9 ms·

The Mathematics of Ebola Trigger Stark Warnings

205 points by 0cool 12y ago

Pxtl 12y ago
This should be obvious to anybody who knows about geometric growth. The only time you can really stop Ebola without a cheap and easily-available cure is now while it's small. As it grows, its rate of growth will increase, and it will quickly spread to every vulnerable area.
- aaron695 12y ago
  < As it grows, its rate of growth will increase No, R will stay the same. Or decrease as the population becomes more exposed.
  - wcoenen 12y ago
    He's taking about the number of people infected per unit of time, which will indeed increase over time if the reproductive number stays larger than 1.
    - biot 12y ago
      Growth is number of people per unit time. Rate of growth is number of people per unit time squared. Just as with speed vs. acceleration, there certainly is a distinction.
      - wcoenen 12y ago
        I'm not a native speaker so I could be wrong. But in the wikipedia article about exponential growth, "growth rate" is defined as the first derivative with respect to time, which contradicts what you are saying: https://en.wikipedia.org/wiki/Exponential_growth#Differential_equation https://en.wikipedia.org/wiki/Exponential_growth#Differentia... I understand the distinction you are trying to make, but I think what you call "growth rate" would actually be "growth acceleration".
  - gbrown 12y ago
    Actually R0 is a measure which captures both population mixing activity and the infectiousness of the pathogen - the two processes are confounded. That means that it varies a lot over space and time.
hollerith 12y ago
Informative graph: http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png
- StephanTLavavej 12y ago
  The log graph is scarier: https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolution_of_the_2014_Ebola_outbreak_in_semiLog_plot..png https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolutio... (It's easier to recognize a straight line on a log scale, than to distinguish an exponential line on a linear scale from a line that's "merely" quadratic, say.)
  - csdrane 12y ago
    What do similar charts for prior outbreaks like?
    - maxerickson 12y ago
      There's never been more than 500 cases: http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks
    - throwaway_yy2Di 12y ago
      Here's one of the previous largest outbreak, 2000-2001 in Uganda. (Note unlike the Wikipedia one, it's not cumulative). Looks like a sudden decline in new cases right after a CDC intervention -- very sharp inflection point. The cumulative version would be roughly a sigmoid. http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%20Libby%20Burch/images/LassaEbolaMarburg_LibbyBurch_3-8-2012_img_19.png http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%... http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm Looks like there were about 10 new cases/day at its peak; the current outbreak is at 150/day. A couple things stood out to me: Fourteen (64%) of 22 health-care workers in Gulu were infected after establishing the isolation wards; these incidenses led to the reinforcement of infection-control measures. So that's not novel to the current outbreak at all! During the 4-month outbreak and response period, approximately 5600 contacts in Gulu District were under surveillance for 21 days by approximately 150 trained volunteers.
schrodingersCat 12y ago
I hate to be the cynical one here, but the countries with the power to stop this outbreak aren't going to start taking it seriously until more people from western nations start dying. It is true, it will be really bad if it is not stopped soon. Containing an outbreak of >5000 is out of the reach of most of the states affected by the disease and quite honestly very expensive for any nation. Once this spreads closer to Europe, watch people start to take more action. I hope it won't be too late
- s4sharpie 12y ago
  There are massive global political ramifications that restrict the ability of those countries that do want to make a difference. As the article refers to, it is ultimately the UN that has the powers to essentially trample on a country's sovereignty (that is what you need to do to make a difference). The UN has been called a toothless tiger in many respects - this is another example where they can and should take a more proactive and aggressive stance. Only then can we comment on the actions of other Western nations. The way that South Africa dealt with their AIDs epidemic (from a western perspective, true head in sand activity) is a case in point: despite many aggressive offers of help from western governments, the South African's continued their denial. To make a change would have required going against the government policy of the time. This is viewed legally as an invasion by an outside force.
  - joe_the_user 12y ago
    I am not sure what relation your (or the article's) talk of trampling sovereignty has to do with the present situation on the ground. The articles I read describe the problematic issues being; a lack of running water in existing clinics, a lack of medical supplies, a lack of clinics and notably a lack of food everywhere - patients are escaping isolation in efforts to find food. Liberian officials have pleaded for help in fairly abject terms (one official mentioned the possibly of nation ceasing to exist - I think that means they're worried). The details of what Western nations have done so far is fuzzy but it seems like there not been a sufficient rush to deliver these acutely needed supplies. Sure, once the existing clinics have food, supplies and running water, parachuted in field clinics sound grand. There's no evidence I've seen that the Liberians would refuse these.
phkahler 12y ago
http://www.telegraph.co.uk/news/worldnews/europe/france/10847344/Jean-Marie-Le-Pen-Ebola-epidemic-would-solve-immigration-problems.html http://www.telegraph.co.uk/news/worldnews/europe/france/1084... I'm afraid some people either think this is a game, or just an opportunity - since most of the worlds problems today stem from overpopulation.
- jnbiche 12y ago
  >since most of the worlds problems today stem from overpopulation Why do you think that most of the world's problems today stem from overpopulation? What problems? If you're talking about hunger, that's demonstrably false. There is plenty of food produced to feed the entire population. Even African produces plenty of food to feed itself. Famine occurs in times of war and natural disaster, or other great upheavals. Most of the causes are man-made and have nothing to do with overpopulation.
  - fractallyte 12y ago
    > What problems? Uh - collapsing ecosystems? More to the point, encroachment of humans into wilderness areas which harbor viruses? The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future.
    - jnbiche 12y ago
      >encroachment of humans into wilderness areas... ...has nothing to do with overpopulation and everything to do with tragedy of the commons and destructive corporations. Brazil's rainforests would be cut down regardless of what the population of Brazil was. >The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future. And it's stunning to see the charge of "mindless consumption" being thrown at areas with the highest population growth like Africa, when their rates of energy and food consumption cannot even compare to those in the developed world. They're miniscule [1][2]. 1. http://en.wikipedia.org/wiki/List_of_countries_by_energy_consumption_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_energy_con... 2. http://en.wikipedia.org/wiki/List_of_countries_by_food_energy_intake http://en.wikipedia.org/wiki/List_of_countries_by_food_energ...
deleted 12y ago
[deleted]
- tokenadult 12y ago
  The Mercola website is absolutely unreliable on just about any medical topic. The article, alas, is par for the course, and it deserves no reading from participants on Hacker News. Here's a link to a criticism of a related mistaken point of view on the Mercola website. http://www.sciencebasedmedicine.org/swine-flu-vaccine-fearmongering/ http://www.sciencebasedmedicine.org/swine-flu-vaccine-fearmo...
tokenadult 12y ago
The author of the article kindly submitted here, which I found quite interesting and informative, notes that she used to write for the Center for Infectious Disease Research and Policy (CIDRAP) based at my alma mater university. Sure enough, CIDRAP has its own current write-up on ebola[1] that is a good supplement to the information in the Wired article we are discussing here. "The possibility of an airborne-transmissible Ebola virus is one 'that virologists are loath to discuss openly but are definitely considering in private,' wrote Osterholm. In its current form, the virus spreads only through contact with bodily fluids, he noted, but with more human transmission in the past few months than probably occurred in the past 500 years, the virus is getting plenty of chances to evolve." The current rather high rate of transmission of the disease from one patient to another is alarming, and is perhaps preventable by better public-health practices aided by significant overseas funding, but if the virus haphazardly mutates into a form that spreads though more modes of transmission while still being as lethal, the world is in for a very severe challenge. As it is, the predicted number of cases by the end of the year will overwhelm several countries in the region where ebola is now spreading. [1] http://www.cidrap.umn.edu/news-perspective/2014/09/experts-raise-specter-more-contagious-ebola-virus http://www.cidrap.umn.edu/news-perspective/2014/09/experts-r...
