Ebola Cases and Health System Demand in Liberia
Publication Date
January 13, 2015
Journal
PLOS Biology
Authors
John M. Drake, Raj Reni B. Kaul, Laura W. Alexander, Suzanne M. O’regan, et al
Volume
13
Issue
1
Pages
e1002056
DOI
https://dx.plos.org/10.1371/journal.pbio.1002056
Publisher URL
http://journals.plos.org/plosbiology/article?id=10.1371%2Fjournal.pbio.1002056
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/25585384
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293091
Europe PMC
http://europepmc.org/abstract/MED/25585384
Web of Science
000349169900018
Scopus
84922250260
Mendeley
http://www.mendeley.com/research/ebola-cases-health-system-demand-liberia
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Mendeley | Further Information

{"title"=>"Ebola Cases and Health System Demand in Liberia", "type"=>"journal", "authors"=>[{"first_name"=>"John M.", "last_name"=>"Drake", "scopus_author_id"=>"7201816666"}, {"first_name"=>"Raj Reni B.", "last_name"=>"Kaul", "scopus_author_id"=>"35491012900"}, {"first_name"=>"Laura W.", "last_name"=>"Alexander", "scopus_author_id"=>"56503092600"}, {"first_name"=>"Suzanne M.", "last_name"=>"O’Regan", "scopus_author_id"=>"56504001400"}, {"first_name"=>"Andrew M.", "last_name"=>"Kramer", "scopus_author_id"=>"36141951500"}, {"first_name"=>"J. Tomlin", "last_name"=>"Pulliam", "scopus_author_id"=>"55541724300"}, {"first_name"=>"Matthew J.", "last_name"=>"Ferrari", "scopus_author_id"=>"55570942700"}, {"first_name"=>"Andrew W.", "last_name"=>"Park", "scopus_author_id"=>"7201557082"}], "year"=>2015, "source"=>"PLoS Biology", "identifiers"=>{"scopus"=>"2-s2.0-84922250260", "sgr"=>"84922250260", "issn"=>"15457885", "isbn"=>"1545-7885 (Electronic)\\r1544-9173 (Linking)", "pmid"=>"25585384", "doi"=>"10.1371/journal.pbio.1002056", "pui"=>"601975861", "arxiv"=>"arXiv:1410.8564v1"}, "id"=>"d54263e8-c7e2-3b5d-b075-77ecc9be4df4", "abstract"=>"In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the planned hospital capacity. A new version of the model, updated to reflect information collected during October and November 2014, predicts a significantly more constrained set of possible futures. This model suggests that epidemic outcome still depends very heavily on individual behavior. Particularly, if future patient hospitalization rates return to background levels (estimated to be around 70%), then transmission is predicted to remain just below the critical point around Reff = 1. At the higher hospitalization rate of 85%, this model predicts near complete elimination in March to June, 2015.", "link"=>"http://www.mendeley.com/research/ebola-cases-health-system-demand-liberia", "reader_count"=>133, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>4, "Researcher"=>23, "Student > Doctoral Student"=>11, "Student > Ph. D. Student"=>23, "Student > Postgraduate"=>8, "Student > Master"=>26, "Other"=>10, "Student > Bachelor"=>9, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>4, "Researcher"=>23, "Student > Doctoral Student"=>11, "Student > Ph. D. Student"=>23, "Student > Postgraduate"=>8, "Student > Master"=>26, "Other"=>10, "Student > Bachelor"=>9, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>9, "Agricultural and Biological Sciences"=>29, "Arts and Humanities"=>3, "Veterinary Science and Veterinary Medicine"=>1, "Computer Science"=>4, "Economics, Econometrics and Finance"=>2, "Engineering"=>6, "Environmental Science"=>6, "Nursing and Health Professions"=>3, "Materials Science"=>2, "Mathematics"=>9, "Medicine and Dentistry"=>49, "Design"=>1, "Physics and Astronomy"=>1, "Psychology"=>1, "Social Sciences"=>7}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>49}, "Social Sciences"=>{"Social Sciences"=>7}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Psychology"=>{"Psychology"=>1}, "Mathematics"=>{"Mathematics"=>9}, "Unspecified"=>{"Unspecified"=>9}, "Environmental Science"=>{"Environmental Science"=>6}, "Arts and Humanities"=>{"Arts and Humanities"=>3}, "Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>6}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>29}, "Computer Science"=>{"Computer Science"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "United States"=>8, "Japan"=>1, "Mexico"=>1, "Italy"=>1, "United Kingdom"=>1, "Australia"=>1, "Spain"=>1}, "group_count"=>10}

