Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas
nytimes.com
nytimes.com
Ebola qualifies as that regardless of its contagiousness. Similarly, one of the most contagious diseases out there, measles, does not, because it is easily vaccinated against.
While the outbreak strain of Ebola may not be airborne now, it's not inconceivable that it could mutate at some point.
http://www.nytimes.com/2009/01/24/health/24ebola.html
"In the first known case of what may be transmission of the Ebola virus from a pig to a human, a pig handler in the Philippines has tested positive for a strain of the virus, world health officials and the Philippine government announced Friday."
"But the strain — Ebola Reston — is not known to be dangerous to humans, and the worker, who was infected at least six months ago, is healthy, officials said."
I want to ask a few questions here:
1. Is there any recorded instance of the particular strain of Ebola in West Africa being transmitted from a bat or another forest animal to a human being?
2. Has that that strain of Ebola virus been found in any bats or other animals in the infected areas?
3. Is there some hard knowledge about the migratory patterns of bats or some other forest creatures to indicate that they have been able to carry the virus all the way from Central Africa to the far end of West Africa without infecting any other people of animals in between?
Why don't people check these facts before they start blaming everything on African backwardness, cultural practices and beliefs? Instead all we have is innuendo from so called experts maligning Africans and ignoring the most likely fact.
This Ebola outbreak was most likely transmitted by humans of which there are two kinds.
1. People who got infected with the disease or harboured a strain of it from Central Africa, travelled to West Africa and infected someone people there. But it doesn't explain how those people did not infect any locals or trigger an outbreak at the source before leaving for West Africa.
2. Researchers who have access to the virus and through carelessness or otherwise managed to infect West Africans with it, said researchers being mainly Westerners working for state institutions, universities or corporations with access to the virus.
Unless there is hard evidence explaining how some animals infect with Ebola travelled over a 1000 miles without infecting whole areas in between whether animals or humans, the search for its origin must focus on the most likely cause, and that means human beings.
If some angry West Africans are attacking western medical personnel in the belief that they are the source of the Ebola virus, they are quite logical in doing so, as Western medical personnel and researchers are the visible common link between the presence of Ebola in Central Africa and West Africa.
This comment may not be focused on how the outbreak may be contained, but it needs to get out there.
Glib words there, Mr. WHO Spokesman!
How do you restrict people to a cordoned area, while respecting their rights?
"Please don't cross this barricade, because I can't do anything to stop you. This gun is a plastic prop issued by the WHO because of your human rights."
Come on, this is purely about sacrificing the few to protect the many. These is no "human rights" about it. It's about the lottery of life handing some people the short straw, and tough luck.
If that is so, it follows that, for instance, kidnappers respect human rights because they provide food, water and any needed medical care. Kidnappers respect human rights only to the extent to which their actions up to any point in time have not shown them to be complete savages.
Using phrases like "human rights" is obviously not applicable in this situation. We must acknowledge that the rights of people who are forcibly confined in a cordoned are are in fact being trampled on (separately from whether or not we agree with the justification for doing so.)
Pretending that human rights are not trampled on if food, water and medicine are provided into the cordoned doesn't help anything.
The question is: can you agree with it, while properly acknowledging that it involves violation of rights. That's my angle, not "boolean thinking".
Even the foreign aid medical infrastructure is inadequate, not enough resources and too overworked to maintain proper isolation protocol, hence all the foreign aid workers getting infected.
Think about how many folk in Europe or the US are against vaccination, or think that big pharma is trying to wipe out everyone.
Now consider how many people are of those opinions in areas that have historically been governed by unbelievably brutal European empires that treated people living there like livestock.
I strongly suspect that a lot more people survive ebola than we hear about because they stay hidden at home with only the hardedst hit cases risk going to the hospital.
So it is more like "Year after year, you have some people get sick, some die, some live. One day somebody gets sick and dies fast and painfully. A few weeks later the rest of their tribe/family is dead or dying. A few weeks after that, the space aliens start coming in, but people continue to die."
The best way, the only acceptable way, is to have medicine for the decease. We have some that we just aren't putting into trials because we aren't sure that it won't kill them - when they are going to die anyway in an absolutely horrible way.
Quarantine is also the only reliable way to prevent the spreading of a disease, and really the only way we have to deal with a disease like ebola which has no known cure. It sucks for the healthy ones in the quarantined zone, but allowing anyone to leave the zone while in the middle of an outbreak risks far more lives.
