The incompetence of Texas Health Presbyterian Hospital Dallas is staggering. In following today’s rapidly developing story of a second nurse at the hospital now testing positive for Ebola, this passage in the New York Times stands out, where the content of a statement released by National Nurses United is being discussed (emphasis added):
The statement asserted that when Mr. Duncan arrived by ambulance with Ebola symptoms at the hospital’s emergency room on Sept. 28, he “was left for several hours, not in isolation, in an area where other patients were present.” At some point, it said, a nurse supervisor demanded that Mr. Duncan be moved to an isolation unit “but faced resistance from other hospital authorities.”
The nurses who first interacted with Mr. Duncan wore ordinary gowns, three pairs of gloves with no taping around the wrists, and surgical masks with the option of a shield, the statement said.
“The gowns they were given still exposed their necks, the part closest to their face and mouth,” the nurses said. “They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical bootees nor were they advised the number of pairs of gloves to wear.”
The statement said hospital officials allowed nurses who interacted with Mr. Duncan at a time when he was vomiting and had diarrhea to continue their normal duties, “taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan that was later recommended by the C.D.C.”
From the context of both the New York Times article and the nurses’ statement, it seems most likely that this movement of nurses from treating Duncan to treating other patients took place during the period after Duncan was admitted to the hospital and before the positive test result for Ebola was known. However, from the nurses’ statement showing that at least some of the personnel on duty realized Duncan almost certainly had Ebola, proper isolation technique should have been initiated immediately.
And that movement of nurses from a patient who should have been in isolation back into the general patient population is a huge, and obvious, error. Consider this publication (pdf) put out in August by the World Health Organization, summarizing precautions to be taken in care of Ebola patients. The very first page of actual content, even before the section labeled “Introduction”, is a page with the heading “Key messages for infection prevention and control to be applied in health-care settings”. The page lists nine bullet points about dealing with ” hemorrhagic fever (HF) cases” (hemorrhagic fever diseases include Ebola). Here is the third entry on that list:
Exclusively assign clinical and non-clinical personnel to HF patient care areas.
There really is no point in saying a patient is isolated if staff are freely moving back and forth between the isolation area and the general patient population. I’m wondering how long it will be until there is a whole new management team at Texas Health Resources, the parent firm for the hospital.
Not long after we learned that a health care worker treating Thomas Duncan has tested positive for Ebola, I ran across this terse tweet from Mackey Dunn, the pen name of Don Weiss, who is “a medical epidemiologist with the New York City Department of Health and Mental Hygiene”. The tweet linked to this short but incredibly important blog post. In the post, Weiss notes the baffling development that a health care worker, who wore full personal protective equipment (PPE), contracted Ebola from Duncan even though at this point, none of his family or other close contacts, who did not have full PPE, have developed symptoms of the disease.
That set of facts prompts Weiss to pose the question “So, what does this tell us about Ebola and how we can attain control?” His answer begins:
One, that Ebola patients become more infectious as the illness progresses. The newly reported case in a healthcare worker had onset on October 10th. If we take 9 days as the mean incubation period for Ebola this means the healthcare worker’s exposure was sometime around October 1, which was day 8 of Mr. Duncan’s illness. This is similar to what was seen with SARS, that patients become more infectious (and dangerous) with time.
In setting up the circumstances for his question, Weiss had noted that Duncan was hospitalized, ending exposure to family members, on day 5 of his disease.
Although he doesn’t mention it, this aspect of Ebola, where patients produce more virus and become more infectious during the course of a fatal infection, also accounts for why burial practices are so important to containing the spread of Ebola. Patients produce the most virus and are thus at their most infectious at death.
The converse also appears to be true. Duncan was symptom-free when he flew from Liberia to Dallas on September 19 to 20. At 24 days since the end of that trip, we have now passed the incubation period, commonly given as 2-21 days, for Ebola to develop in anyone who could have been exposed during the flights. No infections among those airline passengers have been reported. I have yet to see a major media outlet mention this point, though.
We are now at 16 days since Duncan was hospitalized, ending his family’s direct exposure, so we have passed the two-thirds point of the incubation period for them (and well past the 9 days that Weiss gives as the average incubation period for Ebola).
The second part of Weiss’ musings on the infection of the nurse is extremely important:
Second, that only hospitals that are well prepared to care for highly infectious patients should be allowed to do so. Standard practice is to have a staff person dedicated to observing the donning (putting on) and doffing (taking off) of PPE. This observation should continue throughout the period of clinical care (from an ante-room with a window). Perhaps gentle reminders during the doffing can avoid the presumed situation in Spain where the nurse may have touched her face with a gloved hand.
