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Pulmonary Bubonic Plague


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#1 silylene

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Posted 06 October 2017 - 10:59 AM

I have been following this outbreak in Madagascar for a week, and it is worsening!

 

231 cases, most in the main city.  Many dead, case fatality rate = 17% so far.

 

"According to Wikipedia, the urban area of Antananarivo had a population of three million in 2012. Pneumonic plague in a big city is like Ebola in a big city."

 

Pulmonary bubonic plague is the same as the infamous 'Black Plague'.  It is spread by sneezing, coughing and blood products.  (Origination is from rat fleas, but when it gets into the lungs it has a much more virulent mode of transmission.)

 

Epidemic - Plague victims increase

LINK L'Express de Madagascar translated google

 

The lifeless body of a pulmonary plague suspect was buried in Anjanahary yesterday. Eight patients were admitted to the hospital the same day, in Antananarivo. 

Plague is far from being mastered. The eighth plague suspect in Antananarivo-city was buried at the Anjanahary mass grave in the late afternoon yesterday. Coming from Manandriana, in the Avaradrano district, he died on the way to get treatment at a large hospital in Antananarivo on the same day.
"Clinical signs have led us to say that it is a pulmonary plague. He would have had fever, coughs with blood-streaked sputum, chest pain. The rapid diagnostic test (TDR) confirmed this," says a reliable source.
Neither this case, nor that of the adolescent girl who died in Ilafy and buried in Ambohimailala on Tuesday, is yet indicated in the latest statistics of the Ministry of Public Health, posted yesterday at 11.30 am. district of Atsimondrano, and Tsiroanomandidy, between 3 and 4 October, were raised.
In addition, there was an increase in the number of patients admitted to the health facilities of Antananarivo-city yesterday. Six at the Soavinandriana hospital center and two at the anti-plague hospital in Ambohimiandra (CHAPA).
Between 3 and 4 October, thirty-five suspected live cases were recorded in six districts, fifteen in Antananarivo-city, thirteen in Toamasina I, three in Ambohidratrimo, according to the data of the ministry concerned.
Propagation
The Ministry of Public Health welcomes the increase in the number of patients admitted to hospitals. "This means that the population begins to know the precautions to take in case of suspicious symptoms. Treated in time, they will be cured," says a source. Others interpret it as the spread of the bacteria in the capital.
That being said, all must be vigilant. In case of fever, chills, body and head pain, weakness, vomiting and nausea, burning and painful lymph nodes, shortness of breath and coughing, traces of blood on sputum, a doctor is required.
It is only now that the government, headed by Prime Minister Olivier Mahafaly Solonandrasana, seems to be aware of the magnitude of the phenomenon, multiplying the activities of fighting the disease, whereas the first case was recorded in the month of 'August.
These activities concern, among other things, the establishment of a sanitary barrage in the parking areas of the national zone, the requirement for mandatory identity declarations in these parking lots, as it is via public transport that the epidemic of pulmonary plague has spread to Toamasina and Antananarivo.
There is, moreover, a deconcentration of care in all health facilities. Yesterday, a restricted government council, together with the technical and financial partners on the plague epidemic, held at the State Palace in Mahazoarivo. And in the same day, a workshop to update and validate the plan to respond to the plague epidemic took place at the Hotel Colbert. A more precise strategy is needed to limit the number of victims.
Twenty Districts Affected by Plague
Twenty districts are now affected by the plague epidemic. Most are plague areas, but the disease has also spread to Mahajanga, Toliara, and Toamasina, non-plague areas, according to the Ministry of Public Health. In these twenty districts, the Ministry counted one hundred and ninety-four cases. Sixty-eight of them occurred in Antananarivo and forty in Toamasina. There are still six months before the end of the plague season.

 

WHO provides 1.2 million antibiotics to fight plague in Madagascar.

