Could The Ebola Outbreak Spread To Europe Or The U.S.? | Hacker News Reader

Could The Ebola Outbreak Spread To Europe Or The U.S.?

npr.org

85 pointstimr57 comments

The largest driver of this outbreak (and many ebola outbreaks) is the fear of healthcare and the way many cultures treat the deceased. These two issues are what would make transmission to NA or Europe very unlikely.

Many people in African nations will stay away from hospitals because they believe they will get Ebola from the hospital. Therefore often people that are sick die of Ebola in the community and therefore spread the disease (symptoms of ebola are very similar to malaria in the first stages, and therefore does not always draw attention to people familiar with malaria)

Secondly, when people die in many of these cultures, there is much more physical connection with the body, potentially spreading the disease more.

In NA and Europe, people are much more likely to seek care and we also don't have as much contact with deceased person (and also have guidelines for handling of infectious bodies).

Fear of healthcare might actually not be a bad way to reduce the risk of getting ebola as the easiest way to get it is as a result of poor hospital procedure. Here is a snippet from a moving article about a young microbiologist who investigated the first Ebola outbreak.

" It quickly became clear that something was wrong at the hospital. Epidemiological detective work by our team confirmed the suspicions: people were being infected at the hospital through injections made using contaminated needles and syringes (only five syringes and needles were issued to the nurses each morning), and hospital staff and attendees at funerals were falling victim through exposure to body fluids infected with the virus. In addition there seemed to be transmission from mothers to babies. "

The full article is a moving and rewarding read:

http://www.ft.com/intl/cms/s/2/4c1711c2-d004-11e3-a2b7-00144...

As a tragic aside, it is the same poor hospital procedure that gave so many Africans AIDS back in the day. Sexual transmission is now the main vector, but it wasn't always the case.

The problem regards people who already have Ebola. Of course, if you have just a less severe condition, staying a way form a hospital might during an epidemic might be a reasonable move.

Treating those with Ebola at home is a recipe for catastrophe. Contrary to AIDS, Ebola is highly contagious and often leads to the infection of the whole family and visitors.

So no, fear of healthcare is just about the worst possible mindset for those infected with Ebola and their families.

I agree with you. The first outbreak of Ebola was obviously handled incorrectly (5 needles per nurses) and may have been due to the unknown severity of the disease. Now each outbreak is handled by multiple agencies (WHO, Doctors without borders etc) and therefore the hospital is likely given access to proper infection control supplies. This is my conjecture, but likely a safe one.

Secondly, when people die in many of these cultures, there is much more physical connection with the body, potentially spreading the disease more.

You would think this would have been selected against ages ago.

Human culture changes way too fast for evolution to act.

I have no idea why you were down-voted. It's true: even if, somehow, evolution had managed to at some point kill off all cultures with a certain trait, the same trait is likely to develop again in at most a few centuries.

If somebody has solid arguments against emiliobumachar's point, I'd be interested to hear them.

Maybe the downvote was because it isn't completely true. Nothing can be too fast, or too slow for evolution.

It's only that culture evolves by different means than genotipes, and by those means fitting the norm more than compensates any unfitness caused by health problems. At least at the short term.

On the contrary, I would say that evolution works pretty quickly to weed out cultural phenomena like, say, suicide cults, in much the same way that it works quickly to remove gross physical deformities.

It's hard to select against a cultural practice, generally, as there aren't large numbers of possible phenotypes in the area, and it only matters if that cultural practice results in less children. Dying isn't selected against on its own.

It weakens the community. I was thinking of selection on a community (or higher) level, e.g. a community that has different practices will be stronger and either outlast or conquer the community with dangerous traditions.

It takes catastrophic levels of disease (think: Smallpox introduction into the entirely susceptible North and South American populations) to sufficiently weaken a culture to the point of conquerability.

Consider the number of European nations in the middle ages fully capable of going to war with high endemic disease levels, or indeed lasting on the field while there were ongoing epidemics in their armies.

Not necessarily. In the vast majority of cases, being in close contact with a corpse, before it's gotten serious about decomposing, is not a big deal. I would guess the few cases where it is a problem are not enough to exert significant selection pressure.

Eating corpses seems to be selected out with diseases like Kuru.

http://en.m.wikipedia.org/wiki/Kuru_(disease)

That's is rather more contact with a corpse than most funeral practices involve.

Those are all arguments as to why Ebola might not spread within Europe or the U.S. This article is about whether it could spread to those places.

Yea, that's how conversation works. Someone posts an article, then clever people talk about it. Some agree, some give experiences, some add additional facts and resources, and other people offer counter arguments. This is a counter argument to the article. What you posted, besides being blatantly obvious, is simply noise and does not add to the conversation.

