Am I one of the minorities who believe that this hype about Ebola is more sensationalism and news than an actual pandemic we should be fearful for?
Let's take a lot at what we can agree on:
* The number of cases of infected patients is fairly small.
* The vector of transmission is fluid exchange, so that reduces its ability to spread.
* The virus doesn't appear to lie dormant, and is only contagious when the patient becomes symptomatic.
The chances of contracting the disease in a western country so far is near 0. The chances of contracting the disease in AFRICA is fairly improbable too.
It really sounds like sensationalism at its finest.
> * The number of cases of infected patients is fairly small.
This is no longer true. We have no idea how many people are infected anymore because Liberia has too many patients to even keep track. They're literally thousands of beds short and it's actively doubling.
The CDC estimate is 100k-1.4m by the end of the year.
> * The vector of transmission is fluid exchange, so that reduces its ability to spread.
To some degree. It's still highly contagious, especially since it happens to cause people to tend to eject all kinds of different fluids. This is the largest spread of a BSL4 virus in history. It isn't casual.
> The chances of contracting the disease in AFRICA is fairly improbable too.
In places where it's not spreading, absolutely. In Monrovia or Freetown, there's actually a real risk and it's growing worse daily.
That's the scary part. This isn't even about what the risk is right now, though it's terrifying in comparison to where it was a month or two ago. It's about what happens two months from now.
The situation is bad now and rapidly deteriorating.
>>The CDC estimate is 100k-1.4m by the end of the year.
No no, you see, the world has seven billion people, so 100k-1.4m is still a tiny portion and therefore it's all sensationalism!
/s
The fact of the matter is that the current ebola outbreak is a disaster of epic proportions. Whether it becomes a pandemic is irrelevant: it's already devastating several countries in Africa and is likely to move to other underdeveloped nations if not kept in check. Can you imagine what would happen if it started spreading in India?
The original claim would be hyperbolic, except that someone killed in a car crash doesn't increase the risk to other people on the road, but an Ebola infection certainly does. In the mathematics of exponential increase, a small initial amplification factor can produce very impressive results in a short time. Consider the hypothesis that just 1% of Ebola sufferers infect other people. Using this well-established mathematical method:
y' = y (1+p/100)^t
y = infected population % at time zero.
y' = infected population % at time t.
t = time in consistent units
p = percentage increase for one unit of time
So, if it takes a week for the infected population to increase by 1%, then:
IOW if after a week the infected population has increased by 1%, after a year (52 weeks) the infected population has increased by 67%. After 2 years (104 weeks) the infected population has increased to 281% of the original. And so forth.
This isn't true for car crashes, and the above is what is meant by an "exponential increase".
If the ghosts of people who died in the road began to spook drivers and cause more accidents, you would see a rapid spike of mortality in the short term, followed maybe by change of behavior where ~90% of traffic is composed of professional bus/truck drivers that are hardened and not easily affected by ghosts.
It's easy to imagine scenarios that would have it spread in the US.
1) Scenario : some guy/girl lands in Florida, later that day goes for a swim in a big swimming pool with some 100+ people in it because it's a very hot day. Half of those people are on holiday and return to various places in the US before exhibiting symptoms.
2) Ebola is known for spreading fast in hospitals
3) Definitely diagnosing ebola takes several days
The problem with ebola (and all the MRSA variants, a number of which do spread through the air, and a few others) is that it can go from a few patients infected to turning hospitals into death traps in 2 weeks flat.
I haven't yet seen a paper claiming either way. It spreads through fluids, so likely it can remain stable in chlorinated water for at least a few seconds.
I agree there could be a wide initial spread, but I really feel that it would be contained much more efficiently in, for example, the US or UK than is possible in the outbreak areas of Africa, so the outcome would be a lot less catastrophic.
> "The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely."
From the abstract of the report[0] you're citing. Essentially, it's rising exponentially (at smaller numbers) right now so of course if you extrapolate over long enough you're going to get a big scary number. The situation is bad, but we still haven't even engaged the outbreak with anything close to full force yet (a valid indictment on policy makers, not the situation). There's a difference between spreading caution and FUD, let's try and avoid the second.
This is true, but it is still reasonable to discuss current infection rates.
As you note, we still haven't even engaged the outbreak with anything close to full force yet. Until we see the effects of that engagement it makes complete sense to look at what is happening right now, not what countermeasures might or might not achieve.
This is quite an insensitive thing to say ... or maybe just an insensitive thing to say what everyone is wondering anyway.
We don't have a cure ... and won't have one in time to help (almost) anyone who's contaminated in this outbreak. There's really not much we can do except to contain the virus (if we can do that). I don't necessary want to be nuked from orbit, but if I were to contract this illness I'd also rather not linger towards an almost certain death.
I know it sounds a bit fatalistic, but why be an organ donor, draft a living will (etc) if you don't consider that one day you may perhaps die? And the truth is that most of us are unable to help the current situation in even the simplest way. Those of us who have a suitable belief system can only pray.
The US recently announced a commitment to building 1,700 beds over an undefined time period. (They got on the ground and started fairly quickly. They're totally moving fast, but it's still hard and it takes time.)
The WHO report as of Sept 24th estimates that Liberia alone is 1,550 short of what is needed for treating patients.
That was last week. What do you think it's going to look like in a month?
I think if you look at the numbers you'll see this massive scaling up the CDC is referencing isn't getting ahead of things, it's barely keeping up. The numbers are really quite bad and the CDC estimates shouldn't be taken lightly.
Basically the problem is with an epidemic that is growing exponentially, you have to scale your response exponentially just to keep your current rate of growth. To actually make it go down? You have to scale even faster.
Don't epidemics generally spread exponentially? Is it normal for that growth rate to slow as the size of the epidemic increases? (Honest question, not being sarcastic.)
Is the current media frenzy "sensationalism"? Yes.
Is there a risk here? Yes, a small one.
I understand, but am frustrated by, the number of people who keep repeating "it's not airborne", as if this is some kind of definitive argument that a virus cannot spread here.
Something like 80% of cold/flu infections happen via "bodily fluids" -- people snot on a surface, someone else touches the surface, then touch their face, etc. This is an effective means of virus transmission. A virus doesn't need to be airborne for a pandemic to occur.
That said, we have a number of advantages over rural Africa in dealing with illnesses -- we have high standards of sanitation, good electricity, clean water, and our population is generally not afraid of physicians (with notable exceptions in some minority communities). But our biggest advantage, by far, is that Ebola isn't endemic here. Our best and most effective screen is "have you been to Africa recently?"
If that screen loses its effectiveness, you start to have to worry about every patient presenting with a fever and diarrhea, and the epidemiology becomes quite difficult. We're not really prepared for everyone with a fever and vomiting showing up at the emergency room...and it won't take many patients (a few thousand, say) for things to get tense.
Your 80% number is misleading. There is no good data on that. Flu has long been thought to be mainly transmitted through droplets, which fall to the ground quickly, rather than being dispensed in the air, being able to travel large distances (which would be truly airborne). If anything, the latest data suggest that we have actually underestimated the airborne route (relative to the droplet route).
Yes, a pandemic can occur even if the pathogen is not transmitted through there air - see HIV/AIDS.
Airborne and droplet spread make for fast spreading and hard to control epidemics. If something spreads through bodily fluids only, it's easier to do contact tracing and put the right measures in place. I think that's what people want to highlight if they say that Ebola is not airborne.
> Flu has long been thought to be mainly transmitted through droplets, which fall to the ground quickly, rather than being dispensed in the air, being able to travel large distances (which would be truly airborne).
Actually, there was a study earlier this year[0] which showed, with better data and more rigorous treatement of the fluid dynamics, dropplets can travel much farther than previously thought. [1] has a summary of the research, in case the article is not available. But their basic conclusion is that, depending on the size, droplets can travel up to 200 times farther than previously thought, because they are carried along with the "cloud" associated with the sneeze.
