Ebola: learn from the past
nature.com
nature.com
Obviously, we should heed the lessons of the past, but a virus like Ebola is not a static phenomenon and it's concerning that so many seem to have developed strongly-held assumptions. The number of medical personnel infected in this current outbreak is particularly worrisome and we don't yet understand the exact causes of this.
We do know that the strain in the current outbreak is different from those seen before, and that it's mutating[1]. Filoviruses have a rapid rate of mutation, and the longer the outbreak lasts, the more opportunity the virus has to mutate into a form that makes it harder to defeat. The speed with which Ebola kills those it infects is actually disadvantageous to the virus. Natural selection would logically favor a strain of the virus that didn't kill its hosts so quickly.
While a lot of speculation revolves around the possibility that the virus could become more easily transmissible, it would be just as worrisome if there were mutations that affected incubation time or the onset symptoms. These types of mutations could significantly complicate some the strategies we're relying on today, if not render them useless.
[1] http://www.washingtonpost.com/national/health-science/ebola-...
1. The size and the number of people infected.
2. The geographical scale. No outbreak has ever been anything other than localised.
3. It is spreading in urban areas. All previous outbreaks of Ebola have been rural.
If any of these differences are important then we can’t really look to past outbreaks to know what is going to happen.
"As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later.”
I wonder what this sounds like? The good news was it only killed between 1/3 and 2/3rds of the population.
This happened in the past with Yersinia Pestis that wiped out half of the world population through fleas.
I'm not sure sure why there is no centralized effort to accelerate research but rather top virologists focus on logistics of moving dead bodies.
Your answer is right at the bottom of the science article.
"In memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD and lost their battle with the disease before this manuscript could be published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan. We wish to honor their memory."
That usually means find more data!
The truth is probably somewhere in the middle - but for someone in the US who doesn't work in a hospital, at least for now, you have nothing to worry about. If it starts spreading in the US, that is the time to start worrying (as an individual who doesn't work in the industry)
I'm not saying doctors and scientists in this field shouldn't be worrying or doing anything about it - what I'm saying is if you are not one of those people and you're not traveling internationally, there is no logical reason for you to even think about it for the time being - things may change for the worse, but until then it is unnecessary worry for something you have absolutely no control over.
So when someone says, "Ebola might mutate to become a flesh-eating flying monkey" (which is true, by the way, given enough time) they may as well be saying, "Ebola might not mutate..." Both statements are equally true, but they have chosen to say only one.
Why? What actionable information is contained in that choice? I can't see any. Nor (one hopes) does it express their desired outcome.
Statements like "Ebola could mutate..." appear to me to be some kind of verbal reassurance behaviour. From this I infer that they are motivated primarily by fear, and one of the things fear does in social primates is--rather like a virus--spread itself. About which I will now proceed to speculate in an unfortunately data-free way.
People are hierarchical animals, and when we're afraid we feel better if we're not as afraid as everyone else, so we tend to do and say things that will raise alarm in others. Being afraid lowers one's status in the group (and lower status often leads to more fear). There are two ways of dealing with this: reducing one's own fear, or increasing fear in others. Again, this is purely speculative: I've searched around a bit but can't find any research that bears directly on this question. It would be interesting to see it investigated, and relatively straightforward to do.
So "Keep Calm and Carry On" is a good motto to have. It helps us focus on maintaining our place in the monkey hierarchy by controlling our own fear, rather inducing fear in others. And given how frequently fear runs out of control and leads to uncivil behaviour, this seems like a desirable result.
However, patient's don't become infectious until they start showing visible symptoms. Not only that, the symptoms are pretty obvious. Compounding all of that, the vector by which the virus travels is one of the "slowest" routes available.
What I think this outbreak does show however, is that we as a global peoples, need to really rethink how we treat and handle the spread of disease.
Are they? The guy in Dallas originally reported with nothing more than abdominal pain. While he quickly deteriorated after that, was he already contagious at that point?
If a health worker with protective gear can contract Ebola, imagine how easy it is for someone infected with Ebola to transmit the disease on an airplane or a restaurant. If they start vomiting around people, and splatter the people around them, will those people not get infected? Will the workers who try to clean up the mess not get exposed as well?