I'm amazed you managed to misread a comment that was only two sentences long. The title of the article is--in case you missed that, too--"Could The Ebola Outbreak Spread To Europe Or The U.S.?" The previous comment did not address that question and instead answered a completely different question.

What doesn't add to the conversation is obnoxious pedantry like your comment.

What does add to the conversation, apparently, is continual snide assertions that parent didn't add to the conversation.

(I actually don't have any problem with snide obnoxiousness. "I'm amazed you could [be so incredibly idiotic]" is upfront at least. What I do get tired of is a continual tree, like this one, of "You shouldn't have said that.")

I do, I hate when I do it. It also doesn't add to the conversation. Especially when I do so on items that are questionable, as this one is. What bothers me most is that the level of snark I use is dependant not on the level of offence, rather the number of times I've encountered this varian of low quality comment during the day. This example, although I stand by it, clearly is not one of the greater offences, and yet has maximum snark. The greater problem is these conversations actually often surpass the quality conversations being had in the thread.

I'm pretty sure you misread the parent comment.

The original question posed is about the chances of ebola spreading TO western nations. However, the grandparent question answers the chances of ebola spreading WITHIN western nations.

The epidemiology of the former involves questions like transportation controls, quarantine of travelers, border controls, and perhaps even banning international imports from involved nations. The latter involves differences in cultural behaviors, sanitation levels, healthcare coverage, etc.

They are very different questions.

I'm certain I didn't. The article asks the question about spreading, and that includes all vectors and scenarios. Spreading, is all about reaching and establishing an infected base.

As far as if ebola can get TO the western world, that is a 100% chance that it can. Primarily, because there is always an underground movement of goods and people, often women and children into and out of countries, regardless of official lockdowns. Think of it like drugs in prisons. There should be no place more free of drugs and alcohol, and yet it's easier to get drugs in prison than in my town. The conversation then is about the remaining requirements to 'spread'.

When we take a look at spreading of other lifeforms, say for instance seeds in Darwin's Origin of Species, dispersal is only a tiny part of the equation with spread being about not just buoyancy, but rather length of sustainability once the seed arrives at a barren landmass.

This is again consistent with man and Mars. We've gone there with robots, and will one day go there with people, but until we establish a foothold, we have not yet spread to Mars.

Regardless of whether the article addresses the point and only the question, all examples of life (and disputed forms of life in the form of virus), do not spread unless they take root.

When you say a disease has spread to a place, people will assume you mean it's spreading within that place.

If by 'to' you mean there was a case or two from elsewhere that won't spread, it's not something to care about.

So I think that comment is a legitimate argument about the point of the article when it comes to spreading, and you're being too picky.

That's fairly incorrect since the answer to "Could Ebola spread to Europe or US" is an obvious 'yes'. An infected person from West Africa could get on a plane and be in Europe in a few hours. That's how Ebola could spread "to" somewhere. That article would be 2 sentences long. The obviously more important questions, and one that the original article is asking, is whether this person could be patient 0 for an outbreak within a westernized country?

A close family member who is an MD in the USA has on more than one occasion said "the hospital is the last place you want to be when you are sick" though more in reference to the higher liklihood of picking up antibiotic-resistant infections than other communicable diseases.

In fairness, unless you have to be there, hospitals are full of sick people. These are, by and large, places to be avoided.

And this is as a epidemiologist working in hospital infection control.

In all fairness, in previous outbreaks, rural hospitals WERE methods for spreading Ebola.

Yes, but this doesn't mean it isn't spread at home. If you have Ebola it will spread, full stop. It can be better controlled within a hospital than at your home.

Last month, an American doctor who is working with Doctors Without Borders (Médecins Sans Frontières/MSF) wrote these really harrowing and sad letters home from the heart of the Ebola outbreak:

http://news.unchealthcare.org/news/2014/june/dispatch-from-g...

That was an absolutely terrifying read. What seems to make Ebola worse is the manner in which you die...bleeding out on the floor, alone. Doctors Without Borders is an incredible organization, and one that I gladly donate to yearly.

They are not without criticism, in Rawanda they might have supported the wrong side, supporting a group of refuges that would be the imperious for an invasion of Zaire, the destabilization of which has lead to continuous conflict in the Congo.

As Alain Destexhe, the secretary-general of Doctors Without Borders, put it: "How can physicians continue to assist Rwandan refugees when by doing so they are also supporting killers?"[1]

[1]Dancing in the Glory of Monsters: The Collapse of the Congo and the Great War of Africa Paperback – March 27, 2012

  The hygienists listen to music although this week 
  they've been on a Celine Dione kick which requires 
  its own coping strategy.

Ebola and Celine Dion? Christ. No one should ever have to go through that.

