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Am I correct in assuming that cultural differences concerning death and the dead along with our healthcare system mean Ebola in America would be relatively containable?

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Yes. Theoretically this is correct.

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.

It is worse than that - even if her idiotic claims were true it would still be better to vaccinate. Penn & Teller ably explain http://www.youtube.com/watch?v=RfdZTZQvuCo

Part of the problem there is the perception that those diseases aren't serious (and in cases like chicken pox, this can even be somewhat true). No such perception exists with Ebola, I'd say.

I agree mostly, which is why I mentioned I don't think that would play out with Ebola.

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.

You are being downvoted because the 5-year survival rate of pancreatic cancer is 5%. In all probability Jobs was going to die no matter what he did.

Jobs had a rare variant (pancreatic neuroendocrine tumor) that's much more survivable.

> Overall 5-year survival rate is about 42%.

http://www.cancer.gov/cancertopics/pdq/treatment/isletcell/H...

As someone who's had an attack of shingles, saying that chicken pox isn't serious, is bullshit.

It can be very serious, yes. For most, it's not, and anti-vaxxers seem to consider their own lived experiences to be better evidence than stats like "thousands die from flu every year".

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.

I hear you... I've been blessed with multiple recurrences of shingles within six months of one another. I'm one of the lucky recipients of that rarity.

"somewhat true" implies not entirely true. Iv'e had chicken pox. It wasn't serious, but as you point out, that's not the whole picture.

Your expensive health care system may cause people to delay seeing a doctor, which means they might be symptomatic and spreading disease for a few days before being quarantined.

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"

Do people in nations with socialized healthcare go to the doctor as soon as they develop a fever, or do they delay and see if it clears up on its own?

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've worked in the US and France so can speak about both. In France I can self-certify that I am sick and quarantine myself at home. I can call a doctor to make a homecall and the pharmacy will deliver my meds on request.

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!"

For context, the current government in Australia is trying to bring in a minimum doctor visit fee (typically free currently). Their view is people go in too easily for things they should take an aspirin and wait a couple of days for.

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...

This is a great point. A free (or heavily socialised) health care system is probably better equipped to handle an outbreak than a fully privatised one, even if it has fewer total resources.

Why would a socialized healthcare system have fewer resources?

Because it uses said resources more efficiently ;)

The USA spends more on health care than socialized healthcare countries do. Therefore, socialized healthcare systems have less money, and money is an important resource.

The USA may spend more on health care, but how much of that money is wasted on overhead?

Insurance company execs are not likely to be treating Ebola :-)

That money is targetted to older people in the US. Diseases of older people include dementia, cancer, respiratory stuff, orthopedic stuff after falls, etc.

It's unlikely that either system is particularly set up for Ebola style infectious illness.

Probably. Ebola spreads through bodily fluids. This isn't the major, world-ending epidemic that the apocalypse chasers are looking for.

You're also not infectious until you're symptomatic which makes it easier to identify and contain.

Ultimately it should be manageable so long as people follow instructions.

I was about ready to ask that. The guy who's being treated wasn't symptomatic until days after he left the airport, which is encouraging to hear.

Apparently though he was symptomatic for a few days before going to hospital which is significantly not good.

If it mutates and becomes airborne, it might be. That's why containment is so important, even if it doesn't seem so threatening in its current form. Viruses constantly mutate, and every extra person they infect gives them a million more opportunities to do so. All it takes is one of those mutations to make the virus airborne, and we're in big trouble.

While it is tautologically true that if Ebola were to become capable of airborne transmission it would be much more dangerous, there is considerable evidence against the proposition that it is "just one mutation away" from such capability.

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.

There was an airborne strain of ebola that made it to American soil. The catch was that this strain only infected monkeys.

http://en.wikipedia.org/wiki/Reston_virus

> All it takes is one of those mutations to make the virus airborne, and we're in big trouble.

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.

>Except that the mutation to go from a fluid to airborne...is not what we see happening in general

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

If AIDS mutates and becomes airborne, that would also be threatening. Ditto for hantavirus, hepatitis and millions of other diseases. Heck, imagine if black widow venom become airborne and victims started producing more airborne venom themselves! If you're willing to dip into the pool of things that are vanishingly unlikely, there are lots of extremely bad things that could happen.

