CDC confirms first Ebola case diagnosed in US
cnbc.com
cnbc.com
Let's take a lot at what we can agree on:
* The number of cases of infected patients is fairly small.
* The vector of transmission is fluid exchange, so that reduces its ability to spread.
* The virus doesn't appear to lie dormant, and is only contagious when the patient becomes symptomatic.
The chances of contracting the disease in a western country so far is near 0. The chances of contracting the disease in AFRICA is fairly improbable too.
It really sounds like sensationalism at its finest.
Is there a risk here? Yes, a small one.
I understand, but am frustrated by, the number of people who keep repeating "it's not airborne", as if this is some kind of definitive argument that a virus cannot spread here.
Something like 80% of cold/flu infections happen via "bodily fluids" -- people snot on a surface, someone else touches the surface, then touch their face, etc. This is an effective means of virus transmission. A virus doesn't need to be airborne for a pandemic to occur.
That said, we have a number of advantages over rural Africa in dealing with illnesses -- we have high standards of sanitation, good electricity, clean water, and our population is generally not afraid of physicians (with notable exceptions in some minority communities). But our biggest advantage, by far, is that Ebola isn't endemic here. Our best and most effective screen is "have you been to Africa recently?"
If that screen loses its effectiveness, you start to have to worry about every patient presenting with a fever and diarrhea, and the epidemiology becomes quite difficult. We're not really prepared for everyone with a fever and vomiting showing up at the emergency room...and it won't take many patients (a few thousand, say) for things to get tense.
Yes, a pandemic can occur even if the pathogen is not transmitted through there air - see HIV/AIDS.
Airborne and droplet spread make for fast spreading and hard to control epidemics. If something spreads through bodily fluids only, it's easier to do contact tracing and put the right measures in place. I think that's what people want to highlight if they say that Ebola is not airborne.
http://www.ncbi.nlm.nih.gov/pubmed/205151
In that study, 11 of 15 hand-contact exposures to a rhinovirus led to infection, which is not 80%, but it's within the margin of error. Notably, it was almost as good as large-particle aerosol exposure at spreading the virus.
But yes, the important point is that you don't need an airborne virus for a pandemic. Every virus is different, but there's this public fixation on "airborne" transmission that is a bit of a red herring. Ebola is doing just fine without it.
Actually, there was a study earlier this year[0] which showed, with better data and more rigorous treatement of the fluid dynamics, dropplets can travel much farther than previously thought. [1] has a summary of the research, in case the article is not available. But their basic conclusion is that, depending on the size, droplets can travel up to 200 times farther than previously thought, because they are carried along with the "cloud" associated with the sneeze.
[0] http://journals.cambridge.org/action/displayAbstract?fromPag...
[1] http://www.huffingtonpost.com/2014/04/09/sneeze-cloud_n_5110...
Considering that there are still regular flights from African countries to the US, that would be a large number of people.
Maybe that screen should be applied only if you have developed a symptom like a high fever...?
So at the moment, this "screen" is an easy way to rule out Ebola in a patient with potentially Ebola-like symptoms. Obviously we wouldn't expect everyone who has recently been to Africa has Ebola. I didn't downvote you, but I expect this is the reason why you're getting downvotes, not a misunderstanding about your question.
It’s still a disaster in the affected countries, with many knock-on effects. Also, it would have been better to spend more money earlier to prevent unnecessary deaths.
This Ebola epidemic is actually something people hardly care about. Hardly anyone is donating, for example.
Help is needed. Actually. For real. And with better support and a better reaction this could have turned out better.
It might be beneficial to provide a link to where people could/should donate.
Their US donation page is here: https://donate.doctorswithoutborders.org/onetime.cfm
Folks in other countries can find their local donation pages here: http://www.msf.org/donate
EDIT - To give you a sense of how involved MSF has been in the Ebola response: "Since March 2014, 14 MSF staff members have become ill, among whom 8 have sadly passed away." (Source: http://www.msf.org/article/ebola-workers-risk-tragic-reality...)
There's a comprehensive rundown of their efforts to date to help contain Ebola across West Africa here: http://www.msf.org/article/ebola-crisis-update-sept-25th
I don't mean to be callous, but compare that number to the number of total deaths to Malaria or even the flu, and that number pales in comparison. I am not callous to say that we shouldn't care about the Ebola outbreak, but if you look at the numbers, directing that money to buy more mosquito nets or Malaria vaccines will likely save more lives.
Malaria kills close to a million people a year. If you're looking for a cause for donation, the most value per dollar could be directed there.
More than 3,000 people dead, potentially more, and many of the affected places don’t have enough resources to deal with it in a satisfactory manner. That’s the situation here. This could have been controlled better, probably.
They raised over £1m in a few days.
> The blaze, which was tackled by more than 30 firefighters, killed about 60 animals.
> Within 24 hours, more than £1m pounds had been raised to help around 150 surviving dogs.
This happened while Ebola was happening.
What? It might not be surprising, but how is it not depressing?
Of course, we should not fall into panic. Many factors will affect what ends up being the total effect of this outbreak in the mid to long term. But dismissing it as a non issue because "there are just a few thousand cases" misses the point completely.
According to Wikipedia, the total population of the 3 most affected countries - Liberia, Guinea and Sierra Leone - is roughly 20 millions. So there is at least that upper bound.