I'm basing that number on a paper I read a while ago that estimated the infection channels from a variety of experimental and epidemiological data. I can't find the original article with a quick search, but there are plenty of other papers that show how efficient the hand-contact mechanism is. For example:
In that study, 11 of 15 hand-contact exposures to a rhinovirus led to infection, which is not 80%, but it's within the margin of error. Notably, it was almost as good as large-particle aerosol exposure at spreading the virus.
But yes, the important point is that you don't need an airborne virus for a pandemic. Every virus is different, but there's this public fixation on "airborne" transmission that is a bit of a red herring. Ebola is doing just fine without it.
Parent is suggesting that would be an effective screen for people with other symptoms. Hence, "If that screen loses its effectiveness, you start to have to worry about every patient presenting with a fever and diarrhea..."
So at the moment, this "screen" is an easy way to rule out Ebola in a patient with potentially Ebola-like symptoms. Obviously we wouldn't expect everyone who has recently been to Africa has Ebola. I didn't downvote you, but I expect this is the reason why you're getting downvotes, not a misunderstanding about your question.
Edit here - Just realized my comment might have come across the wrong way. I was responding to the OP's suggestion of using the screen of 'Have you been to Africa recently?'. I wasn't actually asking if the OP had been to Africa recently
The likelihood of any kind of pandemic is extremely low, sure. However, your dismissal of this epidemic and its impact is arrogant and disgusting.
It’s still a disaster in the affected countries, with many knock-on effects. Also, it would have been better to spend more money earlier to prevent unnecessary deaths.
This Ebola epidemic is actually something people hardly care about. Hardly anyone is donating, for example.
Help is needed. Actually. For real. And with better support and a better reaction this could have turned out better.
I am having a hard time understanding why people keep saying that donations are the way to go to solve this issue. From what I have seen, many rural communities are rejecting and acting against foreign assistance. I am not sure of the circumstances in urban settings, but I read that they are just as superstitious. How can we help those that do not want our help, especially when it is deadly to help either because of the disease or fear of attack?
This is a reason to donate. These rural areas clearly lack education, knowledge and need help. Just because they are scared/ignorant today doesn't mean they always have to be. For example if radios were distributed to all these communities education programs could start about ways to avoid disease transmission etc. This is going to be a long term strategy and wont happen in a day.
To be honest, I’m not sure how effective these targeted donations are at all. My point was more that in this case, while scary (and probably unrealistic) scenarios of the West somehow being affected were a popular pastime (and seemingly the main frame to view this disaster), hardly anyone seems to actually care about those who are affected by it. (I personally don’t think, for example, that I know better than a charity how to best allocate resources and I think targeted donations tied to a specific cause are quite irresponsible.)
Also, there may have been unique complications that make fighting the spread harder, though we don’t really know how widespread those are and were. They make for good stories, but are they the whole picture? I very much doubt that.
Additionally, it seems to me that even if those troubles were widespread it was possible to a) do something against them with more money (mostly in terms of improving communication about the virus) and b) make up for other deficiencies in resources (like a lack of space and beds and personal).
as far as donations are going, Time had a good breakout. There are many who have gone there, given money, and risked their lives. hint they aren't the type that frequent tech boards but posters here are quick to dismiss some of them for their religious convictions
The tl;dr is that people donate a lot more when they can tangibly understand that a disaster has happened and they make an emotional connection to the disaster (e.g. 9/11, Haitian Earthquake, etc).
When donors are asked to contribute money to prevent something, the emotional connection is a lot harder to make and funds are a lot harder to raise.
I don't know if you can call it a disaster. The total number of cases, as reported by the CDC, is less than 7000 so far.
I don't mean to be callous, but compare that number to the number of total deaths to Malaria or even the flu, and that number pales in comparison. I am not callous to say that we shouldn't care about the Ebola outbreak, but if you look at the numbers, directing that money to buy more mosquito nets or Malaria vaccines will likely save more lives.
Malaria kills close to a million people a year. If you're looking for a cause for donation, the most value per dollar could be directed there.
Malaria has a steady death rate. It's obviously a serious issue that doesn't get enough attention in the West, but immediate action will affect it only marginally.
The issue with Ebola isn't how many people it's killed so far (although the number is already tragic), but the number of deaths it can potentially cause. If left entirely unchecked at this point, it would kill over a million people in the next year. A half assed response limits it to hundreds of thousands, while a solid response limits it to tens of thousands (conceptually, numbers pulled out of ass but reasonable, I'd argue).
Outbreaks grow exponentially unless contained; the point of fast action is to prevent or curtail the exponential growth.
Last week, the total number of cases was ~6500. One month ago it was ~3000. Two months ago it was ~1300. How do you call a process that duplicates itself every fixed unit of time (in this case, every ~3 weeks)?
Of course, we should not fall into panic. Many factors will affect what ends up being the total effect of this outbreak in the mid to long term. But dismissing it as a non issue because "there are just a few thousand cases" misses the point completely.
Hm so that would mean assuming this rate of exponential growth that in ~150 days there would be ~ 1 million cases and roughly a year to reach 100 million. I wonder how well they can model travel patterns, then you could write down an ode for the disease on say a country level and couple them.
I am not saying that this will grow exponentially for ever. For what I know, disease expansion is modeled with a sigmoid curve: exponential at first, then slows down once a saturation level in the population is reached.
According to Wikipedia, the total population of the 3 most affected countries - Liberia, Guinea and Sierra Leone - is roughly 20 millions. So there is at least that upper bound.
The real risk of pandemia comes from the fact that as the number of cases grows, the more likely it is that some of those cases travel through a porous border into other countries which lack the infrastructure and professional discipline to contain new outbreaks. If/when that is the case, each new region will start its own sigmoidal worth.
Well the sigmoid curve you are referring to would be for the case that patients who have contracted the virus and survived would be immune or die. In an SIR model (http://en.wikipedia.org/wiki/Compartmental_models_in_epidemi...) that takes death rate and population number into account you would then expect a disease to either reach a disease free equilibrium or a endemic equilibrium. What I was suggesting is to couple those equations on the country level by modelling travel patterns (flow of Suscebtible Recovered Infected across borders), the result would most likely be that western countries would be able to reach a disease free equilibrium, as they have better recovery rates and lower infection rates, whereas ebola would remain endemic in africa.
Regarding your original question... if you can identify individual regions where the model can be applied, maybe you could use Markov chains to model the transitions between states in each region. I am not qualified enough to do that, but I imagine that the result would be a few endemic nodes where the disease is always present (with different degrees of intensity over time) and from where outbreaks get sporadically "exported" to disease free nodes.
And note the WHO already did bend the curve down once before, back when there were only a couple hundred cases, and then they lost control again. Not confidence-inspiring.
It's not that they lost control per se: when the hard detective work of determining the cause was done, it was already rather late in the game. The foreigners showed up in force but the locals refused to cooperate, hiding it until it couldn't be hidden, at which point it was too late for those three counties, and very possibly a very large part of West Africa or worse.
Donations are always tricky and effectively allocating resources to aid is hard … but can you at least recognise that similarly sized catastrophes get much more attention and money?
More than 3,000 people dead, potentially more, and many of the affected places don’t have enough resources to deal with it in a satisfactory manner. That’s the situation here. This could have been controlled better, probably.
So what? Those are completely different situations. One is a human doing intentional harm to a bunch of innocent creatures. The other is mother nature vs. mankind. One tugs at the heartstrings, fills us with protective emotions for the poor doggies. The other is just another natural disaster. "Thank goodness it didn't happen to me", we think. I don't find this surprising or depressing.
Médecins Sans Frontières/Doctors Without Borders is the first organization that jumps to mind -- they've been helping to lead the response in Africa, more or less on a shoestring.
Thanks for the info, just did a small donation. I suspect it's well beyond their ability to control at this point, but even slightly slowing down that exponential curve can be worth a lot.
> Am I one of the minorities who believe that this hype about Ebola is more sensationalism and news than an actual pandemic we should be fearful for?
If you only care whether the disease is going to hit at home, or (even worse) only if it hits a "western country", then yeah.
