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Ebola cases pass 2k as crisis escalates

177 points by howard941 7y ago

coldcode 7y ago
It's just a question of time before it reaches the US. We were lucky with Dallas. It likely will escape the next time into the general population since many people without health insurance are unlikely seek medical care in time and when they do at the last minute, it will spread.
- raverbashing 7y ago
  Ebola is much less contagious than people think https://www.businessinsider.com/ebola-discoverer-would-sit-next-to-someone-with-the-virus-2014-8?r=US&IR=T https://www.businessinsider.com/ebola-discoverer-would-sit-n...
- low_roar1 7y ago
  Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic. In Congo Kinshasa, it's just the chaos politically, there is no real government in many parts of this country, the real danger is that it is not a small country at all, 80+ millions of inhabitants, many can't be reach by the WHO because of the wars and infighting between the "government" and militias. So the crisis there has great chances of getting worse, not better. Furthermore, many many many people locals despise foreigners and particularly white people, for historical reasons, or just ignorance, and the culture is extremely unsanitary (touching and living with the dead, consuming bush meat or worse, ritualistic cannibalism, and what not), some straight out think Ebola is a white conspiracy. This isn't a problem only money can solve this time.
  - edubs25 7y ago
    >Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic. I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.
    - natalyarostova 7y ago
      What is the politically appropriate word instead of civilized to enumerate the difference between taking a public health first approach vs. killing first responders on conspiracy?
      - roboys 7y ago
        I would call them suspicious instead of uncivilized. Europeans have tested harmful drugs on Africans without their knowledge for more than 2 centuries (including injecting live cancer cells and spreading HIV in very recent cases). I don't think we can blame them for avoiding this treatment like the plague.
        natalyarostova 7y ago
        I'm empathetic to the idea that for entirely uneducated populations differentiating between legitimate treatment and experimentation is impossible, so their instinct is to avoid it. I'd still be wary of making too many excuses for their wanton attack and murder on health-care workers as mere suspicion, as that gives off an impression of racism of lower expectations, in my humble opinion. Or, I mean, even if it doesn't, at a certain point we need to draw the line at acceptable behavior. Whether it's their upbringing, or they are justifiably suspicions, they are evil, or they are uneducated, in the end it sort of doesn't matter, right? It's still some other group trying to kill other people, where we have a belief on which one is correct and which one isn't.
        edubs25 7y ago
        I get your point - my issue was with the long history of cultures being called 'civilized' or 'advanced'. These terms are still too commonly used and mostly out of ignorance of their origins. Just to throw it out there - I don't live there, I'm not a citizen of their community - why does my values judgement matter? Why am I judging what is acceptable for them to do in their neighborhoods and communities? I'm a white american, married into an Cameroonian family, spend my time 90-10 split between US and Cameroon. If Cameroon was having a crisis over 'X', I'd ask my family and our friends what they think should be done in their cities about 'X.' I might ask questions or offer critiques but at the end of the day, they are the only ones that understand their communities, can solve their problems and judge a situation. Similarly, if my city was having an issue, I might be curious what they thought or how they solved similar issues, but I wouldn't expect them to dictate solutions or make a values judgement on my community.
- duxup 7y ago
  Unless you're talking about some unknown evolved version, in a first world country the risk of spreading to a large scale is pretty low. Ebola is not very contagious / risky for the first world as it stands now. Could it be? Yes but you could argue for any number of diseases that "if it changed" would create devastating consequences.
- nostrademons 7y ago
