October 2014

To best understand the variety of applications of GIS in public health maintenance and surveillance, there are numerous sites worth visiting. To see all of these applications in one place, from past to present, I produced a site that is now passing the decade mark. Many of the topics here have have never been covered extensively before. This site receives between 200 and 300 visitors per day.

Source: brianaltonenmph.com

An important thing about African disease outbreak and migration is understanding how it travels, where it travels to and why. Contemporary epidemiologists tend to believe they have the diffusion process down, as a transportation related feature. There are several hundred analyses I performed on the different disease migration patterns. Over the past decade I posted hundreds of links to about half of these maps and videos, fully posted, but not indexed, on my YouTube site. —– Three of these stand out as sources for lessons about Ebola’s possibly diffusion pattern. —– The monkey pox comes from a similar region, is viral, and shows hierarchical peaks around the U.S. Where in migration has defined it potential new misuses around the country. These misuses are also possible for ebola outbreak as a human population density-travel event. —– The Plague IP map is plague diffusion normalized to population density. It demonstrates the peaks we are more expecting of. —– The third map depicts ebola claims, based not on the disease, but on where individuals underwent rule outs, exams, blood testing and the like. —– The remaining information consists of links to numerous pages on the the Monkey Pox itself, the African disease in-migration issue, and the background on my NationalPopulationHealthGrid project. —– Monkey Pox. http://m.youtube.com/watch?v=1amd_QP3YHU Plague, independent (non-krigged) prevalence http://m.youtube.com/watch?v=A78AZDxO0II. Ebola claims in the past: http://m.youtube.com/watch?v=RfvUQfYLlvM. CDC page on Monkey Pox http://www.cdc.gov/ncidod/monkeypox/. WHO page on monkey pox: http://www.who.int/mediacentre/factsheets/fs161/en/. MedicineNet info page: http://www.medicinenet.com/script/main/mobileart.asp?articlekey=23611. MedScape info page: http://emedicine.medscape.com/article/1134714-overview. Emerging diseases from Africa: Emerging Infectious Diseases from the Global to the Local Perspective: A Summary of a Workshop of the Forum on Emerging Infections. http://www.ncbi.nlm.nih.gov/books/NBK99567/. Morens DM, Fauci AS (2013) Emerging Infectious Diseases: Threats to Human Health and Global Stability. PLoS Pathog 9(7): e1003467. doi:10.1371/journal.ppat.1003467. http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1003467 Anthony S. Fauci. January 2006. 2005 Robert H. Ebert Memorial Lecture Emerging and Re-emerging Infectious Diseases: The Perpetual Challenge. http://www.milbank.org/uploads/documents/0601fauci/0601fauci.html National Geographic. BOOK TALK Every Newly Emerging Disease Like Ebola Begins With a Mystery. One crucial factor in the epidemic spread of Ebola is poverty, says author of a new book about the disease. http://news.nationalgeographic.com/news/2014/10/141005-ebola-quammen-west-africa-dallas-gates-foundation/ Social and societal health issues in Pacific Northwest. https://brianaltonenmph.com/gis/population-health-surveillance/production-examples/regions-and-health/part-v/ Medical Geography and Disease Surveillance. https://brianaltonenmph.com/gis/ Extensive coverage of my exceptionally fast mapping technique for national and regional stats on public health issues, at http://nationalpopulationhealthgrid.com/author/altonenb/.

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There are two important historical epidemics to note that are very similar to Ebola.  The first took place in 1816 along the Zaire/Conga River.  The second along the Niger River where it connects with Tschadda.  These are both epidemics that began with fever outbreaks, but which led to a high fatality rate and had symptoms that demonstrate a unique form of internal organs deterioration that other fever epidemics do not normally present with.  Fewer cases demonstrated the internal blood mass formations seen in the more contemporary outbreaks.  The most resemblance between these two outbreaks are their dates of initiation, days until fever symptoms, speed of spread to their others in the teams, and time until death.  Both were also colloquially termed “River Fever”  These support my premise that the Ebola and some  similar diseases have been around since they were first noted by the Portuguese missionaries in the 1690s.  Both of these overlap with the geographic distribution that we currently are familiar with, and are consistent with the topography, ecology and human population features determining how this disease may be spread.

In a related posting, I provided the map depicting German medical cartographer Friedrich Schnurrer’s interpretation of what he learned about the Congo River epidemic documented by a Portuguese missionary leader   Fr. Anton Zuchelli (1696).  (see      https://brianaltonenmph.com/2014/10/14/is-there-an-early-history-for-ebola-preliminary-review-says-yes/  )

The following are the notes contained in reviews of the two writings pertaining to the above mentioned Ebola-like experiences.


