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Comment by cmrivers | Hacker News Reader

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.

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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.

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