LINK

 

WHO has delivered nearly 1.2 million doses of antibiotics and released US$1.5 million dollars in emergency funds to fight plague in Madagascar.
"Plague is curable if detected in time. Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save," said Dr. Charlotte Ndiaye, WHO Representative in Madagascar. 
WHO has delivered 1 190 000 doses of antibiotics to the Ministry of Health and partners this week, and a further supply of 244 000 doses is expected in the days ahead.
The different types of drugs will be used for both curative and prophylactic care. They are enough to treat up to 5000 patients and protect up to 100 000 people who may be exposed to the disease.
The medicines are being distributed to health facilities and mobile health clinics across the country with the support of the Ministry of Health and partners.
WHO is also filling critical shortages in disinfection materials and personal protective equipment for health professionals and safe burials. 
WHO and the Ministry of Health are training local health workers on how to identify and care for patients, and how to trace people who have had close contact with symptomatic patients so that they may be given protective treatment. 
Most of the 231 infections and 33 deaths that the Ministry of Health has reported since August are associated with pneumonic plague – a more dangerous form of the disease that affects the lungs and is transmitted through coughing at close range. 
Both bubonic and pneumonic plague can be cured using common antibiotics if delivered early. Antibiotics can also help prevent infection among people who have been exposed to plague.

 

 

Pictures of Antananarivo, Madagascar

6695029791_2076d34846_b.jpg

 

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#2 ESK

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Posted 06 October 2017 - 11:06 AM

I realize they are poor, but when you live in filth, is anyone surprised there's a plague outbreak. 



#3 SJQ

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Posted 06 October 2017 - 12:59 PM

I;m surprised it's only bubonic plague.  Cholera and a whole host of other nasties should thrive in cities like that.


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#4 silylene

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Posted 06 October 2017 - 03:01 PM

Yes, the exploding population boom has made a mess of Madagascar, which was once a tropical paradise.  GDP/capita for Madagascar is $405/year.  Population is now 25M and the UN projection expects it to quadruple to 100M by the year 2100.  Unless migration or the plague reduces this.

 

Some more pictures of Antananarivo, Madagascar, population 3M.

 

B9ZgvpbCUAE-Sp6.jpg

 

madagascar-v-p-mg-e-00026.jpg

 

 

 

at-the-outside-of-antananarivo-madagasca

 

fig016_Madagascar_MDG_450.png



#5 silylene

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Posted 06 October 2017 - 03:13 PM

A new set of numbers just got published.

 

Madagascar: 256 plague cases, 36 deaths as of October 6

The Ministry of Public Health Madagascar has published a table on the epidemiological situation on October 6. Among other things, it reports 27 new suspected plague cases today, and three deaths. Nationally, the Ministry tallies 258 cases and 36 deaths since August.


Madagascar%2BPlague%2BMap.JPG



#6 silylene

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Posted 07 October 2017 - 11:26 PM

These headlines sound just like Ebola did in Liberia/Sierra Leone  a few years ago !!

 

 

Madagascar: Plague hospital overwhelmed  LINK

 

 

 

An escapee
The risk of spread of the bacteria is serious in the capital. Most cases are affected by pneumonic plague. During this week, a child admitted to a hospital for suspected plague, was taken away by his family, without his treatment being completed, according to Dr. Manitra Rakotoarivony. He could infect all people in contact with him.
In the face of this scourge, all the leaders of fokontany in Antananarivo-city were mobilized for reporting cases and controlling the mobility of inhabitants in their neighborhood. Community workers will also be trained for active case finding.

 

 

 