So should Europe and the U.S. begin worrying about the virus?

As a North African inhabitant (Tunisia), I can't help but consider this egocentric. Are other African countries somehow doomed?

It seems rather egocentric to expect US national radio to serve Africa?

Well, NPR is an American organization, so it's not really surprising that they're writing it with an eye towards their primary demographic (Americans, and to a lesser extent, Europeans) .

> Are other African countries somehow doomed?

It would certainly be interesting to look at the likelihood of propagation in Africa, and hopefully someone does that. But I'd be surprised to see that from a news organization with a primarily American audience. Also, I didn't see anything in the article implying anything about further spread in Africa.

That last question was merely sarcastic and based on my understanding of the article; discussing potential spread to the US/Europe suggests that the virus has already spread in Africa, at least that's how I saw it.

I figured you were being sarcastic. But I do think it would actually be interesting for someone to look into propagation within Africa.

It will very difficult for the virus to cross the Sahara. It needs to infect a traveler at the right time in the right direction. Also, I guess that there are more from trips from Conakry to Paris than to Tunis, so probably Tunis is safer than Paris. But IANAMD and YMMV.

With a 3-week incubation period as mentioned in the MSF letters, that doesn't sound so impossible...

Outbreaks are particularly scary to areas of high population density. It's one of the biggest risks to a city like New York. A highly infectious disease could one day go through that city like a hot knife through butter.

That's something Africa mostly doesn't have to worry about, I would think. This could just be my ignorance showing, but I don't think there are any places in Africa with the density of Manhattan island?

Cairo?

Manhattan's population density is 25,846/km²[1].

Cairo's population density is 46,349/km²[2].

[1] - https://www.google.com/?gws_rd=ssl#q=Manhattan's+population+...

[2] - https://www.google.com/?gws_rd=ssl#q=Cairo's+population+dens...

I stand corrected.

Google "Lagos".

I'd say the assumption is that other African countries already are worried and taking action.

It's also important to consider the severity that an Ebola outbreak develops based on its transport options. Usually, an Ebola outbreak devastates a village or a few villages. This current outbreak has spread over multiple countries.

What do you think will happen, when the first Ebola patient appears in Frankfurt, Heathrow or Dubai?

Ebola is a third-world disease. First world countries are not at risk, due to a combination of health-care, hygiene and "lucky" cultural differences. SARS is much more of a first-world disease because it spreads faster, more easily and has less visible symptoms.

Europe and US should still try everything possible to stop Ebola. And Malaria, and Tuberculosis and all the various parasites that are affecting mostly the poor people of the world....

The burn rate is too fast for Ebola plus Ebola isn't transmitted via air(yet) so even if it did contaminate America or Europe it could be contained rather easily.

The notion that "the burn rate" is too fast is both on epidemiologically shaky ground, and something I'd be disinclined to rely on given "the burn rate is too fast" was supposed to be why we hadn't seen Ebola in places now experiencing outbreaks.

Aparently, so is the air part: http://healthmap.org/site/diseasedaily/article/pigs-monkeys-.... I was fascinated by its structure - a filament - and it's small size of code - only about 20K base pairs. Also, it's mutation rate is pretty high. That sucks.

Notice I put yet in parenthesis. Google: Reston ebola virus, or just read the hot zone.

You want stuff to be afraid of look up: drug resistant tuberculosis, or the scientist Yoshihiro Kawaoka.

What is the likelihood ebola could mutate into something that could be spread by aerosol?

Yes.

But there are a few caveats. First, does ebola have environmental factors? What are the vectors for transmission?

Are parts of the rest of the world immune/partially immune already?

THe problem is that remote africa is very hard to look after, however fortunately for the surrounding areas movement of people is slow and fairly easy to trace.

If it were to hit a town in say nigeria, then its pretty much game over. Country wide quarantines. Stopping of shipping and all movements across borders.

I usually hate mentioning it, but this seems a perfect example of Betteridge's law.

http://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines

Maybe.

One danger that isn't mentioned in the article is that Ebola is suspected of being carried by animals, fruit bats in particular.

Lots of bushmeat gets smuggled into Europe.

> Lots of bushmeat gets smuggled into Europe.

As a delicacy (i.e. people looking for Chimpanzee meat)? Or to serve African immigrant populations (looking to bring home to a foreign land)?

It used to be for personal consumption but now there is a "luxury market" and illegal meat is being traded.

http://www.theguardian.com/environment/2010/jun/18/illegal-b...

Probably not. You'd need a vector. I saw a documentary about an outbreak in the 90s and it was a monkey that a man let loose in the forest.

An infected human is a perfectly functional vector, and this is already a sustained epidemic.

Her name's Betsy.

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