- rdtsc 12y ago
  How hard is it to predict (if possible at all) the mutation based on the virus type and particular strain (maybe somehow computationally simulate or mutate it) ? In general do mutations follow probability distributions that are known? And then let's say someone wanted to cause mutations that would make it airborne. Could they do it?
  - alexbecker 12y ago
    I have to imagine that the answer to all those questions is "no". There are simply too many variables at play, and poorly understood ones at that.
  - tstactplsignore 12y ago
    >In general do mutations follow probability distributions that are known? In some ways, yes. Substitution matrices[0] describe how likely it is for an amino acid to mutate into another amino acid. However, they are generalized descriptors. At the same time, PWMs[1] describe how the probability of any given variant (mutation) is in a specific sequence, and are created by analyzing all known homologs (similar sequences) of that sequence. However, the number of mutations required for a virus which is incapable of becoming airborne is probably large and definitely unknown. I'm not an expert in virology, but I believe that there are two requirements for a pathogen to become airborne: A. It must infect and replicate in an area of the body capable of generating aerosols (generally, the respiratory system, like Influenza and Tuberculosis). B. It must be good at surviving in aerosols- I believe this requires specific environmental adaptations and the right surface proteins and sugars. I believe that Ebola meets neither requirement (especially the first), and you could see how meeting both would require not just large physical adaptation, but also a complete change in the virus' life cycle in the host. >And then let's say someone wanted to cause mutations that would make it airborne. Could they do it? I think in general it would be easier to start with an airborne virus, and make it deadlier. I'm not an expert but this BBC article[2] quotes that a deadly virus has never been observed to change their vector of infection. 0. http://en.wikipedia.org/wiki/Substitution_matrix http://en.wikipedia.org/wiki/Substitution_matrix 1. http://en.wikipedia.org/wiki/Position_weight_matrix http://en.wikipedia.org/wiki/Position_weight_matrix 2. http://www.bbc.com/news/blogs-echochambers-29168905 http://www.bbc.com/news/blogs-echochambers-29168905
FollowSteph3 12y ago
My fear is that we're not able to stop a simple stomach flu which is spread almost the same way, through bodily liquids, so I don't think it will be easy to stop once it hits first world countries like most people currently assume...
- pyre 12y ago
  Wait a minute, when was the last time that the stomach flu was an epidemic?
  - maxerickson 12y ago
    It's frequently a public health issue. Once in a while a school will just close for a few days. Not the same ramifications as Ebola though.
  - rst 12y ago
    The last flu epidemic with a major death toll was the pandemic of 1918, which is estimated to have killed more people than World War I. A less deadly version of the same strain was officially listed as an epidemic in 2009.
    - Pxtl 12y ago
      Stomache flu, which is the symptom gastroenteritis, is unrelated to influenza. It's a misnomer. So the Spanish Flu is not a good example here. And to the point, we've never successfully "beat" GI because the stakes were never this high.
  - swombat 12y ago
    Every winter in England there are reports of the "winter vomiting bug" aka norovirus, and people have a fair (double digits) chance of getting it. From memory over the last ten years I've caught that unpleasant virus a handful of times. It is easily spread by sick people touching things (eg handle bars in the tube) which you then touch, before touching something that goes into your mouth. If Ebola came to the uk without major changes in behaviour it would likely infect millions of active, young people via London.
aaron695 12y ago
I find it interesting that people worry about Ebola going airborne but not something like AIDS. I guess there's a biological reason....
- aianus 12y ago
  Ebola kills 90% of its victims in a matter of weeks while the life expectancy for someone with HIV in the first world is almost the same as anyone else [1] [1] http://www.aidsmeds.com/articles/life_expectancy_1667_24972.shtml http://www.aidsmeds.com/articles/life_expectancy_1667_24972....
  - tonyedgecombe 12y ago
    Ebola hasn't been killing 90% of its victims in the current outbreak, that figure comes from a particular outbreak some years ago.
- huherto 12y ago
  I think the fact that AIDS has not going airborne in 30 years is very good news. But eboloa is different, we don't how easily it will become airborne.
- nostromo 12y ago
  Because Ebola has already been shown to be transmissible via the air, but only in other species. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/ > Piglets [with Ebola] were transferred to the room housing macaques in an open inaccessible cage system. All macaques became infected.
  - techdragon 12y ago
    Dont overstate this particular study, the team did nothing to eliminate the possibility that there was transmission via droplets flung off the animal, and did not fully eliminate the possibility of particulate cross contamination which could have lead to transmission via infectious fluids piggybacking to the macaques on the particulate cross contamination. Yes there is a risk of mutation to transmit via air, but we have not yet seen it. We have merely proven that 'shit happens' and 'ebola is dangerous'.
ChuckMcM 12y ago
Going 'meta' for a moment, this is a tragedy of huge proportions, the question I have been considering is whether or not it is even possible to avoid? Updates from MSF which highlight the level of mistrust and superstition amongst the infected population, where people hide their sick relatives from isolation wards and take them back to their village. We cannot exactly put a giant fence around the place (and not that this would be a reasonable goal anyway). Do we invade these countries and force our will on them in order to prevent a humanitarian tragedy? What gives us that right? What gives anyone that right? To someone who is not sick, forcing them from their village, for forcing them to stay in their village violates their basic human rights, and yet it is for their own good, but if they don't believe that, what moral authority allows us to overrule that belief? As you can see I struggle with the challenge of imposing a solution on these people, knowing that without aggressive actions tens of thousands, perhaps hundreds of thousands of them will die. While explaining to someone who doesn't understand the virus, or the danger, who undergoes forced relocation to a quarantine camp and is never sick during the outbreak, that they were in very real danger from this thing they do not believe in.
- maxerickson 12y ago
  This episode of Frontline is informative as to the situation: http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/ http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/
  - davesque 12y ago
    Yeah...it's heart breaking. One of the people interviewed in that episode died after it was filmed. And, of course, there will be thousands more like him.
- lotsofmangos 12y ago
  "what moral authority allows us to overrule that belief?" Statistics on mortality.
  - Afforess 12y ago
verroq 12y ago
Good luck Ebola-chan!
deleted 12y ago
[deleted]
- icegreentea 12y ago
  ClO2 can be used to carve out safe zones at best. It could definitely be used to control airborne transmission in hospital, or other controlled, high risk settings - but it fundamentally is not a cure. We cannot simply fumigate entire cities at 0.3ppm for weeks at a time until an outbreak dies out. Other means will always be needed. And as a nice aside, here's a nice paper about ClO2 use to control flu form a Japanese pharmaceutical company, referencing amongst other things one of their products that acts as a stable low level ClO2 gas generator. http://benthamopen.com/toantimj/articles/V002/SI0008TOANTIMJ/71TOANTIMJ.pdf http://benthamopen.com/toantimj/articles/V002/SI0008TOANTIMJ...
  - XorNot 12y ago
