Number of Biosafety Level 4 Bio-containment Facilities in The United States 4– Number of Hospital Beds 19 — United States Not Prepared for Ebola Outbreak and Pandemic — Videos
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The ominous math of the Ebola epidemic
By Joel Achenbach, Lena H. Sun and Brady Dennis
When the experts describe the Ebola disaster, they do so with numbers. The statistics include not just the obvious ones, such as caseloads, deaths and the rate of infection, but also the ones that describe the speed of the global response.
Right now, the math still favors the virus.
Global health officials are looking closely at the “reproduction number,” which estimates how many people, on average, will catch the virus from each person stricken with Ebola. The epidemic will begin to decline when that number falls below one. A recent analysis estimated the number at 1.5 to 2.
The number of Ebola cases in West Africa has been doubling about every three weeks. There is little evidence so far that the epidemic is losing momentum.
“The speed at which things are moving on the ground, it’s hard for people to get their minds around. People don’t understand the concept of exponential growth,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. “Exponential growth in the context of three weeks means: ‘If I know that X needs to be done, and I work my butt off and get it done in three weeks, it’s now half as good as it needs to be.’ ”
Frieden warned Thursday that without immediate, concerted, bold action, the Ebola virus could become a global calamity on the scale of HIV. He spoke at a gathering of global health officials and government leaders at the World Bank headquarters in Washington. The president of Guinea was at the table, and the presidents of Liberia and Sierra Leone joined by video link. Amid much bureaucratic talk and table-thumping was an emerging theme: The virus is still outpacing the efforts to contain it.
“The situation is worse than it was 12 days ago. It’s entrenched in the capitals. Seventy percent of the people [who become infected] are definitely dying from this disease, and it is accelerating in almost all settings,” Bruce Aylward, assistant director general of the World Health Organization, told the group.
Aylward had come from West Africa only hours earlier. He offered three numbers: 70, 70 and 60. To bring the epidemic under control, officials should ensure that at least 70 percent of Ebola-victim burials are conducted safely, and that at least 70 percent of infected people are in treatment, within 60 days, he said.
More numbers came from Ernest Bai Koroma, president of Sierra Leone: The country desperately needs 750 doctors, 3,000 nurses, 1,500 hygienists, counselors and nutritionists.
The numbers in this crisis are notoriously squishy, however. Epidemiological data is sketchy at best. No one really knows exactly how big the epidemic is, in part because there are areas in Liberia, Sierra Leone and Guinea where disease detectives cannot venture because of safety concerns.
The current assumption is that for every four known Ebola cases, about six more go unreported.
The latest World Health Organization statistics, published Wednesday, show 8,033 cases of suspected or confirmed Ebola in the West Africa outbreak, with 3,865 deaths. That figure does not include Thomas Eric Duncan, a Liberian man who died Wednesday in Dallas.
How quickly Ebola spreads compared to other diseases VIEW GRAPHIC
“This has been a particularly difficult outbreak because of the difficulty getting a lot of data quickly out of the countries,” said Martin Meltzer, a CDC researcher who models epidemics. “My crystal ball is painted a deep black. It’s like tracking a hurricane.”
Meltzer helped produce a report in late September that said that at current rates of infection, as many as 1.4 million people would become infected by January. That number, officials stressed, was a straight extrapolation of the explosive spread of Ebola at a time when the world had managed to mount only a feeble response. The more vigorous response underway is designed to bend that curve.
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The U.S. military is building 17 treatment centers that can hold 100 people each, but the top military commander in Africa said Tuesday that they won’t be ready until mid-November. Liberia and Sierra Leone have a particularly keen need for more hospital beds. The two countries currently have 924 beds between them, but they need 4,078, according to the WHO.
“The virus is moving on virus time; we’re moving on bureaucracy or program time,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The virus is actually picking up the pace. Even as we add resources, we get farther behind.”
Aylward, the WHO official, pointed to some bright spots in the response in recent weeks. Liberia has gone from just six burial teams to 54. Officials are working with religious leaders to enable safe burials while respecting cultural traditions. “There’s a way to observe most of the ritual while keeping safe,” Aylward said in an interview.
But he said that overall, the countries in West Africa still lack a coordinated response.
“What is needed in every country is a list, an Excel spreadsheet. It’s not complicated. Here is every district, every county, here is burials and who is going to lead them, here is case finding and contact tracing, here is behavioral change,” Aylward said. In effect, the countries need better numbers.
The latest data from the WHO show hints of progress in bringing Ebola under control in certain rural areas stricken by the disease earlier this year. Seven provinces in Guinea that previously reported Ebola cases saw no new infections in the most recent three-week period covered in Wednesday’s WHO update. Two districts in Sierra Leone and one in Liberia showed a decline in infections.