The first is regarding the September to October 1816 Congo or African Fever epidemic experienced by Captain James Hingston [Kingston] Tuckey:


“The crew consisted of eight petty officers, six artificers, fourteen able seamen, a serjeant, a corporal and twelve privates of marines making in all fifty six persons, of whom twenty one were doomed never to return. ‘Never’, says the editor, ‘was an expedition of discovery sent out with more flattering hopes of success, yet, by a fatality almost inexplicable, never were the results of an expedition more melancholy and disastrous.’ Captain Tuckey Lieutenant Hawkey Mr Eyre (purser) and ten (eleven) of the Congo’s crew — Professor Smith, Mr Cranch, Mr Tudor, and Mr Galwey, (a volunteer), in all eighteen persons, died in the short space of three months! Two had died in the passage outwards and the serjeant of marines survived only till the vessels reached Bahia.”


Note:  Captain Tuckey was taken ill September 17, died October 4, 1816.

Source:  Art IV. Narrative of an Expedition to explore the River Zaire usually called the Congo in South Africa in 1816 under the Direction of Captain JH Tuckey . . . to which are added, the Journal of Professor Smith, some General Observations on the Country and its Inhabitants, and an Appendix containing the Natural History of that Part of the Kingdom of Congo through which the Zaire flows. Published by permission of the Lords Commissioners of the Admiralty 4to London 1818.  Book review in ‘The Quarterly review (London)’, January 1818.  See http://books.google.com/books?id=y3i1-YybvCAC&pg=PA335 



This is regarding the Deaths from September to October 1841, at the confluence of the Niger and Tchadda, where Captain B. Allen and the crew were heavily infected, one third deceased, reviewed by Dr. J.O. McWilliam [M’William].


“Of the one hundred and forty five white men, only fifteen escaped the river fever; while of the one hundred and fifty-eight blacks, only eleven were attacked. The number of deaths is not clearly shown; but what from fever and other casualties, the tables appended show a total of fifty-three, among whom were Captain B. Allen, Lieutenant Stenhouse, Dr. Vogel, Mr. Kingdon, Mr. Willie. Mr. Wilmett, and two of the assistant surgeons.”


Source:  Chambers’ Edinburgh Journal, Volume 12, Sept. 9, 1843.

(Note: this Ebola is not as deadly as the current).

For the next several years, “Niger Fever” was a terms used to defines these unique cases presenting along the Niger.   Eleven major publications refer to this term for the diagnosis,, including The Lancet, British and Foreign Medical Review or Quarterly, Medico-Chirurgical review, and Edinburgh Med Surg Jl.  It is also contained in Robley Dunglison’s 185 Medical Lexicon.  See also John Forbes (ed.) book review in Brit. For. Med. Rev. Q., July 1843, at http://books.google.com/books?id=B_AEAAAAQAAJ&pg=PA259&nbsp😉

Supporting documents for these fevers being quite different from yellow fever, malaria, and numerous other more common fevers are contained in McWilliam’s Autopsy notes, details of which were published in his book and as part of the combined book review found in the Edinburgh Med. Surg Jl., 1845, v 63).   Link:     http://books.google.com/books?id=t_8aAQAAMAAJ&pg=PA432 ;  another version http://books.google.com/books?id=-Vo9AQAAMAAJ&pg=PA392

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A section of the first disease map of the world.  From Friedrich Schnurrer’s ‘Charte über die geographische Ausbreitung der Krankheiten: vorgelegt der Versammlung Deutscher Aerzte und Naturforscher zu München’, Published 1827.  

In 1827, Friedrich Schnurrer’s ‘Charte Uber die geographische Ausbreitung der Krankheiten’ was published detailing his summary of diseases around the world.  Schnurrer wasn’t the first to study disease patterns globally, he was simply the first to place all of his notes on the world diseases and epidemics he know and read about onto a single map.  