The symptoms are obvious, but they are obvious symptoms for much more innocuous diseases as well, so it's easy to miss.
Health workers contracting it means that their needs to be either more protective measures or better training to help prevent mistakes.
Because that is the truth.
When someone is working in close quarters to the disease they are substantially more likely to catch it, no? You can wear all the protective gear you want, if protocol for taking off the gear is not followed 100% every single time, you open yourself up to infection. Combine that with fatigue, mistakes happen unfortunately often.
If you are just out walking around coming into normal contact with people, it is incredibly difficult to spread.
Right now we can trace people back to those that traveled in West Africa so it make identification relatively easy.
But once the disease spreads to the point where people who haven't been to West Africa start getting it, then what are we going to do? Quarantine everyone who starts showing the most basic Ebola symptoms, which are high fever and abdominal pains?
And if Ebola starts spreading, what will we do with people with suspected Ebola? Put them in the same facility as those with Ebola? That will drive people to not report their symptoms, increasing their chances of spreading it to others. It's the exact same thing that happened in Africa, and Americans will behave the same way because it's simple Game Theory. If I have Ebola symptoms, and that means I'm going to get stuck into a facility where other Ebola people are, I'd rather just pretend I don't have it because "chances of infection are so low, I probably don't have it."
Think for one second here. If someone makes it into a crowded location and starts puking, do you think people are going to move towards the puking person or get the hell away? Whereas in a hospital if a patient starts puking is a nurse going to move towards the puking patient, or away?
But at the end of the day this is 100% speculation. You are not qualified to have an opinion on the matter and neither am I. This is why I trust the doctors and scientists who are far more qualified to have an opinion when they say there is - for the time being - nothing to worry about.
And that's stupid to say I'm not qualified to have an opinion. I don't need to be a doctor to be allowed to have an opinion. I look at what the so-called experts claim, and understand that what I'm seeing in reality doesn't match what they say. And in fact, my opinion matches what other "experts" are questioning, a la LA Times article[1]. So, yes, I am qualified enough to have an opinion just by using simple common sense. You can feel free to be a good sheep and listen to what you're told, but I prefer to think for myself.
And to be clear, I'm not worried I'm going to get Ebola. I just don't like it when I keep reading in the news that Ebola is extremely hard to catch, when it's obvious that it's not based on the evidence of who and how people are contracting it.
[1] http://www.latimes.com/nation/la-na-ebola-questions-20141007...
I don't know about you, but I personally am not in the habit of exchanging bodily fluids with random strangers in crowded places, and I have been on buses where people have thrown up--amongst other things--and never once worried that I was getting splashed by anything untoward. Based on that experience I judge the odds of random-stranger transmission to be low. Not zero, but low enough to not be a significant factor in the spread of the disease.
With regard to your "simple game theory", you are assuming that people in charge of quarantine and triage are idiots. They are not. They have thought this through. In quarantine patients will be sufficiently isolated from each other to prevent transmission. This is just basic, dumb-as-rocks first order protocol, which you didn't even bother to look up before posting: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-co...
Read the very first item in the table: "single patient room".
Are you sure? What about touching the same doorknobs or handles in trains as other person? Are you always wearing sterile gloves and always wash your hands (with a foot-operated faucet) before scratching your face when it itches?
If not, you are exchanging bodily fluids with random strangers much more often than you think.
And as to the quarantine protocol, you have missed my point. My point is people with symptoms will be scared to be admitted into a hospital because they don't want to be quarantined next to someone who has Ebola, single patient room be damned. Instead they'll take all this nonsense about how it's hard to get Ebola and rationalize to themselves that they don't actually have it, so why bother getting locked up with people who actually have it.
When has any public official ever told the truth when the news is grim. Lets think what Bagdad Bob would say.
I'm constantly reading people being afraid of Ebola mutating to make people survive longer so the virus can spread better. Influenza (Flu) is very good with that, yet not even the very contagious flu was able to cause a significant thread to mankind in the recent history.