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But experts caution against reading too much into small fluctuations that may simply reflect an increase or decrease in surveillance or a reappraisal of older data. This cautious attitude toward lower numbers particularly applies to a reported drop in new cases in Liberia in the past three weeks, which the WHO said is “unlikely to be genuine” and more likely reflects “a deterioration in the ability of overwhelmed responders to record accurate epidemiological data.”
Gerardo Chowell, a mathematical epidemiologist at Arizona State University, used data compiled through the end of August to estimate the reproduction number of 1.5 to 2 for this Ebola epidemic. Chowell said that even modest gains in lowering that number could give health officials and the military a better chance of controlling the epidemic.
“Maybe we can bring it from two to 1.2 or 1.3, which would indicate that the number of new cases will be dramatically reduced, and that will give you time,” he said.
Another key number: how many days elapse between the time symptoms occur (which is when a person becomes contagious) and when health officials diagnose the disease in that person. Driving that number down is critical to containing the virus.
The incubation period for Ebola is usually about a week to 10 days, although it can last as long as 21 days. That creates obvious challenges for health workers who have to do contact tracing — they have to repeatedly knock on doors and take the temperatures of people who weeks earlier were potentially exposed to the virus. But it also gives those same workers a decent interval of time to track down people who may be infected before they start shedding the virus and potentially spreading the disease.
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There are several scenarios for how this plays out. One is that the conventional methods of containing Ebola — isolating patients and doing contact tracing of people who might be exposed — lower the rate of new infections until finally the epidemic burns itself out. That has been the case in all previous outbreaks of Ebola, although no outbreak has ever been nearly as extensive as this one.
A second scenario is more dire: The conventional methods come too late, the epidemic keeps spreading, and the virus is beaten back only when vaccines can be developed and scaled up to the point where they can be widely distributed.
As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.
“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”
The UK is well set for an Ebola outbreak (sarcasm alert) We have TWO isolation units, but one is getting ‘redeveloped’ so it’s not available right now. Called High Security Infectious Diseases Units there are two in the country, each capable of taking two patients. One is at The Royal Free Hospital in Hampstead North London, the other, the one getting a bit of a make-over, is at The Royal Victoria Infirmary in Newcastle, up in the north-east of England.
Four level 4 bio-containment beds between 69,000,000 people
In the US there are 4 units geared up to handle Ebola. The National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, has 3 beds. Nebraska Medical Center, Omaha, has 10 beds. Emory Hospital, Atlanta has 3 beds and St Patricks Hospital, Missoula has 3 beds (source)
19 level four biocontainment beds for 317,000,000 people
I think we just found out why the government(s) are under-playing the situation. They simply do not have the facilities to cope with even a small outbreak. They are, in fact in exactly the same position as the dirt-poor hospitals in West Africa…there are not enough facilities to stop the spread of the disease if it gets out. The quality of care is better, but the availability of containment most likely isn’t.
I am sure ‘regular’ isolation units will be pressed into use but they are not designed to handle level 4 biohazards, they are nowhere near as secure medically speaking, as biocontainment units.
A couple of days ago I explained how exponential spread works. You can read that article here if you like. As a quick recap. Once a disease is at the point where every carrier infects 2 more people,(exponential spread) it will continue until it:
A) runs out of hosts
B) is stopped by medical science or
C) mutates into something less harmful.
What follows will show you how woefully inadequately our governments have prepared for something as lethal as Ebola.
In the flu pandemic of 1918-1920 28% of Americans were infected with the disease…try to remember I am talking numbers here not HOW disease spreads or any medical similarities between diseases, 625,000 Americans lost their lives out of some 29,400,000 infections. The population of the United States at that time was 105,000,000 people. (source)
Fast forward to today. If that flu pandemic had hit the United States in 2014, when the population stands at 317,000,000 people 88,760,000 people would have been infected and 2,130,240 of them would have died.
Now, let’s try this with Ebola. I have picked Liberia just because it is in the news due to the Thomas Duncan case.
Liberia has a population of 4,290,000 people, as of the latest figures there have been 3692 cases of Ebola, this represents 0.0086% of the population.Of those infections, 1998 people have died that’s a fatality rate of 54%. (source)
If that same infection and death rate were applied to the United States Ebola would infect 269,000 people and of those 156,281 would die.
