Saturday, October 25, 2014

Texas : Slowly trending blue?

To be a liberal in Texas (especially in the suburbs) can be dispiriting.  There is not a single democrat elected for statewide office.  For example, in TX-22 congressional district (where I live), Republicans traditionally have enjoyed a 2-1 advantage in voting compared to democrats, and that sort of advantage is fairly common across Texas.  For many positions, there are not even qualified democratic candidates on the ballot.  Well, that was the recent past.

I volunteered today to block-walk canvassing for Wendy Davis, who is running for the governor of Texas.   It was an interesting experience.  A couple of things were worth noting.

1)      I walked in and a gentleman gave me instructions about canvassing.  I walked out with a detailed map of potential democratic voters, and when I returned three hours later, the data was tabulated, and uploaded to a server.  This operation was run by “Battleground Texas”, and the level of sophistication was something that I have never seen before in Texas.

2)      While the volunteers were quite enthusiastic, it remains to be seen, if these efforts translate to votes.  

Based on the early voting results so far (from the top 15 counties), it looks like 2014 early voting trends are very similar to the most recent mid-term election (2010).  Five days into early voting, four of the top five most populated counties, (Harris, Dallas, Bexar, Travis) all show an early voting trend that is very similar to 2010.  However, newspaper reports suggest that early voting is up in Tarrant, and Hidalgo counties, compared to four years ago.

Graph generated with data from Texas Secretary of State's website.

In 2010, Rick Perry got about 20% of the registered voters to beat the democratic challenger Bill White who got 15% of the registered voters.  Compared to four years ago, Wendy Davis has run a more visible campaign, and definitely has a better ground operation. 

Whether all these factors are sufficient to put Wendy Davis in the governor’s office remains to be seen.  In any event, the increasing organizational capacity of the democrats, and the changing demographics of Texas, should concern the Republicans.  

Less than 40% of the registered voters cast a ballot in 2010.  Even if a small percentage of the unlikely voters turn up to vote democratic in this election, it might make for an interesting night on November.   

Monday, October 13, 2014

Ebola – A warning for India

While there are some valid concerns regarding the health care given to the first US Ebola victim, Mr. Duncan1, none would argue the fact that the care received by Mr. Duncan was far superior to what most victims in the West African nations of Liberia, Guinea, and Sierra Leone.  After a plodding start, the Atlanta based Center for Disease Prevention and Control (CDC),  has disseminated clear, simple-to-understand, facts about Ebola to the US public (some would argue that going overboard), and updates its website daily2.   The potency of the Ebola virus is underscored by the infection of a healthcare worker in Dallas who cared for Mr. Duncan. 

Ebola infections/death in West African Nations (Graphic from NYTimes).  Note the ‘J’-curve with a rapid increase particularly in Libeia

Simply put, Ebola is a deadly disease, and kills nearly 40% of those who are infected by it.  The current rate of Ebola infections and deaths, in Liberia, and Guinea may just be the beginning.  The following graphic from NY Times article, highlights an accelerating Ebola epidemic in Liberia [3].  

The unforgiving mathematics behind Ebola epidemic:

 Many have difficulty appreciating exponential growth factors.  Think about this story for a second.   

There is a pond with a single lotus flower, and every day the number of lotus flowers doubles.  An eighth of the pond is filled with lotus flowers.  How many days will it take to have the whole pond covered with lotus flowers?

Mathematical models can predict if an epidemic can spread or not.  If each person who has been infected, on the average, spreads to more than one person the epidemic will accelerate.  This number is called the ‘reproduction number (Ro)’, and when this number falls below unity, the epidemic will die out.  On Sep 2nd 2014, based on the data available until Aug 2014, Swiss researcher, Christian Althaus, published a paper in PLOS, which estimated that the basic reproduction number for infections in Guinea, Sierra Leone, and Liberia were 1.51, 2.53, and 1.59 respectively.   Encouragingly, his models predicted that the control measures taken in Guinea and Sierra Leone, may have brought the ‘effective reproduction number (Re)’, to unity by end of May and July respectively, and Liberia needs to take more control measures.  The graphs shown in the NY Times article seem to support his predictions, Guinea and Sierra Leone, seem to have more of linear increase in infections from Sep-Oct, whereas during the same period the number of infections in Liberia appear to have accelerated.

It is essential to bring the number of infected to a manageable level quickly.  CDC estimates that if we can get 15000 people to treatment centers in West Africa, the epidemic will be contained.  If we wait for a week, that number will quadruple to 40000, and in a month will increase by six fold to 100,000.  There is simply no such capacity in any of these countries.  This is a race against time, in which, at present Ebola is winning. 

How well is India prepared for an epidemic (Ebola or not) ?

In 2013, T.Dikid et al. reviewed the emerging and re-emerging infections in India in the last two decades.  Five of the eight infections were viral in nature.

Figure 2: Recent epidemics in India from 1991-2011 (From T. Dikid et al. Ref 6. below)

The infections ranged from Cholera, Plague, Chikungunya, H1N1, to Diptheria.   In fact, Chikungunya infected almost the entire nation (22 states), and can cause debilitating joint pain for up to six months in those who are infected.

Almost all of India suffered from the debilitating spread of Chikengunia.  The actual incidence of the disease is likely underreported.

The Economist reports that, “Peter Biot - the Belgian microbiologist who discovered Ebola in 1976 in the Congolese rainforest, told the Observer newspaper this month that he is especially worried about the state of public health in India as follows:

"Doctors and nurses in India, too, often don't wear protective gloves. They would immediately become infected and spread the virus." 

Peter Biot, the epidemiologist who discovered Ebola in 1977 in Congo. (From BBC news)

Others have suggested, " it would be a problem that India has only two facilities capable of testing for the virus. Moreover the prevalence of malaria, dengue and other fever-inducing illnesses in India could make it especially difficult to isolate those who might show early onset of Ebola, which has similar symptoms”.

Indian government’s response to date on any of these epidemics is underwhelming at best.  The number and frequency of epidemics in India are probably vastly under reported.    Indian healthcare system is woefully inadequate to meet any epidemic.  It is estimated that 600 million people in India lack access to clean sanitation, or access to healthcare.  Increasingly, most Indians have to buy bottled water to get drinkable water.  An Ebola or for that matter any other epidemic, with just a few thousand infected people in a highly populated urban area, can easily overwhelm the healthcare infra-structure of most cities in India.  

In contrast to the CDC website, the website of the National Center for Disease control in India is uninspiring.  The method of collecting information about potential Ebola infections is through a paper form, completed by hand.  For a country that boasts millions of software engineers, there is not even an online registry.  The website has little information or guidance for private practitioners – the bulk of Indian medical doctors who care for the India's sick.  There is little information about training for Indian nurses in public as well as private hospitals. 

India should actively get involved in the current management of Ebola crisis in West Africa.  It should study the methods that are used to contain the disease, and build the necessary infra-structure – personnel, equipment, knowledge, management, and process controls.  The private sector, non-governmental organizations (NGOs) and activists should turn up the heat on the government and ask tough questions about preparedness and transparency.

Otherwise, India is in for a rude shock for an epidemic (Ebola or not) that is bound to strike.