Ebola: The tolling bell

http://stanfordlawyer.law.stanford.edu/2014/10/ebola-the-tolling-bell/

by superfx • 12 years ago

60 51 12 years ago

stanfordlawyer.law.stanford.edu

Havoc2• 12 years ago

While the situation is serious - it will be contained eventually in my view.

As cynical as it sounds I think there are many positive effects being overlooked here. People need a good wake-up every now and again.

We suddenly realized that there is zero global coordination. There is just no global immediate response mechanism in place to deal with this type of stuff. In the Hollywood movies you see the American tanks roll in as a show of force to contain an area...but where are the American tanks in Nigeria?

Sure eventually UN & US mechanisms kicked in (which is great) but I still feel it was subpar. Not in the sense of the people under-performed (they're great) but rather that the structures in place under-performed / don't exist.

Personally I think there should be a global response team. i.e. one group that has the ability to declare an emergency (Ebola) and then specific governments can buy in or not (and delegate power & funding). Based on that buy-in the team either has power or it does not. In this case, with EU and US buy-in such a team would have vast of power over many nations - and many other nations will follow a US/UN/EU alliance blindly (imagine finding yourself on the wrong side of that). With THAT kind of response you can counter an epidemic.

Thats a bit of a pipe dream sure, but it illustrates what I mean by saying we lack a global immediate response team. Now I'm not suggesting the above should be implemented - its more of a thought experiment...the fact remains that the current model is not capable of deal with Ebola let alone other stuff (that shall remain unnamed in the interest of keeping things on track)

noonespecial• 12 years ago

I have been thinking the same. It seems that America desperately needs an enemy sometimes. If there isn't one available, it kind of makes them up to keep busy. This is a golden opportunity for the USA to bring the world together and fight a real enemy worth defeating and perhaps regain some of it's lost luster. Well I'm hoping anyway.

Havoc2• 12 years ago

USA to bring the world together

Not quite what I had envisioned when I talked about a global response team. I guess thats why we don't have a global response team. :(

And thats not meant as an anti-american comment but rather as a realization that countries don't get along all that well.

rasz_pl2• 12 years ago

USA to bring the world together

oh you already did, together AGAINST USA

jerf• 12 years ago

I often think that people just can not conceive of the scales of disasters that are possible and can befall anybody, including the US. You look at the frankly incredible measures that may be necessary to prevent an outbreak, and it's easy to imagine the costs, the screaming from the affecting (and, given the topic, possibly the literal screaming on the evening news of perfectly innocent people against their will being confined in their own houses unto literal death), the economic costs of shutting things down and quarantining people, etc., politically and economically all very expensive, and in the face of an imagination unable to truly, fundamentally believe these things are possible, the will to take the necessary actions can not be found, because the benefits are literally inconceivable.

And there are oh-so-many things that are so much more fun to spend time on for those in authority, and the odds that their fundamental preparations will be found wanting so low during their tenure, that the appeal of shifting all resources and money away from basic prep is tempting to the point of irresistibility.

Unfortunately, the disasters that can occur are not bounded by our imagination.

(And I do mean fun for those in authority. Contemplating emergencies is not fun. Exerting primate dominance over others in the so very many varied ways that humans are capable of is so much more fun.)

joezydeco• 12 years ago

People need an emotional connection to a disaster or emergency before they begin to contemplate the effects and either take action or donate time/money/resources to help. Asking for money to help prevent a future disaster is a lot harder connection to make with donors.

A recent NPR Planet Money podcast highlighted the difficulty in raising money to fight Ebola:

http://www.npr.org/blogs/money/2014/09/22/349962559/why-rais...

"Donors like being part of a recovery story. In Haiti, buildings and lives were destroyed. The pitch was, let's help them rebuild. In the case of Ebola, it's been harder to make a pitch."

cbd1984• 12 years ago

And, of course, the conspiracy theories.

"They're doing this to institute martial law and kill us all! NWO FEMA death camps! Obama's HitlerStalin on a rampage! JEWS!"