Hundreds of thousands are dying, and it could hit millions.
I'm pretty certain it won't hit that bad "at home", maybe a few isolated cases, we have the infrastructure(s) to contain it adequately.
Not in Africa though. As you may recall, Africa is really really big (depending on map projection). May not literally count as a "pandemic", but this is a disaster of incredible proportions.
... and then there's people suggesting, only half-joking, to "nuke it from orbit". Would they suggest that if it was a "western country"?
It's fine to worry if you may get the disease yourself, personally. The answer is "no / highly improbable". But just because its wreaking havoc mainly in non-western countries, doesn't mean news about the terribleness and spread of this epidemic, that is going on right now (also it's not just some flu, it makes one bleed from their internal organs o_O), doesn't mean it's "hype" or "sensationalism". This is actual human drama and suffering at a massive scale. And it's probably going to get worse before it gets better.
There are roughly three reasons this outbreak became so big: different location (West vs. Central Africa), it took a while for the differential diagnosis (the much less deadly Lasa Fever is endemic in the area, but doesn't cause hiccups), and when the foreigners arrived in force, the locals hid. The WHO et. al. actually thought it was under control, before it couldn't be hid anymore.
Educated guesses would put actual fatalities in the 10s of thousands; 100s is possible, but I don't get the impression it's quite there yet. But with exponential growth, 1 case infecting an average of 3 others by one estimate, there's no way it isn't going to get that bad in West Africa.
tl;dr: Blood samples were taken in villages, laboratory confirmed, but none of these deaths were counted unless the patient actually made it to a treatment center. Much needs revision, which is not a priority right now.
The truth is also that we know fairly little about Ebola. It's fairly recent that we've known any animal vectors for it. It is very effective at killing but until now it has been very isolated. We know it requires fluid exchange but that's a somewhat vague concept to many, is a sneeze in an office a fluid exchange? I mean, that's good enough for flu... I'm not sure that it's known how bats (a vector) exchange or transmit it. Just a lot of unknowns, the idea that the North American bat population could start carrying it is a little scary.
We will stop it but it got a lot closer to home and if a dozen other contract it from this case, I'd say the sensationalism and paranoia are warranted.
No, no, it has to be taken very seriously before it spreads. This is the kind of thing that could completely upend the entire planet if not taken seriously. What would happen if the entire world had to self quarantine for three to four weeks and all transportation grounded for the same period of time. No, this is a huge deal.
I have long believed that some kind of bacteria or virus is going to take out all or a huge chunk of humanity at one point or another. Evolution is a heartless SOB. We could very well be one or two random mutations away from losing half the planet's human population. And, BTW, the mutations in question don't have to attack us. Imagine losing half the worldwide crops, cattle or fish.
Don't get me wrong, I don't lose any sleep over this and don't have a garage full of gas masks and HAZMAT materials. When/if it happens that stuff is likely to be absolutely useless.
I wonder if that's what might finally make the religious "get it". You go ahead and pray to your powerless imaginary intelligent creator. I'll choose science thank you.
Insult unnecessary. At this point, prayer & science have similar influence over curing someone of Ebola. Contradictory to say you'll "choose science thank you" yet don't have (per hyperbolic statement) any sensible tangible preparations to meet an Ebola epidemic with.
Calling nonsense "nonsense" is not an insult unless you believe in said nonsense. No religious person would find the statement "belief in Thor is nonsense" objectionable or offensive at all. In fact, most would agree without reservations.
You also missed my point about taking a scientific approach to something like ebola. Gas masks are utterly irrelevant and pointeless. We know how the virus is spread and we know that if caught reasonably early it is easy to kill. Even if your entire neighborhood consists of people with ebola you and your children are safe as long as you don't swap bodily fluids. I don't know about you, I can't remember the last time I swapped bodily fluids with my neighbors. So, yeah, others can pray --which is utter nonsense-- I'll stick with scientific knowlege --which is not.
Here's the difference with science: If tomorrow someone offered true evidence that ebola is now airborne and prayer kills it, I could not imagine a single scientist who, when presented with the evidence, would not accept these findings to have a high degree of probability of being true.
Current treatment for Ebola is little more than hydration and quarantine, hence my comment. When ZMapp et al are shown effective, I'll change my comment.
You are equating praying to medical treatement. That is utter nonsense on the face of it, regardless of whether or not an established and effective treatement course exists for an ailment. I'm sorry, it's just plain stupid. Would you pray to Thor, Apollo, the Tooth Fairy, Zeus? Why not? So, pray tell, why does your brain magically stop working when your favorite god is invoked?
People understand exponential growth, but the US is not conducive to spread of Ebola. The problems found in Africa that prevent effective management of the situation do not exist here: Lack of hospitals, suspicion of outsiders/doctors, general hygiene, etc.
Despite what you write above, and the attention being paid to ebola, the infection is growing, not shrinking (each ebola patient infects, on average, more than one other person). Reasonable (not breathless) forecasts show the number of infected individuals growing to over 100,000 within a few months, and the CDC could see it growing to over a million cases by early 2015.
Further, this is a disease with a 50% mortality rate, and no verified treatment other than palliative care (even ZMAPP, the supposed magic bullet, did not save at least two patients who were treated).
Most interesting is that this guy apparently became symptomatic 3-4 days before going to the hospital. Arrived on the 20th, felt sick on the 24th, went to hospital on 27th, was isolated on the 28th. How many people did he come in contact with? How many contacts are being traced? This may be very interesting, and I doubt it will stop at just the one case.
This is not completely accurate. The guy went to the hospital on the 26th, was misdiagnosed and sent home on antibiotics. Then he was taken to a different hospital by ambulance 2 days later when he obviously got worse instead of better.
I found that interesting as well. If I had just returned from an area where Ebola is currently spreading and started to feel ill, my first thought would be to head immediately to the hospital as a precaution.
I can tell you that as someone with 90%+ relatives living in Lagos, Nigeria... they don't seem too concerned. But it is a real problem. Not the END OF THE HUMAN RACE ANDROMEDA STRAIN[1] like the western/UK media has been making it sound like, but a problem nonetheless. I also have a feeling if it even approached anything resembling a problem in a first world country, a cure/vaccine would magically be found and made promptly accessible to all......
Listen to this podcast[1] and get back to us. Compared to previous disasters this is a very slow moving disease, extremely contagious, and almost always fatal. And that is part of the problem. No one thinks it's a problem because it's all the way over there.
The CDC and other NGOs are trying to hype up its effects because people, and you are not in the minority, don't think it's a real problem. I know people who think it's corrupt African countries trying to get more aid money.
* 1 gets you 2, 2 gets you 4, 4 gets you 8, and 10 gets you 100. Exponential growth here. See, math is fun.
* How many times have you touched your face today? What else have you touched while outside. Victims don't have to physically bleed all over you. But imagine if just 1 infected person took the NY Subway.
* They become symptomatic and then what? Most people, when starting to feel sick, go to the supermarket and stock up on juice and vitamins. Possibly passing it along to coworkers, friends, and family. Only when they have overwhelming evidence that something is wrong do they head to the hospital. Meanwhile, the entire time, the virus is shedding.
I think there's some exaggeration of ebola when you consider the lack of splashy headlines about heart disease, which by the numbers, is arguably far more important.
That said, if there are rare issues where sensationalism might be justified, this might be one. This is one of those areas where preventative aid funding is incredibly hard to muster, even though money spent in containing the outbreak now could have an oversized impact.
Far from the only one, but it's obvious why it is captivating. It has a high fatality rate (>50%) and is quick not to mention graphic. Oh and there's not a cure (though that may be changing!).
One thing the news stories never mention is that the death toll from malaria every day is comparable to the total deaths in this recent Ebola outbreak:
You're comparing a fairly stable, relatively well understood danger with a rapidly growing, less well understood danger.
Elsewhere in this discussion, someone quotes a CDC estimate that by the end of the year the number of ebola cases could reach 100k to 1.4 million. Taking the lower end of the range, that's 100k new cases in 3 months, so the number of cases grows by a factor greater than 10 in 3 months.
