Comment by timr | Hacker News Reader

Comment by timr | Hacker News Reader

Parent Full thread

"But the truth is that Ebola, murderous though it is, doesn’t have what it takes to produce a pandemic, a worldwide outbreak of infectious disease. It spreads only through intimate contact with infected body fluids; to avoid Ebola, just refrain from touching sweat, blood or the bodies of the sick or dead."

Oh, is that all? Just refrain from touching people? Because last time I checked, we touch people all the damned time, usually without being very aware of it. Easy experiment that will warp your perspective: try to go through an entire day without touching someone, or (harder still) touching something that someone has recently touched. Then track the number of times you accidentally touch something or someone, and later touch your face.

There's a somewhat alarming bit of Comforting Conventional Wisdom floating around the western media that we're totally safe from this because our hospitals are better than in western Africa (true, and yet hospital-acquired infections are incredibly common), or because we have better public health infrastructure (true, and yet we routinely have large outbreaks of rare diseases for which vaccines exist) -- but it's absolutely delusional to think that we're safe because a virus can only be contracted via human contact. The flu is mostly spread by human contact, and it gets around just fine.

The way this doesn't become a global plague is by stopping it before it breaks out of the isolated corner of the world it's flourishing in right now.

According to TFA, "The next pandemic will erupt, not from the jungle, but from the disease factories of hospitals, refugee camps and cities"

The problem, as I see it, is that we have entire swaths of cities in Monrovia, Liberia being sealed off and turned into disease reservoirs [1]. These are precisely the conditions that we are supposed to be worried about!

[1] http://www.breitbart.com/Big-Peace/2014/08/22/West-Point-Slu...

I agree wholeheartedly with your last sentence - stopping transmission in West Africa and improving health systems is key.

I don't agree with your other points though. Ebola patients are only infectious while symptomatic, so accidentally bumping into someone on the subway is not the kind of direct contact needed for transmission. And although the virus can be present in sweat, it's mostly blood, fecal matter, etc. that transmit.

If there were a case introduced in the United States, it's not entirely out of the question that there would be a secondary case or two. Not probable, but not impossible, either. However, I truly believe there would be no more than one secondary generation (two at the absolute max). Western countries can mobilize effective isolation, quarantine, and contact tracing in ways that overburdened West African countries cannot.

It spreads via saliva and survives on surfaces, and the "symptomatic" period starts like a fever. It's not as if people go from being healthy to bleeding from every orifice in 24 hours. It's a hard disease to stop because it initially looks like a thousand other common illnesses.

Again, we're telling ourselves comforting bedtime stories when we pretend that there's something innate to the virus that makes us safe. We've just never had an outbreak in a city before, so we've had the advantage of geographical isolation.

Take a few incipient cases and stick them in a tenement in New York or Paris, and the epidemiology can become incredibly complicated before we even know we have a problem.

But why have we never seen an outbreak in a city before? It's not just good luck. We've had (at least) seven imported cases of Lassa hemorrhagic fever in the US [0], and at least one imported case of Marburg [1]. Both have a similar clinical presentation and epidemiology as Ebola, and both resulted in no secondary transmission inside the US.

SARS was estimated to have a similar basic reproduction number as Ebola (~2), and it was successfully contained globally.

[0] http://www.cdc.gov/media/releases/2014/p0404-lassa-fever.htm... [1] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm

It's obviously a matter of probability -- not every case is going to lead to epidemic. And as long as we're separated from the outbreak by geography, it's relatively easy to say "this person has a fever and was recently in West Africa, therefore we should suspect Ebola." It's much harder when a disease becomes endemic, and suddenly everybody with a fever in St. Paul has to add Ebola to the differential diagnosis.

As for SARS: you're making my argument. It was stopped through a combination of good luck and herculean global effort. This outbreak was ignored by the West for way too long, and I don't think we do ourselves any favors by diminishing the risks of it spreading.

Yes but the point is that Ebola doesn't work like that. While it presents as a fever, you're also not particularly infectious in the early stages. Viral loading matters.

The West then benefits from the fact that all we have to do is push the alert button, and even if we have inconsiderate actors with Ebola out there, people will avoid contact and they will not be well enough to remain mobile for very long.

The problem in Africa, if you've been following the news, is that there is a paucity of education about disease response, hygiene and handling of the dead, as well as a fair amount of "it's definitely America's fault and also it's not real!" going on.

"While it presents as a fever, you're also not particularly infectious in the early stages. Viral loading matters."

I have seen nothing authoritative that backs up this assertion. Our estimates of everything about the epidemiology of this virus are based on rather limited data. The disease isn't spreading like wildfire in Monrovia based on "burial practices" alone; we're getting some new data on what happens when it gets loose in a densely populated urban area.

As for your other point: you're right that rural Africa has problems with education and fear, but it's foolish to think that we'd be substantially better. Look at the response to the (perfectly safe) return of the two infected people to Emory: people were protesting this move, spreading misinformation on social media, and otherwise being complete idiots. If we actually had Ebola circulating in the population of a major US city, I doubt the collective response would be particularly educated or rational.

I hesitate to call these sorts of arguments xenophobic, but there's definitely an element of the "ignorant other" at work in assumptions that the people of Africa are responding in some fundamentally different way than we'd see in any large population of fearful people. We have sophisticated hospitals and high standards of medical care, but crowds are crowds around the world.

Ebola is only infectious when the symptoms already show themselves. When was the last time you touched someone who puked blood?

It is not airborne, therefore it's much less dangerous than other viruses/diseases.

Reply on news.ycombinator.com