Ebola cases pass 2k as crisis escalates

https://www.nature.com/articles/d41586-019-01735-0

by howard941 • 7 years ago

177 81 7 years ago

coldcode• 7 years ago

It's just a question of time before it reaches the US. We were lucky with Dallas. It likely will escape the next time into the general population since many people without health insurance are unlikely seek medical care in time and when they do at the last minute, it will spread.

raverbashing• 7 years ago

Ebola is much less contagious than people think

https://www.businessinsider.com/ebola-discoverer-would-sit-n...

low_roar13• 7 years ago

Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic.

In Congo Kinshasa, it's just the chaos politically, there is no real government in many parts of this country, the real danger is that it is not a small country at all, 80+ millions of inhabitants, many can't be reach by the WHO because of the wars and infighting between the "government" and militias. So the crisis there has great chances of getting worse, not better.

Furthermore, many many many people locals despise foreigners and particularly white people, for historical reasons, or just ignorance, and the culture is extremely unsanitary (touching and living with the dead, consuming bush meat or worse, ritualistic cannibalism, and what not), some straight out think Ebola is a white conspiracy.

This isn't a problem only money can solve this time.

edubs254• 7 years ago

Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic.

I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.

duxup2• 7 years ago

Unless you're talking about some unknown evolved version, in a first world country the risk of spreading to a large scale is pretty low. Ebola is not very contagious / risky for the first world as it stands now.

Could it be? Yes but you could argue for any number of diseases that "if it changed" would create devastating consequences.

nostrademons• 7 years ago

Note that the death rate of Ebola in developed countries in "only" about 10%, and all of those have been people that were severely ill before seeking medical attention. Ebola's one of those diseases that responds well to modern hospital care: sanitation, isolation, and IV rehydration are very effective at keeping patients alive while the disease runs its course.

When looking at death rates, it's important to remember that most Ebola outbreaks have occurred in countries with pre-modern sanitation & medical systems. It's like saying that cholera, scarlet fever, and bubonic plague are deadly diseases: true, but significantly less true in the developed world.

sixQuarks2• 7 years ago

The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking

We have huge groups of actively ignorant people supporting the growth of climate change, anti-vaccination, and a host of other dangerous actions.

Now those fighting Ebola outbreaks are getting attacked.

I hope I’m wrong, but it looks like rationality is fast disappearing from this world. It’s only a matter of time before we destroy ourselves.

I realize this type of gloom and doom stuff has always been predicted throughout history, it just seems “this time is different” for real with the intersection of technology and ignorance reaching levels we’ve never seen.

goldenchrome• 7 years ago

It really sounds like you're reading too much news. News is fear mongering most of the time. Try taking a short break, you might be surprised how much better you feel!

ctrl-j• 7 years ago

Feeling better and taking care of yourself is, of course, really important.

However, measles outbreaks and hate-crimes aren't going to stop because one does not pay attention to the news.

throwayEngineer• 7 years ago

it looks like rationality is fast disappearing from this world.

You'd like history, the masses of humans have always been like this.

prepend• 7 years ago

The people fighting Ebola responders are not actively ignorant. They are just militia and chaotic.

This is more to do with being unlucky where the outbreak occurred in a country without order in that part, than fake news affecting anything.

IllogicalLogic• 7 years ago

There are poor people living on top of trillions of dollars worth of natural resources.

A powerful entity conducting a controlled bio-attack to clear opposition to future mining operations is entirely plausable.

UI_at_80x24• 7 years ago

I would really love to know if this phenomenon is limited to Britain/Canada/USA and the rest of the world wonders if we have collectively gone insane, or if each demographic region is experiencing similar paranoia.

pm90• 7 years ago

Stupid people live everywhere. It’s not a uniquely North American thing unfortunately.

They may face other issues and we just aren’t aware of it.

emiliobumachar• 7 years ago

Hi from South America. Full-blown Marxism is small but not quite tiny here.

Ixiaus• 7 years ago

Honestly, as I've grown older, the more I've come to realize that "rationality" is such an energy intensive skill to cultivate and its payoff so long-term that humans have always been like this and that what we witness in modern times is just a clearer picture of that fact due to the scale of our populations and speed of information transfer.

Rationality is energy intensive and difficult to cultivate and is usually a socially learned or reinforced skill (similar to the fact that long-term research is usually only funded by public tax dollars and not corporations).

So I don't think now is any different, it's just at a different scale and behooves those of us who have had the privilege to cultivate the skill to not gloom and doom and to instead show the way up the ladder (if possible, not all people want to cultivate rationality).

low_roar13• 7 years ago

The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking

We're talking about Congo Kinshasa here, I mean, most of you here, who are not from the region have absolutely no idea about the state of that country. It's a mess.

Internet is the least of the locals worries, many of whom are on a daily survival mode because of the war, can't even read and are strongly influenced by all sort of superstitions.

I'm not sure what point you are trying to make. A lot of them living in remote places controlled by militias never had access to the internet at first place.