> This has the potential to make malaria look like a walk in the park.
Based on what, really ? It may be exponential in some area but not in another with different climate conditions and genetic pool. We have NO IDEA at this stage.
And a random asteroid has the potential to totally like explode the planet and kill everyone. The difference is that I'm talking about present reality.
Since the Ebola outbreak is still growing exponentially, this also means that the death toll of the next three weeks alone will match the daily death toll of malaria, and if it continues to grow exponentially, Ebola will be killing more per day than malaria by around the end of the year.
The death toll from malaria throughout history is orders and orders of magnitude beyond that of Ebola. I don't see how there is any way you can accurately describe it as "a far more dangerous pathogen."
Malaria kills more people than ebola (up to now) but cars kill twice as much as malaria does (http://en.wikipedia.org/wiki/List_of_countries_by_traffic-re...). You could blame me for comparing deaths by cars with deaths by pathogens but let me explain.
Malaria and ebola can't be compared, malaria and cars can. Malaria and ebola are transmitted in very different way. You get malaria if you live in areas where some species of mosquitos carry the malaria plasmodium. This means that it doesn't get you if you don't enter one of those areas. You can't get malaria in NYC. You can be hit by a car there because cars are definitely endemic in NYC as they are in most of the world.
I'm worried by malaria. I don't like the side effects of it prophylaxis and I don't want to risk getting sick (the prophylaxis are not completely effective) so I don't travel in areas where it's endemic. I sincerely hope we can make a vaccine against it.
I'm also worried by cars as anybody else and I take the usual measures (watch left and right before crossing a street, drive carefully) but there are few places to hide, right?
I'm much more worried by ebola because if it gets big enough there will be little we can do to stop it: it's going to overcome quarantines and get to us in our cities across the oceans and it kills with 50% efficiency. If we want to think about something that could send the human population back to 3 billion in a few years we shouldn't look at malaria or cars, but at ebola. That's why also to me this is "a far more dangerous pathogen." Let's concentrate on ebola now, we'll get back to malaria when we'll have fixed it.
You are taking "dangerous" to mean "total number of people killed", while an equally reasonable definition is "likelikhood of dying if you contract it". It all depends on what criteria is being used to define "dangerous".
Absolutely. I'm using the word in the sense of a "public health hazard" rather than the "likelihood of not having a good time once you personally are infected" but there is a valid case for not wanting to contract either disease.
The Hemoraggic fevers are not likely ever to be considered similar to Malaria in objective risk. More likely to remain in the same league as Smallpox, which is still class 4.
And? I’m not sure what the point is. The effect on the affected countries is still disastrous. Do you think having to fight Ebola on top of Malaria is harmless?
Do you think it is worth considering whether a better response was and maybe still is possible to end this quickly (and be better prepared in the future)?
Malaria is a huge disaster. The Ebola epidemic is, too, in the affected countries. (I couldn’t care less about scared idiots in Europe and the US.) Both are.
Sure, the Ebola epidemic is still a disaster for public health in the affected places. Nobody is arguing otherwise.
But it's a bit strange to see all this American media FUD after years and years of not a word about all the destruction caused by malaria (apart from that Bill Gates project), no?
Have you even been to Africa? I lived in Western Africa for 2 years. It is a big deal, and very bad. It is less bad for the US, but that is due to supplies, medical system, education, and other infrastructure improvements.
Yes, exactly. I recommend this episode (https://overcast.fm/podcasts/episode/110040344176) of Stuff To Blow Your Mind if you want to learn what Ebola really is. It was very informative and easy to understand for someone like me who doesn't know anything about diseases/viruses.
Also, there were patients with Lhasa fever and Marburg in the USA before - and nothing happened. Ebola is hyped up because there's an outbreak in Africa.
So far the chances of contracting the disease in a western country was near zero. It's no longer near zero if you define near zero as virtually impossible due to lack of extent cases.
>Am I one of the minorities who believe that this hype about Ebola is more sensationalism and news than an actual pandemic we should be fearful for?
Well, besides media sensenationalism, the idea is that we should be fearful of a possible pandemic BEFORE it becomes a pandemic, and that that's how we take the measures and care we need to contain it. (Being fearful of something like that AFTER it becomes a pandemic goes without saying).
That said, in Nigeria there were abour 3,000 deaths and 6,000 cases. I wouldn't call that "fairly small". Plus stuff like that have a way of skyrocketing if they pass a certain threshold.
In Nigeria at least, they had very good reasons to be fearful, and with modern travel, a few stray travellers could have wiped out similar numbers in other places, or even more.
Nigeria has so far been very lucky: a single index case who was already quite sick when he got on the plane to the country. 20 cases (19 lab confirmed), 8 dead, no new cases since the 5th (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/inde...). They need another 17 days to be sure, if memory serves, but it's looking good. For this index case....
I'm having a hard time accepting the "everyone should stop being stupid and stop panicking about Ebola" argument. To me, an uneducated observer, the problem only appears to be getting worse. And it has gotten significantly worse in spite of all the reassurances that it would not get worse.
i think a lot of the vitriol aimed at people who are worried and a little freaked out by Ebola is unfair. People have lost their minds over much easier to understand and less worrying issues before and those peoples concerns have been met with respectful, educated correction. Now it seems to have descended into name calling and ridicule.
And if anything, I've seen calls for more resources, calls to "do more" about Ebola, etc. Mostly to control it in Africa.
There's the "We are losing the fight to contain Ebola" line, and there's the "it'll never spread outside west Africa" line. Both of which can be (And are, apparently) true - it may become endemic to West Africa, but much like Malaria, it won't be a threat to the developed world.
Nigeria was able to contain their outbreak and kept the levels to under 20 infected. This is a disease that needs 3rd world sanitation and medical care to thrive.
I think that it's totally appropriate to be alarmed by Ebola and the damage it's doing to the people and communities affected. It seems like people understand person concern, and are more trying to discourage un-informed reactions. I don't mean I know better - just that I'm not trained in public health and neither are most of the people who are being alarmist.
The WHO has encouraged the international community to react more strongly to ebola, and I certainly support that. However, I can still look askance at people with no expertise who think we should all be more frightened / upset / etc.
Same here. There have been seemingly credible sources saying it will go nowhere and other seemingly credible sources saying we're too late to stop it from spreading. It's hard to figure out where to fall on this as an uneducated, relatively detached observer.
It's probably more appropriate to short it. Developed health systems aren't going to need ZMAPP to deal with ebola. Quarantine and a steady supply of sterile protective gear will do the trick.
Am I correct in assuming that cultural differences concerning death and the dead along with our healthcare system mean Ebola in America would be relatively containable?
However (though I don't think this will be an issue for Ebola) before we get on any high cultural horse, let us stop to consider how many modern Americans have been perfectly willing to allow serious diseases like whooping cough to make a strong comeback because some Playboy model made lots of public claims which are demonstrably false.
It is worse than that - even if her idiotic claims were true it would still be better to vaccinate. Penn & Teller ably explain http://www.youtube.com/watch?v=RfdZTZQvuCo
Part of the problem there is the perception that those diseases aren't serious (and in cases like chicken pox, this can even be somewhat true). No such perception exists with Ebola, I'd say.
I agree mostly, which is why I mentioned I don't think that would play out with Ebola.
OTOH pancreatic cancer is pretty serious (though not communicable) and we still live in a culture where someone widely lauded as a once-in-an-era genius (and who had ample monetary resources to seek the absolute best medical health care in spite of how bad the economics of our health care system are) thought new age-y solutions were the way to go during the critical early stages.
I guess my basic point is that you don't have to be poverty stricken and living in the third world to make really poor decisions on health issues with severe consequences to yourself and sometimes others.
EDIT: I don't mind the multiple downvotes this post has got, I have plenty of karma to burn and it isn't worth anything, but please respond as well with some sort of rebuttal. No amount of undefended downvotes are going to change the fact that Steve Jobs made a really bad decision that any unbiased oncologist will tell you statistically killed him while he would otherwise still likely be alive (or at the very least, not dead from his cancer) today.
