Hacker News Reader

Comment by nathannecro | Hacker News Reader

For whatever people say, Ebola is still a fairly difficult disease to spread. True, it has jumped borders (even oceans).

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.

View on HN

Why do people keep saying it's a fairly difficult disease to spread, when a health worker in the US contracted Ebola, even while wearing protective gear.

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.

The health worker was working directly with Ebola patients, something went wrong there and should be investigated but, this is still better than a dozen random people contracting it because it actually does spread easily.

Health workers contracting it means that their needs to be either more protective measures or better training to help prevent mistakes.

> Why do people keep saying it's a fairly difficult disease to spread

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.

It's obviously not the truth. If someone stricken with Ebola makes it into a crowded location, then the chances of several people getting it will be high. This is obvious given the fact that a single Ebola patient infected a trained worker with protective gear. Extrapolate that out to an Ebola victim in the middle of Times Square, puking, coughing, sweating, etc.

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."

>It's obviously not the truth. If someone stricken with Ebola makes it into a crowded location, then the chances of several people getting it will be high. This is obvious given the fact that a single Ebola patient infected a trained worker with protective gear. Extrapolate that out to an Ebola victim in the middle of Times Square, puking, coughing, sweating, etc.

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.

They don't need to puke. Sweat transmits Ebola. Someone suffering from Ebola just needs to collapse in the middle of the subway, and people will help the person up, possibly infecting themselves by being coughed on in close quarters, or puked on inadvertently. At this point, once we get uncontrolled Ebola infections in people not remotely associated with West Africa, this is going to be a big problem because we will need to quarantine everyone that has Ebola-like symptoms, which will cause panic and become a huge burden on our medical system.

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...

Ebola has an incubation period of about three weeks before symptoms start to show. Asymptomatic people are not contagious. Ergo, for any Ebola patient admitted to hospital with symptoms there is a three-week window to identify anyone they might have exchanged bodily fluids with. Doing this is not that difficult in the typical case, although obviously anyone with an active imagination can come up with atypical cases, but there is a technical term for people who base their reasoning on imaginary atypical cases.

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".

> I don't know about you, but I personally am not in the habit of exchanging bodily fluids with random strangers in crowded places

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.

Incorrect. It has an incubation period of 8-10 days, and as little as 2 and up to 21 days. There is about a 1 week window to identify anyone they might have exchanged bodily fluids with. Bodily fluids include sweat in this case, as well as tear drops, urine, etc. Any clothing or bedsheets, for example, that came in contact with these bodily fluids can also transmit the disease.

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.

>Why do people keep saying it's a fairly difficult disease to spread, when a health worker in the US contracted Ebola, even while wearing protective gear.

When has any public official ever told the truth when the news is grim. Lets think what Bagdad Bob would say.

I have seen some speculation that the further the disease progresses, the higher the viral load will be, and the more likely it is to spread. So when you are still up and about, you aren't as big a threat as when you are dying in a hospital.

Ebola is fairly difficult to spread, it is not very contagious, no matter what you might believe based on news reports. If you want to look at a contagious disease, look at flu. The 2009 flu pandemic lead to hospitalization of ~200,000 people in the US alone within a few weeks [1]. Talking about the flu, you can somewhat guess the number of infected people to be much much higher. The current Ebola outbreak lead to ~8,000 infected persons since its outbreak more than half a year ago in March. As you see, Ebola is not very contagious when compared to the flu. Yet flu pandemics are usually restricted fairly well once they take off and people are aware.

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.

1) https://en.wikipedia.org/wiki/2009_flu_pandemic

Just because something's growth rate does reach the flu's growth rate doesn't mean that it's not contagious. The flu just happens to be extremely contagious. Ebola is still growing at an exponential rate, the rate just so happens to not be as steep as the flu's.

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'.

Also note that Ebola has 65-90% fatality rate (depending on type), while the flu usually has < 0.1%. As long as Ebola maintains exponential growth, it is much, much more serious than flu.

1. Ebola's rate of infection is ~1.5 - 2 new infections per infected persons [1] Even though this is an exponential rate, it does nowhere get near the rates of many other viruses. As such it is easier to restrict further infections than it is for most other infectious diseases.

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

> Why do people keep saying it's fairly difficult to win the lottery, when a random person won it, even on their first time playing.

You can't take one anecdote and extrapolate from that.

The nurse, who had all the protective gear, and still got the Ebola virus really caught my attention. I don't think we can afford to debate, or wiki the problem. I think it's time to restrict travel--at least to the United States. I gringe when I hear Americans flying back and forth to Sierra Leone in order to mine gold and diamonds. I don't have any great solutions, but if we start restricting travel to these affected countries--the ruling class who have money, and power might take more of an interest in stopping this spread? I know these countries are poor, but in the mist of the horrid poverty--there always seems like there's certain areas that politicians, and the wealthy end up living. Tell them(the haves) "no travel", and they might just find the money to educate and feed to poor if quarantined? (I wondered why Liberia was so mad at Eric Duncan for coming to America. I didn't feel the president of Liberia really cared about our welfare. He didn't want the U.S. to restrict travel?) Down vote me! I'm tired of trying to be so politically correct.

Not only that, the symptoms are pretty obvious.

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?

Isn't the virus as easy to spread as common cold? From what I read, you don't need a direct contact with someone's bodily fluids; you can proxy it through a doorknob or any other object both you and infected touch within (relatively) short period of time.

That is direct contact. Their fluid, under any circumstances, on a surface or not, be it their skin shaking hands, a Door handle after with viral load from their sweat, or them coughing up or sneezing out blood droplets . These are all "direct contact with bodily fluids"

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.

Reply on news.ycombinator.com