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Comment by saulrh | Hacker News Reader

Yep. Ebola is just not a very scary disease. Its incubation period is short and reliable, it doesn't become infectious until symptoms display, it's not particularly infectious in the first place, and its transmission mechanisms are downright pedestrian. 90% of the first world can make themselves completely safe by googling "Ebola Safety". The other 10% are homeless or hippies and will either get similarly informative pamphlets or are living in communes and won't infect the rest of us. And even if all of that fails, we have the industry to literally give every American a hazmat suit. Ebola may become a crisis, but it will not become a pandemic.

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Let me respond point by point.

> Ebola is just not a very scary disease.

Ebola is a frightening disease. On a psychological point, I feel like the shock of the symptoms itself is lessened due to the fact that most of the infected have dark skin. End-stage Ebola leads to the patient bleeding everywhere. Not only is the patient bleeding from obvious places like the eyes, nose, mouth, ears, penis, vagina, rectum, the whole body becomes covered with bloody petechiae (http://en.wikipedia.org/wiki/Vasculitis#mediaviewer/File:Vas...). On lighter skin, the patient's agony is really apparent. Their bedsheets will be dripping with blood and their eyes swell up and turn a deep maroon color.

> Its incubation period is short and reliable, it doesn't become infectious until symptoms display,

Yep.

> it's not particularly infectious in the first place

I feel like that's a point that doesn't have nearly enough information. Previous outbreaks have generally been limited the virus burning its way through a small population before it can hit a major population center. Healthcare workers who are currently treating Ebola patients (who should know proper protocol), are being infected at a rate far higher than expected. (http://www.who.int/mediacentre/news/ebola/25-august-2014/en/)

> its transmission mechanisms are downright pedestrian

I'll grant you that transmission by fluid is generally fairly easy to contain. However, when the patient is draining all of their bodily fluids out onto the floor, cleaning and containment becomes far harder. Not only that, there have been several incidents (at least before this current Mar 2014 outbreak) of patients infecting health workers by coughing and aerosolizing blood droplets into the mouth, nose, and eyes of their caregivers.

> 90% of the first world can make themselves completely safe by googling "Ebola Safety"

I don't think it's that simple. Currently, the CDC holds training sessions for:

"Currently licensed by a recognized professional agency to provide clinical care in some jurisdiction (e.g., hold a medical license to provide care in a state in the United States) and have recent (current or within the past 2 years) relevant experience providing direct care to patients. Participants should be licensed medical doctors (MD, DO, MBBS degrees), licensed nurses (RN, BSN, LPN, etc.), or other licensed clinical care providers (e.g., paramedics, physician assistants, and other clinical providers)."

These training sessions solely concern biohazard safety and last for three full days. Given that the target audience has already has extensive medical training, three full days of lecture, procedure, equipment, and technical training seems far above and beyond what we should expect from a normal citizen. Let me also point out that even with training and equipment, healthcare providers are still getting sick. (http://www.cdc.gov/vhf/ebola/hcp/safety-training-course/inde...)

> The other 10% are homeless or hippies and will either get similarly informative pamphlets or are living in communes and won't infect the rest of us.

I don't even know where you get that 10% from. It's also facetious to state that people "living in communes" "won't infect the rest of us"...do people in communes live in outer space?

> And even if all of that fails, we have the industry to literally give every American a hazmat suit.

I'd like to see how you arrived at that conclusion.

> Ebola may become a crisis, but it will not become a pandemic.

I agree. Ebola may not become a pandemic, but it will still cause great suffering to a large amount of people. I'll also grant that until it becomes a real problem in western countries, no one will really make a move as generally, western pharma ignore diseases which don't hold the promise of profit (see schisto). However, there is a very real chance that we can help and reduce the spread of the suffering by taking violent action _now_.

This goes without saying, but the one thing that anybody can do is to donate to Doctors Without Borders or any other institution trying to quell the crisis.

http://www.msf.org/donate

You make a lot of very good points. The only things I disagree with you on is your final point.

>This goes without saying, but the one thing that anybody can do is to donate to Doctors Without Borders or any other institution trying to quell the crisis.

The scale of the outbreak is now beyond what MSF or any NGO can handle. Only the military can now command the resources needed to get things under control. All donating to MSF is doing is delaying the point in which we activate the military.

