The Mathematics of Ebola Trigger Stark Warnings

http://www.wired.com/2014/09/r0-ebola/

by 0cool • 12 years ago

205 160 12 years ago

Pxtl2• 12 years 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.

aaron6952• 12 years ago

< As it grows, its rate of growth will increase

No, R will stay the same. Or decrease as the population becomes more exposed.

wcoenen2• 12 years 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.

gbrown5• 12 years 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• 12 years ago

Informative graph:

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

StephanTLavavej• 12 years ago

The log graph is scarier: 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• 12 years ago

What do similar charts for prior outbreaks like?

Dolimiter• 12 years ago

Are those cumulative figures? A bit misleading if so.

schrodingersCat• 12 years 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

s4sharpie2• 12 years 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_user5• 12 years 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.

tzs• 12 years ago

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

Many African nations have a history of dealing with problem regions, such as regions that have the wrong politics, tribal affiliation, or religion, by going in with their military and killing everyone in sight.

What are the chances some of these countries might decide to deal with the problem of Ebola infected regions that way? Especially regions where superstition or ignorance lead the people there to avoid treatment? If the rest of the world waits too long to come up with a solution for the problem, I fear we may see a lot more deaths from this than just those who are killed by the Ebola virus directly.

phkahler2• 12 years ago

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.

jnbiche3• 12 years 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• 12 years 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.

phkahler2• 12 years ago

I would argue that war can be a result of overpopulation. Famine is also - it occurs in the places least able to deal with ebola. "Global warming" - we could reduce emissions by reducing population without changing the per capita energy consumption. Unemployment - not enough jobs is the same thing as too many people. Strife in the middle east? Too many people in that area of the world with not enough resource (or governments that squander what they have).

I'm not saying all of these are correct in an absolute sense, just that population certainly plays a role.

giardini• 12 years ago

Some might even classify it as "good". Mao once said:

“I’m not afraid of nuclear war. There are 2.7 billion people in the world; it doesn’t matter if some are killed. China has a population of 600 million; even if half of them are killed, there are still 300 million people left. I’m not afraid of anyone.”

http://www.theepochtimes.com/n3/4758-maos-nuclear-mass-extin...

BTW Ebola propagation maps I've seen show China having the slowest penetration rate of all nations.

tokenadult• 12 years 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-r...

rdtsc2• 12 years 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• 12 years 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• 12 years 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

1. http://en.wikipedia.org/wiki/Position_weight_matrix

2. http://www.bbc.com/news/blogs-echochambers-29168905

FollowSteph3• 12 years 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• 12 years ago

Wait a minute, when was the last time that the stomach flu was an epidemic?

maxerickson3• 12 years 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• 12 years 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.

swombat3• 12 years 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.

aaron6952• 12 years 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• 12 years 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....

tonyedgecombe• 12 years 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• 12 years 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• 12 years 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/

Piglets [with Ebola] were transferred to the room housing macaques in an open inaccessible cage system. All macaques became infected.

techdragon4• 12 years 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'.

maxharris• 12 years ago

HIV has a very fragile envelope, which is formed out of the host cell's wall (a phospholipid bilayer). Also, the spike glycoproteins that mediate entry into new cells are themselves very fragile (a certain number of these come apart from HIV virions as they circulate, even with the full protection of the stable osmotic, pH and temperature conditions found in blood and lymph).

If these things are damaged (as they are when the virus is exposed to the atmosphere, or to enzymes in saliva), they're rendered non-infectious. So many details would have to change about the cells the virus targets, and the way that it enters them that I can't see how it would be the same virus, with the same pathogenic effect if it were somehow to become airborne. There are tradeoffs in everything, and viruses face them too.

ChuckMcM• 12 years 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.

maxerickson3• 12 years ago

This episode of Frontline is informative as to the situation:

http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/

davesque• 12 years 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.

lotsofmangos6• 12 years ago

"what moral authority allows us to overrule that belief?"

Statistics on mortality.

Afforess2• 12 years ago

Let's just say not all of us believe in Utilitarian theories of Ethics.

polarix• 12 years ago

Perhaps we could quarantine air & sea travel.

lettergram• 12 years ago

Even with air and sea travel the chance of someone being infected outside those areas is minimal (unless they give you a nice bloody hug or you are feeling frisky). Much less an outbreak or something of that nature.

Most of the infected cannot even afford to travel.

userbinator• 12 years ago

There's an interesting parallel of this with some of the discussions on (computer) security - if someone's machine is part of a botnet, infected with malware, or possibly running insecure software, does it give us the right to "invade" them and forcibly perform actions which we believe are "for their own good"?