When a patient presents to a hospital early in the illness there is time to transfer to such a facility. That’s the plan here in NYC. Bellevue hospital has a specially equipped ward to care for Ebola patients. Their staff are well trained. The number of healthcare workers entering the room should be kept to a minimum, especially after day 7 of the illness.
Weiss was prescient in his push for an observer for workers putting on and taking off PPE. In today’s New York Times, we have this on the CDC’s thoughts regarding improving practices for health care workers treating Ebola patients: Continue reading
Yesterday, I described what was known at the time about a mysterious blast near the Parchin military site in Iran. I postulated that satellite imagery would soon be available to help sort out the mystery of what took place. A tweet this afternoon from @dravazed alerted me to this article at the Times of Israel, which, in turn, linked to this story posted at israeldefense.com.
Satellite imagery described as from Sunday night’s blast at the Israel Defense site shows several buildings destroyed. The article claims that the blast looks like an attack on a bunker:
Satellite images obtained by Israel Defense and analyzed by specialist Ronen Solomon clearly show damage consistent with an attack against bunkers in a central locality within the military research complex at the Parchin military compound.
Because of the unique shape of the large building adjacent to those destroyed by the blast, I was able to find the location of the blast on Google Maps. Also, with the help of this article from 2012 in The Atlantic, I was able to locate both the area inspected by IAEA in 2005 and the site of the disputed blast chamber where it is alleged that research to develop a high explosive fuse for a nuclear weapon has been carried out. None of these three locations, the blast site, the chamber site or the area inspected in 2005, lies within the boundaries marked as Parchin on Google Maps. The blast site looks to be near a populated area of what is marked on Google Maps as Mojtame-e Maskuni-ye Parchin (which appears to translate as Parchin Residential Complex A if I used Google Translate appropriately). In fact, the blast site appears to be just over a mile from an athletic field. On the map below, #1 is the disputed blast chamber location, #2 is the blast site and #3 is the area inspected in 2005. Note that both the blast chamber site and the area inspected in 2005 are more removed from what appear to be the populated areas.
I am far from an image analysis expert, but the blast site looks to me to be more like an industrial site than a cache for storing explosives. If a bunker were indeed located here, that would put the local planning in this area on a par with West, Texas.
It will be very interesting to see how US officials describe the damage and the site where it occurred.
Detailed information is not yet available, but by all accounts there was a very large explosion east of Tehran Sunday night, around 11:15 local time. Many believe that the explosion took place at Parchin, the military site that has been at the center of controversy raised by those who accuse Iran of carrying out work there to develop an explosive trigger for a nuclear bomb. Some of the most detailed information comes from Thomas Erdbrink of the New York Times:
A mysterious explosion at or near an important military complex rocked the Iranian capital on Sunday, lighting up the skies over the city.
Iranian official sources denied the explosion had taken place at the complex, the expansive Parchin military site east of the city, where international monitors suspect Iran once tested triggers for potential nuclear weapons. But the enormous orange flash that illuminated Tehran around 11:15 p.m. local time clearly came from that direction, several witnesses said.
Officials at Iran’s Defense Industries Organization, though also denying that the explosion took place at Parchin, confirmed that two people were missing after “an ordinary fire” caused by “chemical reactions of flammable material” at an unspecified production unit, according to the semiofficial Iranian Students’ News Agency. There was no word on the location of the fire.
Witnesses in the east of Tehran said that windows had been shattered in the vicinity of the military complex and that all trees in a hundred-yard radius of two villages, Changi and Hammamak, had been burned. The villages are on the outskirts of the military site.
The map below shows the area in question:
As seen on the map, Changi is very close to Parchin, but Hammamak is on the other side of Parchin and the two villages are over three miles from one another. A blast fireball that scorched trees over three miles apart must have been quite spectacular.
Many factors go into calculating the strength of blasts, including the type of explosive and what type of containment might have been present. However, FEMA provides (pdf) this rough guideline (via DTRA) of the radius over which various types of damage might be expected to occur as a function of the amount of explosive material used:
Because it relates to assessing damage from terrorist bombs, the FEMA figure breaks the amounts of explosives down into the amounts that can be carried by cars, vans and large trucks. The Times story doesn’t report on how far away from the complex windows were shattered, but the effect of burned trees in villages over three miles from one another suggests that such damage would reach quite a ways. At the very least, it would appear that the blast had the equivalent of more than 10,000 pounds of TNT, and perhaps significantly more than that.