It can be very serious, yes. For most, it's not, and anti-vaxxers seem to consider their own lived experiences to be better evidence than stats like "thousands die from flu every year".
I have a medically sensitive daughter and the folks who go "flu's not that bad, just get it and move on" drive me insane.
I hear you... I've been blessed with multiple recurrences of shingles within six months of one another. I'm one of the lucky recipients of that rarity.
Your expensive health care system may cause people to delay seeing a doctor, which means they might be symptomatic and spreading disease for a few days before being quarantined.
A patient zero on a new york subway could infect a few people and they would be hard to trace.
Although it's not probible it is scarier than "can't happen"
Do people in nations with socialized healthcare go to the doctor as soon as they develop a fever, or do they delay and see if it clears up on its own?
I'm sure it's not the case for everyone, but when most people develop flu-like symptoms, they usually end up quarantining themselves for a few days while it resolves. If they can't do that, social etiquette dictates that they avoid physical contact and close proximity, wash their hands regularly, not share food, etc.
I've worked in the US and France so can speak about both. In France I can self-certify that I am sick and quarantine myself at home. I can call a doctor to make a homecall and the pharmacy will deliver my meds on request.
In the US I've had colleagues that were told to go home. Even with overwhelming evidence that they should not be at work they came anyway. Unfortunately, some could not afford to be sick. Rather than take the personal financial hit they caused the entire operation to slow/stop as other workers called in sick.
Unfortunately social etiquette in the US means to show you are productive even with sickness. "See how productive I am, I've got the flu and I'm still doing this presentation!"
For context, the current government in Australia is trying to bring in a minimum doctor visit fee (typically free currently). Their view is people go in too easily for things they should take an aspirin and wait a couple of days for.
I couldnt see any studies for this. The best data I found was a per capita doctor rate where countries with universal health tend (but not absolutly) to have more doctors per capita which 'may' indicate more visits assuming doctors are created by demand (loose I know): http://gamapserver.who.int/gho/interactive_charts/health_wor...
This is a great point. A free (or heavily socialised) health care system is probably better equipped to handle an outbreak than a fully privatised one, even if it has fewer total resources.
The USA spends more on health care than socialized healthcare countries do. Therefore, socialized healthcare systems have less money, and money is an important resource.
That money is targetted to older people in the US. Diseases of older people include dementia, cancer, respiratory stuff, orthopedic stuff after falls, etc.
It's unlikely that either system is particularly set up for Ebola style infectious illness.
If it mutates and becomes airborne, it might be. That's why containment is so important, even if it doesn't seem so threatening in its current form. Viruses constantly mutate, and every extra person they infect gives them a million more opportunities to do so. All it takes is one of those mutations to make the virus airborne, and we're in big trouble.
While it is tautologically true that if Ebola were to become capable of airborne transmission it would be much more dangerous, there is considerable evidence against the proposition that it is "just one mutation away" from such capability.
Ebola has been around for a long time, and by your own reckoning has had billions of opportunities to mutate into an airborne form. It has not done so. Why not?
The Ebola genome consists of about nineteen thousand base pairs, compared to three billion in the human genome. While that represents a vast amount of combinatoric complexity, biochemical capabilities are not magic. They are not conjured into existence by the wave of a mutational wand, but have to have some substrate in existing functionality, which is why species exist: they are are islands of relative genetic viability in a sea of chaos. An incremental move away from the stable centre will in general be detrimental to the organism, and it will, in the overwhelmingly most common case, require many small, fortunate steps to add a genuinely new capability.
The fact that Ebola has not yet become airborne despite its many opportunities to mutate and do so suggests that we are dealing with a typical case here: that the current genetic configuration of the virus is more than "one mutation away" from being airborne, and it may well be a case of "you can't get there from here" (at least not easily enough for anyone to very worried about in a country where cars kill tens of thousands of people a year and people with guns kill thousands).
Nor does it follow that an airborne form of Ebola would be as deadly as the current form. With such limited genetic material to play with, an airborne virus would necessarily have to change some other characteristics, any of which could reduce its ability to kill.
> All it takes is one of those mutations to make the virus airborne, and we're in big trouble.
Except that the mutation to go from a fluid to airborne virus isn't one mutation it's lots of mutations and that is simple not what we see happening in general.
The common cold could mutate into a super deadly virus but it doesn't, Flu usually doesn't either but rarely does (you want to see a genuinely terrifying virus at work read the accounts of the 1918 Spanish Flu outbreak, that thing took down the young and strong in days).
Containment is important to prevent the spread via fluid contact.
This "if X then if Y then if C then if D then Global Collapse" scaremongering helps absolutely no one.
>Except that the mutation to go from a fluid to airborne...is not what we see happening in general
I've written a bit about infectious diseases but defer to virologists or other folks who are better informed. I do remember reading these two articles about airborne transmission of Ebola, which might be what the previous poster was thinking about:
http://www.nature.com/srep/2012/121115/srep00811/full/srep00...
EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11
http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-t...
If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico. --Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota
If AIDS mutates and becomes airborne, that would also be threatening. Ditto for hantavirus, hepatitis and millions of other diseases. Heck, imagine if black widow venom become airborne and victims started producing more airborne venom themselves! If you're willing to dip into the pool of things that are vanishingly unlikely, there are lots of extremely bad things that could happen.
To a certain extent, yes. We obviously have much better equipment but I say this only extends to handling a few "single" cases of Ebola in specific hospitals across the nation. However, now that Ebola is actually in the US, what precautionary measures do hospitals and healthcare workers take?
If I show up to a hospital in Texas right now with symptoms such as a high fever, sore throat, and diarrhea, do you treat me as as a normal patient or assume Ebola since it's now appeared within the US? These are extremely commons symptoms and once Ebola is here, which it is, handling patients is going to be much different which affects its likelihood to be contained.
You will see that the CDC defines a case as someone showing symptoms but also has epidemiological link to an EVD case or EVD suspect case. Just being in Texas is not a epi link as there has been no confirmed transmission.
There's also the issue of waste disposal. After a patient is identified can most US hospitals handle the extra waste? I saw this (http://www.cnbc.com/id/102027557) earlier, and it sounds like the hospital in Atlanta that treated those two cases had trouble with waste disposal initially.
The typical precautions in a U.S. hospital will prevent most transmission of Ebola. Doctors and nurses already wear gloves, wash their hands frequently, and avoid contact with bodily fluids to the greatest extent possible.
Depends on whether you listen to your government or the nurses [0] that work in your hospitals.
You'll probably be alright as long as the virus is exposed to a small enough group of people that health workers are able to do contact tracing and secure those that may have the virus.
Edit: Something quite worrying is the number of people infected in Liberia that have resulted in this. What happens if the estimates are right and 100s of thousands of people die - do we expect a percentage of these to arrive on US soils?
Guinea, Sierra Leone and Liberia are some of the most poorest countries on earth. Liberia especially is haunted by its brutal, child-soldier fueled civil war and the entire society is rather rickety.
Nigeria, not even the most advanced nation in Africa, seems to have been able to contain Ebola, according to the CDC [1]. There have been isolated cases in European nations that didn't lead to an outbreak. So I think the US can contain (but don't think I'm not nervous about this still, the disease is distinctly disturbing).
I think one of the reasons why Nigeria was able to contain it compared to Liberia and other countries was an awareness of the disease and the enlightenment campaign from the Government. From initial reports that I read, folks in Liberia didn't really believe it was a 'sickness' till it started killing people. Some of them also first tried 'traditional medicine' and only started going to hospitals when things became really bad. There were also reports that folks were not keeping away from people who were under quarantine believing it wasn't really a disease.
On the other hand, by the time the disease arrived Nigeria, the media was already awash with the number of people who had died and so folks were already aware that this was a deadly disease and started taking the necessary precautions. This coupled with a massive enlightenment campaign by the Government helped tremendously.