The prevailing attitude there seems to be "yes", but the difference is that in those cases the worst that could happen is people lose money, data and maybe their personal information gets leaked; whereas here, with Ebola, people will actually die. Not that I'm advocating either side of the argument, but it's something to think about...

wyager• 12 years ago

I agree that invasion is wrong, but why isn't a large-scale quarantine viable? It's not like you have to lock everyone in; you just allow those who are willing to be subjected to medical treatment passage, and deny passage to anyone else. Seems like it could help those who wish to be helped while not infringing on the right of the superstitious to reject medical treatment.

zachrose• 12 years ago

It's a very important question, but I wonder how accurate and widespread this picture of West Africans is. Practically, I am concerned that there aren't enough treatment/care resources for those that want them.

djcapelis• 12 years ago

That is documented fact in Liberia right now, especially in Monrovia.

This release from WHO sharply highlights this issue: http://who.int/mediacentre/news/ebola/8-september-2014/en/

kijin2• 12 years ago

forcing them to stay in their village violates their basic human rights

Better-informed villages, towns, and cities have every right to refuse to admit, or interact with, individuals from superstitious villages. Self-defense is a powerful right, and I'd say it easily trumps a potentially infected person's right to visit a cousin.

People are free to die for their beliefs, whether such beliefs are true or not. But they have no right to make other people die with them. If push comes to shove, better-informed villages will expel all infected persons (preferably into quarantine centers, not into the jungle), post armed guards at every entrance, and either isolate themselves or only admit visitors from villages that have enacted a similar policy.

swombat3• 12 years ago

That sounds reminiscent to what happened during the Black Death.

Unfortunately, it doesn't sound like it worked particularly well, considering the Plague still took a sizeable percentage of the human population at the time.

joesmo2• 12 years ago

I think you bring up some good points and I don't mean to discount the moral dilemma here, but in reality such moral considerations are hardly ever considered. I don't think the article is suggesting invasion, but if that was the best solution, I don't see a problem with it if it prevents an epidemic or worse, a world wide pandemic(especially if it mutates into airborne transmission). After all, the US has invaded many other countries for absolutely no reason. It'd be hard to justify not invading at this point given our history if this was indeed thought to be the optimal solution. We've invaded at least three countries illegally and started major wars but we ate considering the ethical implications of stopping a pandemic? I suppose such moral questions become quite easy once moral decisions have been discounted in favor of immoral ones repeatedly in the past.

techdragon4• 12 years ago

And given the level of equipment and training the military have with regard to doing their job while wearing full Nuclear/Biological/Chemical protection. I would honestly prefer that if the situation escalates and we see confirmation of airborne transmission, the situation be dealt with by prompt deployment of fully NBC trained military medical units and sufficient security forces to ensure that whatever those doctors say is law within the quarantine.

I do my best not to be a knee jerk reaction person, but an airborne ebola strain, is beyond question a deadly deadly threat. Ebola has an incubation period, there is a period of time where you are infectious, before its obvious, and if airborne your very presence places anyone in the room with you now has 50/50 odds of living. This isn't SARS, this isn't Spanish Flu. This is quite possibly the closest we can get to a disease threat strait out of a zombie movie. I don't feel we should violate the human rights of everyone in that region, but this is one of those things where its squarely a "The needs of the many, outweigh the needs of the few or the one." scenario. So if the army doctor says "that guy has ebola, stop him from running away", I kinda feel (presuming an airborne ebola) that the situation may (depending on how far away he's getting, indoor or outdoor, etc) warrant lethal force.

joe_the_user5• 12 years ago

It's just ugly to see an eagerness to think about invasions when not even simple supplies are not coming through.

Liberian President, Ellen Johnson Sirleaf to Barack Obama: "I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us"

"The dilemma" of invasion and whatnot is beside the point. The Liberian state is desperate. Johnson Sirleaf also recently fired 10 government ministers who had fled the country. Any nation with resources that wants to take over? The Liberian state would eager for the help. Things are that bad.

http://www.nytimes.com/2014/09/13/world/africa/liberian-pres...

rwallace5• 12 years ago

I will suggest that given the historical data of "the US invaded many other countries, and it generally turned out to be a really bad idea," the correct conclusion is not "so let's go ahead and invade a few more countries," particularly when there is plenty of specific reason here to believe such action would make things worse not better.

One of Liberia's biggest newspapers recently ran an editorial claiming the Ebola epidemic was deliberately created by the US government. If that's the sort of paranoia that exists now, what do you think it's going to be like if thousands of Americans with filter masks and machine guns start flooding into the country? In addition to all the usual bad results, you're going to get a lot of people hiding and running - carrying the virus with them.

joe_the_user5• 12 years ago

Now, both countries' government are already engaging in the rather extreme preventative measures that's your talking about. But both also lack basic, basic supplies. It's hard to know whether this event can controlled. It seems obvious it would be more likely to be controlled if more resources are flowing in.