Epidemic - Stolen plague corpses. LINK

Two suspected corpses of plague were stolen from Toamasina and Antananarivo. Their respective families would be responsible. 
In secret. The lifeless body of the deceased at Amboditsiry, following a suspicion of pulmonary plague on Wednesday, could not be buried in the mass grave of Anjanahary, asccording to one official of the Municipal Bureau of Hygiene (BMH) yesterday. The victim's family had reportedly taken him to the Manjakandriana district in the northeast of the capital, where the family tomb was erected. She refused to admit that her loved one succumbed to the plague.
"We were facing people who were ready to kill if we touched the body. Until 11 pm yesterday (Thursday), we were still around to try to negotiate. Unfortunately, they found an underground path to escape. They would have taken him to their family tomb," a source said yesterday.
In the district of Toamasina I, the corpse of a plague-stricken person already buried in the cemetery of Manangareza disappeared from the mass grave. His relatives would have dug him up to put him next to his family in his family vault. The gendarmerie of Toamasina I were alerted only yesterday.
"We do not know which of the two bodies of the plague victims, buried in this cemetery was stolen. The teams of the Ministry of Public Health and gendarmerie went downstairs on that day (yesterday) to find out," a source told the Toamasina gendarmerie.

Exhumation
Physicians claim the risk of spreading the bacteria. "The germ lives in the grave. These tombs where the plague victims have been buried must be sealed for years. Otherwise, the bacteria will continue to spread and affect the living," says a doctor.
Just yesterday, a boy, invited to an exhumation ceremony in the Avaradrano district a few days ago, tested positive for plague in a health facility in Antananarivo-city.
"He surely contracted this illness during this event because he did not go anywhere else," said the grandmother, worried about the health of her already tired grandson. It follows treatments in a large hospital of Antananarivo-city, since yesterday.
In addition, about ten days ago, a girl living in Soavimasoandro, who was returning from an exhumation in Fianarantsoa, ​​lost her life because of a suspicion of plague.
Doctors noticed the coincidence between the period of exhumation and the plague season. "All must be vigilant, especially, doctors. Sometimes the family of the deceased conceals certain information during the interrogation, if the death occurred outside the health facility," says another doctor. 
Active research of all people who have come into contact with these bodies is now underway, according to a source from the Ministry of Public Health. With the slightest error or neglect, the epidemic of plague will continue.



#7 ESK

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Posted 08 October 2017 - 01:08 PM

Oh my God, these people are really ignorant. all of them are going to die. The WHO better quarantine the whole island.

Edited by ESK, 08 October 2017 - 01:12 PM.


#8 XZG 1138

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Posted 08 October 2017 - 04:49 PM

Oh my God, these people are really ignorant. all of them are going to die. The WHO better quarantine the whole island.

Just like Haiti the whole country is nearly deforested. Let it run it's course and the fittest remaining survivors will be inherently smarter.


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#9 Mee_n_Mac

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Posted 08 October 2017 - 05:20 PM

 

Physicians claim the risk of spreading the bacteria. "The germ lives in the grave. These tombs where the plague victims have been buried must be sealed for years. Otherwise, the bacteria will continue to spread and affect the living," says a doctor.

Can the bacteria "hibernate" ? That is survive and re-animate after years w/o food ?


Never attribute to malice that which is adequately explained by stupidity or ignorance. The latter are a lot more common than the former.

#10 silylene

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Posted 08 October 2017 - 06:43 PM

According to PROMED, now 343 cases, 42 dead.  (+87 cases in 2 days)

 

