The Ebola community clinic suggested by WHO and posted on the Washington Post website. U.S. should immediately begin production of self-contained, modular “kits” of this design on a war footing now. They should plan on constructing thousands. Provisions to provide armed security using U.S. military personnel at each of these clinics should be added to this design.
The following is a thought experiment with updates and it should be taken seriously, but not as an inevitability either. Nature can upset these rates of viral diffusion in any number of ways and there are too many variables to know if this estimate is valid. This is just my opinion, and the suggestions are offered as such.
If the number of infected persons should exceed 100,000, then it is unlikely that any international effort will have sufficient resources to make any mathematically non-negligible difference in the rate of diffusion of the virus. At that time, the only means of stopping the diffusion of the virus will by external quarantine.
Will we see that number? If we assume that the total number of infected is three times the estimated amount, as some close to the ground have stated, and the reported figure is 5347 as of 18 September, then the likely more accurate count is 3*5347=16041 persons as of 18 September. Therefore, 100,000 infected persons is notionally reached on the x’th doubling:
105 = 16041*2x
Solving for x and multiplying by the observed doubling time we get:
[log2 (105) – log2 (16041)] * 3 = 7.92 weeks
Defeating this trend with 3000 military personnel and several tons of equipment is improbable in that time. In fact, making any appreciable difference in this rate is improbable when we consider the fact that it will take at least 30 days for this effort to fully stand up. If we cannot defeat this function in this time, then the point in time that the probability of containing the virus is maximum is when that point is reached; that is, in 7.92 weeks. USG should be prepared for that time, which is about 18 November.
At this time USG should (and must if it is to succeed as pointed out) shift to a quarantine solution. At this time, the total number of infected is 100,000. While this may be too many to contain the virus within the population, it is small enough to contain it within the borders of the three affected countries, assuming steps are taken to do so. But simply putting troops on the border may not be enough. A no-fly zone will be required and all arteries of passage outside these countries must be involuntarily (but temporarily) evacuated with a radius of not less than 15 miles from the point where the artery intersects the border (the actual distance would vary depending on the size of the passage and the topology). Refugees should be sent to either Liberia, Sierra Leone or Guinea. And authorities will have to “guard” this area and allow no entry. This is the only solution in the absence of a vaccine. USG should begin now to collaborate with all neighboring countries to give U.S. military personnel access to these “choke points”. USN must enforce a no-sail zone off the coasts of Liberia and Sierra Leone on 18 November.
If these numbers should attain by 18 November USG should initiate stop-loss on all services and respond with a strategic military effort, which may involve the deployment of many tens of thousands of troops. U.S. military forces, if the numbers exceed 3,000, should be issued all chemical, biological and radiological gear (and I do mean ALL three types) to all personnel. Other nations that supply military personnel should do likewise. Prioritization of vaccination, wherever available, should be ranked thusly:
1. Military personnel and health professionals in the hot zone
2. Gibraltar, Sinai and Panama (my concern is that governments will continue to underestimate the scale of human migratory flow, and how this will cause a wave of successive virus infection flow along migration paths, which will converge on these “ambush sites”; in the sense that these sites, if treated wisely, could serve as points to “ambush” the virus).
3. Populations at the periphery of the hot zone
4. The hot zone
5. The global population, en masse.
If the number of infected increases the probability of containment will fall. When the number of infected in the affected countries reaches 1 million, containment will likely fail in any case. 1 million infected will be reached on:
[log2 (106) – log2 (16041)] * 3 about 4.5 months, or January 15.
At that time, should that occur, USG should apply the same tactic at Gibraltar and the Sinai and the no-fly and no-sail zone should be extended to the continent of Africa. If a vaccine is available, a mass and heavy vaccination of the population in the areas of Gibraltar and Sinai should be performed in a buffer area extending about 100 miles on either side of this boundary. The vaccine should be made available to any person seeking it, regardless of origin and indeed, it should be mandatory (if a refugee arrives in a heavily vaccinated area they are less likely to attempt to continue their exodus). If a vaccine is not available in that quantity, the same area should be evacuated. In either case, the area will require U.S. troops to deny passage to all persons. They should also deny entry into the vaccinated zone. Once this is accomplished, and all available assets should be employed to do so, similar checkpoints should be established at successive national borders from the outbreak. Obviously, if sufficient quantities of a vaccine remain, they should be administered at those locations and to the population generally.
USG should begin collaboration with Spain, Morocco, Israel and Egypt now. As a precautionary measure, USG should do the same with Panama and begin plans to set up a similar boundary in Panama. Plans to establish a buffer in Panama from Atlantic to Pacific by evacuation should begin now. If the efforts to contain the outbreak on the continent fail the virus will have run its course by:
[log2 (109) – log2 (16041)] * 3 about 12 months, or about September 15, 2015.
Resulting in the loss of very roughly 500 million human lives.
If containment to the African continent fails, the virus will run its course and preferentially impact countries that are not well developed or which have large, poor populations. In that case, the virus will run its course in roughly:
[log2 (7*109) – log2 (16041)] * 3 about 14 months, or about November 15, 2015.
Resulting in the loss of very roughly 2.5 billion human lives.
If the (by then) pandemic escapes the African continent, China and especially India are at grave risk because of their large, poor populations confined to a single legal jurisdiction. China will likely not allow foreign assistance on a large scale, though India might. The problem that is being overlooked here is that once the virus has a large pool of infected the ability to contain it drops sharply. In reality, I expect the 2.5 billion figure to be higher. We can expect geopolitical destabilization to occur in this case, with war and conflict becoming a salient feature. The worst case scenario, though not a likely one, is for some authorities such as those in China to use a “snake and nape” tactic. I would caution any such nation (think Pakistan and China) that use of nuclear weapons will only exacerbate the problem as the radiological effect will be as bad or worse than the virus itself. The problem here is trying to guess what a developing nation will do when desperate.
There is no way to know how this function will behave in the future and its doubling rate may change, resulting in large differences in these estimates. However, we cannot ignore the fact that the observed doubling rate is the best information we have for projecting the diffusion of the virus. Another reason to be somewhat skeptical of our starting numbers is the fact that we don’t know if the doubling time is an artifact of the reporting fidelity or a true representation of the rate of diffusion of the virus. However, it is probably imprudent to assume the former.
USG and NIH should place GSK on a war footing now, by the manner of imminent domain or national security if necessary. This should be extended to any other private competency as well, if identified. The likelihood of this virus taking a good hold in any industrialized, wealthy nation is very low, but these events could have cataclysmic economic consequences on the entire world nonetheless.
This entire analysis assumes that no mutation rendering transmission airborne occurs. All suggestions provided are made on the premise of minimizing loss of human life.