Sierra Leone's chief Ebola doctor contracts the virus | Hacker News Reader

Sierra Leone's chief Ebola doctor contracts the virus

reuters.com

340 pointsnkurz109 comments

Knowingly putting yourself in danger to be the first line of defense against a potentially epidemic outbreak, deserves special recognition. Everyone should know these doctors' names. We need to make international heroes of these people.

Not just the doctors, the nurses and all those who help.

I'm curious how many nurses or PCTs have already died.

From the article:

"Three days ago, three nurses working in the same Ebola treatment centre alongside Khan died from the disease."

I hope each one of them gets the recognition they deserve.

Somehow having their names out in public would help tremendously, so far they remain a nameless one-liner in an article about the doctor :/

I believe the three nurses referenced are Mbalu Fonnie, Basidatu Sheriff and Princess Iye Gborie and there is also another health worker, Mr. Alex Moigboi, who died at the same time.

source - http://news.sl/drwebsite/publish/article_200525821.shtml

Thanks a lot for finding the names, I hope it'll help just a little bit to give equal credit to all who fights at the front-lines with this disease - they deserve all the possible credit they can get!

Similarly, there is a memorial in Hong Kong Park with statues of the doctors who died during the SARS epidemic.

https://commons.wikimedia.org/wiki/File:Fighting_SARS_Memori...

I'm sorry but I find this statement totally retarded.

Firstly as if anyone is going to be able to know all the doctors names even in this particular case and I'm sure there's plenty of other epidemics out there right now that are also dangerous.

Secondly there are more than doctors working on this case. Three other nurses also died as per the article.

Thirdly this story is hitting all the major news channels. It's currently top of HN. People are knowing this story.

Fourthly we don't live in a fantasy novel where knowing someone's name means something. Could we on HN at least talk about constructive things not emotive clap trap, we see this ever single day anyway from sites like upworthy.

Following that logic, it wasn't even newsworthy for Reuters to post the article at all right? I mean who cares, it's just emotive BS. I mean it's not like humans respond to stories about humans, and become motivated by their actions, selfless heroic etc. Better to just have news in the form of graphs of incidences with no names associated so we can keep track of it.

How on earth does it follow it's not news worthy? I can not even comprehend that logic? I know I upped the story.

But perhaps the fact 3 nurses died before this and it didn't rate as high as this important news (Or OP's comments) you should at least look internally to what exactly the news is and what it means.

Ever heard of Florence Nightingale?

I've also heard of Mother Teresa

Feel free to youtube Christopher Hitchen's round up of her.

How's that relevant?

Because... squirrel!

(argument provided for illustrative purposes)

Knowing someone's name doesn't necessarily mean they're a good person.

What an astute observation.

But not an irrelevant one, in this discussion, surely. Which is the point the comment parent was attempting to make, and you, probably because you dislike Christopher Hitchens (which I do as well, but anyway) you refused to acknowledge.

I've heard of Florence Nightengale. But I've also heard of Mother Teresa. My knowing even good things about a person doesn't necessarily impact how good of a person they actually were. I remember reading books as a kid with Mother Teresa in them as a totally sanctified figure, but what Christopher Hitchens says about her is probably true, and so she's not worth the respect that I gained for her and carried with me for so long.

I think it is an astute observation. For all I really know, Florence Nightengale was just an unskilled doctor-wannabe who ran around Crimea amputating people without cause. People that I think of as good aren't necessarily so. We have to remain skeptical.

Florence Nightingale was not a randomly chosen figure. The argument was about what the point is of making heroes out of people. The thing is, when Florence first got to the Crimea, she was pretty rubbish at keeping folk alive, but she promoted the cause relentlessly back at home. It was her use of that celebrity that eventually got money and resources out to the Crimea and that saved more lives there than her medical skills did at the time.

In the long run, by her use of statistics, she invented modern nursing and much of the practice of evidence based medicine, but she got started by establishing a name for herself.

Remembering the names of people who have done good things and sharing the stories of what they have done to inspire others to go and do the same. It is a simple premise and one that is common enough in human culture that I am not sure where the argument is coming from.

edit - you can also even apply the same technique to try and warn people of bad things. Go wild with it.

OMG. It's not. That's my point. I feel like I'm in an crappy sitcom where everything has to be explained.

Random people idolised does not equal anything.