The more extreme versions won't gain much traction, but the smaller ones which tie into pre-existing crap like anti-vaccine sentiment will gain enough to make life difficult for the people trying to improve things.

thegreatness• 12 years ago

"We suddenly realized that there is zero global coordination. There is just no global immediate response mechanism in place to deal with this type of stuff.

In the Hollywood movies you see the American tanks roll in as a show of force to contain an area...but where are the American tanks in Nigeria?"

This is why I have to apologize on behalf of Americans when I meet foreigners from any of the dozens of countries the US has recently invaded.

They know not what they do.

Sebpereira• 12 years ago

This could become the new trend, as populations concentrate more and more in cities, creating slums, the conditions to catalyze outbreaks increase exponentially. I agree with the author that the cause of the recent epidemic has to do with the geographic location of the initial cases.

Alex3917• 12 years ago

I think the author is overestimating how prepared the US healthcare system is to handle a real threat if one arises:

- The U.S. has been advertising that we're the ones with the cure for ebola, so where is anyone with money going to go as soon as they get exposed? And while most of the victims are among the urban poor, there will be more wealthy people who become infected as the epidemic increases in scale.

- Even if we have better technology, the cost of treating each victim here is exponentially higher. The cost for each patient could easily be close to a million dollars if you count 2+ weeks in the ER, licensed biohazard disposal and decontamination, network tracing, quarantining exposed contacts, etc.

- Nearly 50M Americans don't have health insurance. If going into the ER risked you getting kept there while waiting for test results, possibly losing your job, and getting getting stuck with a bill for tens of thousands of dollars even if you don't have ebola, it's hard to imagine that many of those people aren't going to just wait a few extra days.

- In the US healthcare workers are generally paid well enough that they can just leave their jobs, maybe not comfortably, but with enough money to at least feed themselves and get by. It's hard to imagine that we won't have large numbers of healthcare workers just taking off if this ever gets serious. Especially since US healthcare workers aren't trained to deal with ebola, and largely aren't interested -- notice how most of the people going to west Africa to volunteer in this crisis are missionaries, not doctors.

- We have all sorts of religious fundamentalists in the US who think it's god's will that the US be destroyed for condoning homosexuality or whatever who would be more than happy to help the process along, and more than enough people abroad who would gladly sacrifice their own lives to disrupt our foreign/domestic policy.

adventured• 12 years ago

"The current Ebola epidemic may well become the worst human disaster in this century. And we are not doing enough about it."

Ok, I think anyone here generally understands how dangerous Ebola is and could become if it continues to spread.

That being said, already this century:

Smoking has killed roughly 60 million people

HIV / AIDS has killed 20 to 25 million

Malaria has killed eight million

Diarrhoea has killed perhaps 15 million

We're a long ways yet from Ebola competing as a worst human disaster candidate. To put it in stark perspective, it could kill a million people before it's contained (100+ fold more than it likely currently has), and it still wouldn't get near the health disasters I listed. I don't really understand why people persist with inflating Ebola's stature (or downplaying the other health disasters, however you want to look at it). The only conclusions I've come to, are that Ebola has been sensationalized for years by Hollywood and the media (on-going), and its mortality rate and rapid nature are obvious fear points. I still don't see how the fear adds up when compared to millions of children dying from diarrhoea, except that these are things most people think they can't get / won't die from.

jeffdavis• 12 years ago

But the other problems have been with us for a while. Stacking Ebola on top of them is really bad news.

We've already underestimated Ebola in a number of ways. The assumption was that it's not easily transmissible, but it's spreading, so perhaps that assumption is not as true as we thought. The fact that doctors are getting infected is certainly a bad sign. Perhaps this strain is more easily transmissible, or will be soon due to a larger infected population within which it can evolve.