If you apply the same principle to the US (awareness and if necessary enlightenment campaign), I think your nervousness will be further reduced.
The actions by the doctor in the oil hub of Port Harcourt are a sobering counterpoint to the above. He secretly treated another Liberian diplomat, presumably infected by the index case, in a hotel room. The diplomat recovered, the doctor died, but not before infecting others because he did not take the necessary precautions when he become symptomatic.
People can know which end is up and still act very irresponsibly in the face of such a lethal threat.
Or phasing that another way: It depends how willing you are to ignore the facts and invent unsupported "worst case scenario" scenarios.
There is no factual reason why we should expect the transmission mechanism to suddenly evolve before our eyes. That's raw fear mongering. While Ebola is more deadly than Bird Flu, that kind of wild unsupported speculation is why so many people thought Bird Flu was far more dangerous than it actually was.
"The more time you give a virus to mutate and the more human-to-human transmission you see," she says, "the more opportunities you give it to fall upon some [mutation] that could make it more easily transmissible or more pathogenic."
- Pardis Sabeti, computational biologist at Harvard University
"make it more easily transmissible _or_more_pathogenic_"
You probably should be more concerned about the flu or the common cold becoming lethal than about Ebola becoming airborne. Reason? There are way more throws of the mutation dice for the common cold and flu than for Ebola because these are way more common.
Something like the Spanish Flu returning scares the living shit out of me (while I also know it's remote), that fucker does mutate, it is airborne and it has happened and that was in a world with slow transport.
That said I'm still more likely to die from Heart Disease or Cancer, statistics ftw.
Well, there is this: "While all Ebola virus species have displayed the ability to be spread through airborne particles (aerosols) under research conditions, this type of spread has not been documented among humans in a real-world setting,
such as a hospital or household."
I could've sworn that Ebola-Reston was airborne-transmissible in real-world settings (albeit amongst non-human primates and swine), but I can't find a cite for that; I could just be misremembering things from Richard Preston's The Hot Zone.
Theorized but not conclusively shown, as the "Discussion" section in that study indicates. Transmission may have occurred due to large droplets or fomites contacting the mucosal membranes of the monkeys.
Depends on how fast you are able to identify and isolate the patients. Unless there is reason to suspect ebola it's not exactly the first diagnosis that will come to mind. Most hospitals probably also don't have the necessary isolation facilities or at least not on standby.
Ultimately though ebola is relatively easy to combat, collect the patients, put a fence around them, wait long enough and clean up what's left. The problem is finding and securely containing the patients.
> don't have the necessary isolation facilities or at least not on standby.
What like a quiet room away from other patients?
That is the only "isolation facilities" you actually require alongside making the medical staff use gloves and face mask which I suspect when dealing with an Ebola patient they will remember to do..., it's fluid borne not airborne, you don't even need a negative pressure setup.
> Am I correct in assuming that cultural differences concerning death and the dead along with our healthcare system mean Ebola in America would be relatively containable?
Maybe, but in the US we also have all sorts of people who purposely spread HIV and other deadly diseases, so if that starts happening with ebola then all bets are off. Especially if it gets into the prison system, into the sex worker population, etc.
>> "Obviously Fox takes the FUD crown, but I thought the NYT actually misrepresented it a bit.."
I actually think they were closest to accurate. The other headlines all make it sound like this man caught ebola in the US. They are the only one to indicate he was abroad. I think they've undersold it a bit as he spent several days in the US before being isolated but everyone else has sensationalised to an extent imo (or written the headline in a way that allows us, the reader, to accidentally sensationalise it).
Looking just at the headline, you only know that he was an airline passenger and not abroad. Too, you know immediately that he was in an airliner - a small metal tube, with hundreds of people breathing the same air!
It's actually a pretty masterful headline, in that it doesn't actually come out and say any of that. It seems calm and fairly accurate, but is worded very carefully to encourage fear.
Until he was symptomatic, 4 days after arriving, he wasn't infectious. Or so we believe, with a fair amount of data; obviously we'll be drastically extending our knowledge over the next few years.
What is FUD about it? This is potentially how a epidemic starts.
Stopping this spread depends on everyone checking into a hospital when potential ebola symptoms start, which doesn't happen. Even the current patient didn't think to go to the hospital when he became symptomatic. He potentially infected others. Those contacts have to be traced and put in observational quarantine before they become symptomatic, if they do. If one contact was infected and is missed by the epidemiologists, then the whole process starts over, because whoever it is probably won't know it's ebola and will be symptomatic for days before getting more serious and going to the hospital.
We're also close to the flu season, which has a lot of overlapping early symptoms. If nobody else was infected, or if they proactively quarantine everyone who was infected before symptoms start, then we're good. Otherwise...
I don't understand why there are flights allowed out of ebola-stricken countries. We know ebola has an incubation period. This was just a matter of time.
Just reposting a comment that I made earlier today (re Syria, but apropos here too):
IF you have some free time, the Humanitarian Openstreetmap Team (HOT) is always looking for volunteer mappers. The current ebola outbreak is the #1 priority for HOT.
Tracing buildings, roads, and other features from aerial imagery is something that anybody can do, and it provides immediate benefit to volunteers from the World Health Organization (WHO), Doctors Without Borders (DWB/MSF), IFRC and other humanitarian organizations on the ground responding to the crisis.
"HOT benefits from contributors with a wide range of interests and experience. Almost anyone can make a tremendous contribution to our projects by contributing mapping, but we're also very pleased to hear from developers, documenters and ideas hackers that can engage with us and our work."
If you were on a plane coming back from Europe and the guy in the seat next to you said he was just coming back from spending a year in Liberia, what would you do?
Would you sit there and just make sure he didn't spit on you? Or would you go sit in the bathroom for the flight? Curious as to how people would react...
First, somebody from Liberia probably isn't infected. As bad as things are over there, it's still <1% of the population. (For now.)
Second, if they're well enough to be on the plane, even if they're infected, they're probably not going to be spreading that infection. By the time an ebola patient becomes contagious, they're usually not well enough to travel.
And on top of all that, if they're actually contagious, I'd be worried about fomites generated while they're vomiting. Which they'd be doing in the lavatory.
So in the general case, I don't think I'd be too worried about sitting next to them. (And if they're actually sick enough to be vomiting, I'd recommend being somewhere other than the lavatory.)
As stated by the director of the CDC in the press conference, all air passengers departing the affected countries are screened for fever. Fever is most often the first symptoms present, and therefore you can logically believe that if the passenger left Liberia and is on a plane, he does not have Ebola (or is not symptomatic for Ebola). Therefore I would be fine sitting beside him.
Europe isn't an affected area. No one on my flight from London was checked. It certainly wouldn't be hard to get from Liberia to Europe with no fever, and then board a plane with fever and sweats.
I can speak to the Canadian process. Public Health Agency of Canada is stationed at all major airports and screen passengers that trips originate in an affected country. We had a suspect patient that had arrived from Germany that begin in Nigeria. Due to the routing, they were screened here when they landed in Canada.
Theoretically someone could fly from an affected country to Europe. Spend a few days and book another trip to North America and not be screened. However triage process in hospitals is that patients with fever greater than 38.6C are asked if they have spent any time in an Ebola affected country within the past 21 days (high end of incubation period).
For something that is supposed to be hard to spread, sure is mysterious how people are getting it. This person wasn't a doctor.
Also, we are relying on another country to screen people at airports before they leave. Somehow I suspect this is not being done in a serious manner, ala-TSA.
Yes, but was this person intercepted at a point of entry into the United States, or did they go to a healthcare facility voluntarily once they started noticing symptoms, after they were already in the country?
The former implies that there may be sufficient mechanisms in place to prevent a repeat incident. The latter does not.
The person left Liberia on 19 Sept and arrived here on 20 and had no symptoms when entering the country. On the 24th he developed symptoms, on the 26th he sought care and the 28th was admitted to the hospital.
FWIW, though DFW is a very big airport, there are no direct flights from Africa that land there. If they ended up in Dallas, they at least stopped somewhere outside Africa before they got there.