The real risk of pandemia comes from the fact that as the number of cases grows, the more likely it is that some of those cases travel through a porous border into other countries which lack the infrastructure and professional discipline to contain new outbreaks. If/when that is the case, each new region will start its own sigmoidal worth.
Regarding your original question... if you can identify individual regions where the model can be applied, maybe you could use Markov chains to model the transitions between states in each region. I am not qualified enough to do that, but I imagine that the result would be a few endemic nodes where the disease is always present (with different degrees of intensity over time) and from where outbreaks get sporadically "exported" to disease free nodes.
The issue with Ebola isn't how many people it's killed so far (although the number is already tragic), but the number of deaths it can potentially cause. If left entirely unchecked at this point, it would kill over a million people in the next year. A half assed response limits it to hundreds of thousands, while a solid response limits it to tens of thousands (conceptually, numbers pulled out of ass but reasonable, I'd argue).
Outbreaks grow exponentially unless contained; the point of fast action is to prevent or curtail the exponential growth.
And note the WHO already did bend the curve down once before, back when there were only a couple hundred cases, and then they lost control again. Not confidence-inspiring.
Also, there may have been unique complications that make fighting the spread harder, though we don’t really know how widespread those are and were. They make for good stories, but are they the whole picture? I very much doubt that.
Additionally, it seems to me that even if those troubles were widespread it was possible to a) do something against them with more money (mostly in terms of improving communication about the virus) and b) make up for other deficiencies in resources (like a lack of space and beds and personal).
http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
The tl;dr is that people donate a lot more when they can tangibly understand that a disaster has happened and they make an emotional connection to the disaster (e.g. 9/11, Haitian Earthquake, etc).
When donors are asked to contribute money to prevent something, the emotional connection is a lot harder to make and funds are a lot harder to raise.
I think the media has desensitized many people to the point where they can't recognize a significant and potential danger.
https://en.wikipedia.org/wiki/Biosafety_level
So its "literally more dangerous".
Malaria and ebola can't be compared, malaria and cars can. Malaria and ebola are transmitted in very different way. You get malaria if you live in areas where some species of mosquitos carry the malaria plasmodium. This means that it doesn't get you if you don't enter one of those areas. You can't get malaria in NYC. You can be hit by a car there because cars are definitely endemic in NYC as they are in most of the world.
I'm worried by malaria. I don't like the side effects of it prophylaxis and I don't want to risk getting sick (the prophylaxis are not completely effective) so I don't travel in areas where it's endemic. I sincerely hope we can make a vaccine against it.
I'm also worried by cars as anybody else and I take the usual measures (watch left and right before crossing a street, drive carefully) but there are few places to hide, right?
I'm much more worried by ebola because if it gets big enough there will be little we can do to stop it: it's going to overcome quarantines and get to us in our cities across the oceans and it kills with 50% efficiency. If we want to think about something that could send the human population back to 3 billion in a few years we shouldn't look at malaria or cars, but at ebola. That's why also to me this is "a far more dangerous pathogen." Let's concentrate on ebola now, we'll get back to malaria when we'll have fixed it.
Do you think it is worth considering whether a better response was and maybe still is possible to end this quickly (and be better prepared in the future)?
Malaria is a huge disaster. The Ebola epidemic is, too, in the affected countries. (I couldn’t care less about scared idiots in Europe and the US.) Both are.
But it's a bit strange to see all this American media FUD after years and years of not a word about all the destruction caused by malaria (apart from that Bill Gates project), no?
This has the potential to make malaria look like a walk in the park.
Source: CDC.gov
Based on what, really ? It may be exponential in some area but not in another with different climate conditions and genetic pool. We have NO IDEA at this stage.
Elsewhere in this discussion, someone quotes a CDC estimate that by the end of the year the number of ebola cases could reach 100k to 1.4 million. Taking the lower end of the range, that's 100k new cases in 3 months, so the number of cases grows by a factor greater than 10 in 3 months.
This is no longer true. We have no idea how many people are infected anymore because Liberia has too many patients to even keep track. They're literally thousands of beds short and it's actively doubling.
The CDC estimate is 100k-1.4m by the end of the year.
> * The vector of transmission is fluid exchange, so that reduces its ability to spread.
To some degree. It's still highly contagious, especially since it happens to cause people to tend to eject all kinds of different fluids. This is the largest spread of a BSL4 virus in history. It isn't casual.
> The chances of contracting the disease in AFRICA is fairly improbable too.
In places where it's not spreading, absolutely. In Monrovia or Freetown, there's actually a real risk and it's growing worse daily.
That's the scary part. This isn't even about what the risk is right now, though it's terrifying in comparison to where it was a month or two ago. It's about what happens two months from now.
The situation is bad now and rapidly deteriorating.
No no, you see, the world has seven billion people, so 100k-1.4m is still a tiny portion and therefore it's all sensationalism!