As per the best reply to what about..... squirrel.

Teresa was no Florence Nightingale. They both knew about the power of using celebrity, but from there they substantially diverge.

More deeply entrenching the idea that sacrificing selfish pursuits for the betterment of the human race is a noble ideal is for more constructive than emotive clap trap.

Fourthly we don't live in a fantasy novel where knowing someone's name means something.

It doesn't do much for the dead person, but the names we chose to celebrate shows the traits we value. We make people heroes to celebrate what they did, because we dream of a world in which anyone would be willing to make the same sacrifices for other people.

So...you're a dick. Got it.

I believe the idea was to have those people as heroes replace, say the Kardashian and the Jersey Shore characters in the attention of a large part of the population.

The argument in having them known rather than Nobel Prize laureate is usually is that its easier to make strong emotional connexion with drama queens than nerds scratching theory; in that case, the strong emotional connexion seems far easier to get and we could use medical role models.

Remembering names is hard, even as little as for -- but most people don't seem to remember the names of, say each Kardashian sister, or even Top Gear hosts: they can still point at "the smaller one". Having quotes, biopics, decumentary, rewards... the usual pagentry would allow people to have attitudes towards adversity that are humane, constructive and varied. One of those nurse could be spinned as the Alpha, controlling, head-strong, devil-may-care head nurse; be known widely for that, and still have a first name that most people can't spell. And another nurse could be more fearful, and go through acceptance of her fate, etc.: nothing really new to the ethico-cultural complex.

Someone mentionned Mother Theresa earlier: I doubt anyone can spell her civil name; people still know how loving she was, how opinionated, how indifferent to medical cure she surprisingly proved herself to be and have a complex image of her moral stance. Her influence on reconsidering extensive medical treatment as opposed to simple care at the end of a life is a interesting recent development in medecine.

3 dead nurses don't beat one sick doctor. HN FTW.

Wonder what their names were?

Mbalu Fonnie, Basidatu Sheriff and Princess Iye Gborie.

knowing their names means something

remember them

since you wondered.

I have a better idea: why don't we all start paying these people large sums of money rather than merely thanking them for sacrificing their lives while we don't have to?

We'd be less likely to send people into battle if we actually had to pay our soldiers what they're actually risking.

Nevermind! The emotive clap trap is much easier on my taxes. I'd hate to actually have to pony up for things like VA hospitals. Better to just give them nice parking spots and Veteran's day parades.

2nd edit - removed the post completely, I was being far too offensive.

I think its because historically mercenaries would fight less strenuously, and break at the first sign of real trouble as dead men can't collect their pay.

On a more contemporary note, research has shown that if you replace an intrinsic rationale (e.g. patriotism) for an action with an extrinisc one (e.g. money), its impossible to go back. I imagine its a lot easier to create patriotism than money, so people want to stick with that solution.

> I think its because historically mercenaries would fight less strenuously, and break at the first sign of real trouble as dead men can't collect their pay.

That's debatable. Swiss mercenary pikemen enjoyed two centuries of well-earned respect for their fighting abilities, for instance. Or you can take the Varangian Guard of the Byzantine emperors, or the Gallowglass mercenaries. The issue was more often that many of them would not hesitate to change sides if it was seen as more profitable.

> The issue was more often that many of them would not hesitate to change sides if it was seen as more profitable.

Well at least that's not a concern in the case of ebola researchers.

Indeed, when Alexios Comnenus needed to bribe his way into Byzantium, he didn't even bother trying the Varangians, figuring that it was pointless. And the Swiss were known for loyalty.

Yes, I was more thinking of the European Renaissance period, where many armies incorporated large mercenary contingents which some of them, like the Landsknechts, happily changing employers. Italian Condotierri were also notorious for this behaviour.

Though it should be said that employers were not necessarily more trustworthy, and could be prone to "forget" to pay the mercenaries they had hired once they had no more need for them.

"'I am afraid for my life, I must say, because I cherish my life,' he said in an interview, showing no signs of ill health at the time."

Ugh, what a shame, fingers crossed he's the 10% that survives the disease.

> Ugh, what a shame, fingers crossed he's the 10% that survives the disease.

If only for his detailed knowledge of the disease, yes. One thing that is overlooked when considering the ethics of "that patient is more derserving than others" (see comments about nurses above) is how often throwing everything at a small number of otherwise healthy patients helps finding unexpected cures. It was very true for rich patients with HIV for instance.