Note - we aren't talking about smallpox/typhus/flu - ebola is pretty hard to get. As long as you don't touch the body or its fluids, you aren't going to get ebola.
It's also only a death warrant if the people in the quarantine zones don't observe proper safety. If my city (in the U.S.) had an outbreak of ebola, I'd stay home, and barring someone purposely trying to infect me, I'd be safe. Ebola is not an evil spirit that infects everyone in the quarantine area who doesn't flee. Even if it were a more easily transmissible strain of ebola, if you're not in a housing unit sharing air with people who are infected, you're pretty safe.
Certainly true - but, it's important to note that ebola is not airborne. You can safely sit beside someone with ebola, and as long as they don't throw up on you, and you don't touch any body fluids - you are also pretty safe.
Do you consider that acceptable?
I do not consider compassion with victims misguided.
I don't live with the delusion that there has to be an acceptable solution to every problem - there isn't even one for those 40000 people on that mountain in Kurdistan - but that doesn't mean we shouldn't acknowledge that it is a shitty solution and work towards getting an acceptable one.
What now?
Do you risk thousand (possibly millions)? Or billions?
This does not make it ethically or morally acceptable to create more victims.
You are expecting a perfect solution. There isn't one. We must accept and live with the least bad solution.
But we don't have any right now, so wishing that reality was different from how it actually is doesn't help us to deal with the short term problem. We can work on deveoping and producing medicine, but while we wait for results we also need a strategy to managing the outbreak right now at the local level.
Incidentally I don't agree that we're signing the death warrant for anyone in there. Those people are already at a high risk of death, but we can still treat them even while they're isolated.
Both are, thankfully, reasonably difficult to transmit, though conditions of poverty, with close proximity and contact, as well as poor sanitation, increase the likelihood of transmission.
Camus' The Plague has already been mentioned in this thread. I'd strongly recommend reading it.
Now suddenly quarantines are being presented as the smart thing to do...
The reason this is controversial is because there are close to 2 million people in the affected districts, and only about 500 of them currently have Ebola. At best, you're severely inconveniencing 99.975% of the population, and at worst, you're leaving them to die. It'd be like cutting San Francisco off from the outside world, with armed guards on the bridges and San Bruno Mountain, because measles was found on BART.
I don't know what the situation in Gabon was like, but as I understand it they depended upon local quarantines of villages, and didn't close the border of the whole country, right?
"Its size is due in part to weaknesses in the affected countries’ health systems and a lack of trust in the health workers who are struggling to combat the virus" [0]
Not sure the reliability of this source, but "The health security situation is worsened by an apparent lack of trust by the local population in their own governments and medical staff. Warnings against the consumption and selling of bush meat for instance have largely fallen on deaf ears with an inherent belief of the local populations that Ebola either must be a myth or a scam on behalf of corrupt politicians to deprive them of their most basic needs and livelihoods." [1]
[0] - http://www.intrahealth.org/page/ebola-outbreak-underscores-n...
[1] - http://www.securitynewsdesk.com/2014/08/12/ebola-west-africa...
It is difficult to educate a population in this situation about hygiene. Let alone asking them to not eat bush meat.
Searching for 'BBC Ebola' is now a thankless task - so I can't find the reference.
There are all kinds of things done in some places that have not been seen for centuries in other places.
From the WHO website: "Health-care staff fear for their lives. To date, more than 170 health-care workers have been infected"
http://www.who.int/csr/disease/ebola/overview-august-2014/en...
From the wikipedia article:
"The virus may be acquired upon contact with blood or bodily fluids of an infected animal (commonly monkeys or fruit bats).[1] Spread through the air has not been documented in the natural environment."
Something about this story isn't adding up if you combine multiple legitimate sources. So you can only catch it via bodily fluid (like AIDS). But if you wear the health care worker space suit and bleach and burn everything, then you're probably gonna die.
My theory is its converting into an air-transmission disease. In that case, a military quarantine sounds quite wise. (edited to add, my point being that if its known not to be caused by a civil engineering fixable problem like mosquitos or infected sewage or whatever, then human guards closing the borders to humans is the wisest possible solution, and if we're not being given the whole story which is probably true, this would indicate that what is known, to folks other than us, is that it is definitely not civil-engineering-fixable like if it was spread by contaminated water or vampire bats or wtf. Which is a mildly interesting analysis.)