/s
The fact of the matter is that the current ebola outbreak is a disaster of epic proportions. Whether it becomes a pandemic is irrelevant: it's already devastating several countries in Africa and is likely to move to other underdeveloped nations if not kept in check. Can you imagine what would happen if it started spreading in India?
y' = y (1+p/100)^t
y = infected population % at time zero.
y' = infected population % at time t.
t = time in consistent units
p = percentage increase for one unit of time
So, if it takes a week for the infected population to increase by 1%, then:
http://i.imgur.com/TDPd7ug.png
IOW if after a week the infected population has increased by 1%, after a year (52 weeks) the infected population has increased by 67%. After 2 years (104 weeks) the infected population has increased to 281% of the original. And so forth.
This isn't true for car crashes, and the above is what is meant by an "exponential increase".
1) Scenario : some guy/girl lands in Florida, later that day goes for a swim in a big swimming pool with some 100+ people in it because it's a very hot day. Half of those people are on holiday and return to various places in the US before exhibiting symptoms.
2) Ebola is known for spreading fast in hospitals
3) Definitely diagnosing ebola takes several days
The problem with ebola (and all the MRSA variants, a number of which do spread through the air, and a few others) is that it can go from a few patients infected to turning hospitals into death traps in 2 weeks flat.
From the abstract of the report[0] you're citing. Essentially, it's rising exponentially (at smaller numbers) right now so of course if you extrapolate over long enough you're going to get a big scary number. The situation is bad, but we still haven't even engaged the outbreak with anything close to full force yet (a valid indictment on policy makers, not the situation). There's a difference between spreading caution and FUD, let's try and avoid the second.
[0] http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm?s_cid=... (cool read)
As you note, we still haven't even engaged the outbreak with anything close to full force yet. Until we see the effects of that engagement it makes complete sense to look at what is happening right now, not what countermeasures might or might not achieve.
We don't have a cure ... and won't have one in time to help (almost) anyone who's contaminated in this outbreak. There's really not much we can do except to contain the virus (if we can do that). I don't necessary want to be nuked from orbit, but if I were to contract this illness I'd also rather not linger towards an almost certain death.
I know it sounds a bit fatalistic, but why be an organ donor, draft a living will (etc) if you don't consider that one day you may perhaps die? And the truth is that most of us are unable to help the current situation in even the simplest way. Those of us who have a suitable belief system can only pray.
The WHO report as of Sept 24th estimates that Liberia alone is 1,550 short of what is needed for treating patients.
That was last week. What do you think it's going to look like in a month?
I think if you look at the numbers you'll see this massive scaling up the CDC is referencing isn't getting ahead of things, it's barely keeping up. The numbers are really quite bad and the CDC estimates shouldn't be taken lightly.
Basically the problem is with an epidemic that is growing exponentially, you have to scale your response exponentially just to keep your current rate of growth. To actually make it go down? You have to scale even faster.
And on top of that when the CDC (the experts in this shit) is trying to make projections, they are discounted as spreading FUD!
The CDC just issued instructions for U.S. funeral homes.
Further, this is a disease with a 50% mortality rate, and no verified treatment other than palliative care (even ZMAPP, the supposed magic bullet, did not save at least two patients who were treated).
I think we have good reason to be concerned.
It only looks like 50% at first glance because people are catching the disease so quickly that the number of deaths hasn't had time to catch up.
Well, besides media sensenationalism, the idea is that we should be fearful of a possible pandemic BEFORE it becomes a pandemic, and that that's how we take the measures and care we need to contain it. (Being fearful of something like that AFTER it becomes a pandemic goes without saying).
That said, in Nigeria there were abour 3,000 deaths and 6,000 cases. I wouldn't call that "fairly small". Plus stuff like that have a way of skyrocketing if they pass a certain threshold.
In Nigeria at least, they had very good reasons to be fearful, and with modern travel, a few stray travellers could have wiped out similar numbers in other places, or even more.
I have long believed that some kind of bacteria or virus is going to take out all or a huge chunk of humanity at one point or another. Evolution is a heartless SOB. We could very well be one or two random mutations away from losing half the planet's human population. And, BTW, the mutations in question don't have to attack us. Imagine losing half the worldwide crops, cattle or fish.
Don't get me wrong, I don't lose any sleep over this and don't have a garage full of gas masks and HAZMAT materials. When/if it happens that stuff is likely to be absolutely useless.
I wonder if that's what might finally make the religious "get it". You go ahead and pray to your powerless imaginary intelligent creator. I'll choose science thank you.
You also missed my point about taking a scientific approach to something like ebola. Gas masks are utterly irrelevant and pointeless. We know how the virus is spread and we know that if caught reasonably early it is easy to kill. Even if your entire neighborhood consists of people with ebola you and your children are safe as long as you don't swap bodily fluids. I don't know about you, I can't remember the last time I swapped bodily fluids with my neighbors. So, yeah, others can pray --which is utter nonsense-- I'll stick with scientific knowlege --which is not.
Here's the difference with science: If tomorrow someone offered true evidence that ebola is now airborne and prayer kills it, I could not imagine a single scientist who, when presented with the evidence, would not accept these findings to have a high degree of probability of being true.
This is so ridiculous I had to separate it just to say:
ARE YOU FUCKING KIDDING! SURELY YOU MUST BE BECAUSE NO INTELLIGENT EDUCATED PERSON COULD POSSIBLY HOLD THIS RIDICULOUS BELIEF.
The fact that we have people on this planet in 2014 who can actually believe something like this is the root of many of our problems.
