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The Mathematics of Ebola Trigger Stark Warnings

205 pointsby 0coolover 10 years ago

21 comments

ChuckMcMover 10 years ago
Going &#x27;meta&#x27; for a moment, this is a tragedy of huge proportions, the question I have been considering is whether or not it is even <i>possible</i> to avoid?<p>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).<p>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&#x27;t believe that, what moral authority allows us to overrule that belief?<p>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&#x27;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.
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tokenadultover 10 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 <i>Wired</i> article we are discussing here.<p>&quot;The possibility of an airborne-transmissible Ebola virus is one &#x27;that virologists are loath to discuss openly but are definitely considering in private,&#x27; 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.&quot;<p>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.<p>[1] <a href="http://www.cidrap.umn.edu/news-perspective/2014/09/experts-raise-specter-more-contagious-ebola-virus" rel="nofollow">http:&#x2F;&#x2F;www.cidrap.umn.edu&#x2F;news-perspective&#x2F;2014&#x2F;09&#x2F;experts-r...</a>
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ihnortonover 10 years ago
Doctors Without Borders&#x2F;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):<p><a href="https://donate.doctorswithoutborders.org" rel="nofollow">https:&#x2F;&#x2F;donate.doctorswithoutborders.org</a><p>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.<p>Recent AmA with an MSF doctor:<p><a href="http://www.reddit.com/r/IAmA/comments/2g79ip/i_work_for_doctors_without_borders_ask_me/" rel="nofollow">http:&#x2F;&#x2F;www.reddit.com&#x2F;r&#x2F;IAmA&#x2F;comments&#x2F;2g79ip&#x2F;i_work_for_doct...</a><p>Note that MSF has an excellent efficiency rating (~87% of revenue goes to program expenses, 11% to fundraising):<p><a href="http://www.charitynavigator.org/index.cfm?bay=search.summary&amp;orgid=3628#.VBZqlHWx3UY" rel="nofollow">http:&#x2F;&#x2F;www.charitynavigator.org&#x2F;index.cfm?bay=search.summary...</a>
schrodingersCatover 10 years ago
I hate to be the cynical one here, but the countries with the power to stop this outbreak aren&#x27;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 &gt;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&#x27;t be too late
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rwallaceover 10 years ago
I recommend anyone proposing solutions to the crisis first read this explanation of events to date: <a href="http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment" rel="nofollow">http:&#x2F;&#x2F;www.vanityfair.com&#x2F;politics&#x2F;2014&#x2F;10&#x2F;ebola-virus-epide...</a><p>In particular, the history of events to date makes it clear it is <i>not</i> 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.<p>Unfortunately, it didn&#x27;t, by a long shot. Now WHO and MSF want to repeat that strategy on a much larger scale.<p>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&#x27;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.<p>And no, sending in the military is not the answer. Not only does &quot;it&#x27;s for your own good&quot; 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.<p>The affected area needs to be sealed off so the disease can&#x27;t spread to the rest of Africa and the rest of the world. By all means airdrop medical supplies to Liberia, but <i>don&#x27;t</i> for heaven&#x27;s sake start sending hordes of doctors, soldiers and camp followers there to create more fodder for the virus.
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IvyMikeover 10 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&#x27;s brutal.<p>So this new paper is projecting that Ebola deaths in Africa will be about as common as Malaria deaths.<p>I guess I&#x27;m trying to draw any conclusions or imply anything here other than life in Africa is pretty freakin&#x27; tough.
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DanielBMarkhamover 10 years ago
Time to face some brutal facts here.<p>1) We are due for another pandemic. If this one isn&#x27;t it, there will be another.<p>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&#x27;s not a huge spectacle on YouTube.<p>3) The enemy really isn&#x27;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.<p>4) There was a time when air-dropping in a thousand healthworkers with tent hospitals <i>might</i> have stopped this. That time is over. Now it&#x27;s in the big city, and trying to control or service a population of several hundred thousand is beyond most any country&#x27;s ability to project intervention.<p>5) If it doesn&#x27;t go airborne and stay lethal, which is where the safe money currently is, we&#x27;ll end up with hundreds of thousands or millions dead and it should burn itself out over the next year or two. That&#x27;s the optimistic scenario. We have no reason not to believe that&#x27;s the way it&#x27;s going to play out.<p>6) If it goes airborne and stays lethal, we&#x27;re in for a major shitstorm. But I really don&#x27;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.
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mjnover 10 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: <a href="http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894" rel="nofollow">http:&#x2F;&#x2F;www.eurosurveillance.org&#x2F;ViewArticle.aspx?ArticleId=2...</a>
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Pxtlover 10 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 <i>cure</i> is now while it&#x27;s small. As it grows, its rate of growth will increase, and it will quickly spread to every vulnerable area.