I've always traveled through De Gaulle on my way to and from West Africa (used to take Air Afrique, but these days Air France, Ethiopian and Air Maroc all go to Bamako). However, since the patient wasn't symptomatic until they were in Dallas, transits and port-of-entry don't have to worry. There's a large, fairly dense immigrant neighborhood just east of the hospital in question (the IRC does a lot of refugee relocations there), so there may have been exposure in that area.
There are flights from west Africa to both Atlanta and Houston, plus some other cities. United services Nigeria and Ghana out of Houston and Dulles respectively, Delta has some flights to the same cities out of their hubs.
It is most certainly possible to fly from west Africa to the US without transiting a third region.
"The patient developed symptoms days after returning to Texas from West Africa and was admitted into isolation on Sunday at Texas Health Presbyterian Hospital in Dallas."
You're correct. For instance, there's a lot of ill-founded concern around the flight the patient took into the US. The CDC is doing its damnedest to quell fears around it -- the patient wasn't symptomatic until four days after arrival -- but reason isn't always effective at moderating hysteria. The New York Times' headline, for instance, is currently "Airline Passenger With Ebola Is Under Treatment in Dallas," which is downright irresponsible.
As for "bad news," the patient self-referred to the hospital, Ebola was not suspected, and the patient was initially sent home to recover. (S)he returned once conditions worsened and was then diagnosed with Ebola.
Specifically, the patient arrived in the US on the 20th, became ill on the 24th, visited the hospital on the 26th, and was admitted on the 28th. Which means that Dallas had someone symptomatic in its midst for four days, which is rather unfortunate.
"It is certainly possible that someone who had contact with this individual...could develop Ebola in the coming weeks," Frieden said, but added that "there is no doubt in my mind that we will stop it here," Frieden said.
General rule of thumb:
Anytime someone says "there is no doubt in my mind about X", you can be pretty sure that yeah, they do have a lot of doubt in their mind about X.
My comment is getting down other yet not that log ago it was said our system was so good that someone with Ebola would be immediately quarantined: http://www.foxnews.com/health/2014/06/30/could-ebola-spread-... I guess we missed the boat on that one. They were sent out and continued to expose people to the virus.
People are underestimating this virus and whenever you underestimate something you generally later regret it. Hopefully I'm wrong for example, but I see too many people sending their sick kids to school and so on. I just think that although we can stop it, it's not nearly as easy as it's made it to be. And we need to stop it sooner than later. I hope I'm wrong but I dont want to find out the hard way. Assuming were bettr than a virus is never wise...
Speculation that the person had a hunch they were about to get sick and figured, "what the heck, might as well get to the US where they'll save me... it's kinda glum here in Liberia anyways?"
This is a great semi formal interview with a local infectious disease specialist I heard on montana public radio yesterday that gives a rather unique view:
As he explains, Montana has one of the few labs in the country (actually in the small town I live in) where you can work on live ebola cultures so we have medical people trained to deal with ebola etc and some also have been spending time in africa.
And I bet Rocky Mountain Labs is the only such facility to include a log cabin on the grounds ;)
Actually the history of RML is pretty cool. It was founded in a tent in the early 1900s to study Rocky Mountain Spotted fever and early researchers included the founder of the frozen foods industry (Clarence Birdseye).
Could be worse. The pandemic will start if Ebola spreads to a low-resource country with a large urban population. Worst case, in my opinion, would be an Ebola case diagnosed in Johannesburg.
Johannesburg has a population of ~10 million (including connected urban areas) and is quite a long way from the affected areas.
OTOH, Lagos has a population of around 20 million and is within hundreds of kilometers of active cases. It's almost 10 times more densely populated than Johannesburg too (20,008/km2 vs 2,900/km2).
On the other hand, private hospitals have the same, or similarly trained nurses, who do a great job. So hopefully the nurses' self-preservation instincts will kick in, and similar levels of isolation to those found in advanced healthcare systems will be deployed quickly if it starts spreading in the public healthcare system.
Ebola already spread to Nigeria, but it seems to be contained now. Nigeria has more urban population but less resource than South Africa, so I don't think South Africa is the worst case.
There were cases of Ebola here in Johannesburg in 1996 [1]. Seems like we did a good job of containing it then, since no other cases have been reported since.
Why don't they just stop the flights to and from infected areas until it's "under control". Or why don't they stop the plane at a base and check everyone on board before allowing them back into society? This country's leaders can't be that stupid.
I personally would be concerned if I was sat next to that person on the flight back home. Even if the fear is unrealistic.
Don't tell me you would happily sitting and eating next to someone with confirmed ebola for 8 hours plus, because they haven't started showing symptoms at that very moment.
I would at the very least go to a doctor to be sure.
The Director of the CDC just said in the press conference that the person with Ebola didn’t have any symptoms until a couple days after they arrived.
They departed on the 19th of September, arrived on the 20th, showed first symptoms on the 24th, sought care on the 26th, were admitted to the hospital and isolated on the 28th.
As the Director emphasised again and again, Ebola is only transmittable when you are showing symptoms. There is only the window between the 24th and 28th when the patient with Ebola could have realistically infected anyone, so people travelling along with them aren’t affected. Any people they did have contact with will be monitored for the next 21 days.
Any KNOWN people they did have contact with will be monitored for the next 21 days.
4 days loose is quite a reasonable amount of time to infect others. If they had been using public transport or being in densely populated events e.g. attending a concert/conference it could be quite a lot. I guess we wont know for a couple of weeks. Here's to a functioning health system, a bit of luck.
It's not an unnecessary risk, because "risk" requires there to be some chance of danger. Ebola isn't contagious until symptoms appear, thus there was no risk at that stage.
You are sitting next to someone for 8 hours plus. They will wipe their nose, then put their hand on the arm rest. Then you will proceed to do the same, and eat food at the same time.
I'm not saying it's likely to infect you, I'm saying this would cause personal distress, even if it is unlikely or impossible.
Well people do tend to spit in minuscule amounts when they speak. The person could also cough and throw spit around. It wouldn't be entirely impossible to contract it by sitting near someone for several hours.
From the CDC: "Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease."
>I thought that for a pathogen to be communicable by sneezing made it "airborne,"
You're not the first nor the last to be tripped up by that. Airborne means that the pathogen can survive for some time in extremely small droplets. If you are sitting right next to someone with a non-airborne pathogen you have two problems. First, you will be reached by bigger droplets. Second, virus in very small droplets will only be in that condition very briefly before reaching you, and wont have sufficient time to die.
There is a difference between walking through a cloud of sneezed particles, and sitting and sharing an armrest with someone for an extended period of time.
Though apparently this person wasn't infectious at the time as has been pointed out.
People can be exposed to Ebola virus from direct physical contact with body fluids like blood, saliva, stool, urine, sweat etc. of an infected person and soiled linen used by a patient.
I have always been a bit of a hypochondriac and I was worried about ebola spreading world wide in 1995 during the Zaire outbreak. I was 12 years old at the time and my classmates laughed at me. I just hope that I wouldn't have the last laugh(more like cry).
Headline: "First confirmed case of Ebola confirmed in the United States: CDC"
Article: "[...] an unnamed patient was being tested for Ebola [...]" (emphasis mine)
Besides the obvious pleonasm in the title ("confirmed [...] confirmed" doesn't make it doubly so), nowhere in the article does it say that anyone is certain that this man actually has Ebola, as obviously, tests are still being done. Until the results of these tests are in, there is no confirmation.
Is this some kind of reading comprehension test being dumped on HN? For what nefarious, crowd sourced, statistical research project? <grin>
'Was' obviously is in past tense. If there is high likelyhood of it being Ebola, the article should have made that clear in the very first (few) paragraphs, like stating that further tests are being done to strengthen the confirmation.
Edit: Ah, I understand now that the CDC has a rather peculiar definition of "case" of illness, see giarc's comment below for a link.