One of the earliest essays on disease and place, in terms of the planet, was the work of Johanne Christophor Homann, with his Medicinae Cum Geosophia Nexu [the Medical-Geography Connection], 1720.  (see my page – http://wp.me/Puh6r-7MS&nbsp😉


The next massive tome published on disease patterns was by the famous author and printer of a very young United States, Noah Webster, who wrote a compendium on the history of the outbreaks around the world, all in an attempt to define geographic and climatic reasons for their recurrences (link below).  His book served to explain how and why the United States was experiencing numerous, deadly yellow fever epidemics, which were referred to as the "black plague" at the turn of the century.  Webster’s have a natural explanation for all of these events ensuing around the world, blaming the diseases on volcanoes, massive storm patterns, earthquakes, increased global heating by the sun, and yes, environmental and climate change (for a review of Webster’s theory of weather change patterns, deforestation, and climate change, see: Deforestation and Global Cooling: A New Theory for Disease by Noah Webster, 1810, at http://wp.me/Puh6r-3JA (2012); and http://www.smithsonianmag.com/ist/?next=/history/americas-first-great-global-warming-debate-31911494/ (2011)).


in 1813, Schnurrer wrote ‘Geographische Nosologie oder di lehre von den Veränderungen der Krankheiten’ , that is to say, with brevity, knowing the geography of certain disease types.


which set the stage for his next important publication, the map of world diseases published in the 1828 Das Auslan (full citation with link to scanned copy at the end).  


My purpose for reviewing this map and Schnurrer’s earlier work was to determine if there was any evidence for Ebola found on the map, and/or in the earlier writings by Schnurrer on the global disease patterns documented in explorers’, settlers’ and travelers’ writings. 


The way Schnurrer and others for the time defined disease patterns was by their place of natural existence, known as the nest or nidus for a disease, and by their placement on the earth in relation to its latitudinal patterns, used to describe airflow and climate, the weather associated with the disease patterns documented for the time, and the local topography and natural ecological settings that the authors linked to these disease pattern observations.


Only the map will be reviewed for the moment.  


The current behavior of Ebola shows that it is staying north of the equatorial line.  If we review the diseases of this region, we find thirty nine distinct disease descriptions given for illnesses common to Africa between 0 and 30 degrees north.  That part of African between the 0 and 20 degrees latitude line is for the most part equatorial in nature.  Two attacks of "pestilence" are noted in this "torrid" or tropical zone (as later medical geographers referred to it), one epidemic each for the years 1696 and 1811.  Since both of these are along the eastern end of upper Africa, they are rule out as Ebola possible ebola events for now, even without reviewing their symptomatology .   


Throughout the north torrid region, there are numerous disease types defined symptomatically by Schnurrer as fevers, bearing the word fiber in their categorical name assignments ("Fieber", abbrev. as "Fieb.", "f" or "F.").  The Pox is also noted ("Poken", with a brief reference to the "Quarantaine" performed).   Numerous forms of venereal disease are displayed (abbrev. "v.d." or identified by their namesakes–syphilis and gonorrhea).  


To differentiate the large number of fevers that appear on this map, the related symptoms noted are helpful.  Galliche Fieber is yellow fever, that by Senegal is "common to the Negroes. . . ).   Galliche rem[ittent] fever is possibly yellow fever, but also possibly malaria (remittence refers to cycling).  A number of intestinal worm or "animalcule" diseases are also worth noting ("Faden ~~").


Just south of the equator is Gangran des Mastdarms nach heftigen Kopf u. lenden schmerzen Berriberri (Zuchelli).  It is displayed along and south of the Congo River.  From its name we know that it could be called the "Gangrene de Mastarms", a necrosis or gangrene of the entire intestinal tract commonly linked to some form of diphtheria by the late 1800s (see Semple, 1879).  The descriptive portion of this disease name is "hestigen Kopf u Lenden schmerzen Berriberri", which translates to  "vehement head & lumbar pain beriberi", the last section implying an appearance of beriberi–appearing cyanotic and about to die.  (see http://renovatingyourmind.com/2013/03/25/renovating-your-minds-makes-a-social-call-to-the-first-member-of-the-b-complex-family-b1-thiamine/beriberi-alcoholism-thiamine1-deficiency/&nbsp😉


This is possibly the first documentation of Ebola as a disease native to the Congo River on a map, by Missionary Father Antonio Zuchella in 1696 (Benicken, 1824), in what it now the DR Congo.





REFERENCES (if not in the above text).