  Note that the death rate of Ebola in developed countries in "only" about 10%, and all of those have been people that were severely ill before seeking medical attention. Ebola's one of those diseases that responds well to modern hospital care: sanitation, isolation, and IV rehydration are very effective at keeping patients alive while the disease runs its course. When looking at death rates, it's important to remember that most Ebola outbreaks have occurred in countries with pre-modern sanitation & medical systems. It's like saying that cholera, scarlet fever, and bubonic plague are deadly diseases: true, but significantly less true in the developed world.
docker_up 7y ago
The fact this is going to spread worldwide is inevitable. I honestly think we need to prevent people from this area of the world from coming to the US until they get this under control, this is simply unacceptable from a global standpoint.
- JoeAltmaier 7y ago
  The way people move about the world unchecked is irresponsible. We are more careful about cattle than humans. That said, any mechanism for checking travel will undoubtedly turn corrupt. So it comes with that cost.
  - swalsh 7y ago
    That's because cattle have less civil rights than us.
    - JoeAltmaier 7y ago
      Its because cattle are property? Civil rights are all well and good. But 'everybody dies of Ebola' might take precedence.
- lostlogin 7y ago
  > I honestly think we need to prevent people from this area of the world from coming to the US... ...this is simply unacceptable from a global standpoint. I’m guessing you’re in the US? What about the rest of us?
  - dyarosla 7y ago
    I believe that in times of outbreak it’s often the case that many countries, not just US, try to contain the spread within their own country by disallowing entrance to people from the offending geography. What’s that to say of the people that are in the midst of it? Harder to tell but prevailing policy sure indicates that countries are self-interested first and foremost.
  - 7y ago
sixQuarks 7y ago
The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking We have huge groups of actively ignorant people supporting the growth of climate change, anti-vaccination, and a host of other dangerous actions. Now those fighting Ebola outbreaks are getting attacked. I hope I’m wrong, but it looks like rationality is fast disappearing from this world. It’s only a matter of time before we destroy ourselves. I realize this type of gloom and doom stuff has always been predicted throughout history, it just seems “this time is different” for real with the intersection of technology and ignorance reaching levels we’ve never seen.
- goldenchrome 7y ago
  It really sounds like you're reading too much news. News is fear mongering most of the time. Try taking a short break, you might be surprised how much better you feel!
  - ctrl-j 7y ago
    Feeling better and taking care of yourself is, of course, really important. However, measles outbreaks and hate-crimes aren't going to stop because one does not pay attention to the news.
    - cabaalis 7y ago
      But passively reading the news and feeling like crap aren't going to stop anything either. It seems more would be done if local news, or even just having a conversation with a friend were the primary way of obtaining information. I would venture a guess that you're more likely to pursue a cause if it directly affects your community or someone you know and love thinks it's important, than you are just by reading something on the internet.
    - geddy 7y ago
      They're also not going to stop if you _do_ pay attention to the news. The only difference is you'll still have some sanity left.
jeffdavis 7y ago
Do these ebola outbreaks give the virus substantially more opportunity to evolve? Or is that not a significant risk?
- fredgrott 7y ago
  not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).
  - chimeracoder 7y ago
    > not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find). AIDS does not evolve variants. HIV, which is a virus, can evolve. There is neither a vaccine nor a cure for HIV.
- HarryHirsch 7y ago
  They do: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/ But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.
  - unknowable 7y ago
    I'd argue that there's no way to know such a thing in the moment, and the reason for that is because you're observing a living thing learn and discover facts about the best way to survive. It's an open ended scenario. The organism could learn a robust survival method that helps it survive more efficiently, without making it more lethal. It could learn nothing at all. It could learn to be less lethal but more transmissible. It could learn to spread to other organisms, or whatever opportunity proves advantageous. It's possible we could notice pathways that represent doomsday hazards long before it would be possible for an organism to naturally evolve into a new version of itself. With that, we might focus on adaptations that never appear, yet cannot be ignored. Like watching for a robber that never robs us. It's probably only worth worrying about robberies when it looks like we have a robber on our hands. And right now, we're observing an awfully effective robber in action, right now.