And while I'm pretty cynical as rule, it seems cynicism and despair at this point could actually hurt people.

narrator2• 12 years ago

The American perspective is to solve every problem with the military or money. We believe that violence and more money are the only effective solutions to every single problem the world faces. Original thinking just doesn't happen.

A creative solution would be to temporarily halt all regulations on anti-ebola drug development and let them experiment on any willing person in Liberia who wishes to receive treatment. The example of Banting and Best in the 20s is a great example of the enormous progress that can be accomplished if there is no regulation on medicine. These guys came up with the idea for extracting insulin from animals and injecting it into humans. They tested it out on willing patients, the first being a 14 year old, released the invention for use by the public and won the Nobel prize in the span of 3 years (1921-1923). That speed of drug development and testing is impossible today.

A good analogy of the present situation would be this. Someone is drowning in the river. You can use the military to prevent him from knocking any nearby bathers into the river as he floats down stream but don't you dare throw him something handy like a branch or a quickly improvised flotation device because that might help him float and it may not work and there would be lawsuits or regulatory violations! You can pay someone to swim after him and try and save him, but the stream is really rushing fast and they might drown too, but that's seemingly a-ok.

waps2• 12 years ago

And who pays for the, potentially unbounded fallout from that decision ?

Let's say this happens : http://en.wikipedia.org/wiki/Thalidomide

(First read about the advantages of the drug, then move to the crises. in particular the birth defects crisis)

And please don't just say that people knowingly took the risk, read the article first to see how that played out.

People won't accept the consequences of decisions made under duress (and this decision would be "death or we experiment on you". Decision to be made in an isolation camp, guarded by soldiers with guns), for obvious reasons, and this has been an accepted legal principle since a millenium before Jesus was born. You're suggesting just canceling it ? Really ?

What you're suggesting is a really, really, really, really bad idea.

DennisP• 12 years ago

I'm a libertarian too, and agree that the FDA is overly cautious, but I don't think drug research is an effective response to an acute epidemic. When something's growing exponentially you have to stop it quickly.

krschultz2• 12 years ago

So far it seems like quality of medical facilities & care is far more important than the availability of drugs. I think even without the drugs, if all of the original patients had access to great hospitals, this wouldn't have spread the way it has. Unfortunately those resources simply do not exist in the affected countries.

I'm all for effectively unlimited money from the first world to help pay for a response to this outbreak, but even if there was unlimited resources you can't just build up a whole medical infrastructure with the snap of your fingers.

jfoutz• 12 years ago

I'm from the american southwest, there's a kind of snake here who's effects of venom are remarkably similar to the effects of ebola. All the crazy regulation has been holding up any US research, but in northern mexico, a Doctor Stanley has been doing monkey trials. His unique combination of mineral oil seems to boost immune response, while the venom inures the cells to ebola's most harmful attack vectors.

I realize the people of Africa are very poor and can't really afford the scale of production necessary. Perhaps your country would be willing to help out with a few million dollars, I'm sure this snake oil would do some good.

gear54rus• 12 years ago

They didn't hesitate to send troops for some bullshit reason, why hesitate now when it's actually beneficial (assuming it is executed correctly which may or may not be the case)?

Right, because it is not beneficial right now (it's not like there is oil in there) and we can always take action later when it gets closer and more serious.

saryant• 12 years ago

There's lots of oil in that part of the world. Nigeria is a major producer and there are lots of promising fields off Liberia and Sierra Leone.

https://lukoil-overseas.com/press-centre/7059.php

http://www.chevron.com/countries/liberia/

http://www.bbc.com/news/world-africa-17115042

zvrba• 12 years ago

Related; an example of efficient government action: http://en.wikipedia.org/wiki/1972_outbreak_of_smallpox_in_Yu...

Somehow I don't believe that an action like this is possible in a democracy :/

Asparagirl• 12 years ago

Oh yes it is:

- 1924-1925 smallpox outbreak and mass vaccinations in Duluth, Minneapolis, and St. Paul: http://www.mnopedia.org/event/smallpox-epidemic-1924-1925

- 1947 smallpox outbreak and mass vaccinations in New York City: http://www.virology.ws/2009/12/22/smallpox-in-new-york-city-...

dredmorbius3• 12 years ago

Understanding systems effects (see Donella Meadows Thinking in Systems) is hugely important for understanding complex interactions.

The factors feeding into the Ebola crisis, and emerging from it, are sobering both in their interactions and how they tend to lead toward a fairly inevitable conclusion.

As for whether or not this is possible to avoid: human population and impacts on the world are unsustainable. Something is going to happen to bring numbers down. Voluntary population control, disease, starvation, war, social disruption, or other catastrophe, are pretty much the only real operators.

In that sense, yes, I'd argue that the general concept is pretty unavoidable.

