM (#106976) Journal
        Eh, I suppose they have more than enough manpower to do that. Even if that just puts things off for a few weeks, it might mean that more people survive if say a vaccine or better treatment for Ebola comes out.
  • (Score: 4, Insightful) by frojack on Friday October 17 2014, @01:11AM

    by frojack (1554) Subscriber Badge on Friday October 17 2014, @01:11AM (#106864) Journal

    Not everybody agrees [slate.com] that they did a good job:

    But arguably, Nigeria didn’t actually do a very impressive job. A single Liberian man, who traveled to Nigeria in July, infected 11 hospital staff in the time between his admission to a hospital and when his test results were received. There might have been more infections if not for a doctors’ strike that reduced the number of people who came in contact with him. One doctor told the New York Times, “At the time, nobody was prepared for it.”

    In short, they got lucky. A guy presents in the airport, among crowds, and ONLY 20 got sick, which was pretty much because people were already aware and on alert for ebola cases. Yet, 11 people in the hospital got infected, and they should have known better.

    Most of the infectited were among medical professionals, who probably knew enough to cooperate with the contact tracing and self quarantine.

    1-to-20 infection rate (R0) is very bad. [forbes.com]

    At the start of an outbreak, the rate is called ‘R0′ (the basic reproductive number). R0 indicates whether or not a contagious disease has the potential to become an epidemic. Populations can evolve natural immunity or gain artificial protection through health interventions like vaccination, reducing the proportion of susceptible people, so the reproductive number for later periods of time is ‘Rt’.

    R0 was 1.7 to 2 during the initial period of exponential growth in West Africa, while the current Rt is 1.4-1.8 [1]. (Calculations by the WHO Ebola Response Team are roughly in line with estimates by other researchers.) R = 2 doesn’t sound high until you hear that the deadliest pandemic in recorded history, the 1918 Spanish flu, killed up to 100 million people even though the influenza virus had an R of 2.

    They got lucky.

    --
    No, you are mistaken. I've always had this sig.
    • (Score: 1, Informative) by Anonymous Coward on Friday October 17 2014, @01:44AM

      by Anonymous Coward on Friday October 17 2014, @01:44AM (#106869)

      The Spanish flu was an airborne virus. Easily transmitted.
      Ebola in a fluid-borne infection. It requires close contact with a victim.
      The reason so many people have gotten Ebola is that families gather for ritual washing of the corpse before internment|cremation.

      -- gewg_

      • (Score: 2, Informative) by khallow on Friday October 17 2014, @03:16AM

        by khallow (3766) Subscriber Badge on Friday October 17 2014, @03:16AM (#106879) Journal

        The reason so many people have gotten Ebola is that families gather for ritual washing of the corpse before internment|cremation.

        The reason so many people got Ebola is because, with the limits of its current means of transmission, it is very infectious. Ritual washing is far from the only means of spreading the disease by close contact.

  • (Score: 4, Interesting) by anubi on Friday October 17 2014, @03:20AM

    by anubi (2828) on Friday October 17 2014, @03:20AM (#106880) Journal

    I know its a point of great contention as to whether or not healthcare should be public or a privately held profit center.

    I have been of the impression that having healthcare provided to everyone, regardless of income, would be good for all of us, as it would provide early detection of disease outbreaks, as often the poorer of us are often in service positions, meaning they are in the most critical position possible for spreading an outbreak.

    Imagine someone that had contracted Ebola, working at McDonalds, and is forced by economic realities of her position to come to work, although she feels like shit and anyone else of higher economic class would be visiting the doctor, not the workplace.

    I do not believe a lot of the "upper classes" realize how important it is to them to have the people who serve them to be healthy. I believe a lot of us are so wrapped up in image and presentation that we do not see the reality. I would rather pick my meal from a dumpster than eat one knowing it was prepared by someone being consumed inside-out by some disease that they simply did not have the economic resources to address.

    An ounce of prevention is worth a pound of cure.

    However, all these runaway healthcare costs we are expecting the poor to pay is apt to come back and bite us with rounds of disease outbreaks among the rich served by the poor.

    --
    "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
    • (Score: 0) by Anonymous Coward on Friday October 17 2014, @03:44AM

      by Anonymous Coward on Friday October 17 2014, @03:44AM (#106884)

      The US Surgeon General the other day (without knowing all the facts, obviously) accused the nurse in Texas of not following protocols.
      Is there even a specific protocol for dealing with Ebola patients in the USA?

      I was going to specifically mention Republicans in this thread.
      Oh, look. I just did that.
      Maybe a close brush with death by the "small gov't" types will affect the way they approach these things in the future, James Brady style.
      I will say that your no-finger-pointing approach showed great self-control.

      -- gewg_

      • (Score: 1, Informative) by Anonymous Coward on Friday October 17 2014, @04:53AM

        by Anonymous Coward on Friday October 17 2014, @04:53AM (#106894)

        > The US Surgeon General the other day (without knowing all the facts, obviously) accused the nurse in Texas of not following protocols.