Hantavirus is sorta airborne. http://www.cdc.gov/hantavirus/technical/hanta/airborne-trans...

You can make the exact same statement about every other deadly virus, though. Why is ebola any different?

Because there is evidence that there were airborne strains of it in the past.

Because it's a lot more deadly than the vast majority of viruses.

To a certain extent, yes. We obviously have much better equipment but I say this only extends to handling a few "single" cases of Ebola in specific hospitals across the nation. However, now that Ebola is actually in the US, what precautionary measures do hospitals and healthcare workers take?

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.

You will see that the CDC defines a case as someone showing symptoms but also has epidemiological link to an EVD case or EVD suspect case. Just being in Texas is not a epi link as there has been no confirmed transmission.

[1] http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

There's also the issue of waste disposal. After a patient is identified can most US hospitals handle the extra waste? I saw this (http://www.cnbc.com/id/102027557) earlier, and it sounds like the hospital in Atlanta that treated those two cases had trouble with waste disposal initially.

The typical precautions in a U.S. hospital will prevent most transmission of Ebola. Doctors and nurses already wear gloves, wash their hands frequently, and avoid contact with bodily fluids to the greatest extent possible.

Depends on whether you listen to your government or the nurses [0] that work in your hospitals.

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-...

Guinea, Sierra Leone and Liberia are some of the most poorest countries on earth. Liberia especially is haunted by its brutal, child-soldier fueled civil war and the entire society is rather rickety.

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...

I think one of the reasons why Nigeria was able to contain it compared to Liberia and other countries was an awareness of the disease and the enlightenment campaign from the Government. From initial reports that I read, folks in Liberia didn't really believe it was a 'sickness' till it started killing people. Some of them also first tried 'traditional medicine' and only started going to hospitals when things became really bad. There were also reports that folks were not keeping away from people who were under quarantine believing it wasn't really a disease.

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.

The actions by the doctor in the oil hub of Port Harcourt are a sobering counterpoint to the above. He secretly treated another Liberian diplomat, presumably infected by the index case, in a hotel room. The diplomat recovered, the doctor died, but not before infecting others because he did not take the necessary precautions when he become symptomatic.

People can know which end is up and still act very irresponsibly in the face of such a lethal threat.

It depends in part on how willing you are to assume that the transmission mechanism won't evolve.

Or phasing that another way: It depends how willing you are to ignore the facts and invent unsupported "worst case scenario" scenarios.

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.

> 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.

"The more time you give a virus to mutate and the more human-to-human transmission you see," she says, "the more opportunities you give it to fall upon some [mutation] that could make it more easily transmissible or more pathogenic."

- Pardis Sabeti, computational biologist at Harvard University

Source: http://www.npr.org/blogs/goatsandsoda/2014/08/28/343734184/e...

"make it more easily transmissible _or_more_pathogenic_"

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.

Something like the Spanish Flu returning scares the living shit out of me (while I also know it's remote), that fucker does mutate, it is airborne and it has happened and that was in a world with slow transport.

That said I'm still more likely to die from Heart Disease or Cancer, statistics ftw.

I vaguely remember reading recently that that had actually never happened to any virus that wasn't airborne transmitted to begin with.

Well, there is this: "While all Ebola virus species have displayed the ability to be spread through airborne particles (aerosols) under research conditions, this type of spread has not been documented among humans in a real-world setting, such as a hospital or household."

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.

Ebola has been theorized to be airborne by scientists at the National Microbiology laboratory in Winnipeg.

Cite from 2012: http://www.nature.com/srep/2012/121115/srep00811/full/srep00...

Theorized but not conclusively shown, as the "Discussion" section in that study indicates. Transmission may have occurred due to large droplets or fomites contacting the mucosal membranes of the monkeys.

I thought there was quite a bit of controversy with regards to whether Reston was airborne.

Depends on how fast you are able to identify and isolate the patients. Unless there is reason to suspect ebola it's not exactly the first diagnosis that will come to mind. Most hospitals probably also don't have the necessary isolation facilities or at least not on standby.

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.

> don't have the necessary isolation facilities or at least not on standby.

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.

And specially trained staff. And extra careful staff.

> Am I correct in assuming that cultural differences concerning death and the dead along with our healthcare system mean Ebola in America would be relatively containable?

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.

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