Also, none of those other problems require drastic measures like a 3-week quarantine, which is costly, disruptive, and doesn't scale well.

anigbrowl2• 12 years ago

We've discussed this before. The key differences are that the first two things take quite a long time to kill you; the second two things are very easy to treat/prevent and we know they tend to improve as infrastructure is added. All four of these problems can be managed with current knowledge, at varying degrees of expense. Our failure to eliminate them or other obvious causes of mortality is largely due to a failure of political will, inadequate capital, or some combination of the two. HIV/AIDS is the best example because we don't have a definite cure, and we let it get much worse than it needed to because originally it was treated as a moral disease.

In contrast, we lack the capability to treat Ebola reliably, and it acts fast enough and powerfully enough that patients can't get meaningfully involved in their own treatment the way many HIV patients did in the early days of that epidemic. Our best strategy against Ebola right now is to just isolate people and hope that it burns itself out. Given the size of the area where it is rampant, this is a highly unreliable strategy.

ajani• 12 years ago

At what age did people who died from smoking, first get infected? How many years did they live with the infection? Did they have the difficult but still viable option to quit smoking and survive a few more years or even have a full life?

How many people contracted HIV by hugging someone? Or being in the same environment for a prolonged period of time? How many contracted it because of unprotected sex, or perhaps sharing needles? Again, how long did they live with the disease?

How many people did not die from Diarrhoea and Malaria? Do we have medicines for these diseases?

It takes two weeks to die from Ebola from the moment you are infected. You don't have any choice in the matter. It has extremely low survival rates. We have no cure. It infects anyone and everyone. Being infected with Ebola is closer to being the victim of a random shooting than any of the diseases you mentioned.

And finally, in numbers alone, from the original article: "WHO and Centers for Disease Prevention and Control (CDC) both estimate that the number of people infected is doubling roughly every 20 days. This means that in 20 days 6,000 infections would become 12,000 and in 100 days, 6,000 infections would become about 200,000. In 200 days – early April 2015—there would be 6 million infections and in 400 days—roughly Halloween 2015—we would see over 6 billion people infected, nearly as many as the world’s total population."

He does go on to say: "Unsustainable trends will stop; that rate of new infections will slow down.[3] We will not see the world’s whole population infected with, and more than half of us dead of, Ebola before the end of 2015. It is possible that outbreak may end up largely confined to the three current epidemic countries in West Africa. Other parts of the developing world provide some hopeful signs."

So, there is hope. And it may not be as bad as the whole world being infected, but the possibility is much larger than 60, 25, 6 or 15 million. That too in one year, and not in 14.

robomartin• 12 years ago

And this is the problem I have with a lot of the bullshit back and forth idiotic arguments you can read every day on HN.

Hey, moron, let me spell it out for you. If my little five year old girl gets ebola she will be in horrible pain crying out for Mommy and Daddy and her siblings, anyone, really, to comfort her. And if Mommy and Daddy do comfort her mommy and Daddy FUCKING DIE. And Mommy and Daddy will probably kill themselves if they watch their little girl die without comforting her. Parent, sibling, families, neighborhoods would be ripped to shreads. I don't know about you, but I would gladly die hugging my little girl until she goes if she has to.

I am almost crying as I write this because I can imagine it and it hurts. A parent's worst nightmare. How dare you compare it to smoking and AIDS. How FUCKING CLUELESS can you possibly be? This IS different. Very different.

Sorry for the emotion and the language. I suggest readers place themselves in the above scenario before posting stupid fucking comments.

And please, donate some money to organizations that can help the people in Africa going through this horrible problem. You know, the Mom and Dad choosing to hug and kiss their little girl and die with her rather than watch her die while she cries out for their love.