    All of which is irrelevant in places where there isn't reliable electricity, roads, supplies of precursors or a population who won't believe you're actually affecting chemical warfare on them. Taking a short dip into the chemtrails-nuts in the west should convince you how well this would go over. Ebola is fundamentally a result of a myriad of causes, where "poverty" would be a headlining one (followed shortly by corruption and ineffective governance).
  - VLM 12y ago
    "We cannot simply fumigate entire cities at 0.3ppm for weeks at a time until an outbreak dies out." It would be interesting to see the natural selection effect on other things, both primary like killing off something beneficial-ish and secondary like wiping out a niche which is then re-populated by something tough that is ClO2-proof. The tertiary effect would be most interesting. Imagine if you could kill ever garbage eating plague rat during the black plague era... and then after the plague burns out, all of the rats come back all at once and hyper over populate eating a years worth of garbage and debris in a month.
- gizmo686 12y ago
  Chlorine Dioxide falls into the category of ways to kill a virus that will also kill us. Your second source argues that it is effective at levels "below the long-term permissible exposure level to humans, namely 0.1 p.p.m.", but I would imagine there are still health concerns to using this method. Additionally, that figure is the needed concentration to control the influenza virus (in mice), it is not clear how well this number generalizes to other viruses. While it is nice to have a worst case scenario plan, I suspect the reason the CDC isn't testing it is because they do not believe we will be in a situation where using it is better then the alternative. If we were in a situation where Chlorine Dioxide was a good idea, I suspect even the pharmaceutical companies would be supportive.
jtolds 12y ago
Just for those of you wondering somewhat about the risks of Ebola becoming airborne - it has been shown to be transferred without contact before: http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112 http://healthmap.org/site/diseasedaily/article/pigs-monkeys-...
mjn 12y ago
The article this Wired post is mostly reblogging is quite a bit better imo, at least in having a higher ratio of facts to commentary: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2...
- Crito 12y ago
  Seriously, what utter crap: http://www.wired.com/wp-content/uploads/2014/09/Nishiura-curves.jpg http://www.wired.com/wp-content/uploads/2014/09/Nishiura-cur... Did they seriously screenshot that image with a tooltip up?
IvyMike 12y ago
I had a discussion with a friend, and he pointed out that Malaria infects something like 200 million people a year in Africa, and kills around half a million. It's brutal. So this new paper is projecting that Ebola deaths in Africa will be about as common as Malaria deaths. I guess I'm trying to draw any conclusions or imply anything here other than life in Africa is pretty freakin' tough.
- baddox 12y ago
  > So this new paper is projecting that Ebola deaths in Africa will be about as common as Malaria deaths. Unless the diseases start "competing" with each other. You can't really die of both. I don't know if the demographics of the two diseases overlap enough that this might happen.
- gizmo686 12y ago
  The two main differences I see are: 1) The Ebola death rate is still increasing, which makes it scarier that Malaria, which has a relativly stable death rate. 2) Malaria (being tied to mosquitoes) is inherently a regional disease. Ebola has much more potential to spread to other regions.
- ohitsdom 12y ago
  The most important difference is that a Malaria-infected person isn't contagious.
deleted 12y ago
[deleted]
privong 12y ago
> in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. I have seen this several places over the past week or two – is it actually true that people who survive Ebola are not at risk of re-infection? I can see where that might be true shortly after recovery (i.e., due to there still being antibodies in one's system), but how long would the immunity last?
- philsnow 12y ago
  Antibodies generally last a very long time [citation needed], but would they be useful against such a rapidly-changing pathogen ?
  - privong 12y ago
    > but would they be useful against such a rapidly-changing pathogen ? Does that explain why people are not immune from the flu after having it once – the version they have antibodies to is not the same as the mutated version which circulates later?
    - dreamcompiler 12y ago
      Yes. This is why you have to get a flu shot every year: The flu virus is different every year. The same rapid-mutation phenomenon happens with the so-called "common" cold: Having a cold once provides no immunity to prevent you from getting one again.
    - learc83 12y ago
      >Does that explain why people are not immune from the flu after having it once Yes. There are many strains of Influenza, immunity to one strain doesn't necessarily confer any immunity to another strain. However, Ebola mutates much less rapidly that Influenza.
  - learc83 12y ago
    Ebola isn't rapidly changing. At least in comparison to a virus that does mutate rapidly like influenza.
msie 12y ago
How does the world's response to Indonesia, Haiti compare to this? Do we need some celebrities to put on a telethon to get more nations acting AND acting immediately on this?
ihnorton 12y ago
Doctors Without Borders/Médecins Sans Frontières (MSF) is on the ground and is one of the most effective ways to directly support efforts to aid Ebola victims and stop the spread (disclosure: I just donated): https://donate.doctorswithoutborders.org https://donate.doctorswithoutborders.org The health systems in these countries were already overwhelmed and under-resourced long before Ebola broke out, and the international governmental response has so far been alarmingly tepid. Recent AmA with an MSF doctor: http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doctors_without_borders_ask_me/ http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doct... Note that MSF has an excellent efficiency rating (~87% of revenue goes to program expenses, 11% to fundraising): http://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=3628#.VBZqlHWx3UY http://www.charitynavigator.org/index.cfm?bay=search.summary...
DanielBMarkham 12y ago
Time to face some brutal facts here. 1) We are due for another pandemic. If this one isn't it, there will be another. 2) Democracies run on public opinion. Right now everybody is riled up about some homicidal idiots in Iraq. This is off their radar. Hundreds of thousands of people die from some natural cause or another all of the time. It's not a huge spectacle on YouTube. 3) The enemy really isn't Ebola. Ebola is just the opportunistic pathogen that came along. The enemy is really weak governments with little or no public health systems, combined with very poor local sanitation practices. 4) There was a time when air-dropping in a thousand healthworkers with tent hospitals might have stopped this. That time is over. Now it's in the big city, and trying to control or service a population of several hundred thousand is beyond most any country's ability to project intervention. 5) If it doesn't go airborne and stay lethal, which is where the safe money currently is, we'll end up with hundreds of thousands or millions dead and it should burn itself out over the next year or two. That's the optimistic scenario. We have no reason not to believe that's the way it's going to play out. 6) If it goes airborne and stays lethal, we're in for a major shitstorm. But I really don't think second-guessing how we responded will be useful. There are different countries in the world. They have different governments. We do not have one world government, nor do most of us want one. That means that there are always going to be large pockets of humanity where something like this can take off. Structurally humanity is huge. Disease is going to be an issue for us for a long time.
- philh 12y ago
  > We are due for another pandemic. What do you mean by this?
- jplewicke 12y ago
  Saying that we're due for another pandemic is quite simply the gambler's fallacy: http://en.wikipedia.org/wiki/Gambler's_fallacy http://en.wikipedia.org/wiki/Gambler's_fallacy . The odds of a pandemic may well be higher than recent experience would indicate, but pandemics still occur randomly.
quarterwave 12y ago
I searched for R_0 data on flu pandemics and found this: http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pandemic_influenza_pandemics_of_influenza.pdf http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pan... Note the sharp jump as R_0 goes from sub-2 to over-2, which should not be surprising (hand wave about branch processes, light of a thousand suns, etc). Over to someone better qualified to comment - is the present situation with Ebola taking us into a pandemic territory similar to 1918 H1N1?
vfclists 12y ago