I'm not saying Ebola (or this particular outbreak, or even necessarily disease) is "the one" and that the End Times have come. But it's a bit like an old-school video game. The challenges will keep coming harder and faster until we fail one.

jtolds• 12 years 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-...

mjn• 12 years 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=2...

Crito2• 12 years ago

Seriously, what utter crap: http://www.wired.com/wp-content/uploads/2014/09/Nishiura-cur...

Did they seriously screenshot that image with a tooltip up?

IvyMike• 12 years 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• 12 years 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• 12 years 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• 12 years ago

The most important difference is that a Malaria-infected person isn't contagious.

privong2• 12 years 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• 12 years ago

Antibodies generally last a very long time [citation needed], but would they be useful against such a rapidly-changing pathogen ?

privong2• 12 years 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?

learc833• 12 years ago

Ebola isn't rapidly changing. At least in comparison to a virus that does mutate rapidly like influenza.

msie• 12 years 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• 12 years 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

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_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...

DanielBMarkham• 12 years 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• 12 years ago

We are due for another pandemic.

What do you mean by this?

jplewicke• 12 years ago

Saying that we're due for another pandemic is quite simply the 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• 12 years ago

I searched for R_0 data on flu pandemics and found this:

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• 12 years 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.

rwallace5• 12 years 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-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.

JulianMorrison2• 12 years 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.

rwallace5• 12 years 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.

ghshephard3• 12 years ago

Your recommendations are exactly contrary to the guidance from those who have spent their entire careers studying the best way of responding to these types of epidemics.

Attempting use "force" to seal off the area, is perhaps the single most effective way to lose all control of this disease, and see it spread to hundreds of thousands, if not millions of people who (quite reasonably) decide to fight back against such an activity.

Careful Training, use of locals who have developed immunity, massive injections of beds, medicine, and supplies, can have a huge impact, and keep this current epidemic under control

rwallace5• 12 years ago

Your argument is from authority, but authority is trumped by empirical fact. The kind of strategy you advocate was, yes, the right thing to try back in spring, when there was reasonable hope that it could work. It conclusively failed, at a time when the outbreak was far smaller and more tractable than it is now. It cannot possibly keep the current epidemic under control, because the current epidemic is already not under control, hasn't been for months. Meanwhile, hundreds of healthcare workers have, despite training, been among the dead. No amount of training can compensate for the fact that with a caseload of this magnitude you get overworked to the point of exhaustion and start making mistakes.

By contrast, the strategy I advocate has thus far been working.

Nigeria? Cut travel to the affected area. One idiot had slipped through, causing an outbreak. Because it was only one small outbreak, it was possible to contain it.

Senegal? Same. Tougher problem because it has a land border with the affected area. In response, citizen groups have been supplementing the security forces, patrolling the border and turning back people trying to enter the country, thus far successfully.

Ivory Coast? Cut off travel from the affected area. Thus far, no Ebola detected.

Do you believe in results? I advocate abandoning the strategy that has been proven not to work and focusing on the strategy that has been proven to work.

gbrown5• 12 years ago

You have no idea what you're talking about. Sealing off the area wouldn't just be a crime against humanity, but it isn't possible. This is a region with little infrastructure and extremely porous borders.

The reason things got out of control is that the world relied on charitable organizations to fix things, but the wonderful folks at the MSF were quickly outgunned.

rwallace5• 12 years ago

I would suggest actually reading about the facts of the case before commenting with such unfounded confidence. Empirically, sealing off the area has been working so far. The wonderful folks at the MSF were not outgunned - they had resources that seemed adequate to the task - if you read the article I linked, it explains the actual reason things got out of control. And this disease has the potential to rack up a nine digit death toll if we fail to contain it. Allowing that to happen would be the crime against humanity.

JulianMorrison2• 12 years 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.

wmgries2• 12 years 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.

gbrown5• 12 years ago

A basic reproductive number of two can be really really bad, provided it stays that high. If exponential growth holds long enough, it doesn't matter too much what the rate is, so long as it's above one.

With that being said it varies a LOT between different countries for exactly the reasons you mention. My initial work shows a lot of heterogeneity:

http://grantbrown.github.io/Ebola-2014-Analysis-Archive/Sep_...

I agree wholeheartedly with your last three points. Also, from the looks of things the cheapest and most effective time to tackle the disease was months ago. The second cheapest and most effective time to try to stamp it out is as soon as possible.

P.S. The ProMed daily digests are some of the best and most comprehensive updates on this situation I've seen:

http://www.promedmail.org/

wmgries2• 12 years ago

Thanks for the links!

chestnut-tree• 12 years 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/

Someone's uploaded it to YouTube, although the last 10 minutes are missing https://www.youtube.com/watch?v=bjuQofIleOg

The Mathematics of Ebola Trigger Stark Warnings

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