At http://english.byu.edu/facultysyllabi/KLawrence/WEBSTER.briefhistory.pdf 


Geographische Nosologie oder die Lehre von den Veränderungen der Krankheiten   … 1813.  By Friedrich Schnurrer.  http://books.google.com/books?id=W84UWCIi3qMC 


1824. Das Auslan. Ein Tagblatt fur Kunde des geistigen und sittlichen Lebens der Volker mit besonderer Rucksicht auf verwandte Erscheinungen in Deutschland. Erster Jahrgang. Bd. 1-2. Munchen der Literarisch-Artistischen Anstalt der J. G. Cotta’schen Buchhandlung. 1828 / / 

Der Verleger Johann Friedrich Cotta …, Volume 1, Issues 1787-1814, 
edited by Deutsches Literaturarchiv / / 

Nr. 90, volume 30. 22 Sept 1827, S. 357-359. Die geographische Vertheilung der Krankheiten, vorgelsesen in der Versammlung Deutscher Aertze und naturfirscher zu Munschen den 22 Sept 1827 (S. 3570359). Charte uber die Georgraphische Ausbreitung der Krankheiten von Frid. Schnirrer Med. Doc. Vorgelegt der Versammlung Deutscher und Naturfischer zu Munchen den 22 September 27. Lithographie. 1 gefalt. Bl. 2).  

Title:  Charte über die geographische Ausbreitung der Krankheiten: vorgelegt der Versammlung Deutscher Aerzte und Naturforscher zu München 

The map is available for viewing and download at: 



Robert Hunter Semple.  1879.  On diphtheria


Zeitrechnungs-Tafeln für den historischen Handatlas: Mit steter Rücksicht …

 By Friedrich Wilhelm Benicken . 1824.  



Reference noted in the book (sic): "Deo Pater-Merolla Reife nach Congo. 1696. Der Miffionar Ant. Zuchelli bereifet Congo. – Die Portugifen werden vom Kuatenhandel verbrängt, behalten jedoeh Mazagan und die vier Guinea-Infeln."

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Poughkeepsie Journal (Hudson River Valley, NY), 1797 (from the microfilm collection at Adriance Library, Poughkeepsie, NY).  


Yellow Fever invades Philadelphia.


This small item published in the Poughkeepsie Journal is the tale of what happened in Philadelphia, when the yellow fever struck it in 1797.  40,000 people fled the city in just days.  Once more ships infected with yellow fever struck New York, just as many fled the streets of its greatest city, finding refuse upstream and in the more rural settings of the Hudson River Valley in New York. According to the weekly reports that appeared in the papers about either of these disease outbreaks, deaths climbed from the hundreds to the thousands in a very short time.  


Much the same is happening right now or readying to take place for Ebola.  The article this image links to details how to deal with a global epidemic catastrophe ‘in just five steps.’

Source: www.vox.com

To understand human behavior during an epidemic, we need only turn to American history.  When yellow fever came to Philadelphia in 1797, deaths were in the thousands per week by the time the outbreak peaked within the urban proper.  Many of these deaths occurred at home or in the Almshouses. Much of this news was published by the weekly newspaper of the Hudson River Valley, the Poughkeepsie Journal, the major newspaper for lower New York State along the Hudson River Valley.  


According to this brief report, in just a few days to weeks, the City of Philadelphia experienced 40,000 departures as the residents left surviving escaped from the core of the city, creating congestion along the way as they relied upon local merchant ships and wagoneers to make their way to safe haven.  


At times, these passengers unknowingly brought the disease with them, or at least the means for infecting the next mosquito vector that consumed their blood before making its way to the next victim(s).  In this way, the yellow fever managed to spread from one town to the next, one city to the next, one poor neighborhood to the next, whether it be from hamlet to city, shipping port to shipping port, port city to countryside.  


The late 1790s yellow fever epidemic and the one or two that recurred later were all it took for doctors at medical schools in New York, and Philadelphia to implement and succeed in producing the first effective quarantine practice.  In New York City, they relied on the islands just outside New York City, in the harbor and adjacent riverways.    


These quarantine practices were put to the test over the next decade or two.  In the 1830s, they were no longer that effective when the next major epidemic made its way to the United States.  The famous Asiatic cholera, originating from large ports in India, made a brief stay in the U.S. in 1832.  In winter of 1848/1849, it began are more aggressive importation in February from India to the Mississippi River delta, just before the Gold Rush in lower California began.  


Since the Gold Rush pioneers were mostly boys and men, they did not bring the cholera with them westward as much as the later pioneers would do.  Re-emerging in Spring of 1850, and again in 1852, between April 15th and May 30th for each of these years, the experiences of the large numbers of deaths due to cholera were penned in Oregon trail diaries.  


Just west of Fort Kearney, these Oregon Trail pioneers wrote about the deaths that ensued following their brief stay at Fort Kearney, where thousands of people moved about on a busy day.   Departing Fort Kearney, they penned their experiences and observations and they witnessed dozens of people taken ill by the disease, many dying, except for young men and young boys.  