fredgrott 7y ago
seems like a role of UN troops to maintain peace so that WHO workers can do their jobs
- ars 7y ago
  That's not a good way to gain the trust of the local population. I don't have an answer for what should be done, but I can tell you that your suggestion is not it.
- duxup 7y ago
  Problem is you need the locals to cooperate, not just comply for a short period of time due to force. I suspect mass use of force would work (let's just assume we had unlimited troops or something crazy).... but only for a while. For a health situation like this you need buy in from the locals to change how they handle things longer term or it might pop up again.
- _djo_ 7y ago
  That is part of what the UN troops are attempting to do, but it's an impossibly difficult task. There are far too few troops for the size of the area and population size they need to defend, and that's before you take into account issues like logistics, the unwillingness of some national contingents to deploy far from bases, etc. To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts. Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles. Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.
georgehayduke 7y ago
I am amazed at the bravery of the medical staff, health professionals and volunteers who are trying to contain Ebola in the DRC. Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help. It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult. While spreading to populous areas would be a major concern, I imagine that nations blessed with more resources may be in a better position to quarantine, contain and prevent the spread of Ebola.
- gingabriska 7y ago
  How likely is that most Nurses working there do are not able to comprehend risk in real terms?
  - Zenst 7y ago
    Extremely unlikely, that it's not even an edge-case. I dare say that anybody who has seen directly or indirectly the effects of Ebola, would be more than aware of the risks and if anything, be more inclined to over-react (look at how leprosy was treated socially historically or even AIDS).
  - chronogram 7y ago
    Unlikely with what I heard on this podcast: https://www.economist.com/podcasts/2019/03/19/how-to-fight-ebola-in-a-congolese-war-zone https://www.economist.com/podcasts/2019/03/19/how-to-fight-e...
  - mlevental 7y ago
    that's gotta be one the most presumptuous questions on hn I've ever seen. DRC has been dealing with Ebola outbreaks since the 60s. How do you imagine that they would be unable to comprehend? the clear implication is that they're too dumb.
- deleted 7y ago
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- 7y ago
waynecochran 7y ago
Could someone explain the graph used in the article where the y-axis is labeled as "cumulative" -- does this mean that each bin includes the sums from the previous bins? If so, then this will always be a non-decreasing graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid graphs like this to make it look worse than it is.
- thenipper 7y ago
  If they're using the same data source I am at work it's because that is what the ministry of health for the DRC is releasing daily. They don't track active cases but rather cumulative cases in a health zone.
  - thenipper 7y ago
    Also if you want to explore the data UN OCHA has it here: https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-north-kivu https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-...
- teilo 7y ago
  Yes, you have it exactly right. That graph makes it look like ebola is progressing at a logarithmic rate. It's not. It's nearly linear.
  - waynecochran 7y ago
    I am all for fighting something as horrible as Ebola, but you can't do this ... actual rate => graph const rate => linear graph linear rate => quadratic graph quadratic rate => cubic graph ...
- Balgair 7y ago
  WHO reports are much better overall: https://www.who.int/ebola/situation-reports/drc-2018/en/ https://www.who.int/ebola/situation-reports/drc-2018/en/
DisposibleHero 7y ago