        (1) Not the surgeon general, it was Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. And he didn't accuse anyone. Stop watching tv news.
        "Certainly there has to have been an inadvertent, innocent breach of the protocol of taking care of the patient within the personal protective equipment -- that extremely rarely happens,"

        (2) He was RIGHT. Not only was he right, he vastly under-estimated the level of "protocol breach." [cnn.com] They treated the patient for two days without the appropriate protective clothing - they were putting tape on their exposed skin for chrissakes.

        > Is there even a specific protocol for dealing with Ebola patients in the USA?

        Yes. But it takes a lot of practice to get it right. [vox.com]

        • (Score: 0) by Anonymous Coward on Friday October 17 2014, @05:10AM

          by Anonymous Coward on Friday October 17 2014, @05:10AM (#106896)

          Stop watching tv news

          Radio, but yeah, lamestream media.
          I normally switch the station when AP's headline news comes on but I heard just a bit of it that day.

          treated the patient for two days without the appropriate protective clothing

          ...and they're expecting TSA's high-school-dropout rent-a-cops to spot infectious folks in airports.
          I'm sure that will be a huge success.

          -- gewg_

      • (Score: 2) by khallow on Friday October 17 2014, @10:25AM

        by khallow (3766) Subscriber Badge on Friday October 17 2014, @10:25AM (#106936) Journal

        I was going to specifically mention Republicans in this thread.

        And you did. Aside from identifying yourself as a member of a group with a peculiar obsession for blame finding, what was the point of that? Republicans weren't involved.

        Maybe a close brush with death by the "small gov't" types will affect the way they approach these things in the future, James Brady style.

        Because the only two choices we have are death in the streets xor government micromanagement of health care. Well, there's one obvious third choice just with what meager options we have here, we could have the best of both worlds and have both death in the streets and costly government micro(mis)management.

        I will say that your no-finger-pointing approach showed great self-control.

        And your finger pointing shows something else.

      • (Score: 2) by rts008 on Friday October 17 2014, @01:04PM

        by rts008 (3001) on Friday October 17 2014, @01:04PM (#106985)

        Well, while you are on your Republican topic, I should point out that we do not have a Surgeon General.

        The Republicans filibustered the appointment last year, refusing to allow a S.G. to be appointed.

        IIRC, the heads of the CDC and NIH[1] have been trying to pick up that slack(acting SG) in their 'spare time'.

        [1]CDC= Center for Disease Control; NIH= National Institute of Health

        • (Score: 0) by Anonymous Coward on Friday October 17 2014, @09:41PM

          by Anonymous Coward on Friday October 17 2014, @09:41PM (#107158)

          Thanks to you and the previous AC.
          The fog is clearing.

          I have a low tolerance for the bought-and-paid-for Blues as well, but, with a Red majority in the House and the Blues permitting a (Red)-minority-rules setup in the Senate, it's clear who is gumming up the works so that the black guy isn't allowed to get any points on the scoreboard.

          N.B. My last remaining trustworthy radio news outlet (Pacifica) has been in fund drive mode for a while now and the "special" stuff they're putting on isn't all that useful.

          -- gewg_

    • (Score: 2) by frojack on Friday October 17 2014, @03:57AM

      by frojack (1554) Subscriber Badge on Friday October 17 2014, @03:57AM (#106887) Journal

      as it would provide early detection of disease outbreaks, as often the poorer of us are often in service positions, meaning they are in the most critical position possible for spreading an outbreak.

      Oh, come on.
      The LAST question asked when you arrive complaining about Ebola is "Do you have insurance".

      When there is an epidemic everyone watches out for symptoms. Especially if it's dangerous.
      And restaurants in particular watch out for that sort of thing.

      Ebola is pretty much the last issue you can use for a political agenda.

      --
      No, you are mistaken. I've always had this sig.
      • (Score: 2, Informative) by anubi on Friday October 17 2014, @04:35AM

        by anubi (2828) on Friday October 17 2014, @04:35AM (#106891) Journal

        If one *knew* it was Ebola, its one thing... if one is just feeling lousy, but goes to work anyway - especially if one is afraid of getting involved in "the system", one could easily pass the problem onto thousands of other people while personally trying to avoid a personal loss.

        I do not know about the "Do you have insurance" thing... that was the FIRST thing I was asked when I presented myself at a hospital once. I presented in error thinking I had symptoms of a heart attack. Turns out I just got caught in a panic loop. Things are different for me now; if I need to see a doctor, the first one I see is likely to do a post-mortem to find out what went wrong. That is I cannot afford to get sick.

        --
        "Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
        • (Score: 0) by Anonymous Coward on Friday October 17 2014, @12:02PM

          by Anonymous Coward on Friday October 17 2014, @12:02PM (#106961)

          If one *knew* it was Ebola, its one thing... if one is just feeling lousy, but goes to work anyway - especially if one is afraid of getting involved in "the system", one could easily pass the problem onto thousands of other people while personally trying to avoid a personal loss.

          For an infected and contagious person (in food service, say) to transmit the virus to thousands, he would have to barf into the gazpacho at a massive restaurant every day for a week. Vomiting into the lobster bisque would not do it, because the heat would kill the virus. Blowing his nose with bills from the cash drawer might infect dozens.

