c0mputar

Seesh, maybe even the MSF is unable to keep up. Maybe it's a responder problem and not a capacity problem. Not enough doctors. Well time will tell, but if bodies are still being collected at the door, we can only hope they had been dropped off there already dead and not that there aren't enough doctors to get the sick inside quicker. The former allows potential for education and surveillance to get people into clinics sooner, the latter means we need more doctors which is a harder problem to resolve.

Who is going to man all the new clinics opening up? Can't be journalists such as yourself ^.

Thanks again.

MSF and many media sources in Liberia have noted that recent capacity increases have not been met with an increase in admissions, nor have previous occupancy level highs been maintained. Demand appears to have dropped. For instance, ELWA-3 was expanded to double capacity and only have ever filled half (as it currently stands).

The Montserrado district experienced, during the months leading up to Sept and Oct, a demand for beds exceeding availability. At some point during the past 1-1.5 months, the demand appeared to fall as the occupancy capacity increased. We have seen 450 spaces occupied decline to 300 now, with a recent report stating there are only 400 active cases in the whole country (~300 in Montserrado).

The MSF and some anecdotal diaries have cautioned that there is significant under-reporting of cases, which is likely true, but we do know how many spaces are occupied at the clinics. Regardless of the lacking ability of the government to report cases, it still appears that the outbreak is stabilizing in Liberia by judging it based off occupied beds. Perhaps the aggressive education and surveillance system in place to make people aware and prepared has been very effective at reducing Re.

So my question to you is this:

Has there been any re-evaluation in the number of cases outside the health care system that are neither reported or admitted, or is the 2-2.5x multiplier still reliable even though it was derived during a period when treatment capacity was actually full and less than half what it is now?

In other words, do responders in Liberia feel that the tide has shifted but, regardless, they maintain a cautioned tone to prevent another resurgence?

Thanks for having this AMA, and I feel like someday you'll be posting pictures from Sierra Leone (which may be the dark horse of this outbreak), so stay safe!

Using bodies collected in ETUs vs communities as a measure of the number of cases outside the health care system does suggest perhaps a 1:1 ratio of known and unknown cases at worse, maybe closer to 3:1.

The problem I find is that Liberia's testing infrastructure is piss poor and many of those outside deaths may not be Ebola related. On the flip side, many Ebola deaths are hidden. How many? That's the big question.

Interesting, had not thought of it that way.

When HIV becomes airborne we can start to worry about that.