It's interesting to note how we can have consensus on 2,000 individual cases being called a true crisis, but we still cannot agree ~76,000 monthly border crossing[1] is a true crisis. Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum seekers... both before and after crossing. Perhaps it's because we all fear catching Ebola from an airport or shopping mall, but none of us fear catching "run-for-your-life-itus", or have to wonder how we'll feed, clothe, and shelter ourselves in a brand new country where we don't speak the dominant language or understand the culture, but we know it's safer than where we came from? Or perhaps it's simply because it's not a political punching bag issue? ... that's probably the real truth neither "side" wants to admit. Ebola isn't going to run rampant through the US - we have a great medical system that wouldn't be trying to treat patients in a field in the middle of a war zone. We should lend all the support we can to DRC to help prevent the spread of this terrible virus - not out of fear of it spreading to our home nation, but out of compassion to the people of the DRC. At the same time, we should really step back from our trenches and objectively examine our own domestic problems - not through the lenses of political ideology, but through the lens of a decent human being. (ya, this is a throwaway... advocating we stop being political about our own domestic crisis is sure to attract a lot of negativity, unfortunately). [1] https://www.nytimes.com/2019/03/05/us/border-crossing-increase.html https://www.nytimes.com/2019/03/05/us/border-crossing-increa...
- choult 7y ago
  > Ebola isn't going to run rampant through the US This insular, isolationist attitude is precisely what is currently eroding the United States' soft power in the world today.
  - DisposibleHero 7y ago
    Could you elaborate a bit? The major factor in this Ebola outbreak in DRC is the civil war, which is making it very difficult to effectively treat patients. Ebola is spread through bodily fluids, which are far easier to contain and isolate in a controlled environment than in a field temporary hospital or simply a family member helping care for someone they think is just sick. We don't have these problems here in the US at the present time. Say what you will about the US medical system and insurance, etc... but it is still a very good system that can handle a wide variety of cases and isn't hobbled by armed-conflict/civil war.
i_am_nomad 7y ago
To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.
- mieseratte 7y ago
  Could you elaborate on those challenges?
  - jbob2000 7y ago
    The doctors and medical staff are mostly white, while the people they are treating are mostly black. To the ignorant, this would appear like an attempt at a genocide or recolonization.
    - mieseratte 7y ago
      Is that actually the case on the ground, some type of "the doctors are actually the ones making us sick" scenario?
      - HarryHirsch 7y ago
        That's absolutely the case: https://www.nbcnews.com/news/world/congo-s-ebola-response-threatened-conspiracy-theories-rumors-n994156 https://www.nbcnews.com/news/world/congo-s-ebola-response-th...
  - i_am_nomad 7y ago
    For one thing, some of the burial practices and rituals in the region pose significant risks of communicating Ebola. And, when health workers recommend suspending those practices, those recommendations are not well-received.
- patagonia 7y ago
ajnin 7y ago
The june 2 WHO bulletin about the outbreak, which I believe is the source data for the article. It contains more data including a graph of number of cases by date of illness onset, which I think gives a better idea of the progression of the epidemic : https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...
Balgair 7y ago
The WHO reports are very informative as well: https://www.who.int/ebola/situation-reports/drc-2018/en/ https://www.who.int/ebola/situation-reports/drc-2018/en/ The latest report (4 June 2019): https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/325126/SITR... Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already. One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects. Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper. Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.
favorited 7y ago
As always when an Ebola discussion happens, I want to recommend people interested in the origins of the disease read Richard Preston's 'The Hot Zone.' It details the history of the disease (as well as some related filoviruses, like Marburg), specifically following several doctors and researchers as they track outbreaks and treat victims. It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.