My understanding is that more than 10% survive in cases where they're well-cared-for and hydrated. Still bad odds, but not 10%.

A close family friend is a very senior nurse at the Red Cross, and was deployed to help deal with the Ebola outbreak some months ago.

The emails I've had from her are horrifying. What's being reported in the media is the absolute tip of the iceberg - entire communities are being wiped out, the infection rate is growing in an epidemic fashion, and there are growing concerns that there's an airborne (droplet) transmission method, as there are numerous inexplicable infections. That said, it could also be the prevalence of bush meat which is helping to drive this.

There's talk of the Red Cross imminently pulling out, as it's no longer safe for their staff to be there.

Can you say "sacrifice zone"?

Dr. Sheik Umar Khan, please live. We need people like you.

And for whoever is reading, you can find donate buttons for MSF's ebola emergency appeal and MSF in general, if you follow the links below.

http://www.msf.org.uk/ebola

http://www.doctorswithoutborders.org/article/race-control-eb...

edit - I have no association with MSF, they just seem to be the right people to be giving money to if you want to help with this. If anyone knows of others, please suggest them.

Also, and I appreciate this is pretty rude, but I know that there are some extremely rich people who hang out on here. To those people, see if you can try and arrive at a monetary value on how scared you are of ebola arriving in your backyard, and then donate that.

You can also fund supplies directly to a local NGO that's responding here:

http://www.globalgiving.org/projects/help-stop-the-ebola-epi...

Can you give me more information about them? They seem to be based in Tennessee.

I spent 2 months in Sierra Leone last year and a month working with Wellbody Alliance [1] in the impoverished mining district of Kono. So far that part of Sierra Leone has been spared from the virus but with the limited health resources in that area, it is only a matter of time.

I can personally speak for their effectiveness and tell you that your donations will actually end up in the form of medicine or medical services to someone who really needs them and not in the hands of some giant NGO that ends up swallowing 75% of what you send them for admin costs and first class tickets.

[1] http://wellbodyalliance.org/donate/

I can understand the desire to make sure your money goes towards actual programs instead of overhead, but MSF - at least in the US - is one of the better big name charities I can think of on that front.

http://www.charitynavigator.org/index.cfm?bay=search.summary...

86% for program costs. Wellbody is at 95%, but they don't have any salaries or employee benefits listed, among other things that inevitably gobble up some small percentage of money for bigger charities.

nice thanks for that link, great site to do charity due diligence

One of the only doctors at the second largest (of eight) hospitals in neighboring capital Monrovia, Liberia suffered and died of Ebola too. These doctors certainly are heros. http://allafrica.com/stories/201407021024.html

This video by SkyNews shows the wood-and-plastic rural clinic conditions for Ebola health workers. Urban settings would often also lack any form of air conditioning to limit body fluids. Having lived for several years in similar towns there, it cuts close: http://www.youtube.com/watch?v=FYMOGDI9XkI

https://medium.com/matter/how-to-ignore-a-plague-14ea08694cc "Sweating profusely in the 90-degree heat....The next day, at the Holy Trinity Secondary School, I saw scores of high school kids playing soccer. Some had removed their white uniforms to avoid them getting dirty, and their bodies glistened. The longer they played, the more they sweated, and the more dangerous the game became for them. But they were either oblivious to the dangers of a virus that can kill nine in 10, often by internal bleeding and organ failure, or they did not care."

It's hard to even comprehend his sacrifices. What are the circumstances that causes one person to be selfless in the face of tragedy and others to try and profit from it? Wonder if he knows he inspires people the world over to try and become better.

Not the first one, either.

http://en.wikipedia.org/wiki/Matthew_Lukwiya#Death

I'd upvote that twice if I could. Remarkable story and a remarkable man.

And 3 nurses died from the same treatment center a few days ago.

I wonder if they are using or would consider using blood plasma from Ebola survivors to help people survive. See this article:

http://jid.oxfordjournals.org/content/179/Supplement_1/S18.f...

There is more of a critical mass of recent Ebola survivors than ever before in history.

I know cultural fears can make it difficult to provide plasma transfusions, but this story is about a doctor who has Ebola. He almost certainly understands the science, and this could give him more of a fighting chance and a chance to show that medicine can help.