The CNBC article was put up before the CDC press conference (and seems maybe a little slapped together).
arrrg is pointing you at a more recent article that obviates the need to parse up the CNBC article, in the video the director of the CDC states that the lab tests have confirmed it is Ebola.
We should be cautious and prepared for Ebola and not assume we can contain it. We use isolation chambers and a massive team of doctors in special rooms at the CDC just to take care of 2 people. I take a look at the hospitals in DFW and I doubt they can properly contain a handful of cases concurrently.
All hospitals can contain Ebola. This is not an airborne disease and therefore negative pressure isolation is not needed (unless performing aerosol generating procedures). All you need is a private room and proper PPE use and infection control procedures.
Most modern / renovated hospitals (last ~10-15 years) have designed their isolation rooms to be negative pressure anyway and standard patient rooms also operate under negative pressure because of how airhandling is setup (albeit a very light negative pressure)
Perhaps the US is different(I work in IPC in Canada), but most isolation rooms are not negative pressure capable. It is very expensive to design a room to accommodate negative pressure (separate air handling, HEPA filtered exhaust, sealing the room to the true ceiling). Most isolation rooms are designed to handle contact isolation patients, and therefore no negative pressure is needed.
I'm mostly familiar with ER design so I may be off, as far as what "normal" rooms are like. But from my recollection there was a push after 9/11 to move any new isolation rooms to negative pressure and there were subsidies in place to encourage that. There was also a push to redo airhandling for standard rooms to approximate negative pressure but with less stringent scrubbing.
You could be correct, I'm not familiar with post 9/11 IPC planning in the States, however I highly doubt that all isolation rooms in the USA are negative pressure. I assume the post 9/11 push was for all hospitals in urban settings to have at least negative pressure isolation room (very different from an isolation room).
It may not be airborne but it's still highly infectious and you need proper facilities for that, a private room alone is not enough for that. A lot of hospitals, at least smaller ones, are unable to handle such diseases.
In any case containing a patient you know has ebola, is the least of the problems. Ebola symptoms are not exactly distinctive and if you don't have reason to suspect ebola, it may very well be able to spread before it can be contained.
A private room is indeed able to prevent the spread of Ebola.
From the CDC website.
Yes – any U.S. hospital that is following CDC's infection control recommendations and can isolate a patient in a private room is capable of safely managing a patient with EVD. CDC recommends that U.S. hospitals isolate the patient in a private room and implement standard, contact, and droplet precautions.
Everyone with the "stay calm" attitude is lucky. This whole virus seems like such a "matter of time" situation. #1 finally showed up in the U.S. Do you really think it will just stay at 1? What are they doing with the beds he slept on, the towels he used after a shower, the glasses he drank out of? Did he go to a restaurant? A ball game? Who knows?
How much time do we have until it's in a school, on a subway, or your neighbor has it. Nobody even knows what to do. The first thing Americans do when they get sick is GO TO THE STORE. They go get some over-the-counter med. Literally, the first thing people in this country are going to do is go out and expose more people once symptoms start to appear.
Bodily fluids. A sweaty, feverish person is going to touch a door handle, counter, and anything else along the way. We won't even be able to pump gas without rubber gloves.
My checker at Fred Meyer today blew her nose and proceeded to touch every one of my groceries and scan them. It was disgusting. I literally sterilized yogurt containers when I got home. People have no sense of how to keep their germs to themselves.
Ebola starts with fever and vomiting and diarrhea, from what I've read. How are our sewer treatment facilities going to fare? Seriously, this is going to become a nightmare.
Let me set your mind at ease: I was actually at the hospital in question all day today (disclaimer: non-medical personnel, just coincidence) and I was in more danger from the sushi at dinner than the Ebola in the ICU.
Yes, there is a small chance of a multifocal outbreak, though CDC has moved quickly to identify and isolate potential contacts. There is an infinitesimal but still nonzero chance of an honest-to-god epidemic. But medical institutions and the federal government have wargamed all sorts of epidemic scenarios in the decade and a half of OMG ANTHRAX/SMALLPOX/H-N-SOMETHING-SOMETHING panic we've endured.
Even in the (vanishingly unlikely) worst case scenario, state and local authorities have extremely expansive authorities to impose and enforce isolation and quarantines, violation of which (in Texas) is a third-degree felony. (CDC, under HHS delegation, can also impose quarantines to prevent interstate spread of disease, but generally this is left up to the state.) Dallas and surrounding communities could enforce a quarantine and let the outbreak burn out that way, although the economic cost would be enormous. But even mid-tier nations like Nigeria -- which spends per-capita 1% of what the US does on its health system, and which has what could be charitably described as a less-effective government -- have been able to stop Ebola cold with far less drastic action.
In truth, the greater threat comes from citizens who could mob doctors' offices and ERs, demanding nonexistent ZMAPP cocktails for garden-variety seasonal flu symptoms. Unsurprisingly, there's not much medical surge capacity in most hospitals, and beds and labs are in chronically short supply. Health system resource consumption by scared but non-sick patients is a far more likely cause of mortality than an Ebola outbreak.
Of course being in the same building doesn't matter, and you may be fine.
But if you were one of the doctors who saw him the first time he came in, and then proceeded to help other patients that day after assuming this guy just had the flu... well, that's another story.
Or maybe if you rode in the same ambulance he did over the next couple days.
The thing is, the number of people who may have just been exposed is huge, and how many of those will get caught before it spreads even further?
> But if you were one of the doctors who saw him the first time he came in, and then proceeded to help other patients that day after assuming this guy just had the flu... well, that's another story.
He was infectious. That doctor should be wearing gloves and washing hands between each patient and that doctor would not be infectious until a few days after contact.
"Should", but healthcare workers are infamous for not doing this ... and washing your hands that often would damage your skin, perhaps too much to continue working in the field.
How are you all of you supposedly smart people (you're on hackernews - does that not mean anything anymore?) making such baseless and ignorant comments?
If you don't have a degree in a related field or haven't spent any amount of time studying disease (and no, Pandemic the game does not count) you have NO BUSINESS making comments on the preparedness of the US healthcare system - or on how the disease may affect anything.
All you are doing is spreading FUD - you are acting like Fox News and it is downright shameful.
Don't you think its a little pretentious to imply those that browse Hacker News are somehow smarter than others in a comment on Hacker News?
If you have a legitimate criticism of any of these posts feel free to reply. Better yet, post the type of well-researched article you yearn for on here (you commented on this thread so I assume you have experience in studying disease).
> Don't you think its a little pretentious to imply those that browse Hacker News are somehow smarter than others in a comment on Hacker News?
No. Some people are smarter than others - that's a fact. Hacker news consists of technical discussions on complex topics. Those kind of discussions tend to draw in more intelligent people. Therefore, I have no problem concluding that hn readers are likely to be more intelligent than average.
I didn't overlook anything, but I'm also not under the illusion that Hacker News is a peer reviewed journal. Hacker News doesn't require anything of a commentator, the only requirements are on content.
Unless you can magically ascertain the qualifications, or lack thereof, of someone, maybe you should only criticize on the content of their comments?
> I love how you're complaining about people posting without authority, meanwhile not providing a reason that we should listen. Can you say hypocrite?
There is not even an ounce of hypocrisy.
I didn't make any claims of the US preparedness, nor did I say anything about how the disease may or may not spread. If I was going to do that I would only do so if I had research to back it up with - and I am about to get in the car to drive to dinner with my family so I don't have time to read a bunch of journal articles.
First off, how do you know the credentials of ANYONE commenting? My "profile" doesn't have any information relating to my degrees, my work history, or anything else.
Saying people need a degree to comment is a complete joke. I can make whatever comment I want, regardless of my experience. Get over yourself dude.
Let's take a lot at what we can agree on:
* The number of cases of infected patients is fairly small.
* The vector of transmission is fluid exchange, so that reduces its ability to spread.
* The virus doesn't appear to lie dormant, and is only contagious when the patient becomes symptomatic.
The chances of contracting the disease in a western country so far is near 0. The chances of contracting the disease in AFRICA is fairly improbable too.
It really sounds like sensationalism at its finest.