177 points by howard941 7y ago

It's just a question of time before it reaches the US. We were lucky with Dallas. It likely will escape the next time into the general population since many people without health insurance are unlikely seek medical care in time and when they do at the last minute, it will spread.

raverbashing 7y ago
Ebola is much less contagious than people think https://www.businessinsider.com/ebola-discoverer-would-sit-next-to-someone-with-the-virus-2014-8?r=US&IR=T https://www.businessinsider.com/ebola-discoverer-would-sit-n...
low_roar1 7y ago
Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic. In Congo Kinshasa, it's just the chaos politically, there is no real government in many parts of this country, the real danger is that it is not a small country at all, 80+ millions of inhabitants, many can't be reach by the WHO because of the wars and infighting between the "government" and militias. So the crisis there has great chances of getting worse, not better. Furthermore, many many many people locals despise foreigners and particularly white people, for historical reasons, or just ignorance, and the culture is extremely unsanitary (touching and living with the dead, consuming bush meat or worse, ritualistic cannibalism, and what not), some straight out think Ebola is a white conspiracy. This isn't a problem only money can solve this time.
- edubs25 7y ago
  >Ebola should actually be easier to contain in any civilized country such as the US. Quarantine measures and disposing of infected bodies properly would limit the pandemic. I would be careful of the use of the word 'civilized' in this context. You're implying DRC and/or other African countries are uncivilized. Which is just not true.
  - natalyarostova 7y ago
    What is the politically appropriate word instead of civilized to enumerate the difference between taking a public health first approach vs. killing first responders on conspiracy?
    - roboys 7y ago
      I would call them suspicious instead of uncivilized. Europeans have tested harmful drugs on Africans without their knowledge for more than 2 centuries (including injecting live cancer cells and spreading HIV in very recent cases). I don't think we can blame them for avoiding this treatment like the plague.
      - natalyarostova 7y ago
        I'm empathetic to the idea that for entirely uneducated populations differentiating between legitimate treatment and experimentation is impossible, so their instinct is to avoid it. I'd still be wary of making too many excuses for their wanton attack and murder on health-care workers as mere suspicion, as that gives off an impression of racism of lower expectations, in my humble opinion. Or, I mean, even if it doesn't, at a certain point we need to draw the line at acceptable behavior. Whether it's their upbringing, or they are justifiably suspicions, they are evil, or they are uneducated, in the end it sort of doesn't matter, right? It's still some other group trying to kill other people, where we have a belief on which one is correct and which one isn't.
        edubs25 7y ago
        I get your point - my issue was with the long history of cultures being called 'civilized' or 'advanced'. These terms are still too commonly used and mostly out of ignorance of their origins. Just to throw it out there - I don't live there, I'm not a citizen of their community - why does my values judgement matter? Why am I judging what is acceptable for them to do in their neighborhoods and communities? I'm a white american, married into an Cameroonian family, spend my time 90-10 split between US and Cameroon. If Cameroon was having a crisis over 'X', I'd ask my family and our friends what they think should be done in their cities about 'X.' I might ask questions or offer critiques but at the end of the day, they are the only ones that understand their communities, can solve their problems and judge a situation. Similarly, if my city was having an issue, I might be curious what they thought or how they solved similar issues, but I wouldn't expect them to dictate solutions or make a values judgement on my community.
duxup 7y ago
Unless you're talking about some unknown evolved version, in a first world country the risk of spreading to a large scale is pretty low. Ebola is not very contagious / risky for the first world as it stands now. Could it be? Yes but you could argue for any number of diseases that "if it changed" would create devastating consequences.
nostrademons 7y ago
Note that the death rate of Ebola in developed countries in "only" about 10%, and all of those have been people that were severely ill before seeking medical attention. Ebola's one of those diseases that responds well to modern hospital care: sanitation, isolation, and IV rehydration are very effective at keeping patients alive while the disease runs its course. When looking at death rates, it's important to remember that most Ebola outbreaks have occurred in countries with pre-modern sanitation & medical systems. It's like saying that cholera, scarlet fever, and bubonic plague are deadly diseases: true, but significantly less true in the developed world.

docker_up 7y ago

The fact this is going to spread worldwide is inevitable. I honestly think we need to prevent people from this area of the world from coming to the US until they get this under control, this is simply unacceptable from a global standpoint.

JoeAltmaier 7y ago
The way people move about the world unchecked is irresponsible. We are more careful about cattle than humans. That said, any mechanism for checking travel will undoubtedly turn corrupt. So it comes with that cost.
- swalsh 7y ago
  That's because cattle have less civil rights than us.
  - JoeAltmaier 7y ago
    Its because cattle are property? Civil rights are all well and good. But 'everybody dies of Ebola' might take precedence.
lostlogin 7y ago
> I honestly think we need to prevent people from this area of the world from coming to the US... ...this is simply unacceptable from a global standpoint. I’m guessing you’re in the US? What about the rest of us?
- dyarosla 7y ago
  I believe that in times of outbreak it’s often the case that many countries, not just US, try to contain the spread within their own country by disallowing entrance to people from the offending geography. What’s that to say of the people that are in the midst of it? Harder to tell but prevailing policy sure indicates that countries are self-interested first and foremost.
- 7y ago

sixQuarks 7y ago

The internet was supposed to create an educated society with information at your fingertips, instead we got fake news and echo chambers spreading extreme thinking We have huge groups of actively ignorant people supporting the growth of climate change, anti-vaccination, and a host of other dangerous actions. Now those fighting Ebola outbreaks are getting attacked. I hope I’m wrong, but it looks like rationality is fast disappearing from this world. It’s only a matter of time before we destroy ourselves. I realize this type of gloom and doom stuff has always been predicted throughout history, it just seems “this time is different” for real with the intersection of technology and ignorance reaching levels we’ve never seen.