The reason for these "hot spots" west of the Fort were several.  Climate, distance travelled, close contact and population density were perfect for making this outbreak happen.  With each death, the remains left behind found new victims passing through.  It ended up, the environment was perfect for maintaining a steady culture of Vibrio cholerae within the alkaline waters filling freshly dug drinking wells.  "Dig your own well" was the saying for the time.


This outbreak was more deadly than any other diarrhea like contagious disease for the time, including the most likely dysentery to strike the people in Nebraska at this time.  Until vibrio came upon to the plains, a Salmonella intermedia (and perhaps Listeria) growing upon the rotting flesh of bisons was known to cause severe diarrhea.  For the pioneers, those who made it past Fort Kearney and a similar outbreak next to Fort Laramie, Wyoming, were often put at risk by the decaying carcasses of oxen and cattle that died while trying to ascend the eastern face of the Rockies.  (See my thesis page on this research, for more detail, at http://oregontrailcholera.wordpress.com/  .)


When an outbreak happens. human behavior becomes difficult to manage, almost impossible to control or predict.  If the Ebola outbreak were to reach the U.S., and if its severity were to reach the level that cholera reached during the 1850s, what we should expect to see is a disease that spreads like "wildfire" (taken from the Andromeda Strain).  The diffusion would be from neighborhood to neighborhood, one population setting to another, in a heterogenous, mixed radial-hierarchical diffusion process (using Gordon Pyle’s sense of the words, see https://brianaltonenmph.com/gis/historical-disease-maps/john-c-peters-and-the-asiatic-cholera/1960-pyles-cholera-diffusion-and-migration-patterns/ ).  


By keeping a close watch on this outbreak–were it to happen (I am trying to be rational about this)–spatial epidemiologists would no doubt have a very unique opportunity to map one of the most aggressive epidemics to take hold of its victims in fairly short time.  Due to its incubation time, this Ebola would always be a little ahead of them, by two or three weeks.  


My proposal is that this disease (see my July 7th ScoopIt!, personalblog, and map image: https://wordpress.com/post/7215587/41081 ), is that it will follow a dual path mathematically (nature’s common practical joke on us).  It will be opportunistic and appear very deterministic in its earliest habits, but demonstrate the more complex migration patterns (Pyle’s mixed models) as time passes for each setting;  transportation helps to define these stochastic (chaos theory) behavior of the disease, and will ultimately define whenever and where ever the Ebola decides to travel to next.  All of this makes prediction modeling a much tougher process.  The most likely routes, based on natural ecology, not human ecological impacts, are noted on this map.


It is important to note here that Ebola is a viral disease, not be spread by airborn vectors like the mosquito born yellow fever or more recent west nile (that is for not, it is not airborn).  Still, Ebola is more deadly than the west nile and yellow fever.  In terms of appearances, it may be as bad as or worse than the looks of the yellow fever and cholera victims during their dying hours.


But more importantly, Ebola is different from Yellow Fever and Cholera because it has a more distinctly landborn element as part of its natural ecology.  


Vibrio cholerae remain alive in deltaic brackish saline water, are dependent upon copepods, and from there enter into the higher animal portions of the food chain or web.  West Nile survives the winter due to its hibernation in surviving female mosquito bodies not destroyed by the coldness of winter, able to arise and infect their first animal or human victim of the year.


The spatial limits for each of these are the chemistry and zooecology of the aquatic environment, and the need for the right climate and water.  


Ebola lacks these restrictions to aquatic and shoreline settings.  Yet it still bears some other features of its own, that may even be foretelling.  


Ebolavirus can remain alive on land where certain mammals reside.  Its ability to survive within a supporting ecosystem, without incidence of human involvement, is very much possible.  Even in distant places, Ebola can reside for a considerable length of time, undetectable and unpredictable by contemporary surveillance programs.  Regions that are poorly managed, poorly funded, and otherwise forced to live with underfunded health surveillance programs are going to be the most impacted by this disease.  They also bear the population most at risk due to sanitation problems, their social disconnect, and their problematic lifestyles.  Regions that are rich in domestic and wild animal populations but lacking adequate disease surveillance programs for zoonotic diseases, are where this disease could most likely have its greatest impact on local public health.  


So can we really afford to prevent a disease like Ebola?  much less stop it in its tracks should it become an ecological phenomenon.