This seems to be the usual knee jerk military can solve everything response you would expect from Americans, and also African governments who are always eager for handouts from Western governments. So you want to send the military in? Do you have any idea of the size of the area in which you would have to deploy them, coupled with the panic their presence might cause, together with the issues which would be caused by militia factions which would inevitably arise to tackle what they would rightfully see as an invasion of their countries? What did the UN manage to do after the Haitian earthquake that the Haitians couldn't have done themselves, besides introducing cholera to the region and nearby countries? What African countries need to do is what they would have to do if there was no possibility of outside support. In this case it is not even a question of central government intervention when it is more a question of dealing with Ebola at the local level or county / village level. Moving infected people to centralized locations for treatment means more travel and the possibly infected relatives and carers for the ill spreading the disease more, unless they are transported by specialist units. The process of travelling to report an infection and calling for a specialist unit itself carries the risk of the traveller spreading the disease let alone the person with the symptoms. The only way to contain Ebola is to give the families or communities of infected people the knowledge, the drugs, the equipment and the protective clothing to they need to treat themselves and the economic support they will need when they are isolated, which needs to be done at a local level. That means sustained public education via television and video, protective clothing for carers and disease detection kits.
rwallace 12y ago
I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while, it even looked as though it had worked. Unfortunately, it didn't, by a long shot. Now WHO and MSF want to repeat that strategy on a much larger scale. My opinion is that this is a very bad idea. The epidemic in West Africa not going to be stopped. That window of opportunity closed months ago, if it was ever open. If we send in thousands of doctors now, a large percentage of them will end up dead, and the epidemic still won't be stopped. It will be a waste of life, and at that, of the lives of trained doctors and nurses who will be all too soon and badly needed if the epidemic does start hitting other regions where the outcome would still be in doubt. And no, sending in the military is not the answer. Not only does "it's for your own good" not morally justify aggression, but by further eroding the trust of the local population for authority in general and foreigners in particular, it would make matters worse, not better. The affected area needs to be sealed off so the disease can't spread to the rest of Africa and the rest of the world. By all means airdrop medical supplies to Liberia, but don't for heaven's sake start sending hordes of doctors, soldiers and camp followers there to create more fodder for the virus.
- JulianMorrison 12y ago
  A cordon sanitaire won't work. You're betting against the ingenuity of every single person trapped behind it, and the inevitable infected refugees are very motivated to confound efforts to find them.
  - rwallace 12y ago
    No, I'm betting the world's medical resources can contain the occasional small outbreak created by the occasional individual who gets past the cordon, particularly since such containment doesn't have to last forever. You can't put out an inferno, but you can put out scattered sparks.
JulianMorrison 12y ago
> In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014. What I wonder is: why do they think it will stop? What's going to put a brake on the epidemic's explosion? This is not a world where a disease can burn itself out on the local level by simply killing everyone susceptible.
wmgries 12y ago
I'm no expert and I'm just as frightened by the spread of this disease as everyone else, but I think people in this thread, and the media in general, are being a tad "end-of-the-world"-y about this without looking at some of the important facts. Namely: 1) The article mentions the R0 of Ebola and claims it is between 1-2 in the current outbreak. Previous outbreaks of Ebola have been as high as 2.7. But this is relatively low compared to other diseases... the R0 of the Measles for instance is 12-18 (and nobody is really talking about the recent outbreaks in the US due to parents not vaccinating their children). Chances are, this rate would even be lower in the West because conditions in African slums and even hospitals are downright deplorable. Doctors aren't using suits or even gloves to examine patients, medical staff are reusing disposable needles, hospitals rely on family members to wash soiled linens because they don't have in-house cleaning services like western hospitals, etc. And don't forget that cultural norms are feeding the spread of the disease: well family members are observed to be sharing beds with sick loved ones in hospitals, people are practicing cultural burial routines of washing and in some cases kissing deceased loved ones, people are still eating the meat of things like bats and gorillas that are sick with the virus (and even found dead), etc. These are all things that just wouldn't happen in the West. People also do much better here at heeding the advice of the medical professionals - for instance, bodies of people who had died of Ebola would like be burned without concern for any regular traditions, without much complaint. 2) Part of the reason Ebola is so scary is the high fatality rate cited in articles: 50-90%. If you extrapolate to the entire planet, this sounds like it would be devastating to the human race. But is this the actual fatality rate? Western hospitals do a much better job of carefully monitoring patients and tending to every minor development. The main problem with Ebola isn't that the body can't fight it, it's that it kills you before your body can recover - the drastic difference in care between the West and Africa would likely make a huge difference in mortality. Make no mistake, this is a deadly disease, but probably not quite as bad as 50-90% in the West. 3) This article and others like it have shared the concern that Ebola could mutate into something transmissible by air. This would make the R0 of the disease skyrocket up into something that could quickly overwhelm Western medicine and very rapidly turn into something perhaps even more devastating than the plague. It's possible of course the virus could mutate in this way, of course, it's already believed that it can spread like this in pigs. One important thing to recognize is that Ebola in humans affects the liver not the lungs, which poses a barrier to being airborne. In addition, to become truly airborne, the virus would have to mutate it's outer coating to resist the drying effect of the air. So in order to become transmissible by air, it would have to mutate 2 different major adaptations and completely change everything about itself. The example I've read is that we don't worry about HIV becoming transmissible by air, and it is thought to mutate more quickly than Ebola. We've never observed any deadly virus change it's method of delivery, although of course airborne diseases evolved that adaptation in the first place. None of these points mean we should sit back and do nothing. We need to help at minimum because of the following reasons: 1) People are dying and we can help them. With effective medical care, the mortality rate as mentioned in point 2 above should go down. 2) Ebola is destabilizing the region. This is already a region prone to state failure, corrupt and ruthless governments, etc. This disease could well cause wars in Africa, which in turn would make conditions worse and likely increase the fatality rate and the infection rate. 3) While there is a reasonable scientific case to be made against the unlikelihood of the mutation of the virus into airborne transmissible, it's possible and very scary. When considering the risks, we need to multiply the rather small chance against the rather large negative effect of such a change. We need to stop this to avoid this thing from becoming more deadly.
chestnut-tree 12y ago
If you're in the UK, there's an informative BBC documentary on Ebola broadcast just last week. The programme talks to survivors of the virus, to the staff of Médecins Sans Frontières (MSF) treating victims, to Peter Piot, the Belgian doctor who discovered the virus (and established that the disease was not airborne) and the medical staff seeking a cure. There are some harrowing scenes. It's available on iPlayer until Friday 19 Sept. 2014 http://www.bbc.co.uk/iplayer/episode/b04hcthj/ http://www.bbc.co.uk/iplayer/episode/b04hcthj/ Someone's uploaded it to YouTube, although the last 10 minutes are missing https://www.youtube.com/watch?v=bjuQofIleOg https://www.youtube.com/watch?v=bjuQofIleOg