Enough said.

yxhuvud• 12 years ago

And a hundred years ago 50-100 million people died in the Spanish flu in the space of a few years. A pandemic, which Ebola definitely has a quite high possibility to become, has the ability to do home runs that really blow the ball out of the court when it comes to death tolls.

jliptzin• 12 years ago

I read somewhere about a black market for ebola survivor blood. At first I misread the title and thought it meant a black market for ebola-infected blood (or ebola-infected cadavers). Now that is a truly scary possibility - terrorists intentionally infecting themselves with ebola, then going into airports and other high density areas, infecting surfaces and as many people as they can before succumbing (or maybe even blowing themselves up with a suicide bomb - who knows). I think that's one possibility that's been overlooked and underscores why we really need to be funding greater vaccine/cure research (in addition to the obvious reason of potentially saving millions of lives in Africa).

anigbrowl2• 12 years ago

Terrorists could have done that years ago with AIDS or Hepatitis C but they never have - it's not obviously an effective propaganda tool and religious terrorists are likely to have hangups about dying in an unclean fashion.

ivanca2• 12 years ago

Why you are being down voted is a mystery to me.

(I upvoted you but I have been vote-banned AKA my votes do nothing at all)

noir_lord• 12 years ago

it's not obviously an effective propaganda tool

It's actually a terrible propaganda tool, the "goal" so far as there is one is to strike terror into your opponents (and gain supporters) while not doing something so heinous that you call down the wrath of your target since terrorism is usually the far weaker side opposing the stronger side.

I think for example IS/ISIL/ISIS are just about to cross that line if they haven't already.

startupfounder2• 12 years ago

“No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if promontory were, as well as if a manor of thy friends or thine own were. Any man’s death diminishes me, for I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” - John Donne, Meditation XVII, Devotions upon Emergent Occasions (1624)

It's important that we realize that theses people being affected by viral spread of Ebola are people just like you, me, our families and friends.

Ancorehraq2• 12 years ago

Demonstrably untrue. The people affected are persistently, spectacularly unsuccessful. It's unclear why more investment into helping with Ebola would work where previous intervention in other crises has failed.

lotsofmangos5• 12 years ago

The sickness you are suffering from is much worse than Ebola and much more difficult to treat.

a3voices• 12 years ago

Well what about all the wildlife and rainforests that have been devastated by human population growth in Africa? The continent would be better off without so many people. After all, they're not doing anything to advance humanity technologically. They are just wrecking ecosystems and wasting resources.

goldfeld3• 12 years ago

I wouldn't believe if someone told me they've seen "After all, they're not doing anything to advance humanity technologically" spouted out in plain-sight internet and it wasn't a parody, so I'll just assume you're using really dry (actually excellent) sarcasm. In any case, just to counter the argument that they're wrecking ecosystems, why do the US get to have wrecked their ecosystems in the name of White Man's progress many decades ago and Africans can't?

lotsofmangos5• 12 years ago

Have we double booked the Ebola thread with the support group for "Arseholes Anonymous"?

Anyone from Europe or America who likes to sit in sneering judgment over the wide variety of cultures in Africa either has no education in their own history or hasn't the strength of character to face up to it.

kayoone• 12 years ago

that is a very dangerous train of thought. The worst leaders of the past rationalized some of their actions against humanity with reasons like that. Also what you basically say is that all the good work done by people like Bill Gates helping is nonsense. Bold claim.

sal_paradise• 12 years ago

What are the odds that I see this quote twice on one day for the first time ever?

http://www.reddit.com/r/Showerthoughts/comments/2i418w/every...

jMyles• 12 years ago

I actually want to know the answer to this question.

Mostly because I think the odds are remote, yet it happens more often than is reasonable to predict. Thus, I suppose I believe in a sort of synchronicity. I'm not sure if I realized that before.

eCa• 12 years ago

Sounds like the Baader-Meinhof phenomenon.

http://en.m.wikipedia.org/wiki/Baader-Meinhof_phenomenon#Fre...

tomjen34• 12 years ago

I don't really care about what they are as long as they are a treat to my family, which they can are if they move out of Africa.

I want a good counter argument to this feeling because it is morally wrong but seems logically sound: between terrorist threatening us at home (they just murdered another british aid worker), ugandas death penalty for homosexuality, out of control ebola in Africa (made a lot worse because these people are too uneducated to trust medical staff, but trust their local community witch) I don't see how we can let these people govern themselves any more.