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vfclistsover 10 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.<p>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?<p>What did the UN manage to do after the Haitian earthquake that the Haitians couldn&#x27;t have done themselves, besides introducing cholera to the region and nearby countries?<p>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 &#x2F; village level.<p>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.<p>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.
wmgriesover 10 years ago
I&#x27;m no expert and I&#x27;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 &quot;end-of-the-world&quot;-y about this without looking at some of the important facts. Namely:<p>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&#x27;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&#x27;t have in-house cleaning services like western hospitals, etc. And don&#x27;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&#x27;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.<p>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&#x27;t that the body can&#x27;t fight it, it&#x27;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.<p>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&#x27;s possible of course the virus could mutate in this way, of course, it&#x27;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&#x27;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&#x27;ve read is that we don&#x27;t worry about HIV becoming transmissible by air, and it is thought to mutate more quickly than Ebola. We&#x27;ve never observed any deadly virus change it&#x27;s method of delivery, although of course airborne diseases evolved that adaptation in the first place.<p>None of these points mean we should sit back and do nothing. We need to help at minimum because of the following reasons:<p>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.<p>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.<p>3) While there is a reasonable scientific case to be made against the unlikelihood of the mutation of the virus into airborne transmissible, it&#x27;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.
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quarterwaveover 10 years ago
I searched for R_0 data on flu pandemics and found this:<p><a href="http://www.ecdc.europa.eu/en/healthtopics/documents/0905_pandemic_influenza_pandemics_of_influenza.pdf" rel="nofollow">http:&#x2F;&#x2F;www.ecdc.europa.eu&#x2F;en&#x2F;healthtopics&#x2F;documents&#x2F;0905_pan...</a><p>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).<p>Over to someone better qualified to comment - is the present situation with Ebola taking us into a pandemic territory similar to 1918 H1N1?
privongover 10 years ago
&gt; in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection.<p>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&#x27;s system), but how long would the immunity last?
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chestnut-treeover 10 years ago
If you&#x27;re in the UK, there&#x27;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.<p>It&#x27;s available on iPlayer until Friday 19 Sept. 2014 <a href="http://www.bbc.co.uk/iplayer/episode/b04hcthj/" rel="nofollow">http:&#x2F;&#x2F;www.bbc.co.uk&#x2F;iplayer&#x2F;episode&#x2F;b04hcthj&#x2F;</a><p>Someone&#x27;s uploaded it to YouTube, although the last 10 minutes are missing <a href="https://www.youtube.com/watch?v=bjuQofIleOg" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=bjuQofIleOg</a>
JulianMorrisonover 10 years ago
&gt; 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.<p>What I wonder is: why do they think it will <i>stop</i>? What&#x27;s going to put a brake on the epidemic&#x27;s explosion? This is not a world where a disease can burn itself out on the local level by simply killing everyone susceptible.
jtoldsover 10 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: <a href="http://healthmap.org/site/diseasedaily/article/pigs-monkeys-ebola-goes-airborne-112112" rel="nofollow">http:&#x2F;&#x2F;healthmap.org&#x2F;site&#x2F;diseasedaily&#x2F;article&#x2F;pigs-monkeys-...</a>
FollowSteph3over 10 years ago
My fear is that we&#x27;re not able to stop a simple stomach flu which is spread almost the same way, through bodily liquids, so I don&#x27;t think it will be easy to stop once it hits first world countries like most people currently assume...
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msieover 10 years ago
How does the world&#x27;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?
hollerithover 10 years ago
Informative graph:<p><a href="http://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png" rel="nofollow">http:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;File:Diseased_Ebola_2014.png</a>
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aaron695over 10 years ago
I find it interesting that people worry about Ebola going airborne but not something like AIDS.<p>I guess there&#x27;s a biological reason....
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phkahlerover 10 years ago
<a href="http://www.telegraph.co.uk/news/worldnews/europe/france/10847344/Jean-Marie-Le-Pen-Ebola-epidemic-would-solve-immigration-problems.html" rel="nofollow">http:&#x2F;&#x2F;www.telegraph.co.uk&#x2F;news&#x2F;worldnews&#x2F;europe&#x2F;france&#x2F;1084...</a><p>I&#x27;m afraid some people either think this is a game, or just an opportunity - since most of the worlds problems today stem from overpopulation.
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