205 points by 0cool 12y ago

Pxtl 12y ago

This should be obvious to anybody who knows about geometric growth. The only time you can really stop Ebola without a cheap and easily-available cure is now while it's small. As it grows, its rate of growth will increase, and it will quickly spread to every vulnerable area.

aaron695 12y ago
< As it grows, its rate of growth will increase No, R will stay the same. Or decrease as the population becomes more exposed.
- wcoenen 12y ago
  He's taking about the number of people infected per unit of time, which will indeed increase over time if the reproductive number stays larger than 1.
  - biot 12y ago
    Growth is number of people per unit time. Rate of growth is number of people per unit time squared. Just as with speed vs. acceleration, there certainly is a distinction.
    - wcoenen 12y ago
      I'm not a native speaker so I could be wrong. But in the wikipedia article about exponential growth, "growth rate" is defined as the first derivative with respect to time, which contradicts what you are saying: https://en.wikipedia.org/wiki/Exponential_growth#Differential_equation https://en.wikipedia.org/wiki/Exponential_growth#Differentia... I understand the distinction you are trying to make, but I think what you call "growth rate" would actually be "growth acceleration".
- gbrown 12y ago
  Actually R0 is a measure which captures both population mixing activity and the infectiousness of the pathogen - the two processes are confounded. That means that it varies a lot over space and time.

hollerith 12y ago

Informative graph: http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png

StephanTLavavej 12y ago
The log graph is scarier: https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolution_of_the_2014_Ebola_outbreak_in_semiLog_plot..png https://upload.wikimedia.org/wikipedia/commons/2/2d/Evolutio... (It's easier to recognize a straight line on a log scale, than to distinguish an exponential line on a linear scale from a line that's "merely" quadratic, say.)
- csdrane 12y ago
  What do similar charts for prior outbreaks like?
  - maxerickson 12y ago
    There's never been more than 500 cases: http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks
  - throwaway_yy2Di 12y ago
    Here's one of the previous largest outbreak, 2000-2001 in Uganda. (Note unlike the Wikipedia one, it's not cumulative). Looks like a sudden decline in new cases right after a CDC intervention -- very sharp inflection point. The cumulative version would be roughly a sigmoid. http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%20Libby%20Burch/images/LassaEbolaMarburg_LibbyBurch_3-8-2012_img_19.png http://web.stanford.edu/group/parasites/ParaSites2012/Lassa%... http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm Looks like there were about 10 new cases/day at its peak; the current outbreak is at 150/day. A couple things stood out to me: Fourteen (64%) of 22 health-care workers in Gulu were infected after establishing the isolation wards; these incidenses led to the reinforcement of infection-control measures. So that's not novel to the current outbreak at all! During the 4-month outbreak and response period, approximately 5600 contacts in Gulu District were under surveillance for 21 days by approximately 150 trained volunteers.

schrodingersCat 12y ago

I hate to be the cynical one here, but the countries with the power to stop this outbreak aren't going to start taking it seriously until more people from western nations start dying. It is true, it will be really bad if it is not stopped soon. Containing an outbreak of >5000 is out of the reach of most of the states affected by the disease and quite honestly very expensive for any nation. Once this spreads closer to Europe, watch people start to take more action. I hope it won't be too late

s4sharpie 12y ago
There are massive global political ramifications that restrict the ability of those countries that do want to make a difference. As the article refers to, it is ultimately the UN that has the powers to essentially trample on a country's sovereignty (that is what you need to do to make a difference). The UN has been called a toothless tiger in many respects - this is another example where they can and should take a more proactive and aggressive stance. Only then can we comment on the actions of other Western nations. The way that South Africa dealt with their AIDs epidemic (from a western perspective, true head in sand activity) is a case in point: despite many aggressive offers of help from western governments, the South African's continued their denial. To make a change would have required going against the government policy of the time. This is viewed legally as an invasion by an outside force.
- joe_the_user 12y ago
  I am not sure what relation your (or the article's) talk of trampling sovereignty has to do with the present situation on the ground. The articles I read describe the problematic issues being; a lack of running water in existing clinics, a lack of medical supplies, a lack of clinics and notably a lack of food everywhere - patients are escaping isolation in efforts to find food. Liberian officials have pleaded for help in fairly abject terms (one official mentioned the possibly of nation ceasing to exist - I think that means they're worried). The details of what Western nations have done so far is fuzzy but it seems like there not been a sufficient rush to deliver these acutely needed supplies. Sure, once the existing clinics have food, supplies and running water, parachuted in field clinics sound grand. There's no evidence I've seen that the Liberians would refuse these.

phkahler 12y ago

http://www.telegraph.co.uk/news/worldnews/europe/france/10847344/Jean-Marie-Le-Pen-Ebola-epidemic-would-solve-immigration-problems.html http://www.telegraph.co.uk/news/worldnews/europe/france/1084... I'm afraid some people either think this is a game, or just an opportunity - since most of the worlds problems today stem from overpopulation.

jnbiche 12y ago
>since most of the worlds problems today stem from overpopulation Why do you think that most of the world's problems today stem from overpopulation? What problems? If you're talking about hunger, that's demonstrably false. There is plenty of food produced to feed the entire population. Even African produces plenty of food to feed itself. Famine occurs in times of war and natural disaster, or other great upheavals. Most of the causes are man-made and have nothing to do with overpopulation.
- fractallyte 12y ago
  > What problems? Uh - collapsing ecosystems? More to the point, encroachment of humans into wilderness areas which harbor viruses? The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future.
  - jnbiche 12y ago
    >encroachment of humans into wilderness areas... ...has nothing to do with overpopulation and everything to do with tragedy of the commons and destructive corporations. Brazil's rainforests would be cut down regardless of what the population of Brazil was. >The biggest 'man-made' issue here is more 'man': mindless reproduction and consumption without any regard to the future. And it's stunning to see the charge of "mindless consumption" being thrown at areas with the highest population growth like Africa, when their rates of energy and food consumption cannot even compare to those in the developed world. They're miniscule [1][2]. 1. http://en.wikipedia.org/wiki/List_of_countries_by_energy_consumption_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_energy_con... 2. http://en.wikipedia.org/wiki/List_of_countries_by_food_energy_intake http://en.wikipedia.org/wiki/List_of_countries_by_food_energ...

deleted 12y ago

[deleted]

tokenadult 12y ago
The Mercola website is absolutely unreliable on just about any medical topic. The article, alas, is par for the course, and it deserves no reading from participants on Hacker News. Here's a link to a criticism of a related mistaken point of view on the Mercola website. http://www.sciencebasedmedicine.org/swine-flu-vaccine-fearmongering/ http://www.sciencebasedmedicine.org/swine-flu-vaccine-fearmo...

tokenadult 12y ago

The author of the article kindly submitted here, which I found quite interesting and informative, notes that she used to write for the Center for Infectious Disease Research and Policy (CIDRAP) based at my alma mater university. Sure enough, CIDRAP has its own current write-up on ebola[1] that is a good supplement to the information in the Wired article we are discussing here. "The possibility of an airborne-transmissible Ebola virus is one 'that virologists are loath to discuss openly but are definitely considering in private,' wrote Osterholm. In its current form, the virus spreads only through contact with bodily fluids, he noted, but with more human transmission in the past few months than probably occurred in the past 500 years, the virus is getting plenty of chances to evolve." The current rather high rate of transmission of the disease from one patient to another is alarming, and is perhaps preventable by better public-health practices aided by significant overseas funding, but if the virus haphazardly mutates into a form that spreads though more modes of transmission while still being as lethal, the world is in for a very severe challenge. As it is, the predicted number of cases by the end of the year will overwhelm several countries in the region where ebola is now spreading. [1] http://www.cidrap.umn.edu/news-perspective/2014/09/experts-raise-specter-more-contagious-ebola-virus http://www.cidrap.umn.edu/news-perspective/2014/09/experts-r...