This is a big if - If the data is to be believed, the plots on wikipedia show liberia getting a handle on it in the last couple weeks. The exponential growth in number of cases has been reduced (concave down on the plots). I suspect the people there are finally believing the disease is real and changing their ways, which is reducing transmission. Or it's just a blip or a reduction in quality of the data. I dunno.

>This is a big if - If the data is to be believed, the plots on wikipedia show liberia getting a handle on it in the last couple weeks.

No this is a sign that the hospitals have stopped taking in any new cases as they have reached capacity and hence new cases are not being recorded. No one has any idea of how many new cases there are out in the community. It could be that the R0 has been reduced because of changes in behaviour, or it could be because people are dying at home unrecorded. I hope it is the first, but given the state of things at the moment I fear it is the second.

On your last point. MSF are not just fighting Ebola on the ground, they are also putting pressure on governments. Sending them money helps them have the resources to do both jobs more effectively. Sure, we should be putting pressure on our governments to do more ourselves, but I do not think that there is an inverse relationship between funding MSF and the speed of government response, when MSF are one of the groups trying to increase the rate of government response.

I suspect donations are not going to have any impact on the effectiveness of MSF’s lobbying efforts (i.e. I don’t think MSF’s lobbying for military intervention by the west is money constrained). I am more than happy to be corrected on this if anyone has any data.

What I am hoping by my comment is breaking people out of the thinking that this can be solved by donations to NGO’s like MSF. I believe it is far too big now for any NGO to deal with no matter how well resourced. If we can only get on top of the outbreak by military action lets stop messing around and start lobbying for this directly - every day we delay is only making the problem bigger and harder.

Well, it's one of those low-probability high-risk diseases.

You probably won't get it, but if you do there's a better than middling chance you'll die a horrible death and if you survive you're guaranteed it won't be any fun. Oh, and there's no cure and basically no treatment. You're on your own.

The treatment for it is basically "drink lots of fluids", "keep pumping blood into the patient" (since they're literally losing it all out of every hole in their body) and "pray real hard".

Even with all these resources the tale is pretty bad

Forty-eight were treated in the hospital and 18 survived.

Less than 40% survival rate.

A moderately effective treatment for ebola will come out of all of this.

There hasn't been a huge sum of money poured into ebola therapies, and we already have promising options. ZMapp or a similar treatment will be scaled up over time, and if ZMapp proves itself to work across a larger base of test patients, we'll simply begin keeping X doses available at all times to shut down ebola outbreaks in the future.

That's exactly what people said when AIDS first showed up.

... and treatment for AIDS has improved phenomenally.

And they were right.

Magic Johnson was diagnosed with HIV in 1991, during the relative early days. 23 years later, he's apparently very healthy. The first AIDS cases in the US were in the mid 1970s give or take, with the first recognized at the time to be in 1980. So 11 years after recognizing that first case, they were able to take someone like Johnson and keep him alive indefinitely with a virus that was thought to be a death sentence in 1991.

And that's all prior to having cracked the human genome, prior to understanding stem cells, and so on. So progress was naturally slower in the 1980s or 1991 than it is now. The biotech industry was nowhere near as large in 1980 or 1990 as it is now (Genentech having been founded just in 1976).

Ebola doesn't stand a chance, even though the short term will be scary.

> Ebola doesn't stand a chance, even though the short term will be scary.

Never ever underestimate the rate at which viruses can adapt to new circumstances.

The first world had problems with the single patient in Texas. He was not quarantined white showing symptoms and came in contact with many people. Then those people were not immediately quarantined.

All it takes to get a pandemic going is to lose track of a few dozen infected people. That is easy to do.

You'll probably be very disappointed in the "first" world when you see how it responds if this outbreak spreads further. No one will give out hazmat suits in time, even if we have such an industry.

We're dealing with a living thing. Ebola has never been in a large enough human population to evolve much, but perhaps now it will. We've already underestimated the transmission rates.

Keep in mind how many medical professionals have become infected. These people have a lot more knowledge than somebody who just "googled" some safety tips.

There's a good chance that the active strains are more transmissible than we assume, and might become worse through natural selection.

>There's a good chance that the active strains are more transmissible than we assume, and might become worse through natural selection

We actually have a very poor idea of what is going on the ground in most of the affected countries as the hospital system has effectively stopped admitting new patients. The CDC is using a correction factor of 2.5 (i.e. there are 2.5 case outside of the hospitals for every case in inside), but once you stop admitting new patients then you really have no idea how many infected people there are.

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