It has now been five days since we learned that Thomas Duncan, who came to Dallas from Liberia, tested positive for Ebola. His condition has been downgraded to critical, but so far none of his contacts have come down with Ebola symptoms. Because those most likely to have been infected by him are now under close observation and have limited contact with others, it seems quite likely the disease will not spread in the US beyond the small handful of people under close monitoring.
By contrast, the US is in the midst of an ongoing outbreak of a virus that has put many children into intensive care units with severe respiratory illnesses. A handful of children in Colorado initially having respiratory illness have progressed to paralysis of some limbs and have tested positive for the virus. Four children who died from severe respiratory illness have tested positive for the virus but the CDC states that the role of the virus in these deaths is not yet known. Late yesterday, a medical examiner in New Jersey stated that the virus was the cause of death for a four year old boy.
The virus involved in this outbreak is Enterovirus D68. Background on the virology of enteroviruses in general can be found here, courtesy of Wong’s Virology online. There are five groups within the enterovirus genus. By far, the most well-known group is the one that comprises the polioviruses. Enterovirus D68 falls within the newest group of enteroviruses that are designated with numbers.
These are some of the smallest and simplest viruses known. The viral particle contains only a single piece of RNA. Inside the host cell, this RNA is turned into a single protein that then is capable of chopping itself into the four smaller proteins found on the viral coat. There is no membrane around the virus and the particles are stable at acid pH, so inactivation is best achieved with bleach or other disinfectants whose label say they are active against non-enveloped viruses.
The CDC released information on the outbreak on September 12, noting that hospitals in Kansas City and Chicago first alerted CDC to unusual numbers of children presenting with severe respiratory symptoms. The latest CDC information on the outbreak includes:
From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68.
The report continues:
EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.
The difficulty for healthcare providers with this virus is that symptoms for those infected can range from very mild to severe. As also seen with poliovirus, only a small fraction of those infected get the most severe form of the disease. In the current outbreak, a very high proportion of the children with the worst respiratory symptoms already suffered from asthma:
Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness.
Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing.
Parents and school administrators are being encouraged to monitor children with asthma more closely during this outbreak and to be especially vigilant about measures to prevent spread.
Although not yet widespread, panic and disinformation are emerging surrounding the case of the first patient to have been diagnosed with Ebola while in the United States. The worst of the hysteria surrounds the fact that Thomas E. Duncan flew from Liberia to the United States on a trip that required 28 hours, ending at the Dallas-Fort Worth airport on September 20. It is known that Duncan was screened in Liberia and found not to have a fever when he boarded the first flight. Persons infected with Ebola but not yet exhibiting symptoms are incapable of spreading the disease, primarily because the disease spreads through direct contact of mucous membranes or open wounds with bodily fluids and symptom-free patients are not yet vomiting or having diarrhea, so no virus-carrying fluids are being produced or at risk of being spread in ways that other people will come into contact with them.
On Tuesday, the Director of the CDC, Dr. Tom Frieden, stated outright that there is zero risk to passengers who were on a flight with Duncan:
A national public health official today said there was “zero risk of transmission” of Ebola on a commercial airline flight that a Dallas patient who has tested positive for the disease flew on from Liberia earlier this month.
Centers for Disease Control and Prevention Director Tom Frieden said today in a live briefing from Atlanta that the person — a male who remained unnamed — showed no symptoms before boarding the plane and was not contagious. The CDC doesn’t “believe there is any risk to anyone who was on the flight at that time,” he said.
Despite Frieden’s clear statement that other passengers face no risk, the press continued to hound CDC and the airlines until Duncan’s itinerary was released. While CBS was moderately responsible in their coverage of the flight information, the Daily Mail asked breathlessly in their headline whether YOU were on a flight with Duncan. Even more incredibly, stocks in US airlines were dumped yesterday in response to the news of Duncan’s flights:
Investors were also selling stocks following news that the first case of Ebola had been diagnosed in the U.S. Investors dumped airline stocks and bought a handful of drug companies working on experimental Ebola treatments.