rdtsc 12y ago
How hard is it to predict (if possible at all) the mutation based on the virus type and particular strain (maybe somehow computationally simulate or mutate it) ? In general do mutations follow probability distributions that are known? And then let's say someone wanted to cause mutations that would make it airborne. Could they do it?
- alexbecker 12y ago
  I have to imagine that the answer to all those questions is "no". There are simply too many variables at play, and poorly understood ones at that.
- tstactplsignore 12y ago
  >In general do mutations follow probability distributions that are known? In some ways, yes. Substitution matrices[0] describe how likely it is for an amino acid to mutate into another amino acid. However, they are generalized descriptors. At the same time, PWMs[1] describe how the probability of any given variant (mutation) is in a specific sequence, and are created by analyzing all known homologs (similar sequences) of that sequence. However, the number of mutations required for a virus which is incapable of becoming airborne is probably large and definitely unknown. I'm not an expert in virology, but I believe that there are two requirements for a pathogen to become airborne: A. It must infect and replicate in an area of the body capable of generating aerosols (generally, the respiratory system, like Influenza and Tuberculosis). B. It must be good at surviving in aerosols- I believe this requires specific environmental adaptations and the right surface proteins and sugars. I believe that Ebola meets neither requirement (especially the first), and you could see how meeting both would require not just large physical adaptation, but also a complete change in the virus' life cycle in the host. >And then let's say someone wanted to cause mutations that would make it airborne. Could they do it? I think in general it would be easier to start with an airborne virus, and make it deadlier. I'm not an expert but this BBC article[2] quotes that a deadly virus has never been observed to change their vector of infection. 0. http://en.wikipedia.org/wiki/Substitution_matrix http://en.wikipedia.org/wiki/Substitution_matrix 1. http://en.wikipedia.org/wiki/Position_weight_matrix http://en.wikipedia.org/wiki/Position_weight_matrix 2. http://www.bbc.com/news/blogs-echochambers-29168905 http://www.bbc.com/news/blogs-echochambers-29168905

FollowSteph3 12y ago

My fear is that we're not able to stop a simple stomach flu which is spread almost the same way, through bodily liquids, so I don't think it will be easy to stop once it hits first world countries like most people currently assume...

pyre 12y ago
Wait a minute, when was the last time that the stomach flu was an epidemic?
- maxerickson 12y ago
  It's frequently a public health issue. Once in a while a school will just close for a few days. Not the same ramifications as Ebola though.
- rst 12y ago
  The last flu epidemic with a major death toll was the pandemic of 1918, which is estimated to have killed more people than World War I. A less deadly version of the same strain was officially listed as an epidemic in 2009.
  - Pxtl 12y ago
    Stomache flu, which is the symptom gastroenteritis, is unrelated to influenza. It's a misnomer. So the Spanish Flu is not a good example here. And to the point, we've never successfully "beat" GI because the stakes were never this high.
- swombat 12y ago
  Every winter in England there are reports of the "winter vomiting bug" aka norovirus, and people have a fair (double digits) chance of getting it. From memory over the last ten years I've caught that unpleasant virus a handful of times. It is easily spread by sick people touching things (eg handle bars in the tube) which you then touch, before touching something that goes into your mouth. If Ebola came to the uk without major changes in behaviour it would likely infect millions of active, young people via London.

aaron695 12y ago

I find it interesting that people worry about Ebola going airborne but not something like AIDS. I guess there's a biological reason....

aianus 12y ago
Ebola kills 90% of its victims in a matter of weeks while the life expectancy for someone with HIV in the first world is almost the same as anyone else [1] [1] http://www.aidsmeds.com/articles/life_expectancy_1667_24972.shtml http://www.aidsmeds.com/articles/life_expectancy_1667_24972....
- tonyedgecombe 12y ago
  Ebola hasn't been killing 90% of its victims in the current outbreak, that figure comes from a particular outbreak some years ago.
huherto 12y ago
I think the fact that AIDS has not going airborne in 30 years is very good news. But eboloa is different, we don't how easily it will become airborne.
nostromo 12y ago
Because Ebola has already been shown to be transmissible via the air, but only in other species. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498927/ > Piglets [with Ebola] were transferred to the room housing macaques in an open inaccessible cage system. All macaques became infected.
- techdragon 12y ago
  Dont overstate this particular study, the team did nothing to eliminate the possibility that there was transmission via droplets flung off the animal, and did not fully eliminate the possibility of particulate cross contamination which could have lead to transmission via infectious fluids piggybacking to the macaques on the particulate cross contamination. Yes there is a risk of mutation to transmit via air, but we have not yet seen it. We have merely proven that 'shit happens' and 'ebola is dangerous'.

ChuckMcM 12y ago

Going 'meta' for a moment, this is a tragedy of huge proportions, the question I have been considering is whether or not it is even possible to avoid? Updates from MSF which highlight the level of mistrust and superstition amongst the infected population, where people hide their sick relatives from isolation wards and take them back to their village. We cannot exactly put a giant fence around the place (and not that this would be a reasonable goal anyway). Do we invade these countries and force our will on them in order to prevent a humanitarian tragedy? What gives us that right? What gives anyone that right? To someone who is not sick, forcing them from their village, for forcing them to stay in their village violates their basic human rights, and yet it is for their own good, but if they don't believe that, what moral authority allows us to overrule that belief? As you can see I struggle with the challenge of imposing a solution on these people, knowing that without aggressive actions tens of thousands, perhaps hundreds of thousands of them will die. While explaining to someone who doesn't understand the virus, or the danger, who undergoes forced relocation to a quarantine camp and is never sick during the outbreak, that they were in very real danger from this thing they do not believe in.

maxerickson 12y ago
This episode of Frontline is informative as to the situation: http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/ http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/
- davesque 12y ago
  Yeah...it's heart breaking. One of the people interviewed in that episode died after it was filmed. And, of course, there will be thousands more like him.
lotsofmangos 12y ago
"what moral authority allows us to overrule that belief?" Statistics on mortality.
- Afforess 12y ago

verroq 12y ago

Good luck Ebola-chan!