You are equating praying to medical treatement. That is utter nonsense on the face of it, regardless of whether or not an established and effective treatement course exists for an ailment. I'm sorry, it's just plain stupid. Would you pray to Thor, Apollo, the Tooth Fairy, Zeus? Why not? So, pray tell, why does your brain magically stop working when your favorite god is invoked?
That's why this news is significant.
That said, if there are rare issues where sensationalism might be justified, this might be one. This is one of those areas where preventative aid funding is incredibly hard to muster, even though money spent in containing the outbreak now could have an oversized impact.
More at Radiolab on this: http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
Famines are similar, apparently aid workers all know they're coming, but just no one cares enough to donate until it's far too late to prevent.
The CDC and other NGOs are trying to hype up its effects because people, and you are not in the minority, don't think it's a real problem. I know people who think it's corrupt African countries trying to get more aid money.
* 1 gets you 2, 2 gets you 4, 4 gets you 8, and 10 gets you 100. Exponential growth here. See, math is fun.
* How many times have you touched your face today? What else have you touched while outside. Victims don't have to physically bleed all over you. But imagine if just 1 infected person took the NY Subway.
* They become symptomatic and then what? Most people, when starting to feel sick, go to the supermarket and stock up on juice and vitamins. Possibly passing it along to coworkers, friends, and family. Only when they have overwhelming evidence that something is wrong do they head to the hospital. Meanwhile, the entire time, the virus is shedding.
[1] http://www.npr.org/blogs/money/2014/09/26/351515481/episode-...
If you only care whether the disease is going to hit at home, or (even worse) only if it hits a "western country", then yeah.
Hundreds of thousands are dying, and it could hit millions.
I'm pretty certain it won't hit that bad "at home", maybe a few isolated cases, we have the infrastructure(s) to contain it adequately.
Not in Africa though. As you may recall, Africa is really really big (depending on map projection). May not literally count as a "pandemic", but this is a disaster of incredible proportions.
... and then there's people suggesting, only half-joking, to "nuke it from orbit". Would they suggest that if it was a "western country"?
It's fine to worry if you may get the disease yourself, personally. The answer is "no / highly improbable". But just because its wreaking havoc mainly in non-western countries, doesn't mean news about the terribleness and spread of this epidemic, that is going on right now (also it's not just some flu, it makes one bleed from their internal organs o_O), doesn't mean it's "hype" or "sensationalism". This is actual human drama and suffering at a massive scale. And it's probably going to get worse before it gets better.
3000 have died so far. 6500 have been infected. It certainly could grow much bigger, but it hasn't yet.
There are roughly three reasons this outbreak became so big: different location (West vs. Central Africa), it took a while for the differential diagnosis (the much less deadly Lasa Fever is endemic in the area, but doesn't cause hiccups), and when the foreigners arrived in force, the locals hid. The WHO et. al. actually thought it was under control, before it couldn't be hid anymore.
Educated guesses would put actual fatalities in the 10s of thousands; 100s is possible, but I don't get the impression it's quite there yet. But with exponential growth, 1 case infecting an average of 3 others by one estimate, there's no way it isn't going to get that bad in West Africa.
tl;dr: Blood samples were taken in villages, laboratory confirmed, but none of these deaths were counted unless the patient actually made it to a treatment center. Much needs revision, which is not a priority right now.
Doesn't take away from my main point, really, but apologies for the untrue and unnecessary hyperbole :)
The truth is also that we know fairly little about Ebola. It's fairly recent that we've known any animal vectors for it. It is very effective at killing but until now it has been very isolated. We know it requires fluid exchange but that's a somewhat vague concept to many, is a sneeze in an office a fluid exchange? I mean, that's good enough for flu... I'm not sure that it's known how bats (a vector) exchange or transmit it. Just a lot of unknowns, the idea that the North American bat population could start carrying it is a little scary.
We will stop it but it got a lot closer to home and if a dozen other contract it from this case, I'd say the sensationalism and paranoia are warranted.
i think a lot of the vitriol aimed at people who are worried and a little freaked out by Ebola is unfair. People have lost their minds over much easier to understand and less worrying issues before and those peoples concerns have been met with respectful, educated correction. Now it seems to have descended into name calling and ridicule.
And if anything, I've seen calls for more resources, calls to "do more" about Ebola, etc. Mostly to control it in Africa.
There's the "We are losing the fight to contain Ebola" line, and there's the "it'll never spread outside west Africa" line. Both of which can be (And are, apparently) true - it may become endemic to West Africa, but much like Malaria, it won't be a threat to the developed world.
The WHO has encouraged the international community to react more strongly to ebola, and I certainly support that. However, I can still look askance at people with no expertise who think we should all be more frightened / upset / etc.
http://www.nytimes.com/2014/10/01/health/ebola-outbreak-in-n...
Oh god the mayhem.
You'll probably be alright as long as the virus is exposed to a small enough group of people that health workers are able to do contact tracing and secure those that may have the virus.
Edit: Something quite worrying is the number of people infected in Liberia that have resulted in this. What happens if the estimates are right and 100s of thousands of people die - do we expect a percentage of these to arrive on US soils?
[0] http://www.sacbee.com/2014/09/24/6731509/nurses-to-march-on-...
Ultimately it should be manageable so long as people follow instructions.