Now, if as doctors and scientists fear the basic reproduction rate rises to 2 in Liberia the numbers change very quickly. Using the mean average incubation time of 9 days it would take around 13 weeks for the entire population of Liberia to become infected. (10 doublings starting with 3692 = just under the population of Liberia. This multiplied by 9 days gives us 90 days which divided by 7 gives 12.85 weeks.) Of the 4,290,000 people infected 2,316,000 would lose their lives.
This is just Liberia, not the other affected countries in West Africa.
Translated to an equivalent outbreak in the United States, where the basic reproduction rate is also 2, the numbers are horrifying. Starting with patient zero it would take around 245 days, 35 weeks for every person in the United States to become infected. Of those 17,118,000 people would die. (27.17 doublings x 9 days = 245 days =35 weeks)
Please remember the figures for Liberia are pulled from the CDC website, the percentages are correct. The scenario for the United States was based on exactly the same parameters as for Liberia…a like for like comparison.
The CDC could be spending their time educating people, advising people to stock up, get ready for the possibility of staying in their homes. Self imposed isolation, or if need be state imposed isolation, that may last for an extended time period may become a reality. They’re not doing it though are they? They are sprouting figures and applying them to West Africa, and they can’t even get that right. They are saying that there could be 1.4 deaths in West Africa in a worst case scenario. When actually applying the figures they supplied with some simple mathematics we can see that 1.4 million deaths is a gross understatement.
Even a basic reproduction rate of 1.7, the latest figure for Liberia it will only take around 30 weeks to get to the same point as the above scenario, over 2,000,000 dead.
Don’t get me wrong, I am not saying that the UK government is any better, if anything they are worse, they don’t even try to do the maths. Most of them went to Eton (a very expensive school that churns out politicians) so it’s unlikely they would be capable of it even if they wanted to. You only have to look at our national finances to see they are no good at sums. They send out press briefings that there will be an emergency COBRA meeting, do you have any clue what that stands for? Let me enlighten you, Cabinet Office Briefing Room A. COBRA is not an emergency planning group, it’s an effing office.
Although I am loathed to say it, it’s time that our governments started worrying about the facilities at home rather than worrying about the facilities abroad. Stopping the disease in Africa does not mean we are out of the woods. There are so many unreported cases, people turned away from medica facilities in West Africa that nobody has the slightest idea how many cases of Ebola are actually out there. The porous borders of the region mean that people move around without the controls that are usually exercised in the west. There has to be a travel ban on non-US citizens entering the United States from these areas, the same applies from the UK.
Border control has to be improved in both countries if we have any hope of halting the spread of this terrible disease. The west is going to be the destination for anyone from Ebola hit areas that can afford to make their way from Africa. Many West Africans have contacts in the west who will help them get out, and shelter them when they arrive. As harsh as it seems this has to be stopped, it’s time for governments to put their own citizens first. Repatriation of your own is one thing, risking millions of lives at home because you won’t man up and prevent foreigners entering is quite another.
There are currently 13 operational or planned BSL-4 facilities within the United States of America. These are listed below.
In February 2002, consultations between the National Institute of Allergy and Infectious Diseases (NIAID) and its Blue Ribbon Panel on Bioterrorism produced several recommendations for NIAID to better protect people from the threat of bioterrorism. Fulfilling some of those recommendations required more laboratory space for working with dangerous pathogens than was previously available in the United States. In September 2003 and September 2005, NIAID announced the recipients of grants partially funding the construction of two National Biocontainment Laboratories (NBLs) and thirteen Regional Biocontainment Laboratories (RBLs), increasing Biosafety Level-4 (BSL-4) and BSL-3 lab space nationwide.
The NBLs and RBLs are operated by the grant recipients, research institutions across the country. These labs support biodefense and emerging infectious diseases research as resources that provide lab space for basic research of dangerous pathogens and development of new vaccines and treatments. The NBLs are required to have BSL-4, BSL-3, and BSL-2 labs, animal facilities, insectary facilities, clinical facilities, and research support space. The RBLs are required to have BSL-3 and BSL-2 labs, animal facilities, and research support space. While fulfilling the need of researchers occupying the facility, the NBLs and RBLs can be used by other biodefense researchers within the region, particularly those within the Regional Centers of Excellence in Biodefense and Emerging Infectious Diseases. In addition, these labs are available to provide assistance to national, state, and local public health efforts during a biological attack.
The Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases (RCEs) are consortia of universities and research institutions that pursue research with the intentions of producing therapeutics, vaccines, and diagnostics for pathogens that could be used in a bioterrorist attack or could become more widespread. Activities within the RCEs include developing and conducting research programs, training new scientists in research activities, and developing and maintaining facilities and services supportive of activities of the RCEs and other regional biodefense investigators. The RCEs also develop effective treatments and treatment strategies from basic research findings and provide first-line responders with facilities and support during a biological attack.