Gene_Parmesan• 7 years ago

Rationality never existed. Humans are fundamentally irrational actors, and the 'news' has always been about tribalism and fear-mongering. You are unknowingly falling victim to the age-old condition called "going-to-hell-in-a-handbasket-ism," where once you reach a certain age and level of experience with the world, you realize the world isn't how you want it to be and never will be; you become disillusioned; and you begin telling people that "this generation/the world is going to hell in a handbasket."

Every generation does this. It doesn't mean that actually, the world is a fine place. It just means that your rose-colored glasses are coming off.

sixQuarks2• 7 years ago

Yes, this is definitely the other perspective I consider, however I’ve never been one to disparage “new generations”

mod_stretch• 7 years ago

You're correct. There are some painful ways to right our course, but it's unlikely we'll implement them. - Take money out of politics and media, completely. - Responsible reproduction policies.

Creationer• 7 years ago

The average IQ in the DPRC is 78. The population has grown from 12 million in 1950 to 87 million today.

You cannot evaluate the actions taking place in that country and then apply them to the rest of the world.

jeffdavis• 7 years ago

Do these ebola outbreaks give the virus substantially more opportunity to evolve? Or is that not a significant risk?

fredgrott2• 7 years ago

not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).

chimeracoder• 7 years ago

not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).

AIDS does not evolve variants. HIV, which is a virus, can evolve.

There is neither a vaccine nor a cure for HIV.

HarryHirsch3• 7 years ago

They do: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/

But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.

phkahler2• 7 years ago

The best evolutionary path from virus point of view is to reduce lethality so the host can spread it longer. I thought I read that HIV did something similar and used to be more deadly - even without modern treatment.

Problem with Ebola is that its transmission among humans is via the same thing that kills humans.

fredgrott2• 7 years ago

seems like a role of UN troops to maintain peace so that WHO workers can do their jobs

ars• 7 years ago

That's not a good way to gain the trust of the local population.

I don't have an answer for what should be done, but I can tell you that your suggestion is not it.

duxup2• 7 years ago

Problem is you need the locals to cooperate, not just comply for a short period of time due to force.

I suspect mass use of force would work (let's just assume we had unlimited troops or something crazy).... but only for a while.

For a health situation like this you need buy in from the locals to change how they handle things longer term or it might pop up again.

_djo_• 7 years ago

That is part of what the UN troops are attempting to do, but it's an impossibly difficult task. There are far too few troops for the size of the area and population size they need to defend, and that's before you take into account issues like logistics, the unwillingness of some national contingents to deploy far from bases, etc.

To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts.

Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles.

Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.

georgehayduke• 7 years ago

I am amazed at the bravery of the medical staff, health professionals and volunteers who are trying to contain Ebola in the DRC.

Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help.

It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult.

While spreading to populous areas would be a major concern, I imagine that nations blessed with more resources may be in a better position to quarantine, contain and prevent the spread of Ebola.

gingabriska• 7 years ago

How likely is that most Nurses working there do are not able to comprehend risk in real terms?

Zenst• 7 years ago

Extremely unlikely, that it's not even an edge-case. I dare say that anybody who has seen directly or indirectly the effects of Ebola, would be more than aware of the risks and if anything, be more inclined to over-react (look at how leprosy was treated socially historically or even AIDS).

chronogram• 7 years ago

Unlikely with what I heard on this podcast: https://www.economist.com/podcasts/2019/03/19/how-to-fight-e...

mlevental• 7 years ago

that's gotta be one the most presumptuous questions on hn I've ever seen. DRC has been dealing with Ebola outbreaks since the 60s. How do you imagine that they would be unable to comprehend? the clear implication is that they're too dumb.

Balgair4• 7 years ago

The weather in Goma, the capital of North-Kivu province, is going to be ~75F (24C) and ~80% humidity tomorrow.

Imagine having to wear all that protective gear in 80% humidity, limiting your visibility and hearing, limiting your bathroom habits and ability to rehydrate and eat, for hours at a time, in potentially hostile social situations, while dealing with a person or a corpse that you have a very good suspicion could infect and kill you with literal Ebola, a disease that will liquify you from the inside, every day, for months at a time, with no end in sight, and the virus seemingly 'winning.'

Absolute heroes.

waynecochran3• 7 years ago

Could someone explain the graph used in the article where the y-axis is labeled as "cumulative" -- does this mean that each bin includes the sums from the previous bins? If so, then this will always be a non-decreasing graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid graphs like this to make it look worse than it is.

thenipper2• 7 years ago

If they're using the same data source I am at work it's because that is what the ministry of health for the DRC is releasing daily. They don't track active cases but rather cumulative cases in a health zone.

thenipper2• 7 years ago

Also if you want to explore the data UN OCHA has it here: https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-...

teilo• 7 years ago

Yes, you have it exactly right. That graph makes it look like ebola is progressing at a logarithmic rate. It's not. It's nearly linear.

waynecochran3• 7 years ago

I am all for fighting something as horrible as Ebola, but you can't do this ...

    actual rate    => graph

    const rate     => linear graph
    linear rate    => quadratic graph
    quadratic rate => cubic graph
    ...