CrossRef

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1865895"], "description"=>"<p>Hospital capacity in Ebola treatment units (total number of beds in country, dark blue line) was compiled from non-governmental organizations, media, and government sources. Beginning in September 2014, the WHO situation reports were considered to be unreliable with respect to the timing of case reports and the epidemic curve is discontinued. The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>; data from WHO situation reports.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289090, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g001", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Weekly_number_of_suspected_probable_and_confirmed_cases_of_Ebola_virus_in_Liberia_in_the_seven_days_terminating_with_each_date_blue_bars_and_daily_cumulative_reports_gray_line_/1289090", "title"=>"Weekly number of suspected, probable, and confirmed cases of Ebola virus in Liberia in the seven days terminating with each date (blue bars) and daily cumulative reports (gray line).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865897"], "description"=>"<p>Flow of transmission is depicted through two generations of infection in a multi-type branching process model of Ebola virus transmission. Grey panels show that infected persons may be treated in either the community (C, blue paths) or hospital (H, purple paths). Community-treated patients may give rise to secondary infections in community members through nursing care (CM) or in the process of body preparation and burial (FNR). Hospital-treated patients may give rise to secondary infections in HCWs or visitors (VIS). Infected persons may either be treated in the community or in the hospital at rates that depend on the conditions under which the infection was acquired.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289092, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g002", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Structure_of_a_model_for_human_to_human_transmission_of_Ebola_virus_/1289092", "title"=>"Structure of a model for human-to-human transmission of Ebola virus.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865901"], "description"=>"<p>The heavy blue line shows the cumulative number of cases reported. The yellow region shows the model-predicted range of cases expected to be reported given incomplete reporting. The blue region shows the model-predicted total number of cases over the same time. The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289096, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g003", "stats"=>{"downloads"=>3, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_fit_model_for_Ebola_transmission_in_Liberia_initialized_on_4_July_/1289096", "title"=>"The fit model for Ebola transmission in Liberia initialized on 4 July.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865902"], "description"=>"<p>Shown are values for all cases (left panel) and cases among HCWs (right panel). The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289097, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g004", "stats"=>{"downloads"=>0, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_between_the_total_number_of_reported_cases_aggregated_data_from_Table_2_red_asterisks_and_model_generated_distribution_box_and_whisker_plots_during_four_generations_of_the_epidemic_starting_4_July_2014_/1289097", "title"=>"Comparison between the total number of reported cases (aggregated data from Table 2, red asterisks) and model-generated distribution (box-and-whisker plots) during four generations of the epidemic, starting 4 July 2014.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865903"], "description"=>"<p>The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289098, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g005", "stats"=>{"downloads"=>4, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Effective_reproduction_numbers_for_Ebola_virus_in_Liberia_from_July_8211_October_2014_/1289098", "title"=>"Effective reproduction numbers for Ebola virus in Liberia from July–October 2014.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865905"], "description"=>"<p>Dark blue lines show 100 realizations of the stochastic model. Shaded region shows 95% quantiles over 10,450 realizations; <i>x</i>-axis is the final date of the infection generation, e.g., 17 September is for all cases in the infection generation beginning 2 September. The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289100, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g006", "stats"=>{"downloads"=>2, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Number_of_cases_in_each_infection_generation_when_transmission_occurs_at_the_baseline_rate_as_predicted_by_the_data_available_by_September_2014_/1289100", "title"=>"Number of cases in each infection generation when transmission occurs at the baseline rate as predicted by the data available by September 2014.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865906"], "description"=>"<p>Gray line and inset plot show the median daily number of cases. The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289101, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g007", "stats"=>{"downloads"=>2, "page_views"=>21, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Projected_daily_hospital_demand_in_2015_for_Ebola_patients_in_Liberia_if_hospitalization_rates_are_the_same_as_in_July_8211_September_Summer_2014_/1289101", "title"=>"Projected daily hospital demand in 2015 for Ebola patients in Liberia if hospitalization rates are the same as in July–September Summer 2014.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865907"], "description"=>"<p>Gray line and inset plot show the median daily number of cases. The underlying data and code to generate this figure may be obtained by running the file “ebola-forecasting-main-text.R” deposited in the Dryad repository: <a href=\"http://doi.org/10.5061/dryad.17m5q\" target=\"_blank\">http://doi.org/10.5061/dryad.17m5q</a>.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289102, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.g008", "stats"=>{"downloads"=>2, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Projected_daily_hospital_demand_in_2015_for_Ebola_patients_in_Liberia_if_85_of_cases_are_hospitalized_/1289102", "title"=>"Projected daily hospital demand in 2015 for Ebola patients in Liberia if 85% of cases are hospitalized.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865908"], "description"=>"<p>Parameter values of the basic branching process model for Ebola transmission.