The way the narrative has shifted in the past week has done a really good job of discrediting any routes to denial I'd previously had.
I would love to hear some credibly informed people disabuse me of this notion, in some way beyond calling my impressions those of an ignorant, panicky fool.
As I understand it, the most dangerous type of "worse" is ebola becoming less deadly.
I suppose you could describe being contagious for longer or being contagious with less prominent symptoms as "less deadly".
The problem is hoping for a spontaneous change in behaviour that gets the R0 below 1 is like have a small fire that has started in the corner of your living room. Sure the fire might go out on its own, but is wise to sit there doing nothing just because it might go out?
[1] http://www.tillett.info/2014/10/08/ebola-what-needs-to-be-do...
I don't want tens of thousands in west Africa to die of ebola, but I certain don't want them to die lonely, thirsty, and ducking for cover. :-(
It seems like the most important tactic for reducing the R0 to <1 is building isolation treatment centers, yes?
1. The scale of the problem is too large (both geographically and in the numbers of people affected) for any organisation (or group of organisations) other than the military to handle. Even if we moved to immediate mobilisation today it would still take months to get up and running on the ground by which time the problem will be vastly bigger.
2. We need to enforce a effective quarantine in the area and provide protection for the health care personnel. Only the military has the ability to do this.
3. I think we will have problems recruiting enough volunteer medical staff and may need to conscript them to get them to go.
4. Only full-scale mobilisation will stop the political games. Only if this problem is treated as war will we be able to get effective action out of the bickering political parties.
Details are searchable, but the upshot is that NGOs (I no longer recall if the term was used then) provided far more disaster relief assets and supplies, than the military did.
What the Marines brought to the party was command and control, and the ability to field, and support, a thousand guys in only days for delivering food, water, and medical aid.
And also, one shouldn't underestimate the ability of a brigade of disciplined troops to control masses of infected people. If they're told 'don't shoot' then they won't shoot.
http://www.nbcnews.com/storyline/ebola-virus-outbreak/anothe...
If people want to know what it is like on the ground have a read of this blog post [1].
[1] http://pfmhcolumbia.wordpress.com/2014/10/12/les-roberts-the...
That's crazy. The Seebees and other military engineers have rock crushers, and construction equipment. They know how to break that stuff down and put it on airplanes. The Air Force is used to transporting that stuff.
Now, I was only a stupid jarhead, and there may be issues not called out in the article, but I'd expect a week, tops, could get engineers on site, working, with their own equipment.
If they deployed the SeaBees this wouldn't be happening. The key word is 'contractor', by using companies to avoid the political taint of 'getting involved where they aren't wanted' or being accused of 'wasting money' we send the proverbial 'lowest bidder' instead of the trained experts. Sad but true.
Perhaps he's there as sort of general contractor, working with the locals to build stuff, and not part of a battalion.
Which seems stupid, to me. Building a lot of stuff on short notice, as a team, is what the Seebee battalions are for.
That might make it worse. In Africa, the distance between the gutter and the water supply isn't very far nor clearly defined (bad water causes a lot of deaths in Africa already). And given that the Ebola virus causes people to literately leak, dropping them in the street may containment local water supplies. Plus, the Ebola virus can probably survive in wet but dead tissue a lot longer than in the open area. So each one of these bodies would become a mini bio hazard, until the tissue decays to the point that the virus dies.
Of course. I was just trying to give a concrete example of a change that might cause the R0 to drop below 1. It would be great if the R0 did drop below 1 on its own, but planning on this is not any wiser than hoping the small fire in the corner will go out on its own.
Ebola does not have to become airborne for it to be a problem. Polio is not airborne and it has a very high R0 (5 − 7). The difference is polio is adapted for human-to-human transmission while Ebola is very unlikely to be. I don’t want to find out how well adapted Ebola can become.
[1] Something that I have noticed about the discussion here is many people are unclear about what it mean for a virus to be “airborne” (this is not surprising since most people are not virologists). What airborne mean is that the virus is adapted to spreading via small mucosal droplets. The classic virus for this is rhinovirus (the most common cold virus). Rhinovirus infects the mucosal cells of the upper respiratory tract, it causes you to produce lots of mucus, it makes you sneeze a lot releasing this mucus in small droplets into the air, the virus is hardy enough to survive in the small mucosal droplets, and it doesn’t make you that ill so you still go to work where you can spread it around your co-workers. Doing all the things required the evolution of many interlocking adaptations in the Rhinovirus genome.