Except that the mutation to go from a fluid to airborne virus isn't one mutation it's lots of mutations and that is simple not what we see happening in general.
The common cold could mutate into a super deadly virus but it doesn't, Flu usually doesn't either but rarely does (you want to see a genuinely terrifying virus at work read the accounts of the 1918 Spanish Flu outbreak, that thing took down the young and strong in days).
Containment is important to prevent the spread via fluid contact.
This "if X then if Y then if C then if D then Global Collapse" scaremongering helps absolutely no one.
I've written a bit about infectious diseases but defer to virologists or other folks who are better informed. I do remember reading these two articles about airborne transmission of Ebola, which might be what the previous poster was thinking about:
http://www.nature.com/srep/2012/121115/srep00811/full/srep00... EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11
http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-t... If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did in 2009, after its birth in Mexico. --Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota
Ebola has been around for a long time, and by your own reckoning has had billions of opportunities to mutate into an airborne form. It has not done so. Why not?
The Ebola genome consists of about nineteen thousand base pairs, compared to three billion in the human genome. While that represents a vast amount of combinatoric complexity, biochemical capabilities are not magic. They are not conjured into existence by the wave of a mutational wand, but have to have some substrate in existing functionality, which is why species exist: they are are islands of relative genetic viability in a sea of chaos. An incremental move away from the stable centre will in general be detrimental to the organism, and it will, in the overwhelmingly most common case, require many small, fortunate steps to add a genuinely new capability.
The fact that Ebola has not yet become airborne despite its many opportunities to mutate and do so suggests that we are dealing with a typical case here: that the current genetic configuration of the virus is more than "one mutation away" from being airborne, and it may well be a case of "you can't get there from here" (at least not easily enough for anyone to very worried about in a country where cars kill tens of thousands of people a year and people with guns kill thousands).
Nor does it follow that an airborne form of Ebola would be as deadly as the current form. With such limited genetic material to play with, an airborne virus would necessarily have to change some other characteristics, any of which could reduce its ability to kill.
Cite: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_She...
I could've sworn that Ebola-Reston was airborne-transmissible in real-world settings (albeit amongst non-human primates and swine), but I can't find a cite for that; I could just be misremembering things from Richard Preston's The Hot Zone.
Cite from 2012: http://www.nature.com/srep/2012/121115/srep00811/full/srep00...
There is no factual reason why we should expect the transmission mechanism to suddenly evolve before our eyes. That's raw fear mongering. While Ebola is more deadly than Bird Flu, that kind of wild unsupported speculation is why so many people thought Bird Flu was far more dangerous than it actually was.
Indeed and when something genuinely lethal comes along lots of people will ignore it because of the scare mongering.
This isn't the wolf but one of them might be.
- Pardis Sabeti, computational biologist at Harvard University
Source: http://www.npr.org/blogs/goatsandsoda/2014/08/28/343734184/e...
You probably should be more concerned about the flu or the common cold becoming lethal than about Ebola becoming airborne. Reason? There are way more throws of the mutation dice for the common cold and flu than for Ebola because these are way more common.
That said I'm still more likely to die from Heart Disease or Cancer, statistics ftw.
However (though I don't think this will be an issue for Ebola) before we get on any high cultural horse, let us stop to consider how many modern Americans have been perfectly willing to allow serious diseases like whooping cough to make a strong comeback because some Playboy model made lots of public claims which are demonstrably false.
OTOH pancreatic cancer is pretty serious (though not communicable) and we still live in a culture where someone widely lauded as a once-in-an-era genius (and who had ample monetary resources to seek the absolute best medical health care in spite of how bad the economics of our health care system are) thought new age-y solutions were the way to go during the critical early stages.
I guess my basic point is that you don't have to be poverty stricken and living in the third world to make really poor decisions on health issues with severe consequences to yourself and sometimes others.
EDIT: I don't mind the multiple downvotes this post has got, I have plenty of karma to burn and it isn't worth anything, but please respond as well with some sort of rebuttal. No amount of undefended downvotes are going to change the fact that Steve Jobs made a really bad decision that any unbiased oncologist will tell you statistically killed him while he would otherwise still likely be alive (or at the very least, not dead from his cancer) today.
> Overall 5-year survival rate is about 42%.
http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/H...
I have a medically sensitive daughter and the folks who go "flu's not that bad, just get it and move on" drive me insane.
If I show up to a hospital in Texas right now with symptoms such as a high fever, sore throat, and diarrhea, do you treat me as as a normal patient or assume Ebola since it's now appeared within the US? These are extremely commons symptoms and once Ebola is here, which it is, handling patients is going to be much different which affects its likelihood to be contained.
Maybe, but in the US we also have all sorts of people who purposely spread HIV and other deadly diseases, so if that starts happening with ebola then all bets are off. Especially if it gets into the prison system, into the sex worker population, etc.
Ultimately though ebola is relatively easy to combat, collect the patients, put a fence around them, wait long enough and clean up what's left. The problem is finding and securely containing the patients.
What like a quiet room away from other patients?
That is the only "isolation facilities" you actually require alongside making the medical staff use gloves and face mask which I suspect when dealing with an Ebola patient they will remember to do..., it's fluid borne not airborne, you don't even need a negative pressure setup.