 

~~~

 

In other potential pandemic news, there is also a growing outbreak of monkeypox in Nigeria, and it has now spread to 3 southern Nigerian states.  Fatality rate = 10%.  I may start another thread if the monkeypox case if this persists and the body count starts to skyrocket.  People shouldn't eat monkey meat.



#11 Bill Slugg

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Posted 08 October 2017 - 07:07 PM

I don't know much about the life sciences but I believe bacteria only need food when they are multiplying. Many of them can exist in "suspended animation" or something similar. I believe they dug up 1919 corpses and found viable flu bugs.

​The key is whether it is anaerobic. With air and water it will compost, in an active pile, 160°F is not unusual. Buried deep, with no air, they will likely not degrade but over many tens of years.


Edited by Bill Slugg, 08 October 2017 - 07:22 PM.


#12 silylene

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Posted 09 October 2017 - 09:10 PM

According to WHO, now 387 cases, 45 dead.  (+40 cases in 1 days, CFR = 11.5%)

 

Situation update

The outbreak of plague in Madagascar continues to evolve. Since our last report on 4 October 2017, a total of 230 new suspected cases including 17 deaths (case fatality rate 7.4%) were reported. Between 1 August and 8 October 2017, a total of 387 cases (suspected, probable and confirmed) including 45 deaths (case fatality rate 11.6%) have been reported from 27 out of 114 districts in the country. Of these, 277 cases (71.6%) had the pneumonic form of the disease, 106 were bubonic plague, one case was septicaemic plague, and 3 cases were unspecified.

 

Current risk assessment

While the current outbreak was triggered by the occurrence of one large epidemiologically-linked cluster, cases of pneumonic plague without apparent epidemiological links have since been detected in 14 regions across the country, including densely population cities of Antananarivo and Toamasina. Due to the increased risk of further spread and severe nature of disease, the overall risk at the national level is considered very high. The overall regional risk remains moderate due to frequent travel (by air and sea) to neighbouring Indian Ocean islands and several other African countries. The overall global risk is perceived to be low.

 

WHO%2BPlague%2BEpi%2BCurve%2B1.JPG



#13 Ath3na

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Posted 09 October 2017 - 09:22 PM

This is one of those diseases that we just shouldn't get involved in.  Let it run.  In modern medicine, plague is pretty easy to deal with, so it's a best-case scenario; easily managed in the developed world, and great population control everywhere else.  Like a few percent mortality rate in the developed world?  And not likely to burn through the population with clean modern environment.


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#14 silylene

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Posted 09 October 2017 - 09:34 PM

In other epidemic news, the Monkeypox outbreak in southern Nigeria has spread to two more states (now 5 states involved) with 36 cases.  I think that is +20 cases in 2 days. CFR is about 10% with this disease. I may start a new thread if this gets some legs, and the case number exceeds 100.

 

Monkeypox: Transmission is via contact with infected animal, human, or contaminated materials. Animal-to-human transmission occurs through bite or scratch from animals and bush meat preparation. It can also be transmitted from one person to another. Human-to-human transmission occurs through respiratory droplets, contact with infected persons or contaminated materials. Control measures include isolation of suspected or confirmed cases, strict adherence to universal precautions, especially frequent handwashing with soap and water, and use of personal protective equipment.



#15 silylene

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Posted 09 October 2017 - 09:40 PM

Hah, as Ath3na might have guessed:

 

Air Seychelles suspends flights to Madagascar over plague fears

LINK

 

"Following the advice and request of the Public Health Authority of Seychelles concerning the plague epidemic in Madagascar, Air Seychelles will temporarily suspend its services between Seychelles and Madagascar from Sunday 8 October 2017."
This is the content of the official communiqué of Air Seychelles which will no longer serve Madagascar from tomorrow 08 October 2017.

 

It is certain that the Seychelles authorities did not appreciate the death of the Seychellois basketball coach in Madagascar following a pulmonary plague he contracted on the spot during the basketball tournament in Antananarivo. It was only after this unfortunate death that the Malagasy authorities took action and began a thorough awareness campaign.



#16 Ath3na

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Posted 09 October 2017 - 10:25 PM

 