Tekmira is furthest along in development of a vaccine/cure but is stuck in Phase I trials with FDA regulatory hurdles. Ebola is not always fatal this guy cured himself http://www.npr.org/blogs/goatsandsoda/2014/07/22/333628899/e...

I wonder if contracting other diseases along the way had somehow contributed toward his resistance, as long as the immune system has recovered since. The plague stopped rather abruptly in the Middle Ages either due to sudden herd immunity of the survivors' immune systems or other unfavorable circumstances to its propagation.

I imagine there exist a portion of the population with a genetic mutation that is resistant to Ebola, considering it may have existed in the wild for a much longer period than its first description in the mid 70's.

>> The plague stopped rather abruptly in the Middle Ages

Really? If we are speaking of the Black Death, I believe it returned every decade or so.

http://en.wikipedia.org/wiki/Black_Death#Recurrence

>Ebola kills up to 90 percent of those infected and there is no cure or vaccine

Apparently this strand of the virus "only" kills 63% of the patients[1]. Even if it doesn't kill him, does anybody know what are the consequences of having suffered from ebola?

I don't mean to disrespect his work, and I'm asking this without having any clue: Why is this doctor so important? If there is no cure, what was his main role? Can't he be easily "replaced" by another brave person that is also willing to risk his life?

On another note, the article says that ebola has killed 600 people. Apparently this strand of ebola "only" killed 63% of the people that contract the disease. So far 964 people contracted the disease in a country of more than 6 million people. Aren't HIV or Hep C worst threats than ebola?

[1] http://en.wikipedia.org/wiki/Ebola_virus

Replace him with another brave person and they are also a hero. You don't need to have super powers to be a hero.

you need super powers to be a super hero.

> Aren't HIV or Hep C worst threats than ebola?

They've certainly killed more people, but the terrifying thing about ebola is how very contagious it is.

There are fairly basic steps to prevent HIV or Hep C. The worry has been if Ebola really gets loose and how quickly that could utterly fuck the world up.

I always thought the issue with Ebola was how quickly the host dies. If there were a period of about a week where no symptoms arose, then the virus would become significantly more deadly.

Until then, it doesn't seem probable that the host lives long enough to spread the virus.

Then again, my info is based off of what I researched in school around the mid 90s (fresh off of reading The Hot Zone).

"If there were a period of about a week where no symptoms arose, then the virus would become significantly more deadly."

This is precisely the problem with the new Ebola Zaire strain: the incubation period varies from ~3-21 days, during which the patient may show no symptoms yet can spread the virus. And since Ebola Zaire's mortality rate is 60-90% (early estimates were on the high end) this is an epidemiologist's nightmare.

I looked at the graphs and thought it might be time to go live in the woods for a bit.

Wow do you have a citation for that? Because that's utterly terrifying.

100% of people die, This strand of Ebola kills 63% of people who contract it within weeks, as opposed to your examples of HIV and Hep C. It's also a particularly gruesome way to go. I suggest you look up what some of those symptoms listed actually are.

Doctors with experience trying to treat incurable viruses are also much less interchangeable than you seem to think. There's also a lot of work done to try and limit the spread of the virus as well as attempting to learn what we can to cure/prevent it in the future.

If you look at the outbreak list that you linked to, you can see that this is also the largest outbreak listed.

My understanding is Ebola is incurable but sometimes treatable, so while there is no medicine you can give that will stop it, you can care for the patient in ways that increase the chances of them surviving.

edit - and if you want to know why this is being taken so seriously as a threat, have a look at this graph - http://en.wikipedia.org/wiki/2014_West_Africa_Ebola_outbreak... - it is chilling.

That is chilling. As wise people have said, be always on look out for any exponential trends because that's what would change the world. In this graph, although data is limited, it appears the number of cases are doubling every month. At this rate we can easily hit 10,000 by end of year. And THE 10,000 is almost always a magic number where tipping point occurs and power laws becomes unstoppable then on. It is a chilling graph. I'll keep an eye on this every month now.

This one [1] however looks more optimistic. While the disease is still spreading, how fast is is spreading is slowing.

[1]: http://en.wikipedia.org/wiki/2014_West_Africa_Ebola_outbreak...

They should really try to recruit the survivors to do some of this work. They very likely have immunity now.

A lower initial mortality and a longer incubation time combined are the differences between a really bad virus for a small number of people and a potential global pandemic.