Due to the mobility of its hosts and carriers (mammals, esp. frugivorous bats), Ebola is capable of migrating where ever it needs to, given enough time and new victims.  It may not even be an immediate human threat, until its finds the right human ecological setting to establish its new domain.  According to the research of its hosts, carriers, vectors, zoonosis ecology, there are specific regions that exist, each with its own outbreak and nidus development potentials.  The way to define these regions and what the Russian geographer call their ‘metaxenotic potential’ and combined host-human spatial region, is defined by the works of Voronov and Pavlovsky. ( https://brianaltonenmph.com/gis/historical-disease-maps/zoonoses/ &nbsp😉

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http://youtu.be/Yb4P_QM-Rjc IMG 1275 AFRICA

Source: www.youtube.com

I did these studies years ago about African health history, disease patterns, linked human behaviors, genetic, and culturally-bound disease patterns into the US.     


I broke down the African cultures in-migrating into the slavery era defined, post slavery and predominantly Muslim related in-migration periods.  These ICDs related to African heritage were then  reclassed into those groups,  and about 180 definitive ICDs for African influence defined.     


This 3D rotating map is one of the first I produced depicting my study results.  It was used to demonstrate the value of the Remote Sensing equations when applied to grid modeling techniques, the mathematical method I designed for implementing this detailed US epidemiological surveillance technique.   


Other examples of my cultural ICD 3D mapping studies are at [Topic: Inmigrating Disease Patterns]     https://www.youtube.com/watch?v=zQ60npQzdTk&list=PLWrApErk5bybFfsOWTXWjlwvIM7D4d6-h    


The primary, secondary and tertiary mapping developed begins with the basic in-migration patterns, followed by cultural-behavioral and then genetic diseases, all identified based upon ICDs.   


This Youtube site is also rich in sociological, zoonotic, genetic, V-code and numerous other foreign born and/or re-emerging disease patterns that I developed NPHGs for.   


See: https://www.youtube.com/watch?v=dSP6tOQs-RQ&list=PLWrApErk5byZnE0bWUqdfH4CYVmnETLg6    


My REGIONS & HEALTH pages provide specific applications for these techniques.  The Pacific Northwest issue for example was detailed and discussed extensively a few years ago, beginning with    


Regional Health Planning and the Pacific Northwest Medical GIS and Regions series    



I posted hundreds of examples of the 3D mapping in this series, 

with GIS applied specific to Pacific NW issues on the page at     http://wp.me/Puh6r-8l2    

See on Scoop.itNational Population Health Grid

CDC Confirms First Ebola Case Diagnosed in U.S.

Source: abcnews.go.com

We can rationalize it as much as we want to, but it still happened. Now we are left with an opportunity to look at the exact number of people possibly in direct, indirect and atmospheric to inferred indirect contact. Directly and indirectly infected places versus infected people can be documented. Right now it is only a case that is a loner within the lone star state. It is not how many cases there have been and how many of these were fatal that matters so much any more. The question might do become what stage in that exponential growth curve are we in? and what is the doubling time? Right now we are in the first stage of disease ecological development in a spatial diffusion process. Pure spatial features defining this outbreak make it a radial event to imagine. Hierarchical human diffusion pattern make us worry about whether there is (will be or could be) a direct flow of the contagion between airports impacting other latitudes in the US, or might it be restricted mostly to intrastate patterns? Due to incubation times, we may now have to wait two or three weeks to find out. Fortunately, seasonal climate changes are on our side, since the cooler months of winter are approaching in Texas. Geography and climate are in favor of the outbreak for the next month or two spatially. The lack of US engagement in this crisis several months ago means we are directly responsible for our own fate at this point. There was no reason or logic for our failure to engage in appropriate preventive health care practices two to three months ago. The outbreak status here has moved from prevention to containment stage. By now, if we are fully prepared in Atlanta, transportation analysts should know the flow patterns in and around this new potential nidus–by air, land and even water. If not, we’ve been caught with our guards down. By tomorrow we’d better know how a potential host-vector relationship might develop. Even once human cases are fully contained, an animal born ecological nidus can still develop. An eastward, northeastward flow pattern out of Texas is therefore favored. But I am really just looking at worst scenarios here. Let’s hope this Texas case remains on its own turf and hospital bed in the Lone Star state. History show us that it is nearly impossible to prevent foreign born diseases from coming to the U.S. We can delay entry, but if ecology is in favor of transmission and human behavior remains the same, nature simply waits until we let our guards down again. When it comes to man versus nature, we may first win out spatially. However, temporally, nature is not on our side.

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