goldenchrome 7y ago
It really sounds like you're reading too much news. News is fear mongering most of the time. Try taking a short break, you might be surprised how much better you feel!
- ctrl-j 7y ago
  Feeling better and taking care of yourself is, of course, really important. However, measles outbreaks and hate-crimes aren't going to stop because one does not pay attention to the news.
  - cabaalis 7y ago
    But passively reading the news and feeling like crap aren't going to stop anything either. It seems more would be done if local news, or even just having a conversation with a friend were the primary way of obtaining information. I would venture a guess that you're more likely to pursue a cause if it directly affects your community or someone you know and love thinks it's important, than you are just by reading something on the internet.
  - geddy 7y ago
    They're also not going to stop if you _do_ pay attention to the news. The only difference is you'll still have some sanity left.

jeffdavis 7y ago

Do these ebola outbreaks give the virus substantially more opportunity to evolve? Or is that not a significant risk?

fredgrott 7y ago
not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find).
- chimeracoder 7y ago
  > not sure as its slightly different in packaging say from AIDS which does in fact evolve variants in an infected human(reason why the vaccine cure took so long to find). AIDS does not evolve variants. HIV, which is a virus, can evolve. There is neither a vaccine nor a cure for HIV.
HarryHirsch 7y ago
They do: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580494/ But the jury is still out on what evolutionary processes are ongoing. Is the virus adapting to its new host and consequently evolving more slowly, or is it quickly developing increased transmissibility? It's not quite clear.
- unknowable 7y ago
  I'd argue that there's no way to know such a thing in the moment, and the reason for that is because you're observing a living thing learn and discover facts about the best way to survive. It's an open ended scenario. The organism could learn a robust survival method that helps it survive more efficiently, without making it more lethal. It could learn nothing at all. It could learn to be less lethal but more transmissible. It could learn to spread to other organisms, or whatever opportunity proves advantageous. It's possible we could notice pathways that represent doomsday hazards long before it would be possible for an organism to naturally evolve into a new version of itself. With that, we might focus on adaptations that never appear, yet cannot be ignored. Like watching for a robber that never robs us. It's probably only worth worrying about robberies when it looks like we have a robber on our hands. And right now, we're observing an awfully effective robber in action, right now.

fredgrott 7y ago

seems like a role of UN troops to maintain peace so that WHO workers can do their jobs

ars 7y ago
That's not a good way to gain the trust of the local population. I don't have an answer for what should be done, but I can tell you that your suggestion is not it.
duxup 7y ago
Problem is you need the locals to cooperate, not just comply for a short period of time due to force. I suspect mass use of force would work (let's just assume we had unlimited troops or something crazy).... but only for a while. For a health situation like this you need buy in from the locals to change how they handle things longer term or it might pop up again.
_djo_ 7y ago
That is part of what the UN troops are attempting to do, but it's an impossibly difficult task. There are far too few troops for the size of the area and population size they need to defend, and that's before you take into account issues like logistics, the unwillingness of some national contingents to deploy far from bases, etc. To provide some context, just the eastern provinces of the DRC, where most of the violence is concentrated, have a population of more than 20 million people and a land area larger than Germany. The UN mission in the DRC, MONUSCO, has just 15 000 troops. A figure which shrinks annually as a result of US-forced budget cuts. Those budget cuts (which the Trump administration has loudly boasted about, FWIW) have also severely depleted the aviation budget, preventing MONUSCO from being able to deploy as many attack helicopters as its commanders say it needs to go after armed groups and reducing its ability to transport troops by air. This forces them to take long, slow journeys on the country's dilapidated road network, even in cases of urgent responses. During the rainy season it can take hours to travel a few kilometres despite having specialised vehicles. Add to that the fact that government troops are often corrupt and local commanders can be in league with some of the rebel groups, and it's a pretty difficult mission at the best of times.