This is very serious.

So far Ebola was not capable of killing a large number of hosts because it killed swiftly and symptoms occurred very shortly after contracting it.

It's about respecting the loss of life for someone who devoted their own to improving others'.

I'll try to answer your questions and clear some fear about Ebola that I read in this topic.

Ebola is unlikely to become a massive pandemic mostly because it isn't airborne. To contract it, you need to touch the victim's fluid (alive or dead)[1]. Some funeral practices in Africa involve the family cleaning the defunct body and washing their hands in the same bowl. As this is the first serious outbreak in West Africa, people have a hard time understanding they can't touch their loved ones bodies after they're gone. Besides, Ebola kills too fast to become a world-spread pandemic, probably even if it was airborne.

Surviving Ebola is possible - this epidemic so far kills between 60 and 70 % - but because of the numerous haemorrhages you endure you may suffer consequences, such as eye or liver damage. Apparently most people don't have sequelae but it's hard to find relevant sources for this.

[1] https://en.wikipedia.org/wiki/Ebola_virus_disease#Transmissi...

Ebloa source code - 18,959bp

http://www.ncbi.nlm.nih.gov/nuccore/NC_002549.1

I'm confused by the picture in the article... I thought anyone dealing with ebola was wearing a positive pressure "spacesuit" ...

The picture shows someone in the most primitive surgical gown, covered in blood, with exposed skin.

Is that just a stock photo ? It seems awfully cavalier...

The videos from the early days of Ebola and Marburg are quite remarkable. There is one that I recall of a group of young doctors wearing face masks and purple nitrile gloves, and being very delicate removing those nitrile gloves.

I don't know if that would pass JCAHO muster, much less protect one from Ebola. Cavalier is one way to put it, but I think the biggest issue is resource constraint.

The photo is real.

> Health workers take blood samples for Ebola virus testing at a screening tent in the local government hospital in Kenema, Sierra Leone, June 30, 2014.

Ebola is generally transferred through bodily fluids so being careful and covering skin is good enough most of the time. Keep in mind that a lot of these outbreaks happen in poor rural Africa. Some of the earlier outbreaks were made worse by the clinics being so low budget and reusing needles.

Researchers working on Ebola in rich western labs will have full measures of protection.

Doctors working on the front lines of an outbreak in rural Africa don't necessarily have that option.

That's a translucent gown over a red shirt, not a gown covered in blood.

You aren't really ignorant and entitled enough to think a doctor in an impoverished clinic in sub-Saharan Africa has the money for all the basic supplies they need, much less a positive pressure environment suit, are you?

This is Africa, we don't have the luxury of positive pressure spacesuit. They are dealing with a deadly virus with the tools they have.

Still, a full "remediation" suit (for dealing with old remodels or crawlspaces) including very fine vapor mask, very thick gloves and a full-body coverall can be had from 3M for ... $80 or so ?

I cleaned out a hayloft of our barn recently with far more protection (hanta virus) than what is being described here.

Who can I mail some 10-packs of 3M protective gear to ?

Contact MSF or the CDC and ask them what would help.

Don't make assumptions on what would help most from what you have seen in a press photo.

They may well have dressed down for the photo to encourage people to go along to the screening.

If you want to help from your PC at home: http://tasks.hotosm.org/

I originally flagged this as spam; it did not seem immediately relevant. Now I see it DOES contain a task related to the Ebola outbreak... but I still don't understand what it is.

Can you explain what this is, and how it helps?

http://hot.openstreetmap.org/projects/guinea_ebola_epidemic

> An outbreak of Ebola struck Guinea causing at least 187 infections and 117 deaths. Aid organisations are taking emergency measures to contain the spread of this highly infectious and deadly virus. Crucial to this work, is an understanding of where the populations are centred. Detailed and accurate maps of the region are vital, which is why organisations such as MSF are working closely with the Humanitarian OpenStreetMap Team to coordinate our mapping community and deliver maps to field workers.

As far as I can tell, it's a crowdsourced effort to turn satellite photos of the area into high-quality maps, which sadly do not exist in these areas.

It's a real thing, and there has been some news coverage indicating that the effort has been helpful. Here's a blog post with a little more detail, and several relevant links:

https://www.mapbox.com/blog/osm-ebola-mapping/

This page discusses the work they did with MSF in March:

http://cartong.org/news/collaboration-hotmsfcartong-guinea-c...

are there any epidemiologists here that can comment on the likelihood of this spreading out of n.w. africa?

