Ask HN: What would you do in case of a large Ebola outbreak? | Hacker News Reader

Ask HN: What would you do in case of a large Ebola outbreak?

22 pointsrodrigocoelho25 comments

This blog post provides some good, straight-forward information about epidemiology, clinical characteristics, and infection control recommendations for Ebola: http://haicontroversies.blogspot.com/2014/07/ebola-hemorrhag... (It's written by an infectious disease physician.)

"Contact and airborne precautions are indicated for suspected and confirmed cases" refers to:

- Contact: wearing disposable gowns and gloves to interact with the patient

- Airborne: putting the patient in a negative pressure room (to avoid spreading air from the room around the hospital), and wearing a N-95 respirator or PAPR (http://www.3m.com/Product/information/Powered-Air-Purifying-...) in addition to the contact precaution stuff.

Source: http://www.cdc.gov/HAI/settings/outpatient/basic-infection-c...

That gives you a sense of what you'd need to do to safely interact/care for someone with Ebola. However, remember that several doctors treating Ebola have come down with the disease during the current epidemic. Hopefully (for the rest of us), there was some sort of infection control lapse that lead to their infection, rather than these infection control measures not being sufficient.

"rather than these infection control measures not being sufficient."

Per my understanding of things, that seems frighteningly unlikely[1]. As I understand it, there are a substantially greater portion of health workers getting sick than in previous outbreaks, and those health workers are not tied to a particular location. If that's the case (and mind you, this is all very much Nth hand what-I-got-from-the-radio stuff - either of those could certainly not be the case) then it seems to follow that probably this strain of ebola has some attribute that makes the recommended countermeasures inadequate (at least the countermeasures recommended for deployment in the field, which may or may not be this set of countermeasures).

[1]: That isn't to say "tremendously unlikely", just "unlikely enough to be frightening."

The problem is that contact + airborne precautions are the highest level of infection control precautions that hospitals in the US usually do. The blog post I linked to above indicates that there are additional recommendations on top of contact + airborne that are unusual in the US.

Infection control practices are assumed to be effective when adhered to. With a disease like Ebola, it's almost guaranteed that health care providers will follow the rules to the letter, at least in the US (and hopefully everywhere).

So: scary.

I doubt that all, and maybe any, of those recommendations can be followed by the medical staff currently responding to the outbreak in Africa. We're talking about an area of the world that struggles to provide any clean water to humans at all, and where many rural residents are actively hostile toward medical staff.

I know they're following some set of protocols, as it was reported at least one of the infected doctors claimed to have abided by them. I have no idea the degree to which they match the linked recommendations. Previous outbreaks have been in the same areas, though, so more infections with (we hope) the same or better protocols followed (presumably) comparably well is still worrisome.

I found this comment to have an undertone of ignorance.

1) Implying a cluster of 54 countries are all homogeneous, have poor health standard, etc

2) "Struggles to provide any clean water to humans at all" - this is much more heresy than fact. Please rely on statistics

African countries by no means are world superpowers, but this comment is pretty ignorant. Please think twice about such comments, they can be interpreted as offensive

Guinea, Liberia, and Sierra Leone are all poor countries with limited access to health care.

Additionally, http://en.wikipedia.org/wiki/Water_supply_in_Sierra_Leone opens with "Water supply in Sierra Leone is characterized by limited access to safe drinking water."

The parent made no statement that all of Africa is so limited, only that the outbreak was in Africa. The countries most affected by the outbreak were correctly described.

I did not mean to imply that all of Africa lacks clean water and is hostile to doctors--just the areas of the current outbreak. Sorry for the imprecise language.

I think it is instructive that ebola has not spread to the more developed areas of Africa in 30 years. Compare to AIDS, which also originated in Africa and rapidly spread into cities worldwide.

Well, the infectiousness of Ebola specifically is questionable. In essence, there is good reason to believe the virus won't be able to spread far outside the areas where it already proved to be successful. So if you're in the EU or the US, even large parts of Asia, you're probably safe.