Monkeypox: Transmission is via contact with infected animal, human, or contaminated materials. Animal-to-human transmission occurs through bite or scratch from animals and bush meat preparation.


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#17 Bill Slugg

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Posted 10 October 2017 - 08:23 AM

People who kill and eat monkeys in the bush are known for their strict regimens of hand washing, personal protective equipment and case isolation.



#18 silylene

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Posted 10 October 2017 - 10:01 PM

This is getting worse.  Accelerating.

 

According to MMH, now 449 cases, 48 dead.  (+62 cases in 1 day)

 

Madagascar: 62 new plague cases in 24 hours; most are pneumonic

 

The Ministry of Public Health has published a detailed tally of plague in Madagascar as of today, October 10: 62 new cases between October 9 and 10. Of these, 45 are pneumonic and 17 are bubonic. The outbreak has also seen one case of septicemic plague and three suspected plague cases.

 

Five new districts have reported plague today; one, Fandriana, has seven cases and one death.

Total cases as of today are now 449 since the start of the outbreak on August 1. Forty-eight cases have been fatal.



#19 Mee_n_Mac

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Posted 10 October 2017 - 10:46 PM

I can only hope the lemurs there are;
- not a transmission vector
- not a "monkey" to be eaten

After that, the stupid humans are free to kill themselves off.
Never attribute to malice that which is adequately explained by stupidity or ignorance. The latter are a lot more common than the former.

#20 SJQ

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Posted 11 October 2017 - 10:02 AM

This is one of those diseases that we just shouldn't get involved in.  Let it run.  In modern medicine, plague is pretty easy to deal with, so it's a best-case scenario; easily managed in the developed world, and great population control everywhere else.  Like a few percent mortality rate in the developed world?  And not likely to burn through the population with clean modern environment.

 

 

Absolutely.  Embargo flights to/from anywhere in Africa.  I'd look into refusing carriage to anyone who had been in Africa within the last, say, 6 months (i.e., double the normal incubation period of the slowest-known disease, whatever that is).  And no aid of any sort - technical, financial, medical, whatever.  Harsh?  Yeah, it is.  Necessary?  Absolutely.  Either we cull the herd, or we're lost.  The areas that can least afford it simply have too many "stupid humans".  Go Lemurs!!


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#21 silylene

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Posted 11 October 2017 - 10:04 PM

It gets worse.  And bubonic plague has spread to the Seychelles !

 

Now 500 cases, 54 dead.  (+51 cases in 1 day)

Madagascar: 51 new plague cases in 24 hours; most are pneumonic

 

The Ministry of Public Health has published an update for October 11 on plague cases: 51 new cases in 24 hours across the island. Of these, 29 are pneumonic and 12 are bubonic. Ten additional cases are suspected, and six persons have died. The total numbers for the outbreak are now 500 cases and 54 deaths.

 

The update is not as detailed as yesterday's, but it does report that the port city of Toamisina has had no new cases or deaths, while Antananarivo, the capital has had 37 cases—26 pneumonic and four bubonic, with four deaths and an additional seven suspected cases. Presumably the other cases are scattered across the country.

 

The spread of plague in the capital and other towns is especially worrying. Historically, outbreaks have occurred in remote areas with few people, much like Ebola before 2014. But just like Ebola in Freetown and Monrovia, plague in Antananarivo means a serious increase in cases.

 

Some additional headlines:

Seychelles MOH :1 Imported Plague Case ex Madagascar

 

Two days ago the ECDC: Rapid Risk Assessment - Pneumonic Plague In Madagascar warned that while the global risk was low, there was a moderate risk of seeing the regional spread of exported plague cases in the Indian Ocean region.
The Seychelles islands - which sit about 1,000 miles north and slightly east of Madagascar in the Indian Ocean - is one of those regions at risk.

 

Man tests positive for plague following presentation of symptoms

 

In interview today, Tuesday 10th October 2017, Dr Jude Gedeon, Public Health Commissioner confirmed that a 34 year old man has been infected with the plague. The man who travelled to Madagascar, arrived in Seychelles on Friday 6th October 2017, at which point he was placed under passive surveillance.

 

“He presented with symptoms yesterday. He was not feeling well and reported to a health centre. Because he was under surveillance, he was immediately put in isolation at the Seychelles Hospital,” Dr Gedeon said. Several tests were done, some of which had normal results. “We also conducted a rapid plague test which produced a weakly positive result,” Dr Gedeon added. Following this, the result was sent to L’institut Pasteur in France for cross-checking, at which point it was confirmed to be a positive plague result.

 