deleted 12y ago

[deleted]

icegreentea 12y ago
ClO2 can be used to carve out safe zones at best. It could definitely be used to control airborne transmission in hospital, or other controlled, high risk settings - but it fundamentally is not a cure. We cannot simply fumigate entire cities at 0.3ppm for weeks at a time until an outbreak dies out. Other means will always be needed. And as a nice aside, here's a nice paper about ClO2 use to control flu form a Japanese pharmaceutical company, referencing amongst other things one of their products that acts as a stable low level ClO2 gas generator. http://benthamopen.com/toantimj/articles/V002/SI0008TOANTIMJ/71TOANTIMJ.pdf http://benthamopen.com/toantimj/articles/V002/SI0008TOANTIMJ...
- XorNot 12y ago
  All of which is irrelevant in places where there isn't reliable electricity, roads, supplies of precursors or a population who won't believe you're actually affecting chemical warfare on them. Taking a short dip into the chemtrails-nuts in the west should convince you how well this would go over. Ebola is fundamentally a result of a myriad of causes, where "poverty" would be a headlining one (followed shortly by corruption and ineffective governance).
- VLM 12y ago
  "We cannot simply fumigate entire cities at 0.3ppm for weeks at a time until an outbreak dies out." It would be interesting to see the natural selection effect on other things, both primary like killing off something beneficial-ish and secondary like wiping out a niche which is then re-populated by something tough that is ClO2-proof. The tertiary effect would be most interesting. Imagine if you could kill ever garbage eating plague rat during the black plague era... and then after the plague burns out, all of the rats come back all at once and hyper over populate eating a years worth of garbage and debris in a month.
gizmo686 12y ago
Chlorine Dioxide falls into the category of ways to kill a virus that will also kill us. Your second source argues that it is effective at levels "below the long-term permissible exposure level to humans, namely 0.1 p.p.m.", but I would imagine there are still health concerns to using this method. Additionally, that figure is the needed concentration to control the influenza virus (in mice), it is not clear how well this number generalizes to other viruses. While it is nice to have a worst case scenario plan, I suspect the reason the CDC isn't testing it is because they do not believe we will be in a situation where using it is better then the alternative. If we were in a situation where Chlorine Dioxide was a good idea, I suspect even the pharmaceutical companies would be supportive.

jtolds 12y ago

Just for those of you wondering somewhat about the risks of Ebola becoming airborne - it has been shown to be transferred without contact before: http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112 http://healthmap.org/site/diseasedaily/article/pigs-monkeys-...

mjn 12y ago

The article this Wired post is mostly reblogging is quite a bit better imo, at least in having a higher ratio of facts to commentary: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2...

Crito 12y ago
Seriously, what utter crap: http://www.wired.com/wp-content/uploads/2014/09/Nishiura-curves.jpg http://www.wired.com/wp-content/uploads/2014/09/Nishiura-cur... Did they seriously screenshot that image with a tooltip up?

IvyMike 12y ago

I had a discussion with a friend, and he pointed out that Malaria infects something like 200 million people a year in Africa, and kills around half a million. It's brutal. So this new paper is projecting that Ebola deaths in Africa will be about as common as Malaria deaths. I guess I'm trying to draw any conclusions or imply anything here other than life in Africa is pretty freakin' tough.

baddox 12y ago
> So this new paper is projecting that Ebola deaths in Africa will be about as common as Malaria deaths. Unless the diseases start "competing" with each other. You can't really die of both. I don't know if the demographics of the two diseases overlap enough that this might happen.
gizmo686 12y ago
The two main differences I see are: 1) The Ebola death rate is still increasing, which makes it scarier that Malaria, which has a relativly stable death rate. 2) Malaria (being tied to mosquitoes) is inherently a regional disease. Ebola has much more potential to spread to other regions.
ohitsdom 12y ago
The most important difference is that a Malaria-infected person isn't contagious.

deleted 12y ago

[deleted]

privong 12y ago

> in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. I have seen this several places over the past week or two – is it actually true that people who survive Ebola are not at risk of re-infection? I can see where that might be true shortly after recovery (i.e., due to there still being antibodies in one's system), but how long would the immunity last?

philsnow 12y ago
Antibodies generally last a very long time [citation needed], but would they be useful against such a rapidly-changing pathogen ?
- privong 12y ago
  > but would they be useful against such a rapidly-changing pathogen ? Does that explain why people are not immune from the flu after having it once – the version they have antibodies to is not the same as the mutated version which circulates later?
  - dreamcompiler 12y ago
    Yes. This is why you have to get a flu shot every year: The flu virus is different every year. The same rapid-mutation phenomenon happens with the so-called "common" cold: Having a cold once provides no immunity to prevent you from getting one again.
  - learc83 12y ago
    >Does that explain why people are not immune from the flu after having it once Yes. There are many strains of Influenza, immunity to one strain doesn't necessarily confer any immunity to another strain. However, Ebola mutates much less rapidly that Influenza.
- learc83 12y ago
  Ebola isn't rapidly changing. At least in comparison to a virus that does mutate rapidly like influenza.

msie 12y ago

How does the world's response to Indonesia, Haiti compare to this? Do we need some celebrities to put on a telethon to get more nations acting AND acting immediately on this?

ihnorton 12y ago

Doctors Without Borders/Médecins Sans Frontières (MSF) is on the ground and is one of the most effective ways to directly support efforts to aid Ebola victims and stop the spread (disclosure: I just donated): https://donate.doctorswithoutborders.org https://donate.doctorswithoutborders.org The health systems in these countries were already overwhelmed and under-resourced long before Ebola broke out, and the international governmental response has so far been alarmingly tepid. Recent AmA with an MSF doctor: http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doctors_without_borders_ask_me/ http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doct... Note that MSF has an excellent efficiency rating (~87% of revenue goes to program expenses, 11% to fundraising): http://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=3628#.VBZqlHWx3UY http://www.charitynavigator.org/index.cfm?bay=search.summary...

DanielBMarkham 12y ago

Time to face some brutal facts here. 1) We are due for another pandemic. If this one isn't it, there will be another. 2) Democracies run on public opinion. Right now everybody is riled up about some homicidal idiots in Iraq. This is off their radar. Hundreds of thousands of people die from some natural cause or another all of the time. It's not a huge spectacle on YouTube. 3) The enemy really isn't Ebola. Ebola is just the opportunistic pathogen that came along. The enemy is really weak governments with little or no public health systems, combined with very poor local sanitation practices. 4) There was a time when air-dropping in a thousand healthworkers with tent hospitals might have stopped this. That time is over. Now it's in the big city, and trying to control or service a population of several hundred thousand is beyond most any country's ability to project intervention. 5) If it doesn't go airborne and stay lethal, which is where the safe money currently is, we'll end up with hundreds of thousands or millions dead and it should burn itself out over the next year or two. That's the optimistic scenario. We have no reason not to believe that's the way it's going to play out. 6) If it goes airborne and stays lethal, we're in for a major shitstorm. But I really don't think second-guessing how we responded will be useful. There are different countries in the world. They have different governments. We do not have one world government, nor do most of us want one. That means that there are always going to be large pockets of humanity where something like this can take off. Structurally humanity is huge. Disease is going to be an issue for us for a long time.

philh 12y ago
> We are due for another pandemic. What do you mean by this?
jplewicke 12y ago
Saying that we're due for another pandemic is quite simply the gambler's fallacy: http://en.wikipedia.org/wiki/Gambler's_fallacy http://en.wikipedia.org/wiki/Gambler's_fallacy . The odds of a pandemic may well be higher than recent experience would indicate, but pandemics still occur randomly.

quarterwave 12y ago

I searched for R_0 data on flu pandemics and found this: http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pandemic_influenza_pandemics_of_influenza.pdf http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pan... Note the sharp jump as R_0 goes from sub-2 to over-2, which should not be surprising (hand wave about branch processes, light of a thousand suns, etc). Over to someone better qualified to comment - is the present situation with Ebola taking us into a pandemic territory similar to 1918 H1N1?