My partner is a microbiologist in Scotland and she is on high alert for the disease

What does being on high alert entail for her?

Review of containment procedures, lower threshold for a more senior review of any patients that are non-typical, more caution basically.

The primary positive is that the disease has a very quick run from infection to visibly symptomatic to death. While long distance spread is still possible, most outbreaks have been somewhat geographically contained because of this. The worst case scenario for deadly diseases is asymptomatic carriers, and I don't know if there is such a thing with ebola (except for the first few days of infection). It's why diseases like HIV have ultimately had greater impact. It can spread for years before anyone becomes symptomatic.

The virus can take up to 21 days to become symptomatic. More worrisome is that it's been found in fluids up to 60 days post infection. If the flu can spread widely, so can this -- the main limits thus far have been that it doesn't spread via the air, and that it's been geographically isolated. You can't call this outbreak geographically isolated anymore.

http://www.who.int/mediacentre/factsheets/fs103/en/

Unfortunately, this oft-repeated description is wrong. Ebola has a weeks-long incubation period and is contagious throughout most of the incubation period. Plenty of time to spread the virus before the host becomes symptomatic.

>and is contagious throughout most of the incubation period.

Can you give a source for this?

There was an article on that very subject - in short very unlikely, but if it did Paris would be the location.

http://www.npr.org/blogs/health/2014/06/25/324941229/could-t...

It's hard to comment on the specific likelihood, but a few general observations:

1. Ebola transmits via bodily fluids (blood, mucus). Plus, Ebola does not establish a chronic infection in a host. Pathogens with those characteristics usually don't spread that fast / wide.

2. Past observations support 1) - transmission in airplanes has never been observed AFAIK.

3. Infected people can transmit the virus while having a fever, and through later stages of disease. This means you can identify potentially contagious people quickly, which helps control efforts.

4. Having said that, there are lots of things we don't know about Ebola, and it's always best to plan for the worst.

The diseases that keep me up at night are those that spread via airborne or vector transmission & have lots of asymptomatic carriers. Ebola has neither of those. Nevertheless, as far as Ebola outbreaks go, this one is the worst yet and correspondingly worrying.

Ebola can be transmitted by an airborne vector - droplet transmission.

That's not a vector - a vector is another species

I hope this doesn't sound insensitive, but I've heard that Ebola kills its host too often and too quickly to pose a worldwide threat.

I REALLY hope he survives. And not only because he is a hero and I hope not a single person has to die from that horrible disease anymore. The other reason is that one of the reasons for the long lasting epidemia is distrust for foreign doctors and as a native, he has a much better chance of reaching and educating people.

Perhaps a Stupid Question: If Ebola is a virus, does that mean this man is permanently inoculated against it if he happens to survive?

The Ebola virus's spread is completely unnatural (it jumps entire regions where there are no major travel patterns). And people are supposed to believe a disease spread that naturally impossible.

You would think there would be an investigation. The last case of a disease sprouting at random with no previous occurrence was Cholera in Haiti, a disease that was introduced by Nepalese UN Aid workers.

> And educated people are supposed to believe a disease spread that naturally impossible.

Are you a virologist? Can you take a minute and think about something you say before you jump into conspiracy theories? This is a tragedy, not an opportunity to spin your silly ideas.

Educated people question your unsourced and unfounded assertion: "The Ebola virus's spread is completely unnatural (it jumps entire regions where there are no major travel patterns)."

Perhaps your brand of "educated people" should stop begging questions to arrive at their points.

On HN people will usually expect you to cite some sources when making claims like this.

Arriving via "Nepalese UN Aid workers" is not "sprouting at random" and completely natural, surely?

He does have a point. From Central Africa to the west end of West Africa is over a 1000 miles, yet Ebola did not show up in the area in between.

That supposes that a carrier from an infected area is able to travel for months or weeks, whether by road or through the jungle without passing on the virus along the way.

But do all carriers necessarily leave the place where they get infected, and do all the people or animals in infected areas develop an immunity that stops the disease from flaring up again in the same areas?

Conspiracy insinuations or not how the disease arose there is a very important issue which needs to be seriously addressed. It could just as easily have travelled to a major urban area.

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