Like I said I don't want to feel this way, so good logical counter arguments are much appreciated.

lotsofmangos5• 12 years ago

Not letting others govern themselves has largely been the problem. If my country had been fucked around by foreign empires for several hundred years rather than being the one doing the fucking, I'd probably trust my local witch more than outside doctors too.

Also, the distance between the groups you are treating as some sort of homogeneous lump is 4000 miles, or about the same as Washington State to Northern Japan.

goldfeld3• 12 years ago

You feel this way because you think there is a solution to human nature (there isn't) and that your developed country and society have a more admirable morality because their political crimes don't look like blue-collar crimes that directly threaten your safety, they're just white-collar crimes to impoverish, restrain, destabilize and control (at home and abroad.) Often they even work within the legal framework.

RVuRnvbM2e• 12 years ago

I don't see how we can let these people govern themselves any more.

Many thought the same of Germany in 1945. Be glad that they didn't get their way.

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

jostmey• 12 years ago

Stopping Ebola now could be one of the single most important decisions the world makes this century. Just imagine what would happen if Ebola emerged in lets say India. It doesn't sound so far fetched now that we have seen a case in America.

Exponential growth tends to catch people off-guard. Just like Moore's Law lead to a rapid emergence of the home computer, a deadly disease could reshape the world overnight.

tomjen34• 12 years ago

The viral factor of ebola is 1.7, but it is also is the place in the world where there is the least amount of medical staff.

In addition it would be a lot easier to ban plane travel out of Africa than it would be to end the ebola outbreak. Both options would prevent ebola getting into India.

In addition I am not that terrified of India - the kind of people who live about the airline are the kind of people who have access to medical resources. I don't want to live in India, but it is not entirely a third-world country, certainly not for the middle-class and above.

Now if it got into the slums of Calcutta we might a bigger problem.

616c• 12 years ago

Unfortunately, with all do respect, you do not know the current plight of Indian and South Asian population.

Many of them work in the Persian Gulf in labor camps. ANd I do not mean a couple thousand. In Qatar, there is 10 million plus population, the population is overwhelmingly male, and the Qataris are less one million of that population. Male South Asian laborers are the largest demographic group in the whole country. This is an increasingly common pattern in the region.

There is little or no medical care, and despite first class medical care for expats, it would be way too late for the unprepared MoH units, which receive basically minimal training from the CDC to react in time. This area, specifically Qatar, has become a major transportation for hub internationa flights, hence the real underlying panic for MERS (Middle East Respiratory Syndrome).

If South Asia (India, Pakistan, Nepal, etc.) were hit in any real way, the world would be fucked ... probably in the course of weeks.

lotsofmangos5• 12 years ago

Donation pages for Médecins Sans Frontières:

http://www.msf.org.uk/make-a-donation

https://donate.doctorswithoutborders.org/

Better to cough up cash now...

ivanca2• 12 years ago

The fact that this article has been flagged (is no longer in the front page despite being way up there minutes a go) and the lack of upvotes (compared to other less important articles) makes me fear for the future of humanity. Because despite being made of fairly smart people not even the HN crowd still realizes the gravity of the situation.

bjornsing2• 12 years ago

Does anybody know how the (immune) survivors are engaged in the health care system of the affected countries? The treatment itself doesn't seem so advanced, it's main challenge being not getting infected. Being immune would be a huge advantage.

bjornsing2• 12 years ago

Seems there are quite serious plans to even tap their blood: https://news.ycombinator.com/item?id=8410437

oxioxi• 12 years ago

I am sad that Ebola has become an epidemic, but worried that it might be used as a weapon by a fundamentalist. Our cavalier attitude in treating that man from Liberia who developed Ebola in the US Presents a difficult problem to prevent. That was an accidental event. What precautions can we take against intentional events?

Ebola: The tolling bell

Related Stories