vfclists 12y ago

This seems to be the usual knee jerk military can solve everything response you would expect from Americans, and also African governments who are always eager for handouts from Western governments. So you want to send the military in? Do you have any idea of the size of the area in which you would have to deploy them, coupled with the panic their presence might cause, together with the issues which would be caused by militia factions which would inevitably arise to tackle what they would rightfully see as an invasion of their countries? What did the UN manage to do after the Haitian earthquake that the Haitians couldn't have done themselves, besides introducing cholera to the region and nearby countries? What African countries need to do is what they would have to do if there was no possibility of outside support. In this case it is not even a question of central government intervention when it is more a question of dealing with Ebola at the local level or county / village level. Moving infected people to centralized locations for treatment means more travel and the possibly infected relatives and carers for the ill spreading the disease more, unless they are transported by specialist units. The process of travelling to report an infection and calling for a specialist unit itself carries the risk of the traveller spreading the disease let alone the person with the symptoms. The only way to contain Ebola is to give the families or communities of infected people the knowledge, the drugs, the equipment and the protective clothing to they need to treat themselves and the economic support they will need when they are isolated, which needs to be done at a local level. That means sustained public education via television and video, protective clothing for carers and disease detection kits.

rwallace 12y ago

I recommend anyone proposing solutions to the crisis first read this explanation of events to date: http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment http://www.vanityfair.com/politics/2014/10/ebola-virus-epide... In particular, the history of events to date makes it clear it is not a case of the world doing nothing. Back in the spring, when there was reasonable hope that sending a bunch of foreign doctors could stop the outbreak, that was done - for a little while, it even looked as though it had worked. Unfortunately, it didn't, by a long shot. Now WHO and MSF want to repeat that strategy on a much larger scale. My opinion is that this is a very bad idea. The epidemic in West Africa not going to be stopped. That window of opportunity closed months ago, if it was ever open. If we send in thousands of doctors now, a large percentage of them will end up dead, and the epidemic still won't be stopped. It will be a waste of life, and at that, of the lives of trained doctors and nurses who will be all too soon and badly needed if the epidemic does start hitting other regions where the outcome would still be in doubt. And no, sending in the military is not the answer. Not only does "it's for your own good" not morally justify aggression, but by further eroding the trust of the local population for authority in general and foreigners in particular, it would make matters worse, not better. The affected area needs to be sealed off so the disease can't spread to the rest of Africa and the rest of the world. By all means airdrop medical supplies to Liberia, but don't for heaven's sake start sending hordes of doctors, soldiers and camp followers there to create more fodder for the virus.

JulianMorrison 12y ago
A cordon sanitaire won't work. You're betting against the ingenuity of every single person trapped behind it, and the inevitable infected refugees are very motivated to confound efforts to find them.
- rwallace 12y ago
  No, I'm betting the world's medical resources can contain the occasional small outbreak created by the occasional individual who gets past the cordon, particularly since such containment doesn't have to last forever. You can't put out an inferno, but you can put out scattered sparks.

JulianMorrison 12y ago

> In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014. What I wonder is: why do they think it will stop? What's going to put a brake on the epidemic's explosion? This is not a world where a disease can burn itself out on the local level by simply killing everyone susceptible.

wmgries 12y ago

I'm no expert and I'm just as frightened by the spread of this disease as everyone else, but I think people in this thread, and the media in general, are being a tad "end-of-the-world"-y about this without looking at some of the important facts. Namely: 1) The article mentions the R0 of Ebola and claims it is between 1-2 in the current outbreak. Previous outbreaks of Ebola have been as high as 2.7. But this is relatively low compared to other diseases... the R0 of the Measles for instance is 12-18 (and nobody is really talking about the recent outbreaks in the US due to parents not vaccinating their children). Chances are, this rate would even be lower in the West because conditions in African slums and even hospitals are downright deplorable. Doctors aren't using suits or even gloves to examine patients, medical staff are reusing disposable needles, hospitals rely on family members to wash soiled linens because they don't have in-house cleaning services like western hospitals, etc. And don't forget that cultural norms are feeding the spread of the disease: well family members are observed to be sharing beds with sick loved ones in hospitals, people are practicing cultural burial routines of washing and in some cases kissing deceased loved ones, people are still eating the meat of things like bats and gorillas that are sick with the virus (and even found dead), etc. These are all things that just wouldn't happen in the West. People also do much better here at heeding the advice of the medical professionals - for instance, bodies of people who had died of Ebola would like be burned without concern for any regular traditions, without much complaint. 2) Part of the reason Ebola is so scary is the high fatality rate cited in articles: 50-90%. If you extrapolate to the entire planet, this sounds like it would be devastating to the human race. But is this the actual fatality rate? Western hospitals do a much better job of carefully monitoring patients and tending to every minor development. The main problem with Ebola isn't that the body can't fight it, it's that it kills you before your body can recover - the drastic difference in care between the West and Africa would likely make a huge difference in mortality. Make no mistake, this is a deadly disease, but probably not quite as bad as 50-90% in the West. 3) This article and others like it have shared the concern that Ebola could mutate into something transmissible by air. This would make the R0 of the disease skyrocket up into something that could quickly overwhelm Western medicine and very rapidly turn into something perhaps even more devastating than the plague. It's possible of course the virus could mutate in this way, of course, it's already believed that it can spread like this in pigs. One important thing to recognize is that Ebola in humans affects the liver not the lungs, which poses a barrier to being airborne. In addition, to become truly airborne, the virus would have to mutate it's outer coating to resist the drying effect of the air. So in order to become transmissible by air, it would have to mutate 2 different major adaptations and completely change everything about itself. The example I've read is that we don't worry about HIV becoming transmissible by air, and it is thought to mutate more quickly than Ebola. We've never observed any deadly virus change it's method of delivery, although of course airborne diseases evolved that adaptation in the first place. None of these points mean we should sit back and do nothing. We need to help at minimum because of the following reasons: 1) People are dying and we can help them. With effective medical care, the mortality rate as mentioned in point 2 above should go down. 2) Ebola is destabilizing the region. This is already a region prone to state failure, corrupt and ruthless governments, etc. This disease could well cause wars in Africa, which in turn would make conditions worse and likely increase the fatality rate and the infection rate. 3) While there is a reasonable scientific case to be made against the unlikelihood of the mutation of the virus into airborne transmissible, it's possible and very scary. When considering the risks, we need to multiply the rather small chance against the rather large negative effect of such a change. We need to stop this to avoid this thing from becoming more deadly.

chestnut-tree 12y ago

If you're in the UK, there's an informative BBC documentary on Ebola broadcast just last week. The programme talks to survivors of the virus, to the staff of Médecins Sans Frontières (MSF) treating victims, to Peter Piot, the Belgian doctor who discovered the virus (and established that the disease was not airborne) and the medical staff seeking a cure. There are some harrowing scenes. It's available on iPlayer until Friday 19 Sept. 2014 http://www.bbc.co.uk/iplayer/episode/b04hcthj/ http://www.bbc.co.uk/iplayer/episode/b04hcthj/ Someone's uploaded it to YouTube, although the last 10 minutes are missing https://www.youtube.com/watch?v=bjuQofIleOg https://www.youtube.com/watch?v=bjuQofIleOg