The National Institute of Allergy and Infectious Diseases (NIAID) created the RCE program in response to a recommendation from meetings between the NIAID and its Blue Ribbon Panel on Bioterrorism in February 2002. By June 2005, NIAID had established a total of ten RCEs in ten geographical regions across the country. Each RCE is composed of the investigators from the lead institution that submitted the application and collaborating investigators at universities and research institutions within the consortium. The consortia have access to resources such as facilities and services within the RCE and the National Biocontainment Laboratories and the Regional Biocontainment Laboratories.
Biosafety Level 4 Labs and BSL Information
The data behind this map of BSL-4 labs worldwide is freely available on Google Fusion Tables. Looking for the old map that also conatined some BSL-3 Labs? View it here. There are many thousands of BSL-3-capable labs worldwide, so they have been left off this new version of the map to focus on BSL-4 labs and enchance its usefulness.
Biosafety Level Information
Required for work with dangerous and exotic agents which pose a high individual risk of life-threatening disease. The facility is either in a separate building or in a controlled area within a building, which is completely isolated from all other areas of the building. Walls, floors, and ceilings of the facility are constructed to form a sealed internal shell which facilitates fumigation and is animal and insect proof. A dedicated non-recirculating ventilation system is provided. The supply and exhaust components of the system are balanced to assure directional airflow from the area of least hazard to the area(s) of greatest potential hazard. Within work areas of the facility, all activities are confined to Class III biological safety cabinets, or Class II biological safety cabinets used with one-piece positive pressure personnel suits ventilated by a life support system. The Biosafety Level 4 laboratory has special engineering and design features to prevent microorganisms from being disseminated into the environment. Personnel enter and leave the facility only through the clothing change and shower rooms, and shower each time they leave the facility. Personal clothing is removed in the outer clothing change room and kept there. A specially designed suit area may be provided in the facility to provide personnel protection equivalent to that provided by Class III cabinets. The exhaust air from the suit area is filtered by two sets of HEPA filters installed in series. Supplies and materials needed in the facility are brought in by way of double-doored autoclave, fumigation chamber, or airlock, which is appropriately decontaminated between each use. Viruses assigned to Biosafety Level 4 include Crimean-Congo hemorrhagic fever, Ebola, Junin, Lassa fever, Machupo, Marburg, and tick-borne encephalitis virus complex (including Absettarov, Hanzalova, Hypr, Kumlinge, Kyasanur Forest disease, Omsk hemorrhagic fever, and Russian Spring-Summer encephalitis).
BSL-3, Biosafety Level 3
Applicable to clinical, diagnostic, teaching, and research or production facilities involving indigenous or exotic strains of agents which may cause serious or potentially lethal disease as a result of exposure by inhalation. All procedures involving the manipulation of infectious material are conducted within biological safety cabinets or other physical containment devices, or by personnel wearing appropriate personal protective clothing and equipment. The laboratory has special engineering and design features. A ducted exhaust air ventilation system is provided. This system creates directional airflow that draws air from “clean” areas toward “contaminated” areas. The High Efficiency Particulate Air (HEPA)-filtered exhaust air from Class II or Class III biological safety cabinets is discharged directly to outside or through the building exhaust system. The typical HEPA filter removes 99.97% of all particles that are 0.3 micron or larger in size, which means that all microbial agents will be trapped in the filter. Biosafety Level 3 practices, containment equipment, and facilities are recommended for manipulations of cultures or work involving production volumes or concentrations of cultures associated with most biological warfare agents.
Suitable for work involving agents of moderate potential hazard to personnel and the environment. Agents which may produce disease of varying degrees of severity from exposure by injection, ingestion, absorption, and inhalation, but which are contained by good laboratory techniques are included in this level. Biosafety Level 2 practices, containment equipment, and facilities are recommended for activities using clinical materials and diagnostic quantities of infectious cultures associated with most biological warfare agents.
Suitable for work involving well-characterized agents of no known or of minimal potential hazard to laboratory personnel and the environment. The laboratory is not necessarily separated from the general traffic patterns in the building. Work is generally conducted on open bench tops using standard microbiological practices. Special containment equipment is not required or generally used. This is the type of laboratory found in municipal water- ing laboratories, in high schools, and in some community colleges.
Biosafety Level Information
For more information about BSL facilities in the United States and worldwide, please see the links below.
Biosecurity Challenges of the Global Expansion of High-Containment Biological Laboratories, a report from the National Academy of Science