The story of just how Duncan became infected is a sad one. On September 15 (recall that he left Liberia on the 19th and arrived in Dallas the 20th), Duncan helped neighbors take their 19-year-old daughter to the hospital. Sadly, the hospital was already overwhelmed with patients and she was turned away, only to die early the next morning after returning:
In a pattern often seen here in Monrovia, the Liberian capital, the family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help on Sept. 15 after failing to get an ambulance, said her parents, Emmanuel and Amie Williams. She was convulsing and seven months pregnant, they said.
Turned away from a hospital for lack of space in its Ebola treatment ward, the family said it took Ms. Williams back home in the evening, and that she died hours later, around 3 a.m.
Mr. Duncan, who was a family friend and also a tenant in a house owned by the Williams family, rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Mr. Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening, neighbors said.
The hospital in Dallas where Duncan is being treated has received a lot of criticism because he first went there on September 26 but was sent home when only exhibiting a low grade fever:
When Mr. Duncan first arrived at the hospital last Friday, six days after he had arrived in America, he told a nurse that he had come from West Africa. Public health officials have been urging doctors and nurses to be on the alert for Ebola in anyone who has been in Guinea, Liberia or Sierra Leone. But information about Mr. Duncan’s travel was not “fully communicated” to the full medical team, said Dr. Mark Lester, executive vice president of Texas Health Resources, the parent organization that oversees Texas Health Presbyterian Hospital.
As a result, that information was not used in the clinical diagnosis and Mr. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection, Dr. Lester said.
Those with whom Duncan had contact from the time of the onset of his symptoms until he returned the hospital on September
30 28 (corrected; September 30 was when tests confirmed Ebola after he returned to the hospital on September 28) in much worse condition and was then isolated are being monitored for signs that they may be infected:
Officials said Wednesday that they believed Mr. Duncan came into contact with 12 to 18 people when he was experiencing active symptoms and when the disease was contagious, and that the daily monitoring of those people had not yet shown them to be infected.
The incubation period (the time between exposure to the disease and the onset of symptoms in an infected person) for Ebola varies from 2 to 21 days. Recall that Duncan was exposed on September 15 and visited the hospital for the first time on September 26, so his incubation period was around eleven days. We are now around six days into the time since Duncan first visited the hospital, so those with whom he came into contact will need to be monitored for for another two weeks or so until at least 21 days have passed since their last contact with Duncan.
While there is some chance that one or more of those with whom Duncan had contact while he was contagious will become infected, as long as everyone who was in contact with him during that critical period is under observation now, there is virtually no chance of the disease spreading outside that small group of people. And you can rest assured that nobody from any of the flights Duncan was on will come down with disease from exposure to him.
As the Ebola outbreak in West Africa continues to grow, fresh attention was focused on it yesterday when the CDC announced that in a mathematical model they developed of the outbreak, failing to intervene in spread of the virus could lead to as many as 1.4 million people infected by late January. Somewhat lost in the response to the “wow factor” of a projection of over a million people being infected is that the model also very powerfully demonstrates how the viral outbreak can be contained simply through moderate adoption of the most basic aspects of an infection control program.
The key to preventing spread of the virus is for those who care for infected patients, whether they are health care workers at a hospital or family members in the home, is preventing contact with fluids from the patient. CDC has prepared an informative guidance document for how health care workers can control the spread of Ebola in their facilities. The key steps are to provide protective clothing to cleaning staff, use an effective disinfectant, avoid re-use of materials with pourous surfaces and dispose (as regulated medical waste) of all textiles, linens, pillows and mattresses that may be contaminated.
Because practices such as these are routinely implemented in US health facilities when patients with high risk infectious diseases are being treated, there is little to no chance of Ebola spreading within the US. As noted in the previous Ebola post, the extreme poverty of the health care systems in the affected countries in Africa is what has allowed the disease to spread, as health care facilities there simply cannot afford the materials they need for implementing safe practices.
Here is the output of the model for Ebola spread in Liberia and Sierra Leone if infection control is not implemented beyond the current level. As noted in the NYTimes article linked above, the current estimate is that 18% of patients in Liberia and 40% of patients in Sierra Leone are treated in facilities that prevent spread of the virus. The model predicts both the number of infected patients in the two countries and the number of beds devoted to care of those patients (“corrected” means that the estimate for number of infected individuals is corrected for the assumption that 2.5 times more patients are infected than have been officially reported):
As noted above and widely cited in the press yesterday, if the virus outbreak is left unchecked, the model predicts a cumulative total 1.4 million infected patients in the two countries by January 20 (many of whom are dead by then) and a need for up to 100,000 beds for treatment of these patients.