          Let's remember how the US infections came about: Duncan helped move the oozing corpse of an ebola victim. The two nurses collected samples and waste of a victim. They may have been involved in cleaning the patient and his bed of diarrhea and blood-oozing sores. That is direct, close contact. Sitting on a plane next to a guy with a fever is highly unlikely to result in infection.

          • (Score: 1) by monster on Friday October 17 2014, @02:53PM

            by monster (1260) on Friday October 17 2014, @02:53PM (#107033) Journal

            For an infected and contagious person (in food service, say) to transmit the virus to thousands, he would have to barf into the gazpacho at a massive restaurant every day for a week. Vomiting into the lobster bisque would not do it, because the heat would kill the virus. Blowing his nose with bills from the cash drawer might infect dozens.

            ... Or just be the waiter who handles the knives and forks to patrons.

            Ebola transmission isn't growing because it's deadly, it's growing because it's easy to transmit.

            • (Score: 1, Informative) by Anonymous Coward on Friday October 17 2014, @05:28PM

              by Anonymous Coward on Friday October 17 2014, @05:28PM (#107092)

              For an infected and contagious person (in food service, say) to transmit the virus to thousands, he would have to barf into the gazpacho at a massive restaurant every day for a week. Vomiting into the lobster bisque would not do it, because the heat would kill the virus. Blowing his nose with bills from the cash drawer might infect dozens.

              ... Or just be the waiter who handles the knives and forks to patrons.

              Ebola transmission isn't growing because it's deadly, it's growing because it's easy to transmit.

              I don't think ebola is quite that easy to transmit. The two nurses who ended up getting infected were in sustained, intimate contact with a patient in the latter stages of the disease; they were the ones cleaning up vomit and feces, washing him and changing his sheets, taking blood and other samples, etc. Even the friends who Eric Duncan had come to visit in the USA haven't come down with ebola. So, unless your server at the restaurant is vomiting into your food or using the utensils to pick at bleeding sores, you are probably going to be OK. You can exhale and relax a bit now. Stay vigilant, yes. But don't panic, at least not yet.

      • (Score: 2) by c0lo on Friday October 17 2014, @07:28AM

        by c0lo (156) Subscriber Badge on Friday October 17 2014, @07:28AM (#106906) Journal

        The LAST question asked when you arrive complaining about Ebola is "Do you have insurance".

        I can believe it is indeed the last if the answers to it happens to be No.

        --
        https://www.youtube.com/watch?v=aoFiw2jMy-0
      • (Score: 3, Interesting) by Phoenix666 on Friday October 17 2014, @10:13AM

        by Phoenix666 (552) Subscriber Badge on Friday October 17 2014, @10:13AM (#106932) Journal

        How much of your life have you spent living on the margins? I do not now but have in the past and the parent's take rings true to me. People with no cushion or perception of permission make different decisions than those who do, because their cost-benefit analysis looks so very different. They cannot afford to lose their jobs because they spent 6 hours waiting in a free clinic or emergency room for a mis-diagnosis by somebody who has no idea what ebola looks like, so they will go to work, infect many scores more people, and collapse on the job.

        The most important take-away from what he said you have proven: the better-off ought to care about the health of those who serve them because it will affect their own health. You proved how right he was by dismissing his point as political rather than the utterly practical comment it was.

        --
        Washington DC delenda est.
      • (Score: 0) by Anonymous Coward on Friday October 17 2014, @12:15PM

        by Anonymous Coward on Friday October 17 2014, @12:15PM (#106967)

        The LAST question asked when you arrive complaining about Ebola is "Do you have insurance".

        No, that will still be among the first questions asked. Your response will not influence the resulting care (very much), but the hospital absolutely cares whether their compensation will be coming from Kaiser, medicaid, or the taxpayers.

        The bigger problem is the one so clearly demonstrated in Dallas: if you show up at the emergency room complaining of fever and diarrhea, the most likely diagnosis is food poisoning - take these antibiotics and go home. In, literally, 47,999,999 out of 48,000,000 cases, it's food poisoning and not ebola. Catching ebola victims at the ER is like catching terrorists at airport screening. Dallas failed to connect one very important dot: recent travel from West Aftrica, and - like the shoe bomber - you can expect that ERs across the country are going to be much more diligent following up that particular question.

  • (Score: 4, Funny) by M. Baranczak on Friday October 17 2014, @03:24AM

    by M. Baranczak (1673) on Friday October 17 2014, @03:24AM (#106881)

    Let's just quarantine the state of Texas.

    While we're at it, let's give Texas back to Mexico. Let them deal with it for a change.

  • (Score: 0) by Anonymous Coward on Friday October 17 2014, @08:50AM

    by Anonymous Coward on Friday October 17 2014, @08:50AM (#106919)

    Hello I'm Princce Moghroboggobu from the capital of Nigeria and I am writing to you for an Imporant business proposal which you will find highly lugrative. I'm looking to moving 4 million dollaars (400,000,000.000$) to international waters. This is the Ebola cure fund. I require your assisance and trust you help myself.

    Please reply as soon as possible so we can do Business.

    Ministerr Mogrorobobuub
    Nigeria
    419 Scam Avenue
    Lagos