Nigeria, not even the most advanced nation in Africa, seems to have been able to contain Ebola, according to the CDC [1]. There have been isolated cases in European nations that didn't lead to an outbreak. So I think the US can contain (but don't think I'm not nervous about this still, the disease is distinctly disturbing).
[1] http://www.nytimes.com/2014/10/01/health/ebola-outbreak-in-n...
On the other hand, by the time the disease arrived Nigeria, the media was already awash with the number of people who had died and so folks were already aware that this was a deadly disease and started taking the necessary precautions. This coupled with a massive enlightenment campaign by the Government helped tremendously.
If you apply the same principle to the US (awareness and if necessary enlightenment campaign), I think your nervousness will be further reduced.
People can know which end is up and still act very irresponsibly in the face of such a lethal threat.
A patient zero on a new york subway could infect a few people and they would be hard to trace.
Although it's not probible it is scarier than "can't happen"
Insurance company execs are not likely to be treating Ebola :-)
It's unlikely that either system is particularly set up for Ebola style infectious illness.
I'm sure it's not the case for everyone, but when most people develop flu-like symptoms, they usually end up quarantining themselves for a few days while it resolves. If they can't do that, social etiquette dictates that they avoid physical contact and close proximity, wash their hands regularly, not share food, etc.
I couldnt see any studies for this. The best data I found was a per capita doctor rate where countries with universal health tend (but not absolutly) to have more doctors per capita which 'may' indicate more visits assuming doctors are created by demand (loose I know): http://gamapserver.who.int/gho/interactive_charts/health_wor...
In the US I've had colleagues that were told to go home. Even with overwhelming evidence that they should not be at work they came anyway. Unfortunately, some could not afford to be sick. Rather than take the personal financial hit they caused the entire operation to slow/stop as other workers called in sick.
Unfortunately social etiquette in the US means to show you are productive even with sickness. "See how productive I am, I've got the flu and I'm still doing this presentation!"
CNBC: First confirmed case of Ebola confirmed in the United States: CDC
NYT: Airline Passenger With Ebola Is Under Treatment in Dallas
BBC: First Ebola case diagnosed on US soil
CNN: Ebola case is the first diagnosed in the U.S.
FOX: EBOLA HITS AMERICA CDC identifies first case on US soil
Obviously Fox takes the FUD crown, but I thought the NYT actually misrepresented it a bit..
I actually think they were closest to accurate. The other headlines all make it sound like this man caught ebola in the US. They are the only one to indicate he was abroad. I think they've undersold it a bit as he spent several days in the US before being isolated but everyone else has sensationalised to an extent imo (or written the headline in a way that allows us, the reader, to accidentally sensationalise it).
It's actually a pretty masterful headline, in that it doesn't actually come out and say any of that. It seems calm and fairly accurate, but is worded very carefully to encourage fear.
Nothing accidental there.
Stopping this spread depends on everyone checking into a hospital when potential ebola symptoms start, which doesn't happen. Even the current patient didn't think to go to the hospital when he became symptomatic. He potentially infected others. Those contacts have to be traced and put in observational quarantine before they become symptomatic, if they do. If one contact was infected and is missed by the epidemiologists, then the whole process starts over, because whoever it is probably won't know it's ebola and will be symptomatic for days before getting more serious and going to the hospital.
We're also close to the flu season, which has a lot of overlapping early symptoms. If nobody else was infected, or if they proactively quarantine everyone who was infected before symptoms start, then we're good. Otherwise...
I don't understand why there are flights allowed out of ebola-stricken countries. We know ebola has an incubation period. This was just a matter of time.
IF you have some free time, the Humanitarian Openstreetmap Team (HOT) is always looking for volunteer mappers. The current ebola outbreak is the #1 priority for HOT.
Tracing buildings, roads, and other features from aerial imagery is something that anybody can do, and it provides immediate benefit to volunteers from the World Health Organization (WHO), Doctors Without Borders (DWB/MSF), IFRC and other humanitarian organizations on the ground responding to the crisis.
To map something now: http://tasks.hotosm.org/
More on HOT: http://hot.openstreetmap.org/get-involved
"HOT benefits from contributors with a wide range of interests and experience. Almost anyone can make a tremendous contribution to our projects by contributing mapping, but we're also very pleased to hear from developers, documenters and ideas hackers that can engage with us and our work."
OpenStreet Map need to be commended for their humanitarian work. Their work helped in Haiti and could help here.
http://news.bbc.co.uk/1/hi/8517057.stm
http://hot.openstreetmap.org/projects/haiti-2
There are simple easy things that people can do that are useful.
Would you sit there and just make sure he didn't spit on you? Or would you go sit in the bathroom for the flight? Curious as to how people would react...
Theoretically someone could fly from an affected country to Europe. Spend a few days and book another trip to North America and not be screened. However triage process in hospitals is that patients with fever greater than 38.6C are asked if they have spent any time in an Ebola affected country within the past 21 days (high end of incubation period).
Second, if they're well enough to be on the plane, even if they're infected, they're probably not going to be spreading that infection. By the time an ebola patient becomes contagious, they're usually not well enough to travel.
And on top of all that, if they're actually contagious, I'd be worried about fomites generated while they're vomiting. Which they'd be doing in the lavatory.