But that doesn't mean a mutated strain could potentially befall the whole world. The same goes for the more terrifying types of the flu. There is always the potential for a deadly and extremely contagious pathogen to develop.

So what to do in a pandemic situation? I'm hesitant to admit it, but basically the survivalists have it right: hole up somewhere off the beaten path and avoid all outside contact, that potentially includes all kinds of animals like birds and livestock. Then you'll have to wait until a vaccine is developed. If a vaccine is feasible.

Limiting contact to limit spread is hugely important, but that has to be weighed against maintaining support for those working on vaccines, treatments, and cures.

Only thing I am missing here: Become realistic. You will need to make decisions. Some of your decisions might kill you. Some of your decisions might save you. Some of your decisions might seem scary and end up with no impact. Some of your decisions might look beneficial and end up with no impact.

At some point, you have to act upon instinct and that's fine. And in the case of a serious pandemic, we'll all die or end up in the stone age within 5 - 10 years anyway.

1918 - Spanish Flu killed 50-100 million people (hard to count accurately back then especially on the back of a world war) at the time 3-5% of the population, it was a horrible mutation that attacked the young and strong as well as the old and weak.

The chance of that happening is remote in any particularly decade the chance of something worse that would "put us back to the stone age" happening is incredibly unlikely.

Hell Europe survived the black death and by some counts that took out a third of the population of some countries.

It's not sunshine and flowers but it's not a world ender either.

>So if you're in the EU or the US, even large parts of Asia, you're probably safe.

Well, Germany announced that it accepted a patient with Ebola.[1] I guess it's not completely out of the question now?

Wouldn't it make more sense to go where the virus is and not bring it home?

[1] http://www.telegraph.co.uk/news/worldnews/europe/germany/109...

That's not what I mean. Researchers in all countries get infected with these things all the time, too. But it's questionable whether Ebola specifically can take hold in the northern countries at all.

Wash my hands a lot, stay indoors, avoid people.

And if Ebola got loose around here, I guess I'd do that then, too.

>Wash my hands a lot, stay indoors, avoid people.

So just a normal day

>So just a normal day

That is unfortunate

If an outbreak lasts longer than individual patients are sick (earlier patients have either died or recovered), then you could start recruiting survivors to help care for victims later in the outbreak. This will work better for diseases with lower mortality (e.g. the 1918 Spanish Flu) than one with a higher mortality like Ebola (Wikipedia says a 56% mortality rate, but maybe that includes people who are still sick and haven't died yet).

This assumes that surviving the disease confers serious immunity, which I believe is normally the case, but I don't really know. In the case of Ebola it also assumes a relatively fast recovery time if the disease doesn't kill you, but I don't know if that is true either.

Buy a boat, load it up with non-perishables, and go chill off the coast for a few weeks until I can have a vaccine waiting for me when I come back to land.

Read my favorite book (Richard Preston's The Hot Zone) while barricading myself in my apartment for awhile and waiting for things to blow over.

Probably tweet about it, and hope that it happens in SF.

Watching Valleywag or TechCrunch scamper to provide coverage would be delightful.

"VCs suddenly interested in funding medical care"

"Marc Andresson calls out for single-payer healthcare"

"ebo.la: disrupting filoviruses"

$ rm hat.jpg

I would probably die first.

We probably should have nationwide "fire drills" for these sort of society-level threats.

This reminds me of Bruce Schneier's Security Theatre - that we should not try the preventative approach to terrorism (including spying on everyone) but should focus on detective work and emergency response.

As a society, at the society wide level, we have few if any accepted plans. Sure there is the usual martial law plus bits but that is bound to be resisted or ignored. The fact that HN (with a higher % of the population of people who actually ask themselves these sort of questions) has no single answer tells me we need a commonly understood response - most people instinctively know "stay inside, no travel" but the barest preparation would help exponentially if anything did happen.

apply for a job at the CDC?

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