In submitting too fast punishment mode:
cwal37 is quite possibly correct. I am attempting to find death stats from the numerous historical outbreaks. Presumably "20% of the dead being medical workers" should apply in past outbreaks.
cwal37 - Update: from CDC MMWR wrt the Uganda '00 outbreak, with lower tech and less experience the Gulu district of Uganda had 393 total cases of which 22 were health care workers. So the infection percentage of healthcare workers under slightly worse conditions was documented at about 5.6%. The stat for this time around is 170 medical workers some time ago vs a CDC reported 1848 confirmed cases or about 9%.
There are several ways to interpret these stats. One is that the rate is increasing despite experience and technology getting better. Maybe. Another is the reported number of infected might be half or less of total infected. Maybe. If you assume "about 1 in 20 infected will be health care workers" from historical experience, then 170 infected workers would imply the total number actually infected as of some time ago is closer to 3500 or so rather than the official count of 1800 or so.
So that's the numbers. I continue to research to figure out which of many possible interpretations is most likely.
"That is straight up fear-mongering." LOL if I wanted to do that, I could do a better job. "Its all obama's fault" "Buy overpriced ammo from me" "I'm getting a commission on these MREs" etc.
disputin - I see I have been scooped by zerohedge. Embarrassing because I often scan zerohedge headlines. On the other hand a bunch of stock traders are not going to have much of anything intelligent to say about non-economic issues, beyond being pretty good at making "isn't that odd" connections, like this post.
- a large percentage of those health-care workers were infected before full protection was widespread
- they have many chances for infection and mistakes happen
- healthcare workers in regions where Ebola was not known to have reached yet did not take necessary precautions.
Edited to add: Lots of paternalism in the responses. I live in an area that's never had an earthquake or hurricane yet I have a pretty good idea whats up. That's not because I'm white and Africans not being white therefore cannot read or draw analogies. Not cool guys, not cool at all. Docs in Africa are not necessarily stupid just because they're in Africa as some guy claims it on HN so all they have is Gilligans Island class knowledge and gear. I'm inclined to believe its the opposite, they know what they're doing, yet unfortunately of a population of the most qualified generalist personnel 170 got none the less got infected. That something sad and bad happened to them despite their abilities, doesn't mean those foreigners must therefore just be dumb and we'll be OK because we're a different race. Poverty does not necessarily equal stupidity. Reading and knowledge is getting cheaper every day. I don't buy an explanation based on middle ages era cultural outlook. That explanation (of ignorance, and poverty) would have actually worked in 1500. They just aren't that dumb, over there. That's what makes the statistics so bad.
It was only formally identified in the 1970's, and has never killed anything like the amount of people it is killing now.
Nobody in the world has experience of this. We are in completely uncharted territory.
Also, you are being a complete asshole. Try educating yourself about what you are talking about and show some fucking empathy.
Western doctors handling outbreaks screw up with some degree of frequency - the simple volume of cases they're dealing with, combined with some low but non-zero chance of error means that infections like this are inevitable.
Rather than elaborate speculation about the virus mutating to an entirely new transmission path (with new cellular receptors, a built in way of dealing with mucosal immunity, a capsid capable of being suspended and transmitted in droplets, etc.) a much more reasonable explanation is this:
Humans screw up. Doctors are humans. Ergo, Doctors screw up.
All it takes is a sliver or a sharp edge to compromise a suit. You can imagine working beyond overtime in a space suit in a hot shitty old hospital (or whatever passes for it) filled with death. The tiniest mistake can lead to infection, and in that environment there are far too many opportunities for tiny mistakes.
About half way through the footage, one of them removes his goggles and rubs his eye, with a gloved hand. The glove is wet from one of the samples. I wondered if we just watched him kill himself.
He personally helped treat over a hundred ebola cases and he only needed to screw up once.
Health workers get infected because they are physically dealing with patients in areas with some of the lowest healthcare standards in the world. Throw in some local wariness of foreign workers, and resistance to treatment until it's too late and it is totally understandable why 170 health-care workers have been infected.
There are tons of healthcare workers and sick people in the regions affected, most patients don't have ebola and most workers probably don't have training and equipment to deal with it, so undiagnosed ebola patients with generic flu symptoms infect unwitting workers.
Most of the health care worker deaths have been people working in rural hospitals who may not have known what they were dealing with or had adequate means to protect themselves. Ebola patients also produce a lot of bodily fluids as the disease progresses and the virus is a lot more transmissible than HIV.