The good news that is buried in the CDC model is that stopping the virus outbreak does not require implementation of virus control measures for treatment of every infected patient. In the graphs below, we see the output from the model under the assumption that viral control practices start to be implemented now and expand to a level of 70% of infected patients (25% of them in hospitals and 45% in home treatment) being treated under safe practices by December:
Note that the cumulative number of cases levels off between 25,000 and 30,000 and the total number of beds needed peaks at around
13,000 1300 before dropping rapidly.
This model demonstrates very clearly that the highest priority for stopping the Ebola outbreak should be rapid and widespread implementation of basic infection control practices. Spreading this information into homes where patients are being treated is key. Convincing families of the importance of removing infected clothing and bedding seems likely to be the pivotal aspect of the public information campaign. Help from the West will be essential in providing the huge amount of disposable protective clothing and the necessary cleaning and disinfecting supplies. Replacement clothing, linens, mattresses and pillows should be provided as many of the affected families will be hard-pressed to replace these items under the already difficult conditions of an infected family member.
Further good news is that these projections were based on conditions in August and there is reason to believe that the situation may already be getting better. From the Times, again:
The caseload projections are based on data from August, but Dr. Thomas R. Frieden, the C.D.C. director, said the situation appeared to have improved since then because more aid had begun to reach the region.
“My gut feeling is, the actions we’re taking now are going to make that worst-case scenario not come to pass,” Dr. Frieden said in a telephone interview. “But it’s important to understand that it could happen.”
Let’s hope that Dr. Frieden is correct.
The woman in the photo at the right has big titanium ovaries — not malleable brass or rusting iron. Do I know Mary Barra personally to attest to this fact? No. But I have a pretty damned good idea where GM’s new CEO has been, and it takes a pretty tough set of specifications to survive the road she’s traveled.
Like her I grew up in the I-75 corridor in Michigan, where much of the automotive industry’s OEM facilities and Tiers 1 through 3 suppliers could be found. Like her father, my father worked in the automotive business; if her household was like mine, there were copies of Car and Driver, Road & Track, machinist, tool-and-die, and metalforming magazines cluttering coffee tables or in dad’s man-cave. The smell of machine oil and the grit of metal chips are familiar, as are an ever-present collection of safety glasses, hearing protection, and greasy jumpsuits. Picture a garage like that in Clint Eastwood’s movie Gran Torino; I’ll lay good money her dad probably spent a lot of his free time between shifts in a home shop like that, and where she might have been found as well if he needed a hand or she needed a tool to fix something.
It was in her blood, I’m sure; I’ll bet she could taste it. I’m pretty certain this is why she went into engineering, and likely why she went to that particular private engineering school.
After working for a couple years as a high school engineering co-op student I had been accepted at the same school, but I went a different road, preferring business and then-nascent computing technology over engineering. My daughter, though, is at that school now. She could taste it, too; we have pictures of her at age nine, wearing safety glasses, proudly holding her first aluminum machined part. She’s the first person her dad asks for help when working on the cars at home.
I wish now I’d taken pictures of her the time she was so damned mad at her brother and his friend for accidentally breaking the sibling-shared PlayStation 2 console. She ripped it down, diagnosed it using internet research, fixed and reassembled it on her own in an afternoon.
Driven to identify and solve the problem — that’s what it takes to choose engineering as a career, particularly if you are a woman.
Sure, men too must be driven to pursue the same field, but they don’t face the hurdles that women faced then or even now, 30 years after General Motors’ new CEO first started college at the former General Motors Institute. Nobody ever questions a boy’s right to pursue engineering, or a man’s right to practice that discipline. Nobody ever questions the gender of a man with an engineering degree when he makes it to the pinnacle of the corporate ladder. Continue reading
The Republican-led House Committee on Science, Space and Technology, chaired by Rep. Lamar Smith (TX-21), wants the National Science Foundation’s grants to be evaluated based on the “national interest.”
Bring it, boneheads. By all means let’s try that standard against EVERYTHING on which we spend federal money.