Ebola is the cause for a humanitarian crisis in West Africa and we should put all our efforts to helping the people who are affected by it, rather than worrying about ourselves for no good reason.
Even the CDC has predicted 1.4M people infected with Ebola in West Africa alone, at its current rate of increase. Who knows what the infection rate will be outside of West Africa. That doesn't sounds like something that is 'not very contagious'.
2. The 1.4M people prediction from the CDS assumed no intervention or help from other countries and a collapse of the local healthcare systems. That's why I am saying that we should focus our efforts on helping the healthcare workers in West Africa.
> Who knows what the infection rate will be outside of West Africa Way lower than the rate in West Africa, that is for sure. Ebola doesn't spread through the air, you have to get in direct contact with body fluids. You don't get infected by sitting in a bus or plane with someone, who is infected. Most of the infected people are healthworkers in a setting without protective clothing, even gloves are rare to come by. Others are direct relatives who don't know much about ebola and who have burial rituals that are very different to the ones most of us are used to. It is very common in West Africa to wash out the mouth of dead persons and to kiss them goodbye. I am pretty sure this would not happen in the US or Europe, especially not if the deceased person died by bleeding out of all body openings.
A very large majority of ebola infected people in West Africa can't go to a hospital - there are no free beds at the moment. So they go back home to their families. THIS is how ebola spreads.
That's why we have to act, but not by panicking, but rather by sending well trained medical staff to help.
[1] http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=article
You can't take one anecdote and extrapolate from that.
Please note, that last example is not the same as sneezing spreading the flu. The flu will remain "airborne" for a period while the droplets of blood don't remain airborne, sure sneeze droplets can get some impressive travel but it's not the same issue, the virus is in the fluid. Medical rules for the appropriate protective gear boil down to "cover all skin" and either "filter breathing intake" or "closed circuit air if possible" ... None of these require a full airtight, spacesuit style seal around the body which is what is needed to protect from a truly airborne disease.
The flu gets a lot of its infectious capability from infecting our respiratory tract. Ebola... Not so much, sure it's damn infectious, but picture a "zone of infectious reach" the flu might get to you at 50 feet, Ebola will get you at 10 only in the worst cases, it's usually more like 5 or less.
The virus doesn't have to kill half of the population to cripple the west. It only has to disturb food production and energy infrastructure enough for modern civilization to collapse under its own weight.
(I am presuming that it would be possible to bring in at least 1 seasonal harvest on an emergency basis, I don't think this is a huge assumption, especially given the way big harvests are already done, with specialist equipment starting in the south and working their way north)
Perhaps a more convincing statistic would be that Ebola does not have a 100% mortality rate. This would suggest that, technically, it will pass since there will be survivors. Again, I think people are more concerned about how quickly that will happen and if/when it will resurface, which it probably will.
It would require that three diseases with a 90% kill rate strike in quick succession to drive humanity down to a few million survivors. Not even the current outbreak of ebola is up to that kill rate, nevermind where the other two plagues would come from.
That still leaves 7 million humans on the planet, and the ones most likely to be left at the end of that are also those most likely to have already dealt with basic security and food.
My point wasn't that it would be a good thing, just that killing ALL humans is a much harder task than it sounds.
My point wasn't that lots of people wouldn't die, it's that it's remarkably hard to kill all humans. Even if 90% of people died to a disease, people fighting killed 90% of the ebola survivors, and famine killed 90% of the fighting survivors, we'd still have 7 million humans left on Earth.
Nothing you've outlined even pushes us out of the millions of people alive range - not by a longshot, considering none of those things mentioned above would actually be 90% deadly. My point was entirely that it's not an existential threat to humanity, and the only things that can actually pose such a threat are environmental (eg, the planet enters a new ice age, but even this might not be existential) or astronomical scale (meteors, gamma ray bursts, etc).
Ed:
Using slightly more reasonable numbers of disease killing 60%, fighting after killing 60% of the disease survivors, and famine killing 60% of the fighting survivors, over one billion people would be left on the planet. A catastrophe bigger than anything we've faced before, for sure, but not an existential threat to the species.