Ebola's infection mechanism is nothing like Rhinovirus. While in theory it is possible that Ebola could acquire all the adaptions required to be spread efficiently by small mucosal droplets, it is really unlikely as there are so many changes required. This is why most experts think it is unlikely that Ebola will become “airborne”.
http://www.cidrap.umn.edu/news-perspective/2014/09/commentar...
Some health workers have been infected even though they were equipped with significant protection.
Clearly infection rates in unprotected populations would be non-trivial, even without the kind of mutation that would make Ebola as infectious as a rhinovirus.
Given that many public spaces in Western cities are more densely populated than equivalent spaces in Africa, and there are much greater numbers passing through them, I'm genuinely concerned this has the potential to blow up in a vey bad way.
I'm not heading for the hills yet, but if case numbers begin increasing I'm going to consider it seriously.
This would mean that you're not at all likely to get Ebola if you just happen to stand near an infected person, but we will still occasionally hear of people who seem to have been infected "through the air." These, one would think, would tend to be healthcare workers since they see patients at their sickest and may be performing procedures (e.g. intubation) that aerosolize saliva.
a) ignorant of virology
b) enamoured of a multiply-debunked case "they've heard" that "might have" involved "airborne" transmission despite the massive unlikeliness of that
c) deeply, deeply fearful about the "possibility of Ebola becoming airborne"
and
d) have never once anywhere posted anything wittering fearfully about influenza becoming a deadly pandemic, which is so many orders of magnitude more likely it isn't funny.
The degree of cognitive failure exhibited by these fearful posters is saddening. There is no obvious reason for them posting their fears and disinformation.
My prediction for Ebola is that it eventually becomes like norovirus (stomach flu): a common gastrointestinal ailment that is painful and inconvenient, but seldom lethal, and spreads easily through contaminated surfaces.
Secondly, the mechanism of transmission of Ebola is quite closely tied to the cause of death. To be transmitted it needs to turn you into a massive viral factory and then make you very “leaky” so the virus gets spilled out into the environment. Any mutations that decrease mortality are also likely to decrease the infectiousness of Ebola
Thirdly, Ebola is starting off from a very high death rate. Even if there was a major decrease in the mortality rate (say it only kill 5% instead of 50 to 75% people), it would still be a huge problem.
"The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy.[3] From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today."
It doesn't take millions of years for diseases to adapt.
It's not meaningful to talk about the R0 of Ebola in any kind of historic sense. Jungle/rural outbreaks are going completely different from urban ones, and this is a very different outbreak than previous ones. Very simply, if you have a 100% transmissible disease and are in a sealed room with 0 people until the pathogen is gone, your R0 is zero. If you're in a room with 100 people, it's 100.
I guess I'm saying that I'd love a reliable citation for your claim. Changes in R0 aren't necessarily evidence of that, and those claims (especially airborne transmission) is just needlessly and baselessly worrying people.
Viruses--parasite and pathogens generally-are incredibly narrowly adapted to their preferred mode of attack. They have to be, because the chinks in the host's immune system are almost by definition incredibly narrow. If they weren't the host species would not have survived.
This gives pathogens and parasites very little room to maneuver. They can't just arbitrarily bolt on new capabilities. They have relatively little genetic material to work with: 19 kilobases in the case of Ebola, which is less than the coding length of the majority of human genes (which can run comfortably into the hundreds of kilobases).
So think of Ebola like an evil eight-bit micro-controller. It's only got 256 bytes to work with. It has been carefully programmed with a tiny attack program that depends on a very specific weakness in the target system that requires it be plugged into a USB port controlled by a particular chipset rev from a particular manufacturer. The claim "it might go airborne" is equivalent to the claim that such a chip, under millions of random mutations, might be able to infect systems via network ports while remaining the same in every other respect.
This is not (provably) impossible, but it is of such low probability that I'm pretty sure anyone concerned about it should be in a state of panic regarding cows, coconuts, coronal mass ejections, and other far-more-probable causes of death if they want to make any claims to intellectual consistency.