Balgair4• 7 years ago

WHO reports are much better overall: https://www.who.int/ebola/situation-reports/drc-2018/en/

waynecochran3• 7 years ago

But you can't trust Nature?

RandomInteger4• 7 years ago

No, cumulative is correct if you want to show a rate increase which you clearly see twice based on this graph.

DisposibleHero• 7 years ago

It's interesting to note how we can have consensus on 2,000 individual cases being called a true crisis, but we still cannot agree ~76,000 monthly border crossing[1] is a true crisis.

Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum seekers... both before and after crossing. Perhaps it's because we all fear catching Ebola from an airport or shopping mall, but none of us fear catching "run-for-your-life-itus", or have to wonder how we'll feed, clothe, and shelter ourselves in a brand new country where we don't speak the dominant language or understand the culture, but we know it's safer than where we came from?

Or perhaps it's simply because it's not a political punching bag issue? ... that's probably the real truth neither "side" wants to admit.

Ebola isn't going to run rampant through the US - we have a great medical system that wouldn't be trying to treat patients in a field in the middle of a war zone. We should lend all the support we can to DRC to help prevent the spread of this terrible virus - not out of fear of it spreading to our home nation, but out of compassion to the people of the DRC.

At the same time, we should really step back from our trenches and objectively examine our own domestic problems - not through the lenses of political ideology, but through the lens of a decent human being.

(ya, this is a throwaway... advocating we stop being political about our own domestic crisis is sure to attract a lot of negativity, unfortunately).

[1] https://www.nytimes.com/2019/03/05/us/border-crossing-increa...

choult• 7 years ago

Ebola isn't going to run rampant through the US

This insular, isolationist attitude is precisely what is currently eroding the United States' soft power in the world today.

sctb• 7 years ago

Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents.

https://news.ycombinator.com/newsguidelines.html

i_am_nomad5• 7 years ago

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

mieseratte2• 7 years ago

Could you elaborate on those challenges?

jbob2000• 7 years ago

The doctors and medical staff are mostly white, while the people they are treating are mostly black. To the ignorant, this would appear like an attempt at a genocide or recolonization.

i_am_nomad5• 7 years ago

For one thing, some of the burial practices and rituals in the region pose significant risks of communicating Ebola. And, when health workers recommend suspending those practices, those recommendations are not well-received.

patagonia• 7 years ago

Is it effective for all current strains and future mutations of Ebola?

maxerickson• 7 years ago

It appears to be effective against a range of viruses:

https://en.wikipedia.org/wiki/Remdesivir

But of course there's no guarantee, it's not really a great question when it comes to biology.

asdf21• 7 years ago

Near 100% successful in preventing death specifically? Are there other health issues for survivors?

phkahler2• 7 years ago

There are vaccines being tested on people in DRC right now. Is there any data coming back on those? I dont care much about macaques.

i_am_nomad5• 7 years ago

As I mentioned, macaques are in this case a pretty good predictor for efficacy in humans. I don’t have data on the human trials though.

kjs3• 7 years ago

Fortunately, you aren't in the medical field, and no ones life relies on what you "care" about.

jlmorton• 7 years ago

U.S. Army Medical Research Institute for Infectious Diseases is doing the important testing work, but the novel drug is GS-5734 / Remdesivir from Gilead Sciences.

https://www.gilead.com/purpose/advancing-global-health/ebola

i_am_nomad5• 7 years ago

Right, thank you for the clarification, I should have been specific about that.

TallGuyShort2• 7 years ago

I'm curious to learn more about how well we can ramp up production and distribution of such drugs in the event of a fast-moving pandemic. With Ebola you have 1-2 weeks after symptoms before death is likely. You have a few more weeks after exposure, but you might not know you're exposed and I would assume the treatment needs time and can't save you at the last minute. If everyone around was clamoring for treatment, could you get your hands on it that fast?

i_am_nomad5• 7 years ago

Sorry, I don’t know much about large-scale production of that type of compound, it’s not my field. But, I would question the premise, in that Ebola is not a likely candidate for a fast-moving pandemic.

ajnin• 7 years ago

The june 2 WHO bulletin about the outbreak, which I believe is the source data for the article. It contains more data including a graph of number of cases by date of illness onset, which I think gives a better idea of the progression of the epidemic : https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...

Balgair4• 7 years ago

The WHO reports are very informative as well: https://www.who.int/ebola/situation-reports/drc-2018/en/

The latest report (4 June 2019): https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...

Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already.

One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects.

Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper.

Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.

favorited• 7 years ago

As always when an Ebola discussion happens, I want to recommend people interested in the origins of the disease read Richard Preston's 'The Hot Zone.' It details the history of the disease (as well as some related filoviruses, like Marburg), specifically following several doctors and researchers as they track outbreaks and treat victims.

It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.

Ebola cases pass 2k as crisis escalates

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