How many television and radio stations, licensing publicly-owned airwaves, are granted licenses under which they are supposed to serve the “public interest, convenience, or necessity”? Because apart from emergency broadcast signal testing, most of them don’t actually do that any longer, suggesting we really need to re-evaluate broadcasters’ licenses. Let’s put the FCC’s licensing under the microscope. If broadcasters aren’t truly serving “national interest” in the manner parallel to a House Science Committee discussion draft — proposed criteria being “economic competitiveness, health and welfare, scientific literacy, partnerships between academia and industry, promotion of scientific progress and national defence” — the least they could do is pay us adequately for a license to abuse our publicly-owned assets as well as our sensibilities. There’s probably something in the defunct Fairness Doctrine about broadcasting and the nation’s interests…unless, of course, “public” does not mean “nation.” Perhaps Rep. Smith believes “national interest” = “business interest,” which opens up a massive can of definition worms.
How about banks and insurance companies? How many of them were in one way or another not merely affected by the financial meltdown of 2008, but direct contributors to the cataclysm because their standards of operation were shoddy — specifically, with regard to subprime mortgages. Why not put their regulation under the same lens: are these financial institutions serving the “nation’s interest”? The financial industry’s business practices and the regulatory framework existing in early 2008 certainly didn’t defend this nation’s economic competitiveness, damaging the ability to obtain credit as liquidity was threatened. Jeepers, wasn’t that the intent of defunct Glass-Steagall Act after the Great Depression, to assure that commercial and investment banking acted in a secure manner consistent with the nation’s interests?
We could go on and on across the breadth of departments and regulatory bodies which either issue funds or licenses, putting them all to the same test. Do they serve the “national interest”?
The problem here isn’t that the NSF in particular isn’t validating grants as to whether they serve the “national interest.” The NSF already uses criteria to evaluate proposal submissions for their alignment with the nation’s aims. Continue reading
An earthquake measuring 7.7 on the Richter scale hit southwest Pakistan yesterday. The Balochistan province where the quake struck is isolated and has been plagued by sectarian violence as well as clashes between government forces and local militias.
Dawn brings us news of the devastation:
The death toll from a massive earthquake that jolted southwest Pakistan rose to 306 on Wednesday, with officials saying thousands have been left homeless in remote parts of Balochistan province.
The 7.7-magnitude quake struck Tuesday afternoon in the province, toppling thousands of mud-built homes as it spread havoc through Awaran and Kech districts and the southwestern parts of the country.
Pakistan’s military on Wednesday rushed to reach the scene of the earthquake to launch a relief operation in the affected areas. Officials said the toll was expected to rise as rescue teams reach more villages in the remote area.
Provincial home secretary Asad Gilani confirmed 306 people had been killed and more than 400 injured from the huge quake.
In the areas hit worst, virtually all of the mud homes were leveled:
The scale of the affected territory is daunting. Awaran’s population is scattered over an area of more than 21,000 square kilometres. More than 60,000 people live within 50 kilometres of the epicentre, according to the UN disaster agency, mostly in easily collapsible mud homes.
Television footage showed collapsed houses, caved-in roofs and people sitting in the open air outside their homes, the rubble of mud and bricks scattered around them.
Abdul Rasheed Baloch, a senior official in the district, said teams had worked through the night to try to retrieve bodies and survivors from the rubble. “Around 90 per cent of houses in the district have been destroyed. Almost all the mud houses have collapsed,” he said.
The earthquake hit in the late afternoon local time, so we can hope that many people were able to move out of mud brick structures before they collapsed, but it still would not be surprising for the death toll to continue a rapid climb as more information emerges from remote sites.
Just off the port city of Gwadar, the earthquake appears to have created a new island. The island is not the result of uplifting of tectonic plates but is instead a structure referred to as a mud volcano:
Mohammad Danish, a marine biologist from Pakistan’s National Institute of Oceanography, said a team of experts had visited the island and found methane gas rising.
“Our team found bubbles rising from the surface of the island which caught fire when a match was lit and we forbade our team to start any flame. It is methane gas,” Danish said on a local television news channel.
The island is about 60 to 70 feet (18 to 21 metres) high, up to 300 feet wide and up to 120 feet long, he said. It sits about 200 metres away from the coast.
Gary Gibson, a seismologist with Australia’s University of Melbourne, said the new island was likely to be a “mud volcano”, created by methane gas forcing material upwards during the violent shaking of the earthquake.
In this video, we can see the methane bubbles coming to the surface on the new island:
Islands of this sort have been formed by earthquakes in the region before, and they tend to get washed away by wave action:
“It’s happened before in that area but it’s certainly an unusual event, very rare,” Gibson told AFP, adding that it was “very curious” to see such activity some 400 kilometres from the quake’s epicentre.
The so-called island is not a fixed structure but a body of mud that will be broken down by wave activity and dispersed over time, the scientist said.