So in the general case, I don't think I'd be too worried about sitting next to them. (And if they're actually sick enough to be vomiting, I'd recommend being somewhere other than the lavatory.)
Also, we are relying on another country to screen people at airports before they leave. Somehow I suspect this is not being done in a serious manner, ala-TSA.
The former implies that there may be sufficient mechanisms in place to prevent a repeat incident. The latter does not.
It is most certainly possible to fly from west Africa to the US without transiting a third region.
"The patient developed symptoms days after returning to Texas from West Africa and was admitted into isolation on Sunday at Texas Health Presbyterian Hospital in Dallas."
This is from the CDC briefing happening now.
As for "bad news," the patient self-referred to the hospital, Ebola was not suspected, and the patient was initially sent home to recover. (S)he returned once conditions worsened and was then diagnosed with Ebola.
Specifically, the patient arrived in the US on the 20th, became ill on the 24th, visited the hospital on the 26th, and was admitted on the 28th. Which means that Dallas had someone symptomatic in its midst for four days, which is rather unfortunate.
Cite: http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-...
General rule of thumb:
Anytime someone says "there is no doubt in my mind about X", you can be pretty sure that yeah, they do have a lot of doubt in their mind about X.
Also the odds of it leaving Africa and coming to the us were virtually non-existant: http://www.npr.org/blogs/health/2014/06/25/324941229/could-t... I guess that's another oops.
People are underestimating this virus and whenever you underestimate something you generally later regret it. Hopefully I'm wrong for example, but I see too many people sending their sick kids to school and so on. I just think that although we can stop it, it's not nearly as easy as it's made it to be. And we need to stop it sooner than later. I hope I'm wrong but I dont want to find out the hard way. Assuming were bettr than a virus is never wise...
http://mtpr.org/post/missoula-doctor-ebola-front-lines
As he explains, Montana has one of the few labs in the country (actually in the small town I live in) where you can work on live ebola cultures so we have medical people trained to deal with ebola etc and some also have been spending time in africa.
And only 15 in the US planned or capable of operating at that level. At least a couple will only do BSL4 work if surge capacity is needed.
Actually the history of RML is pretty cool. It was founded in a tent in the early 1900s to study Rocky Mountain Spotted fever and early researchers included the founder of the frozen foods industry (Clarence Birdseye).
http://www.niaid.nih.gov/about/organization/dir/rml/pages/hi...
(The BSL 4 is in a modern building that, amongst other measures, maintains a negative air pressure os any leaks are leaks into the building.)
On the other hand, private hospitals have the same, or similarly trained nurses, who do a great job. So hopefully the nurses' self-preservation instincts will kick in, and similar levels of isolation to those found in advanced healthcare systems will be deployed quickly if it starts spreading in the public healthcare system.
OTOH, Lagos has a population of around 20 million and is within hundreds of kilometers of active cases. It's almost 10 times more densely populated than Johannesburg too (20,008/km2 vs 2,900/km2).
[1] http://en.wikipedia.org/wiki/Ebola_virus_disease#mediaviewer...
Don't tell me you would happily sitting and eating next to someone with confirmed ebola for 8 hours plus, because they haven't started showing symptoms at that very moment.
I would at the very least go to a doctor to be sure.
Only after it already happened they confirm if it is safe.
On a global safety issue it isn't a problem, but on an individual level, it is scary.
The passengers were screened for fever before boarding the plane. On the individual level there are thousands of better things to worry about.
I can't immediately find a source for your claim that sneezing is the "primary means" of transmission - can you provide one?
Though apparently this person wasn't infectious at the time as has been pointed out.
--WHO
You're not the first nor the last to be tripped up by that. Airborne means that the pathogen can survive for some time in extremely small droplets. If you are sitting right next to someone with a non-airborne pathogen you have two problems. First, you will be reached by bigger droplets. Second, virus in very small droplets will only be in that condition very briefly before reaching you, and wont have sufficient time to die.
http://www.pathogenperspectives.com/2014/08/debunking-airbor...
I'm not saying it's likely to infect you, I'm saying this would cause personal distress, even if it is unlikely or impossible.
They departed on the 19th of September, arrived on the 20th, showed first symptoms on the 24th, sought care on the 26th, were admitted to the hospital and isolated on the 28th.
As the Director emphasised again and again, Ebola is only transmittable when you are showing symptoms. There is only the window between the 24th and 28th when the patient with Ebola could have realistically infected anyone, so people travelling along with them aren’t affected. Any people they did have contact with will be monitored for the next 21 days.
4 days loose is quite a reasonable amount of time to infect others. If they had been using public transport or being in densely populated events e.g. attending a concert/conference it could be quite a lot. I guess we wont know for a couple of weeks. Here's to a functioning health system, a bit of luck.
I'm only half joking.
Ps: yes I expect to see this doe voted too :(
Article: "[...] an unnamed patient was being tested for Ebola [...]" (emphasis mine)
Besides the obvious pleonasm in the title ("confirmed [...] confirmed" doesn't make it doubly so), nowhere in the article does it say that anyone is certain that this man actually has Ebola, as obviously, tests are still being done. Until the results of these tests are in, there is no confirmation.
Is this some kind of reading comprehension test being dumped on HN? For what nefarious, crowd sourced, statistical research project? <grin>
Watch the video embedded in this to get the verbatim statement of the director of the CDC: http://www.nytimes.com/2014/10/01/health/airline-passenger-w...