georgehayduke 7y ago

I am amazed at the bravery of the medical staff, health professionals and volunteers who are trying to contain Ebola in the DRC. Not only are they potentially exposed to the deadly disease, they have to content with violent attacks from the population they're trying to help. It sounds incredibly complex - a mix of political mistrust, lack of education and difficult terrain making containment difficult. While spreading to populous areas would be a major concern, I imagine that nations blessed with more resources may be in a better position to quarantine, contain and prevent the spread of Ebola.

gingabriska 7y ago
How likely is that most Nurses working there do are not able to comprehend risk in real terms?
- Zenst 7y ago
  Extremely unlikely, that it's not even an edge-case. I dare say that anybody who has seen directly or indirectly the effects of Ebola, would be more than aware of the risks and if anything, be more inclined to over-react (look at how leprosy was treated socially historically or even AIDS).
- chronogram 7y ago
  Unlikely with what I heard on this podcast: https://www.economist.com/podcasts/2019/03/19/how-to-fight-ebola-in-a-congolese-war-zone https://www.economist.com/podcasts/2019/03/19/how-to-fight-e...
- mlevental 7y ago
  that's gotta be one the most presumptuous questions on hn I've ever seen. DRC has been dealing with Ebola outbreaks since the 60s. How do you imagine that they would be unable to comprehend? the clear implication is that they're too dumb.
deleted 7y ago
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7y ago

waynecochran 7y ago

Could someone explain the graph used in the article where the y-axis is labeled as "cumulative" -- does this mean that each bin includes the sums from the previous bins? If so, then this will always be a non-decreasing graph. Ebola outbreaks are horrible, but it doesn't do any good to use stupid graphs like this to make it look worse than it is.

thenipper 7y ago
If they're using the same data source I am at work it's because that is what the ministry of health for the DRC is releasing daily. They don't track active cases but rather cumulative cases in a health zone.
- thenipper 7y ago
  Also if you want to explore the data UN OCHA has it here: https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-north-kivu https://data.humdata.org/dataset/ebola-cases-and-deaths-drc-...
teilo 7y ago
Yes, you have it exactly right. That graph makes it look like ebola is progressing at a logarithmic rate. It's not. It's nearly linear.
- waynecochran 7y ago
  I am all for fighting something as horrible as Ebola, but you can't do this ... actual rate => graph const rate => linear graph linear rate => quadratic graph quadratic rate => cubic graph ...
Balgair 7y ago
WHO reports are much better overall: https://www.who.int/ebola/situation-reports/drc-2018/en/ https://www.who.int/ebola/situation-reports/drc-2018/en/

DisposibleHero 7y ago

It's interesting to note how we can have consensus on 2,000 individual cases being called a true crisis, but we still cannot agree ~76,000 monthly border crossing[1] is a true crisis. Perhaps it's because Ebola is deadly and it's easy to remain ignorant of the humanitarian crisis plaguing many of those 76,000 monthly refugee/asylum seekers... both before and after crossing. Perhaps it's because we all fear catching Ebola from an airport or shopping mall, but none of us fear catching "run-for-your-life-itus", or have to wonder how we'll feed, clothe, and shelter ourselves in a brand new country where we don't speak the dominant language or understand the culture, but we know it's safer than where we came from? Or perhaps it's simply because it's not a political punching bag issue? ... that's probably the real truth neither "side" wants to admit. Ebola isn't going to run rampant through the US - we have a great medical system that wouldn't be trying to treat patients in a field in the middle of a war zone. We should lend all the support we can to DRC to help prevent the spread of this terrible virus - not out of fear of it spreading to our home nation, but out of compassion to the people of the DRC. At the same time, we should really step back from our trenches and objectively examine our own domestic problems - not through the lenses of political ideology, but through the lens of a decent human being. (ya, this is a throwaway... advocating we stop being political about our own domestic crisis is sure to attract a lot of negativity, unfortunately). [1] https://www.nytimes.com/2019/03/05/us/border-crossing-increase.html https://www.nytimes.com/2019/03/05/us/border-crossing-increa...

