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Comment by jewbacca | Hacker News Reader

My total layman's impression of this has been that it doesn't matter if the virus mutates to something "worse" -- that, short of some currently politically impossible action several orders of magnitude beyond what is currently being done, there is no really solid, non-magical-thinking, reason to believe this outbreak won't kill tens/hundreds of millions of people and threaten world civilization as we know it, even with the virus as it currently is.

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.

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While I am firmly on the side that believes that Ebola is very serious and we need to do everything we can to stop it [1], it is possible the R0 could drop below 1 via changes in behaviour of the people in west Africa. Since we really have a poor idea of what factors are driving the spread of Ebola, it is possible that these factors could change spontaneously. For example, people might get so scared of Ebola in the affected countries that people just stop caring for the sick and throw them out on the street to die. This might be enough to get the R0 below 1 and the disease will burns itself out.

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...

In your piece, you advocate a military response. What do you want militaries to do to combat this problem? I'm terrified of this becoming a shooting war in which people suffering such horrible misery also become victims of violence intended to keep them "away."

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?

I should write a follow up piece explaining why a military response, but the basic reasons are:

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.

The military is quite good at operations 'other than war'. I was a minor cog in one effort, in 1991: Joint Task Force Sea Angel.

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.

That is already happening. There are already 565 US military in the region, and Obama plans to deploy up to 4000.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/anothe...

Which is way less than the number we need there right now let alone in a couple of months it will take these troops to all get there.

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...

Honestly I have been disappointed by how effective they have been. I would expect the Army to be able to build field hospitals faster than this. There have been a lot of setbacks, detailed in a recent NYTimes article: http://www.nytimes.com/2014/10/03/us/us-effort-in-liberia-ba...

" the local contractor announced that the crusher’s engine, needed to smash rocks, had broken" and "Hauling parts and equipment from the United States and Europe takes time, and then there are negotiations with local contractors for heavy equipment."

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.

replying to you since i can't reply to the child reply i wanted to address.

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.

The linked article is now slow to load, for me. But I recall that the fellow who was having issues with the rock crusher was called out as a Seebee.

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.

"For example, people might get so scared of Ebola in the affected countries ... and throw them out on the street to die."

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.

>That might make it worse.

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.

I am bouncing back and forth between the positions you describe. At the end of the day, though, if the "R-naught" is less than 2 in uncontrolled situations, and something like 1 in a hospital, it seems like it can be reduced to <1 pretty easily.

As I understand it, the most dangerous type of "worse" is ebola becoming less deadly.

> becoming less deadly

I suppose you could describe being contagious for longer or being contagious with less prominent symptoms as "less deadly".

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