Edit: Ah, I understand now that the CDC has a rather peculiar definition of "case" of illness, see giarc's comment below for a link.
arrrg is pointing you at a more recent article that obviates the need to parse up the CNBC article, in the video the director of the CDC states that the lab tests have confirmed it is Ebola.
In any case containing a patient you know has ebola, is the least of the problems. Ebola symptoms are not exactly distinctive and if you don't have reason to suspect ebola, it may very well be able to spread before it can be contained.
From the CDC website.
Yes – any U.S. hospital that is following CDC's infection control recommendations and can isolate a patient in a private room is capable of safely managing a patient with EVD. CDC recommends that U.S. hospitals isolate the patient in a private room and implement standard, contact, and droplet precautions.
Source: http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospi...
The probability of ebola spreading to any significant portion of the united states is virtually nil.
Everyone with the "stay calm" attitude is lucky. This whole virus seems like such a "matter of time" situation. #1 finally showed up in the U.S. Do you really think it will just stay at 1? What are they doing with the beds he slept on, the towels he used after a shower, the glasses he drank out of? Did he go to a restaurant? A ball game? Who knows?
How much time do we have until it's in a school, on a subway, or your neighbor has it. Nobody even knows what to do. The first thing Americans do when they get sick is GO TO THE STORE. They go get some over-the-counter med. Literally, the first thing people in this country are going to do is go out and expose more people once symptoms start to appear.
Bodily fluids. A sweaty, feverish person is going to touch a door handle, counter, and anything else along the way. We won't even be able to pump gas without rubber gloves.
My checker at Fred Meyer today blew her nose and proceeded to touch every one of my groceries and scan them. It was disgusting. I literally sterilized yogurt containers when I got home. People have no sense of how to keep their germs to themselves.
Ebola starts with fever and vomiting and diarrhea, from what I've read. How are our sewer treatment facilities going to fare? Seriously, this is going to become a nightmare.
Yes, there is a small chance of a multifocal outbreak, though CDC has moved quickly to identify and isolate potential contacts. There is an infinitesimal but still nonzero chance of an honest-to-god epidemic. But medical institutions and the federal government have wargamed all sorts of epidemic scenarios in the decade and a half of OMG ANTHRAX/SMALLPOX/H-N-SOMETHING-SOMETHING panic we've endured.
Even in the (vanishingly unlikely) worst case scenario, state and local authorities have extremely expansive authorities to impose and enforce isolation and quarantines, violation of which (in Texas) is a third-degree felony. (CDC, under HHS delegation, can also impose quarantines to prevent interstate spread of disease, but generally this is left up to the state.) Dallas and surrounding communities could enforce a quarantine and let the outbreak burn out that way, although the economic cost would be enormous. But even mid-tier nations like Nigeria -- which spends per-capita 1% of what the US does on its health system, and which has what could be charitably described as a less-effective government -- have been able to stop Ebola cold with far less drastic action.
In truth, the greater threat comes from citizens who could mob doctors' offices and ERs, demanding nonexistent ZMAPP cocktails for garden-variety seasonal flu symptoms. Unsurprisingly, there's not much medical surge capacity in most hospitals, and beds and labs are in chronically short supply. Health system resource consumption by scared but non-sick patients is a far more likely cause of mortality than an Ebola outbreak.
Of course being in the same building doesn't matter, and you may be fine.
But if you were one of the doctors who saw him the first time he came in, and then proceeded to help other patients that day after assuming this guy just had the flu... well, that's another story.
Or maybe if you rode in the same ambulance he did over the next couple days.
The thing is, the number of people who may have just been exposed is huge, and how many of those will get caught before it spreads even further?
He was infectious. That doctor should be wearing gloves and washing hands between each patient and that doctor would not be infectious until a few days after contact.
I recently went to a doctor, he came in and shook my hand, THEN went to put on hand sanitizer. Then I did too. He said he was sorry.
Well, with Ebola, "oops" isn't going to work out too well.
If you don't have a degree in a related field or haven't spent any amount of time studying disease (and no, Pandemic the game does not count) you have NO BUSINESS making comments on the preparedness of the US healthcare system - or on how the disease may affect anything.
All you are doing is spreading FUD - you are acting like Fox News and it is downright shameful.
If you have a legitimate criticism of any of these posts feel free to reply. Better yet, post the type of well-researched article you yearn for on here (you commented on this thread so I assume you have experience in studying disease).
No. Some people are smarter than others - that's a fact. Hacker news consists of technical discussions on complex topics. Those kind of discussions tend to draw in more intelligent people. Therefore, I have no problem concluding that hn readers are likely to be more intelligent than average.
Unless you can magically ascertain the qualifications, or lack thereof, of someone, maybe you should only criticize on the content of their comments?
There is not even an ounce of hypocrisy.
I didn't make any claims of the US preparedness, nor did I say anything about how the disease may or may not spread. If I was going to do that I would only do so if I had research to back it up with - and I am about to get in the car to drive to dinner with my family so I don't have time to read a bunch of journal articles.
Saying people need a degree to comment is a complete joke. I can make whatever comment I want, regardless of my experience. Get over yourself dude.