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289103, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.t001", "stats"=>{"downloads"=>8, "page_views"=>41, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Parameter_values_of_the_basic_branching_process_model_for_Ebola_transmission_/1289103", "title"=>"Parameter values of the basic branching process model for Ebola transmission.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865909"], "description"=>"<p>Data were obtained by aggregating into 15-day intervals the new cases that were irregularly reported by the WHO and Liberia Ministry of Health between endpoints of each interval. Dates in this table represent the last date of an interval.</p><p>Reported cases and reported cases among health care workers during five infection generations of the 2014 outbreak of Ebola in West Africa.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289104, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.t002", "stats"=>{"downloads"=>6, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Reported_cases_and_reported_cases_among_health_care_workers_during_five_infection_generations_of_the_2014_outbreak_of_Ebola_in_West_Africa_/1289104", "title"=>"Reported cases and reported cases among health care workers during five infection generations of the 2014 outbreak of Ebola in West Africa.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865910"], "description"=>"<p><a href=\"http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1002056#pbio.1002056.s012\" target=\"_blank\">S12 Fig.</a> shows results are robust to the range of the latin hypercube sample.</p><p>IQR, inter-quartile range.</p><p>Mean values and inter-quartile ranges of plausible parameter sets.</p>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289105, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>"https://dx.doi.org/10.1371/journal.pbio.1002056.t003", "stats"=>{"downloads"=>6, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_values_and_inter_quartile_ranges_of_plausible_parameter_sets_/1289105", "title"=>"Mean values and inter-quartile ranges of plausible parameter sets.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-01-13 02:43:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/1865911", "https://ndownloader.figshare.com/files/1865912", "https://ndownloader.figshare.com/files/1865913", "https://ndownloader.figshare.com/files/1865914", "https://ndownloader.figshare.com/files/1865915", "https://ndownloader.figshare.com/files/1865916", "https://ndownloader.figshare.com/files/1865917", "https://ndownloader.figshare.com/files/1865918", "https://ndownloader.figshare.com/files/1865919", "https://ndownloader.figshare.com/files/1865920", "https://ndownloader.figshare.com/files/1865921", "https://ndownloader.figshare.com/files/1865922", "https://ndownloader.figshare.com/files/1865923", "https://ndownloader.figshare.com/files/1865924", "https://ndownloader.figshare.com/files/1865925", "https://ndownloader.figshare.com/files/1865926"], "description"=>"<div><p>In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the planned hospital capacity. A new version of the model, updated to reflect information collected during October and November 2014, predicts a significantly more constrained set of possible futures. This model suggests that epidemic outcome still depends very heavily on individual behavior. Particularly, if future patient hospitalization rates return to background levels (estimated to be around 70%), then transmission is predicted to remain just below the critical point around <i>R</i><sub>eff</sub> = 1. At the higher hospitalization rate of 85%, this model predicts near complete elimination in March to June, 2015.</p></div>", "links"=>[], "tags"=>["Health System Demand", "epidemic outcome", "Ebola virus disease", "hospital capacity", "future patient hospitalization rates return", "model"], "article_id"=>1289106, "categories"=>["Uncategorised"], "users"=>["John M. Drake", "RajReni B. Kaul", "Laura W. Alexander", "Suzanne M. O’Regan", "Andrew M. Kramer", "J. Tomlin Pulliam", "Matthew J. Ferrari", "Andrew W. Park"], "doi"=>["https://dx.doi.org/10.1371/journal.pbio.1002056.s001", "https://dx.doi.org/10.1371/journal.pbio.1002056.s002", "https://dx.doi.org/10.1371/journal.pbio.1002056.s003", "https://dx.doi.org/10.1371/journal.pbio.1002056.s004", "https://dx.doi.org/10.1371/journal.pbio.1002056.s005", "https://dx.doi.org/10.1371/journal.pbio.1002056.s006", "https://dx.doi.org/10.1371/journal.pbio.1002056.s007", "https://dx.doi.org/10.1371/journal.pbio.1002056.s008", "https://dx.doi.org/10.1371/journal.pbio.1002056.s009", "https://dx.doi.org/10.1371/journal.pbio.1002056.s010", "https://dx.doi.org/10.1371/journal.pbio.1002056.s011", "https://dx.doi.org/10.1371/journal.pbio.1002056.s012", "https://dx.doi.org/10.1371/journal.pbio.1002056.s013", "https://dx.doi.org/10.1371/journal.pbio.1002056.s014", "https://dx.doi.org/10.1371/journal.pbio.1002056.s015", "https://dx.doi.org/10.1371/journal.pbio.1002056.s016"], "stats"=>{"downloads"=>64, "page_views"=>25, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Ebola_Cases_and_Health_System_Demand_in_Liberia_/1289106", "title"=>"Ebola Cases and Health System Demand in Liberia", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-01-13 02:43:03"}

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  • {"unique-ip"=>"7", "full-text"=>"9", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"4", "cited-by"=>"0", "year"=>"2019", "month"=>"1"}
  • {"unique-ip"=>"6", "full-text"=>"7", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2018", "month"=>"6"}
  • {"unique-ip"=>"11", "full-text"=>"12", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"4", "cited-by"=>"0", "year"=>"2018", "month"=>"4"}
  • {"unique-ip"=>"7", "full-text"=>"9", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"5"}
  • {"unique-ip"=>"7", "full-text"=>"2", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"5", "cited-by"=>"0", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"7", "full-text"=>"6", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"4", "full-text"=>"4", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"9"}
  • {"unique-ip"=>"4", "full-text"=>"4", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"3", "full-text"=>"2", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"16", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
  • {"unique-ip"=>"4", "full-text"=>"4", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"12"}
  • {"unique-ip"=>"6", "full-text"=>"6", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"1", "full-text"=>"1", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"3", "full-text"=>"3", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}

Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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