Today's #hackebola piece is a guest post by Jessie Gunter - follower her @JessieGunter.
A particularly alarming characteristic of the Ebola epidemic is the high infection rates and deaths of healthcare workers. Many community health workers, nurses, doctors, and even hospital administrators have been infected since the outbreak began, sometimes even while taking diligent precautions against exposure to the bodily fluids of the patients whom they are treating (according to this report by the WHO, 401 healthcare workers have been infected since the beginning of the outbreak, and 232 have died).There have been several scenarios that have resulted in the infection of healthcare workers, according to the WHO:
To give you an idea of the number of healthcare worker (HCW) cases in Liberia, this plot shows the cumulative number of HCW cases by county. I included the top five hardest-hit counties:
However, it will probably give us more information if we look at the cumulative HCW cases as a proportion of how many cases there are in each county (again in Liberia):
My first reaction was: Woah. What’s going on in Bong County? Here is what the proportion of HCW cases over time looks like, broken down:
It looks like cases first appeared in Bong County on July 17, and the first four cases were HCW.
So, taking another look at the graph “Cumulative healthcare worker cases by county as a proportion of total cases”, we can see that Bong County still finishes at the top for the most HCW cases as a proportion of total cases in the county. Unfortunately, a news report from early October reports that a newly constructed Ebola Treatment Unit has been abandoned by HCW and staff in Bong County, who feel that the risk is too high and who have not been paid in a timely manner for this life-threatening work.
One glimmer of hope here is the small decline in HCW cases as a proportion of total cases in Montserrado (county within which Monrovia lies). However, as shown in the first graph, the number of HCW cases in Montserrado continues to climb.
One thing we know for sure about this outbreak, illustrated in periodic inventory reports from the Liberian Ministry of Health, is that desperately needed medical and protective equipment has been in short supply. We also know that as soon as new treatment centers are opening up, they are immediately flooded with patients
Based on this information, we should see the number of patients admitted to the centers each week equal with the number of beds, or higher. Instead what the Liberia data show is the number of patients in treatment well below the number of total beds at a national level. This could mean that MoH is only reporting admission statistics and cases at their national treatment centers, and not at the treatment centers set up by MSF and other NGOs. WHO has warned that the Liberia data is fairly unreliable, since responders are completely overwhelmed. The situation on the ground would be a little less bleak if this graph actually depicted the bed capacity and the number of patients in treatment:
However, although the problem of bed shortage doesn't appear using the MoH data and my graphing capabilities, the WHO report from October 8 speaks for itself:
Hopefully, with many new treatment centers, HCW training, and the new United Nations Mission for Ebola Emergency Response, planned, some of the gaps between existing and desperately needed facilities and infrastructure will be closed.
**Excerpt from an interview with an MSF nurse: “... doctors and nurses work 15 or 16 hours every day, seven days a week. When in the treatment facility they wear thick protective yellow impermeable suits, rubber boots and respirator masks, two pairs of rubber gloves, thick goggles and rubber full-length aprons to protect them from the disease. In the warm, humid climate, this gets extremely hot. One day, Fischer took a thermometer with him in his pocket to measure the temperature in his suit; it was 115 degrees. Dehydration or fainting from heat exhaustion are ever-present dangers; in a day, one person can lose as much as eight litres in sweat.”
Thank you to Caitlin for allowing me to contribute to the #hackebola series, maintaining the Ebola data (at https://github.com/cmrivers/ebola), and for the guidance in Python.
"Send me your data - PDF is fine," said no one ever
The public health paradox ("When public health works, it's invisible")
Let's make data a civic right
Scholarly impact of open access journals
Six months later, disease detectives still battling fungal meningitis outbreak