~ ~ ~ 

 

Seychelles Ministry of Health Denies two additional plague cases

 

Seychelles MOH :1 Imported Plague Case ex Madagascar, we saw official confirmation of one imported plague case by the Minister of Health.  In the past few hours the MOH has issued two additional statements.
The main statement outlines quarantine and surveillance procedures to be followed for all arrivals from Madagascar while the other denies what they call `false' media reports of 2 additional cases, and the closure of all schools in the country.

 

~ ~ ~ 

 

Visitors to Seychelles who spent time in Madagascar to be monitored for plague by health officials (updated)

 

Visitors to Seychelles who have visited Madagascar or transited through that island nation in the last seven days will be placed under observation by health officials upon arrival to Mahe.

 

~ ~ ~

 

Madagascar: President declares war on plague

 

The head of the State goes on a crusade against the plague. Speaking for the first time on the epidemic,  he calls for calm and discernment of the population. 

 

~ ~ ~

 

Madagascar: About 20 plague red zones in Antananarivo

 

Circulating in the city of Antananarivo becomes more than frightening. We are talking about twenty red zones of the plague epidemic, at the level of the Ministry of Public Health.

"Recently, we counted fifteen. Currently, there are about 20," a source said yesterday. Among the fokontany cited by this source are those of Andraisoro, Antsahatsiroa, Tsarahonenana, Ambodotsiry, Manjakaray, Andoha-tapenaka, Saropody, Androndra, Ankaraobato, where suspected cases of plague have been recorded.



#22 silylene

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Posted 13 October 2017 - 09:49 AM

And it gets worse.

 

Now 561 cases, 57 dead.  (+61 cases in 1 day)   CFR = 10.2%

Cases have been reported in 35 of the country's 42 districts.

 

 

WHO: The trajectory of the outbreak continues to be concerning, with 561 cases now reported across 35 districts.  Remarkably, of those, 415 (74%) are pneumonic plague, which is normally a relatively rare presentation which spreads as a respiratory illness.

 

 

Madagascar: WHO warns of "very high risk" of plague spreading  ("Grade 2 epidemic")

 

According to the WHO, the epidemic of plague in Madagascar is of "grade 2". Although the isolation of the Big Island is discarded, the risk of national spread is, however, "very high".

 

Cards on table: According to the World Health Organization, the plague epidemic in Madagascar is grade 2—a classification that means a very high risk of national spread. This information was shared during the meeting between the government, the diplomatic corps and the technical and financial partners (PTF), yesterday, in Mahazoarivo.
The meeting, which lasted nearly two hours, aimed at sharing information between the State and international partners on the evolution of the disease and the mechanisms committed to combat it.

Franchise and transparency were the watchwords of the meeting. "We are totally transparent by giving you all the information. There is no reason not to be so," said Henri Rabary-Njaka, Minister of Foreign Affairs, according to sources at the meeting.
That said, Charlotte Ndiaye, WHO representative in Madagascar,  explained to the audience that this international body had classified the Grade 2 epidemic. This would mean that the risk of the spread of plague at national level is very high. At the regional level, the risk is moderate and at the international level, it is low.
Tracing

To the international partners of the Big Island, the representative of WHO then indicated that given the level of risk, the international health regulations, voted and approved by all the countries of the world, don't restrict flights and trade movements in Madagascar, on entry and exit: a green light, subject to the application of WHO health controls.



#23 ESK

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Posted 13 October 2017 - 10:08 AM

Don't restrict flights? WTF

#24 silylene

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Posted 13 October 2017 - 10:26 AM

Seychelles didn't restrict flight quickly enough and look what happened to them.

 

Find Madagascar in this graph    :whistle: .   Seychelles is actually tops.

 

DL3o_yzWsAAJYnG.jpg



#25 Bill Slugg

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Posted 13 October 2017 - 10:52 AM

The comparable wealth per capita for the top three countries:

- Hong Kong    $189,000

- Luxembourg  $184,000
​- USA               $144,000

- Switzerland    $138,000

​- UK                  $129,000

 

-Seychelles       $  26,000, but only $16k in the reference in post #24 above.

​There is some offset between data bases. 
 


Edited by Bill Slugg, 13 October 2017 - 10:57 AM.





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