choult 7y ago
> Ebola isn't going to run rampant through the US This insular, isolationist attitude is precisely what is currently eroding the United States' soft power in the world today.
- DisposibleHero 7y ago
  Could you elaborate a bit? The major factor in this Ebola outbreak in DRC is the civil war, which is making it very difficult to effectively treat patients. Ebola is spread through bodily fluids, which are far easier to contain and isolate in a controlled environment than in a field temporary hospital or simply a family member helping care for someone they think is just sick. We don't have these problems here in the US at the present time. Say what you will about the US medical system and insurance, etc... but it is still a very good system that can handle a wide variety of cases and isn't hobbled by armed-conflict/civil war.

i_am_nomad 7y ago

To those of you worried about a global outbreak: USAMRIID is closing in on a highly effective (near 100%) treatment for Ebola. So far it is 100% successful in macaques, which is a good animal model for the disease in humans. The project lead spoke to my research group - his talk about Ebola, and some of the cultural and geographic challenges in fighting it, was fascinating.

mieseratte 7y ago
Could you elaborate on those challenges?
- jbob2000 7y ago
  The doctors and medical staff are mostly white, while the people they are treating are mostly black. To the ignorant, this would appear like an attempt at a genocide or recolonization.
  - mieseratte 7y ago
    Is that actually the case on the ground, some type of "the doctors are actually the ones making us sick" scenario?
    - HarryHirsch 7y ago
      That's absolutely the case: https://www.nbcnews.com/news/world/congo-s-ebola-response-threatened-conspiracy-theories-rumors-n994156 https://www.nbcnews.com/news/world/congo-s-ebola-response-th...
- i_am_nomad 7y ago
  For one thing, some of the burial practices and rituals in the region pose significant risks of communicating Ebola. And, when health workers recommend suspending those practices, those recommendations are not well-received.
patagonia 7y ago

ajnin 7y ago

The june 2 WHO bulletin about the outbreak, which I believe is the source data for the article. It contains more data including a graph of number of cases by date of illness onset, which I think gives a better idea of the progression of the epidemic : https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/325126/SITR...

Balgair 7y ago

The WHO reports are very informative as well: https://www.who.int/ebola/situation-reports/drc-2018/en/ https://www.who.int/ebola/situation-reports/drc-2018/en/ The latest report (4 June 2019): https://apps.who.int/iris/bitstream/handle/10665/325126/SITREP_EVD_DRC_20190602-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/325126/SITR... Figure 1 on Page 3 is a good-ish overall representation of the situation. Ebola is sustaining itself. It hasn't gone geometric yet, but it could at nearly any time, if not already. One important thing to note is that though it may seem that in the last 3 weeks the epidemic has been tapering off, that is an artifact of the reporting situation there. There is a significant lag in identification of deaths and causes. Feel free to look back over the other reports to see this reporting lag effects. Another thing to note is that North-Kivu province is about the same size as West Virginia with about 2.5X the population. Goma, the capital there, has a population of about that of San Jose proper. Combined with other sources that other HNers have linked, the Nature article is correct to sound the alarm here. The Ebola fighters are trying their best (despite the complicated social situations, weather, gear, humidity, and resource limitations), but Ebola is not quitting either. This situation is not something to wave away and is very deserving of international attention.

favorited 7y ago

As always when an Ebola discussion happens, I want to recommend people interested in the origins of the disease read Richard Preston's 'The Hot Zone.' It details the history of the disease (as well as some related filoviruses, like Marburg), specifically following several doctors and researchers as they track outbreaks and treat victims. It was turned into a 6-episode miniseries on National Geographic (just aired last week), but the book is 100% worth the read if you're interested in the topic.